1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 EFFECTIVE JANUARY 1, 2008-DECEMBER 31, 2008 DATE 07/17/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0101 41.24 39.18 45.06 G0270 27.71 26.32 30.27 G0102 24.15 22.94 26.38 # G0270 27.21 25.85 29.73 # G0102 9.17 8.71 10.02 G0271 15.41 14.64 16.84 G0104 155.55 147.77 169.94 # G0271 14.91 14.16 16.28 # G0104 63.67 60.49 69.56 G0275 14.91 14.16 16.28 G0105 449.44 426.97 491.02 G0278 14.91 14.16 16.28 # G0105 218.75 207.81 238.98 G0281 12.56 11.93 13.72 G0105 53 155.55 147.77 169.94 G0283 12.56 11.93 13.72 # G0105 53 63.67 60.49 69.56 G0288 296.50 281.68 323.93 G0106 226.44 215.12 247.39 G0289 93.20 88.54 101.82 G0106 TC 174.66 165.93 190.82 G0308 804.84 764.60 879.29 G0106 26 51.77 49.18 56.56 G0309 657.96 625.06 718.82 G0108 35.75 33.96 39.05 G0310 513.26 487.60 560.74 G0109 20.27 19.26 22.15 G0311 552.28 524.67 603.37 G0117 52.93 50.28 57.82 G0312 453.80 431.11 495.78 G0118 37.14 35.28 40.57 G0313 355.10 337.35 387.95 C G0120 221.94 210.84 242.47 G0314 488.53 464.10 533.72 C G0120 TC 170.17 161.66 185.91 G0315 400.97 380.92 438.06 G0120 26 51.77 49.18 56.56 G0316 310.41 294.89 339.12 G0121 449.44 426.97 491.02 G0317 308.50 293.08 337.04 # G0121 218.75 207.81 238.98 G0318 252.24 239.63 275.57 G0121 53 155.55 147.77 169.94 G0319 196.38 186.56 214.54 # G0121 53 63.67 60.49 69.56 G0320 621.51 590.43 678.99 G0124 28.08 26.68 30.68 G0321 435.82 414.03 476.13 G0127 22.16 21.05 24.21 G0322 379.50 360.53 414.61 # G0127 9.17 8.71 10.02 G0323 238.26 226.35 260.30 G0128 4.04 3.84 4.42 G0324 22.44 21.32 24.52 G0130 45.20 42.94 49.38 G0325 13.13 12.47 14.34 G0130 TC 33.95 32.25 37.09 G0326 15.20 14.44 16.61 G0130 26 11.24 10.68 12.28 G0327 8.50 8.08 9.29 G0141 28.08 26.68 30.68 G0329 9.75 9.26 10.65 G0166 204.38 194.16 223.28 G0332 98.37 93.45 107.47 G0168 104.46 99.24 114.13 G0339 3,915.07 3,719.32 4,277.22 # G0168 27.06 25.71 29.57 G0340 2,658.17 2,525.26 2,904.05 G0179 53.73 51.04 58.70 G0341 379.25 360.29 414.33 G0180 69.46 65.99 75.89 G0342 713.92 678.22 779.95 G0181 118.59 112.66 129.56 G0343 1,179.53 1,120.55 1,288.63 G0182 123.59 117.41 135.02 G0344 105.17 99.91 114.90 G0202 166.61 158.28 182.02 # G0344 71.71 68.12 78.34 G0202 TC 129.92 123.42 141.93 G0364 14.18 13.47 15.49 G0202 26 36.68 34.85 40.08 # G0364 9.68 9.20 10.58 G0204 187.76 178.37 205.13 C G0365 208.15 197.74 227.40 G0204 TC 141.91 134.81 155.03 C G0365 TC 194.94 185.19 212.97 G0204 26 45.86 43.57 50.11 G0365 26 13.22 12.56 14.44 G0206 149.83 142.34 163.69 G0366 27.75 26.36 30.31 G0206 TC 113.15 107.49 123.61 G0367 18.58 17.65 20.30 G0206 26 36.68 34.85 40.08 G0368 9.17 8.71 10.02 G0237 17.58 16.70 19.21 G0372 17.16 16.30 18.75 G0238 18.58 17.65 20.30 # G0372 8.68 8.25 9.49 G0239 16.58 15.75 18.11 G0389 143.62 136.44 156.91 G0245 71.82 68.23 78.46 G0389 TC 112.75 107.11 123.18 # G0245 46.36 44.04 50.65 G0389 26 30.87 29.33 33.73 G0246 43.74 41.55 47.78 G0392 2,962.77 2,814.63 3,236.82 # G0246 23.77 22.58 25.97 # G0392 519.10 493.15 567.12 G0247 47.80 45.41 52.22 G0393 2,263.52 2,150.34 2,472.89 # G0247 26.83 25.49 29.31 # G0393 332.64 316.01 363.41 G0248 250.46 237.94 273.63 G0396 32.13 30.52 35.10 G0249 184.05 174.85 201.08 # G0396 30.13 28.62 32.91 G0250 10.07 9.57 11.01 G0397 62.55 59.42 68.33 G0268 54.22 51.51 59.24 # G0397 60.06 57.06 65.62 # G0268 32.75 31.11 35.78 G9041 25.57 24.29 27.93 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 2 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G9042 11.82 11.23 12.91 10121 278.82 264.88 304.61 G9043 11.82 11.23 12.91 # 10121 189.44 179.97 206.97 G9044 10.32 9.80 11.27 10140 159.86 151.87 174.65 M0064 44.19 41.98 48.28 # 10140 123.41 117.24 134.83 # M0064 17.73 16.84 19.37 10160 132.01 125.41 144.22 P3001 28.08 26.68 30.68 # 10160 100.06 95.06 109.32 Q0035 25.25 23.99 27.59 10180 244.66 232.43 267.29 Q0035 TC 16.58 15.75 18.11 # 10180 183.25 174.09 200.20 Q0035 26 8.68 8.25 9.49 11000 55.33 52.56 60.44 Q0091 48.98 46.53 53.51 # 11000 32.36 30.74 35.35 # Q0091 19.52 18.54 21.32 11001 22.87 21.73 24.99 Q0092 20.27 19.26 22.15 # 11001 16.38 15.56 17.89 R0070 157.76 149.87 172.35 11004 570.05 541.55 622.78 R0075 157.76 149.87 172.35 11005 753.42 715.75 823.11 0067T 721.35 685.28 788.07 11006 710.34 674.82 776.04 C 0067T TC 243.18 231.02 265.67 11008 273.61 259.93 298.92 0067T 26 136.42 129.60 149.04 11010 505.94 480.64 552.74 0073T 782.84 743.70 855.26 # 11010 288.23 273.82 314.89 0075T 1,216.96 1,156.11 1,329.53 11011 572.15 543.54 625.07 0076T 401.60 381.52 438.75 # 11011 301.52 286.44 329.41 0078T 1,383.76 1,314.57 1,511.76 11012 799.16 759.20 873.08 0079T 1,275.07 1,211.32 1,393.02 # 11012 445.14 422.88 486.31 0080T 244.75 232.51 267.39 11040 49.00 46.55 53.53 0081T 244.75 232.51 267.39 # 11040 28.03 26.63 30.62 0145T 750.93 713.38 820.39 11041 58.22 55.31 63.61 C 0145T TC 379.89 360.90 415.04 # 11041 36.75 34.91 40.15 0145T 26 110.03 104.53 120.21 11042 79.27 75.31 86.61 0146T 750.93 713.38 820.39 # 11042 48.31 45.89 52.77 C 0146T TC 379.89 360.90 415.04 11043 286.39 272.07 312.88 0146T 26 110.03 104.53 120.21 # 11043 244.45 232.23 267.06 0147T 750.93 713.38 820.39 11044 386.95 367.60 422.74 C 0147T TC 379.89 360.90 415.04 # 11044 338.01 321.11 369.28 0147T 26 110.03 104.53 120.21 11055 50.35 47.83 55.00 0148T 750.93 713.38 820.39 # 11055 23.38 22.21 25.54 C 0148T TC 379.89 360.90 415.04 11056 61.21 58.15 66.87 0148T 26 110.03 104.53 120.21 # 11056 32.75 31.11 35.78 0149T 750.93 713.38 820.39 11057 73.37 69.70 80.16 C 0149T TC 379.89 360.90 415.04 # 11057 42.91 40.76 46.87 0149T 26 110.03 104.53 120.21 11100 106.62 101.29 116.48 0150T 750.93 713.38 820.39 # 11100 47.70 45.32 52.12 C 0150T TC 379.89 360.90 415.04 11101 33.18 31.52 36.25 0150T 26 110.03 104.53 120.21 # 11101 24.20 22.99 26.44 0151T 236.88 225.04 258.80 11200 85.06 80.81 92.93 C 0151T TC 128.13 121.72 139.98 # 11200 70.08 66.58 76.57 0151T 26 72.68 69.05 79.41 11201 18.78 17.84 20.52 10021 155.24 147.48 169.60 # 11201 16.78 15.94 18.33 # 10021 69.86 66.37 76.33 11300 72.96 69.31 79.71 10022 163.63 155.45 178.77 # 11300 29.02 27.57 31.71 # 10022 66.76 63.42 72.93 11301 96.00 91.20 104.88 10040 101.07 96.02 110.42 # 11301 49.57 47.09 54.15 # 10040 86.59 82.26 94.60 11302 113.95 108.25 124.49 10060 112.66 107.03 123.08 # 11302 61.02 57.97 66.67 # 10060 95.18 90.42 103.98 11303 135.19 128.43 147.69 10061 188.64 179.21 206.09 # 11303 71.78 68.19 78.42 # 10061 166.17 157.86 181.54 11305 73.16 69.50 79.93 10080 188.75 179.31 206.21 # 11305 37.20 35.34 40.64 # 10080 99.87 94.88 109.11 11306 99.11 94.15 108.27 10081 281.37 267.30 307.40 # 11306 56.17 53.36 61.36 # 10081 166.03 157.73 181.39 11307 115.69 109.91 126.40 10120 148.78 141.34 162.54 # 11307 65.26 62.00 71.30 # 10120 93.86 89.17 102.55 11308 131.39 124.82 143.54 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 3 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11308 79.46 75.49 86.81 11602 246.79 234.45 269.62 11310 88.70 84.27 96.91 # 11602 153.42 145.75 167.61 # 11310 42.26 40.15 46.17 11603 278.18 264.27 303.91 11311 108.96 103.51 119.04 # 11603 180.31 171.29 196.98 # 11311 61.52 58.44 67.21 11604 306.51 291.18 334.86 11312 126.73 120.39 138.45 # 11604 196.66 186.83 214.85 # 11312 70.80 67.26 77.35 11606 421.12 400.06 460.07 11313 158.91 150.96 173.60 # 11606 287.31 272.94 313.88 # 11313 94.99 90.24 103.78 11620 193.38 183.71 211.27 11400 128.84 122.40 140.76 # 11620 110.99 105.44 121.26 # 11400 77.41 73.54 84.57 11621 228.54 217.11 249.68 11401 151.96 144.36 166.01 # 11621 143.16 136.00 156.40 # 11401 100.53 95.50 109.83 11622 256.98 244.13 280.75 11402 168.23 159.82 183.79 # 11622 164.11 155.90 179.29 # 11402 109.81 104.32 119.97 11623 297.67 282.79 325.21 11403 191.24 181.68 208.93 # 11623 199.80 189.81 218.28 # 11403 139.31 132.34 152.19 11624 335.38 318.61 366.40 11404 216.83 205.99 236.89 # 11624 227.52 216.14 248.56 # 11404 153.41 145.74 167.60 11626 410.71 390.17 448.70 11406 294.29 279.58 321.52 # 11626 288.88 274.44 315.61 # 11406 222.89 211.75 243.51 11640 202.15 192.04 220.85 11420 127.06 120.71 138.82 # 11640 119.26 113.30 130.30 # 11420 83.62 79.44 91.36 11641 244.36 232.14 266.96 11421 160.52 152.49 175.36 # 11641 156.48 148.66 170.96 # 11421 110.59 105.06 120.82 11642 280.02 266.02 305.92 11422 178.96 170.01 195.51 # 11642 183.15 173.99 200.09 # 11422 133.03 126.38 145.34 11643 325.92 309.62 356.06 11423 207.47 197.10 226.67 # 11643 226.05 214.75 246.96 # 11423 153.54 145.86 167.74 11644 402.90 382.76 440.17 11424 236.45 224.63 258.32 # 11644 282.07 267.97 308.17 # 11424 176.53 167.70 192.86 11646 523.77 497.58 572.22 11426 329.47 313.00 359.95 # 11646 397.44 377.57 434.21 # 11426 263.06 249.91 287.40 11719 21.96 20.86 23.99 11440 142.53 135.40 155.71 # 11719 9.47 9.00 10.35 # 11440 103.08 97.93 112.62 11720 32.15 30.54 35.12 11441 173.47 164.80 189.52 # 11720 17.17 16.31 18.76 # 11441 131.53 124.95 143.69 11721 45.38 43.11 49.58 11442 194.08 184.38 212.04 # 11721 29.40 27.93 32.12 # 11442 145.15 137.89 158.57 11730 101.13 96.07 110.48 11443 230.96 219.41 252.32 # 11730 60.19 57.18 65.76 # 11443 177.53 168.65 193.95 11732 46.16 43.85 50.43 11444 287.71 273.32 314.32 # 11732 30.68 29.15 33.52 # 11444 224.80 213.56 245.59 11740 47.59 45.21 51.99 11446 379.93 360.93 415.07 # 11740 33.61 31.93 36.72 # 11446 313.02 297.37 341.98 11750 217.11 206.25 237.19 11450 372.41 353.79 406.86 # 11750 180.16 171.15 196.82 # 11450 229.60 218.12 250.84 11752 306.68 291.35 335.05 11451 490.05 465.55 535.38 # 11752 274.22 260.51 299.59 # 11451 302.30 287.19 330.27 11755 139.14 132.18 152.01 11462 370.96 352.41 405.27 # 11755 87.22 82.86 95.29 # 11462 222.16 211.05 242.71 11760 211.85 201.26 231.45 11463 499.84 474.85 546.08 # 11760 141.95 134.85 155.08 # 11463 306.60 291.27 334.96 11762 275.40 261.63 300.87 11470 401.33 381.26 438.45 # 11762 211.48 200.91 231.05 # 11470 260.52 247.49 284.61 11765 138.44 131.52 151.25 11471 513.61 487.93 561.12 # 11765 71.03 67.48 77.60 # 11471 327.86 311.47 358.19 11770 274.08 260.38 299.44 11600 191.79 182.20 209.53 # 11770 176.21 167.40 192.51 # 11600 109.90 104.41 120.07 11771 535.30 508.54 584.82 11601 226.65 215.32 247.62 # 11771 403.48 383.31 440.81 # 11601 141.27 134.21 154.34 11772 664.30 631.09 725.75 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 4 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 11772 541.47 514.40 591.56 12031 234.24 222.53 255.91 11900 57.57 54.69 62.89 # 12031 148.36 140.94 162.08 # 11900 30.11 28.60 32.89 12032 316.82 300.98 346.13 11901 69.78 66.29 76.23 # 12032 192.49 182.87 210.30 # 11901 46.81 44.47 51.14 12034 303.73 288.54 331.82 11920 213.64 202.96 233.40 # 12034 194.88 185.14 212.91 # 11920 117.27 111.41 128.12 12035 392.58 372.95 428.89 11921 240.59 228.56 262.84 # 12035 236.80 224.96 258.70 # 11921 138.23 131.32 151.02 12036 430.42 408.90 470.24 11922 70.38 66.86 76.89 # 12036 276.13 262.32 301.67 # 11922 30.93 29.38 33.79 12037 482.84 458.70 527.51 11950 81.23 77.17 88.75 # 12037 321.06 305.01 350.76 # 11950 49.28 46.82 53.84 12041 248.28 235.87 271.25 11951 104.37 99.15 114.02 # 12041 160.40 152.38 175.24 # 11951 65.92 62.62 72.01 12042 294.07 279.37 321.28 11952 150.07 142.57 163.96 # 12042 189.71 180.22 207.25 # 11952 99.14 94.18 108.31 12044 332.25 315.64 362.99 11954 177.23 168.37 193.63 # 12044 205.43 195.16 224.43 # 11954 112.82 107.18 123.26 12045 395.24 375.48 431.80 11960 943.21 896.05 1,030.46 # 12045 246.45 234.13 269.25 11970 609.76 579.27 666.16 12046 466.74 443.40 509.91 11971 532.94 506.29 582.23 # 12046 288.98 274.53 315.71 # 11971 315.74 299.95 344.94 12047 498.63 473.70 544.76 11976 153.71 146.02 167.92 # 12047 321.38 305.31 351.11 # 11976 96.79 91.95 105.74 12051 276.07 262.27 301.61 11980 108.77 103.33 118.83 # 12051 176.21 167.40 192.51 # 11980 80.31 76.29 87.73 12052 303.62 288.44 331.71 11981 144.42 137.20 157.78 # 12052 201.76 191.67 220.42 # 11981 86.00 81.70 93.96 12053 331.16 314.60 361.79 11982 165.49 157.22 180.80 # 12053 206.83 196.49 225.96 # 11982 104.57 99.34 114.24 12054 353.61 335.93 386.32 11983 243.77 231.58 266.32 # 12054 220.79 209.75 241.21 # 11983 190.35 180.83 207.95 12055 428.87 407.43 468.54 12001 156.55 148.72 171.03 # 12055 272.08 258.48 297.25 # 12001 101.12 96.06 110.47 12056 531.30 504.74 580.45 12002 166.02 157.72 181.38 # 12056 339.56 322.58 370.97 # 12002 113.59 107.91 124.10 12057 569.96 541.46 622.68 12004 194.14 184.43 212.09 # 12057 389.71 370.22 425.75 # 12004 132.72 126.08 144.99 13100 328.07 311.67 358.42 12005 240.96 228.91 263.25 # 13100 235.69 223.91 257.50 # 12005 164.06 155.86 179.24 13101 408.04 387.64 445.79 12006 298.75 283.81 326.38 # 13101 284.70 270.47 311.04 # 12006 207.38 197.01 226.56 13102 109.53 104.05 119.66 12007 335.40 318.63 366.42 # 13102 74.08 70.38 80.94 # 12007 238.03 226.13 260.05 13120 339.94 322.94 371.38 12011 167.19 158.83 182.65 # 13120 245.07 232.82 267.74 # 12011 104.77 99.53 114.46 13121 446.60 424.27 487.91 12013 183.12 173.96 200.05 # 13121 318.77 302.83 348.25 # 12013 120.20 114.19 131.32 13122 126.17 119.86 137.84 12014 213.67 202.99 233.44 # 13122 84.23 80.02 92.02 # 12014 143.26 136.10 156.52 13131 373.27 354.61 407.80 12015 267.40 254.03 292.13 # 13131 277.90 264.01 303.61 # 12015 178.52 169.59 195.03 13132 577.91 549.01 631.36 12016 314.86 299.12 343.99 # 13132 461.07 438.02 503.72 # 12016 216.99 206.14 237.06 13133 169.41 160.94 185.08 12017 262.51 249.38 286.79 # 13133 130.97 124.42 143.08 12018 314.80 299.06 343.92 13150 381.55 362.47 416.84 12020 287.66 273.28 314.27 # 13150 278.69 264.76 304.47 # 12020 191.79 182.20 209.53 13151 420.96 399.91 459.90 12021 163.34 155.17 178.45 # 13151 322.10 306.00 351.90 # 12021 139.87 132.88 152.81 13152 569.72 541.23 622.41 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 5 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 13152 429.41 407.94 469.13 15151 131.80 125.21 143.99 13153 188.86 179.42 206.33 # 15151 115.32 109.55 125.98 # 13153 143.42 136.25 156.69 15152 161.62 153.54 176.57 13160 808.95 768.50 883.78 # 15152 144.15 136.94 157.48 14000 672.66 639.03 734.88 15155 764.79 726.55 835.53 # 14000 540.83 513.79 590.86 # 15155 709.87 674.38 775.54 14001 866.05 822.75 946.16 15156 173.04 164.39 189.05 # 14001 719.25 683.29 785.78 # 15156 160.06 152.06 174.87 14020 749.09 711.64 818.39 15157 193.05 183.40 210.91 # 14020 618.77 587.83 676.00 # 15157 174.57 165.84 190.72 14021 971.05 922.50 1,060.88 15170 418.76 397.82 457.49 # 14021 833.24 791.58 910.32 # 15170 346.86 329.52 378.95 14040 784.13 744.92 856.66 15171 90.95 86.40 99.36 # 14040 664.29 631.08 725.74 # 15171 85.96 81.66 93.91 14041 1,062.94 1,009.79 1,161.26 15175 547.65 520.27 598.31 # 14041 909.15 863.69 993.24 # 15175 478.74 454.80 523.02 14060 794.90 755.16 868.43 15176 146.77 139.43 160.34 # 14060 698.53 663.60 763.14 # 15176 137.79 130.90 150.54 14061 1,154.75 1,097.01 1,261.56 15200 821.33 780.26 897.30 # 14061 985.98 936.68 1,077.18 # 15200 652.56 619.93 712.92 14300 1,108.19 1,052.78 1,210.70 15201 165.50 157.23 180.81 # 14300 957.39 909.52 1,045.95 # 15201 78.12 74.21 85.34 14350 764.18 725.97 834.87 15220 790.35 750.83 863.45 15002 351.21 333.65 383.70 # 15220 633.56 601.88 692.16 # 15002 224.88 213.64 245.69 15221 153.80 146.11 168.03 15003 75.67 71.89 82.67 # 15221 72.41 68.79 79.11 # 15003 43.71 41.52 47.75 15240 933.19 886.53 1,019.51 15004 420.19 399.18 459.06 # 15240 798.88 758.94 872.78 # 15004 277.39 263.52 303.05 15241 195.50 185.73 213.59 15005 123.77 117.58 135.22 # 15241 114.11 108.40 124.66 # 15005 88.32 83.90 96.49 15260 993.98 944.28 1,085.92 15040 288.38 273.96 315.05 # 15260 861.16 818.10 940.82 # 15040 130.60 124.07 142.68 15261 224.92 213.67 245.72 15050 565.47 537.20 617.78 # 15261 147.02 139.67 160.62 # 15050 455.12 432.36 497.21 15300 340.76 323.72 372.28 15100 932.87 886.23 1,019.16 # 15300 284.33 270.11 310.63 # 15100 736.64 699.81 804.78 15301 61.65 58.57 67.36 15101 221.16 210.10 241.62 # 15301 56.66 53.83 61.90 # 15101 116.80 110.96 127.60 15320 387.12 367.76 422.92 15110 899.56 854.58 982.77 # 15320 324.70 308.47 354.74 # 15110 748.27 710.86 817.49 15321 92.48 87.86 101.04 15111 125.60 119.32 137.22 # 15321 85.49 81.22 93.40 # 15111 106.63 101.30 116.50 15330 319.02 303.07 348.53 15115 881.38 837.31 962.91 # 15330 261.10 248.05 285.26 # 15115 772.53 733.90 843.99 15331 62.15 59.04 67.90 15116 165.52 157.24 180.83 # 15331 57.66 54.78 63.00 # 15116 145.55 138.27 159.01 15335 341.45 324.38 373.04 15120 964.22 916.01 1,053.41 # 15335 283.03 268.88 309.21 # 15120 793.45 753.78 866.85 15336 90.83 86.29 99.23 15121 301.12 286.06 328.97 # 15336 82.34 78.22 89.95 # 15121 181.28 172.22 198.05 15340 333.75 317.06 364.62 15130 729.89 693.40 797.41 # 15340 276.83 262.99 302.44 # 15130 582.59 553.46 636.48 15341 50.00 47.50 54.63 15131 100.97 95.92 110.31 # 15341 27.53 26.15 30.07 # 15131 85.99 81.69 93.94 15360 381.18 362.12 416.44 15135 896.84 852.00 979.80 # 15360 313.77 298.08 342.79 # 15135 792.48 752.86 865.79 15361 70.74 67.20 77.28 15136 96.18 91.37 105.08 # 15361 63.25 60.09 69.10 # 15136 87.19 82.83 95.25 15365 377.89 359.00 412.85 15150 742.12 705.01 810.76 # 15365 316.47 300.65 345.75 # 15150 659.74 626.75 720.76 15366 89.21 84.75 97.46 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 6 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 15366 81.72 77.63 89.27 # 15786 138.15 131.24 150.93 15400 390.06 370.56 426.14 15787 60.50 57.48 66.10 # 15400 359.60 341.62 392.86 # 15787 18.56 17.63 20.27 15401 111.09 105.54 121.37 15788 479.36 455.39 523.70 # 15401 58.16 55.25 63.54 # 15788 255.16 242.40 278.76 15420 439.65 417.67 480.32 15789 612.71 582.07 669.38 # 15420 383.23 364.07 418.68 # 15789 440.94 418.89 481.72 15421 119.94 113.94 131.03 15792 469.62 446.14 513.06 # 15421 85.49 81.22 93.40 # 15792 293.86 279.17 321.05 15430 561.90 533.81 613.88 15793 496.89 472.05 542.86 # 15430 540.93 513.88 590.96 # 15793 369.06 350.61 403.20 15570 919.72 873.73 1,004.79 15819 735.67 698.89 803.72 # 15570 711.00 675.45 776.77 15820 555.60 527.82 606.99 15572 860.24 817.23 939.81 # 15820 490.69 466.16 536.08 # 15572 706.45 671.13 771.80 15821 590.68 561.15 645.32 15574 929.16 882.70 1,015.11 # 15821 517.78 491.89 565.67 # 15574 769.38 730.91 840.55 15822 442.81 420.67 483.77 15576 830.44 788.92 907.26 # 15822 380.89 361.85 416.13 # 15576 679.64 645.66 742.51 15823 675.69 641.91 738.20 15600 398.06 378.16 434.88 # 15823 608.28 577.87 664.55 # 15600 220.80 209.76 241.22 15830 1,161.33 1,103.26 1,268.75 15610 351.69 334.11 384.23 15832 901.29 856.23 984.66 # 15610 257.32 244.45 281.12 15833 840.80 798.76 918.57 15620 491.53 466.95 536.99 15834 857.30 814.44 936.61 # 15620 329.75 313.26 360.25 15835 873.73 830.04 954.55 15630 499.10 474.15 545.27 15836 739.59 702.61 808.00 # 15630 357.79 339.90 390.89 15837 789.11 749.65 862.10 15650 532.89 506.25 582.19 # 15837 687.25 652.89 750.82 # 15650 387.59 368.21 423.44 15838 583.65 554.47 637.64 15731 1,119.71 1,063.72 1,223.28 15839 857.19 814.33 936.48 # 15731 991.88 942.29 1,083.63 # 15839 713.88 678.19 779.92 15732 1,556.81 1,478.97 1,700.82 15840 1,020.91 969.86 1,115.34 # 15732 1,322.13 1,256.02 1,444.42 15841 1,675.48 1,591.71 1,830.47 15734 1,600.11 1,520.10 1,748.12 15842 2,645.93 2,513.63 2,890.67 # 15734 1,360.94 1,292.89 1,486.82 15845 950.09 902.59 1,037.98 15736 1,447.62 1,375.24 1,581.53 15851 106.98 101.63 116.87 # 15736 1,177.48 1,118.61 1,286.40 # 15851 45.07 42.82 49.24 15738 1,525.58 1,449.30 1,666.70 15852 46.96 44.61 51.30 # 15738 1,279.92 1,215.92 1,398.31 15860 110.95 105.40 121.21 15740 1,010.44 959.92 1,103.91 15920 584.70 555.47 638.79 # 15740 859.64 816.66 939.16 15922 754.69 716.96 824.50 15750 928.79 882.35 1,014.70 15931 662.30 629.19 723.57 15756 2,383.50 2,264.33 2,603.98 15933 824.19 782.98 900.43 15757 2,377.85 2,258.96 2,597.80 15934 914.28 868.57 998.86 15758 2,371.43 2,252.86 2,590.79 15935 1,087.49 1,033.12 1,188.09 15760 870.20 826.69 950.69 15936 893.44 848.77 976.09 # 15760 716.90 681.06 783.22 15937 1,048.13 995.72 1,145.08 15770 665.40 632.13 726.95 15940 687.16 652.80 750.72 15775 329.73 313.24 360.23 15941 918.63 872.70 1,003.61 # 15775 214.89 204.15 234.77 15944 890.66 846.13 973.05 15776 467.60 444.22 510.85 15945 984.66 935.43 1,075.74 # 15776 335.78 318.99 366.84 15946 1,617.52 1,536.64 1,767.14 15780 881.85 837.76 963.42 15950 574.47 545.75 627.61 # 15780 682.63 648.50 745.78 15951 818.02 777.12 893.69 15781 568.97 540.52 621.60 15952 846.90 804.56 925.24 # 15781 454.62 431.89 496.67 15953 946.44 899.12 1,033.99 15782 624.56 593.33 682.33 15956 1,146.44 1,089.12 1,252.49 # 15782 448.30 425.89 489.77 15958 1,175.03 1,116.28 1,283.72 15783 527.21 500.85 575.98 16000 72.41 68.79 79.11 # 15783 386.40 367.08 422.14 # 16000 45.45 43.18 49.66 15786 255.49 242.72 279.13 16020 89.75 85.26 98.05 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 7 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 16020 58.29 55.38 63.69 17311 755.95 718.15 825.87 16025 152.96 145.31 167.11 # 17311 373.47 354.80 408.02 # 16025 115.02 109.27 125.66 17312 461.98 438.88 504.71 16030 185.27 176.01 202.41 # 17312 198.83 188.89 217.22 # 16030 132.34 125.72 144.58 17313 691.96 657.36 755.96 16035 212.63 202.00 232.30 # 17313 335.45 318.68 366.48 16036 84.19 79.98 91.98 17314 427.09 405.74 466.60 17000 81.87 77.78 89.45 # 17314 183.92 174.72 200.93 # 17000 54.41 51.69 59.44 17315 88.00 83.60 96.14 17003 8.14 7.73 8.89 # 17315 52.55 49.92 57.41 # 17003 5.15 4.89 5.62 17340 45.73 43.44 49.96 17004 184.34 175.12 201.39 # 17340 46.23 43.92 50.51 # 17004 139.90 132.91 152.85 17360 133.96 127.26 146.35 17106 402.18 382.07 439.38 # 17360 98.51 93.58 107.62 # 17106 335.28 318.52 366.30 19000 128.77 122.33 140.68 17107 689.96 655.46 753.78 # 19000 45.88 43.59 50.13 # 17107 595.59 565.81 650.68 19001 28.18 26.77 30.79 17108 925.26 879.00 1,010.85 # 19001 22.69 21.56 24.79 # 17108 823.40 782.23 899.56 19020 465.99 442.69 509.09 17110 109.51 104.03 119.63 # 19020 285.23 270.97 311.62 # 17110 64.07 60.87 70.00 19030 193.92 184.22 211.85 17111 131.89 125.30 144.10 # 19030 81.57 77.49 89.11 # 17111 81.96 77.86 89.54 19100 152.55 144.92 166.66 17250 82.46 78.34 90.09 # 19100 67.17 63.81 73.38 # 17250 37.02 35.17 40.45 19101 343.91 326.71 375.72 17260 100.24 95.23 109.51 # 19101 214.58 203.85 234.43 # 17260 67.79 64.40 74.06 19102 255.43 242.66 279.06 17261 145.01 137.76 158.42 # 19102 106.63 101.30 116.50 # 17261 90.09 85.59 98.43 19103 675.63 641.85 738.13 17262 174.90 166.16 191.08 # 19103 196.78 186.94 214.98 # 17262 114.48 108.76 125.07 19105 2,458.70 2,335.77 2,686.14 17263 192.24 182.63 210.02 # 19105 186.30 176.99 203.54 # 17263 125.83 119.54 137.47 19110 463.29 440.13 506.15 17264 207.51 197.13 226.70 # 19110 315.99 300.19 345.22 # 17264 134.11 127.40 146.51 19112 450.02 427.52 491.65 17266 234.01 222.31 255.66 # 19112 288.24 273.83 314.90 # 17266 154.12 146.41 168.37 19120 463.50 440.33 506.38 17270 151.10 143.55 165.08 # 19120 383.61 364.43 419.09 # 17270 96.68 91.85 105.63 19125 509.44 483.97 556.57 17271 164.77 156.53 180.01 # 19125 424.55 403.32 463.82 # 17271 108.85 103.41 118.92 19126 155.95 148.15 170.37 17272 188.35 178.93 205.77 19260 1,203.39 1,143.22 1,314.70 # 17272 125.94 119.64 137.59 19271 1,677.12 1,593.26 1,832.25 17273 209.04 198.59 228.38 19272 1,842.93 1,750.78 2,013.40 # 17273 141.13 134.07 154.18 19290 189.30 179.84 206.82 17274 247.43 235.06 270.32 # 19290 67.46 64.09 73.70 # 17274 172.53 163.90 188.49 19291 81.17 77.11 88.68 17276 286.87 272.53 313.41 # 19291 33.24 31.58 36.32 # 17276 206.98 196.63 226.12 19295 124.63 118.40 136.16 17280 142.01 134.91 155.15 19296 5,416.52 5,145.69 5,917.54 # 17280 88.59 84.16 96.78 # 19296 204.11 193.90 222.99 17281 177.90 169.01 194.36 19297 91.24 86.68 99.68 # 17281 122.48 116.36 133.81 19298 1,822.64 1,731.51 1,991.24 17282 205.65 195.37 224.68 # 19298 332.67 316.04 363.45 # 17282 141.24 134.18 154.31 19300 579.66 550.68 633.28 17283 247.30 234.94 270.18 # 19300 381.43 362.36 416.71 # 17283 176.39 167.57 192.71 19301 569.68 541.20 622.38 17284 287.47 273.10 314.07 19302 844.45 802.23 922.56 # 17284 209.57 199.09 228.95 19303 876.30 832.49 957.36 17286 363.25 345.09 396.85 19304 542.98 515.83 593.20 # 17286 283.86 269.67 310.12 19305 1,053.84 1,001.15 1,151.32 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 8 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 19306 1,101.86 1,046.77 1,203.79 # 20526 59.39 56.42 64.88 19307 1,107.39 1,052.02 1,209.82 20550 62.02 58.92 67.76 19316 789.15 749.69 862.14 # 20550 41.55 39.47 45.39 19318 1,163.18 1,105.02 1,270.77 20551 61.22 58.16 66.88 19324 488.52 464.09 533.70 # 20551 43.74 41.55 47.78 19325 656.86 624.02 717.62 20552 56.69 53.86 61.94 19328 496.52 471.69 542.44 # 20552 35.21 33.45 38.47 19330 626.99 595.64 684.99 20553 63.52 60.34 69.39 19340 397.87 377.98 434.68 # 20553 39.05 37.10 42.67 19342 929.02 882.57 1,014.96 20555 328.67 312.24 359.08 19350 945.35 898.08 1,032.79 20600 58.08 55.18 63.46 # 19350 696.19 661.38 760.59 # 20600 41.61 39.53 45.46 19355 757.32 719.45 827.37 20605 63.36 60.19 69.22 # 19355 550.60 523.07 601.53 # 20605 42.89 40.75 46.86 19357 1,572.33 1,493.71 1,717.77 20610 81.16 77.10 88.67 19361 1,617.34 1,536.47 1,766.94 # 20610 51.20 48.64 55.94 19364 2,792.40 2,652.78 3,050.70 20612 62.25 59.14 68.01 19366 1,383.14 1,313.98 1,511.08 # 20612 44.27 42.06 48.37 19367 1,835.38 1,743.61 2,005.15 20615 240.84 228.80 263.12 19368 2,248.87 2,136.43 2,456.89 # 20615 166.94 158.59 182.38 19369 2,073.22 1,969.56 2,264.99 20650 207.23 196.87 226.40 19370 691.10 656.55 755.03 # 20650 161.79 153.70 176.76 19371 795.81 756.02 869.42 20660 269.48 256.01 294.41 19380 777.97 739.07 849.93 # 20660 233.03 221.38 254.59 19396 224.16 212.95 244.89 20661 485.34 461.07 530.23 # 19396 140.77 133.73 153.79 20662 490.88 466.34 536.29 20000 217.99 207.09 238.15 20663 463.85 440.66 506.76 # 20000 162.56 154.43 177.59 20664 763.63 725.45 834.27 20005 315.21 299.45 344.37 20665 139.43 132.46 152.33 # 20005 242.81 230.67 265.27 # 20665 109.47 104.00 119.60 20100 593.64 563.96 648.55 20670 522.52 496.39 570.85 20101 437.07 415.22 477.50 # 20670 163.51 155.33 178.63 # 20101 202.89 192.75 221.66 20680 643.51 611.33 703.03 20102 511.08 485.53 558.36 # 20680 414.82 394.08 453.19 # 20102 244.45 232.23 267.06 20690 501.57 476.49 547.96 20103 615.34 584.57 672.26 20692 922.72 876.58 1,008.07 # 20103 360.19 342.18 393.51 20693 483.68 459.50 528.43 20150 931.65 885.07 1,017.83 20694 477.37 453.50 521.53 20200 210.24 199.73 229.69 # 20694 355.03 337.28 387.87 # 20200 93.40 88.73 102.04 20802 2,428.22 2,306.81 2,652.83 20205 283.76 269.57 310.01 20805 3,216.39 3,055.57 3,513.91 # 20205 147.94 140.54 161.62 20808 4,184.77 3,975.53 4,571.86 20206 328.80 312.36 359.21 20816 2,583.85 2,454.66 2,822.86 # 20206 66.15 62.84 72.27 20822 2,277.89 2,164.00 2,488.60 20220 227.55 216.17 248.60 20824 2,551.59 2,424.01 2,787.61 # 20220 82.74 78.60 90.39 20827 2,329.47 2,213.00 2,544.95 20225 981.52 932.44 1,072.31 20838 2,409.24 2,288.78 2,632.10 # 20225 125.19 118.93 136.77 20900 668.17 634.76 729.97 20240 239.62 227.64 261.79 # 20900 491.41 466.84 536.87 20245 649.41 616.94 709.48 20902 635.55 603.77 694.34 20250 386.76 367.42 422.53 20910 451.50 428.93 493.27 20251 430.55 409.02 470.37 20912 510.25 484.74 557.45 20500 136.59 129.76 149.22 20920 420.44 399.42 459.33 # 20500 106.63 101.30 116.50 20922 633.90 602.21 692.54 20501 159.28 151.32 174.02 # 20922 503.08 477.93 549.62 # 20501 40.44 38.42 44.18 20924 529.62 503.14 578.61 20520 208.77 198.33 228.08 20926 453.51 430.83 495.45 # 20520 151.35 143.78 165.35 20931 115.15 109.39 125.80 20525 542.34 515.22 592.50 20937 175.51 166.73 191.74 # 20525 257.22 244.36 281.01 20938 190.84 181.30 208.50 20526 80.87 76.83 88.35 20950 326.12 309.81 356.28 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 9 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 20950 96.43 91.61 105.35 # 21084 1,507.23 1,431.87 1,646.65 20955 2,597.53 2,467.65 2,837.80 21085 728.45 692.03 795.83 20956 2,749.15 2,611.69 3,003.44 # 21085 605.61 575.33 661.63 20957 2,542.80 2,415.66 2,778.01 21086 1,885.95 1,791.65 2,060.40 20962 2,745.09 2,607.84 2,999.02 # 21086 1,666.74 1,583.40 1,820.91 20969 2,892.94 2,748.29 3,160.53 21087 1,869.36 1,775.89 2,042.27 20970 2,882.54 2,738.41 3,149.17 # 21087 1,655.16 1,572.40 1,808.26 20972 2,571.20 2,442.64 2,809.04 21100 826.84 785.50 903.33 20973 2,769.00 2,630.55 3,025.13 # 21100 424.39 403.17 463.65 20974 66.30 62.99 72.44 21110 786.58 747.25 859.34 # 20974 50.32 47.80 54.97 # 21110 673.74 640.05 736.06 20975 183.93 174.73 200.94 21116 200.39 190.37 218.93 20979 59.70 56.72 65.23 # 21116 43.61 41.43 47.64 # 20979 37.73 35.84 41.22 21120 695.35 660.58 759.67 20982 5,007.56 4,757.18 5,470.76 # 21120 543.06 515.91 593.30 # 20982 412.82 392.18 451.01 21121 801.50 761.43 875.64 20985 150.04 142.54 163.92 # 21121 677.67 643.79 740.36 21010 743.56 706.38 812.34 21122 754.78 717.04 824.60 21015 446.49 424.17 487.80 21123 874.57 830.84 955.47 21025 1,040.84 988.80 1,137.12 21125 3,369.53 3,201.05 3,681.21 # 21025 873.57 829.89 954.37 # 21125 760.58 722.55 830.93 21026 626.17 594.86 684.09 21127 3,660.20 3,477.19 3,998.77 # 21026 515.32 489.55 562.98 # 21127 891.47 846.90 973.94 21029 785.95 746.65 858.65 21137 767.75 729.36 838.76 # 21029 651.14 618.58 711.37 21138 924.20 877.99 1,009.69 21030 519.51 493.53 567.56 21139 1,000.45 950.43 1,092.99 # 21030 424.64 403.41 463.92 21141 1,372.95 1,304.30 1,499.95 21031 403.49 383.32 440.82 21142 1,333.24 1,266.58 1,456.57 # 21031 304.13 288.92 332.26 21143 1,417.90 1,347.01 1,549.06 21032 411.96 391.36 450.06 21145 1,572.48 1,493.86 1,717.94 # 21032 299.12 284.16 326.78 21146 1,552.02 1,474.42 1,695.58 21034 1,390.12 1,320.61 1,518.70 21147 1,690.64 1,606.11 1,847.03 # 21034 1,213.36 1,152.69 1,325.59 21150 1,807.74 1,717.35 1,974.95 21040 521.50 495.43 569.74 21151 1,928.03 1,831.63 2,106.37 # 21040 415.65 394.87 454.10 21154 2,170.74 2,062.20 2,371.53 21044 905.00 859.75 988.71 21155 2,457.30 2,334.44 2,684.61 21045 1,249.66 1,187.18 1,365.26 21159 2,830.94 2,689.39 3,092.80 21046 1,122.01 1,065.91 1,225.80 21160 3,011.05 2,860.50 3,289.58 21047 1,338.83 1,271.89 1,462.67 21172 1,762.09 1,673.99 1,925.09 21048 1,140.06 1,083.06 1,245.52 21175 2,081.31 1,977.24 2,273.83 21049 1,288.28 1,223.87 1,407.45 21179 1,494.93 1,420.18 1,633.21 21050 883.15 838.99 964.84 21180 1,691.82 1,607.23 1,848.31 21060 812.46 771.84 887.62 21181 747.74 710.35 816.90 21070 665.66 632.38 727.24 21182 2,063.15 1,959.99 2,253.99 21073 402.35 382.23 439.56 21183 2,361.90 2,243.81 2,580.38 # 21073 243.06 230.91 265.55 21184 2,437.88 2,315.99 2,663.39 21076 1,031.22 979.66 1,126.61 21188 1,706.13 1,620.82 1,863.94 # 21076 889.41 844.94 971.68 21193 1,271.90 1,208.31 1,389.56 21077 2,542.70 2,415.57 2,777.91 21194 1,450.93 1,378.38 1,585.14 # 21077 2,245.10 2,132.85 2,452.78 21195 1,397.47 1,327.60 1,526.74 21079 1,750.63 1,663.10 1,912.57 21196 1,512.21 1,436.60 1,652.09 # 21079 1,495.47 1,420.70 1,633.81 21198 1,191.51 1,131.93 1,301.72 21080 1,992.48 1,892.86 2,176.79 21199 1,032.36 980.74 1,127.85 # 21080 1,686.40 1,602.08 1,842.39 21206 1,157.83 1,099.94 1,264.93 21081 1,816.98 1,726.13 1,985.05 21208 1,803.65 1,713.47 1,970.49 # 21081 1,531.37 1,454.80 1,673.02 # 21208 856.94 814.09 936.20 21082 1,668.02 1,584.62 1,822.31 21209 862.60 819.47 942.39 # 21082 1,412.37 1,341.75 1,543.01 # 21209 674.36 640.64 736.74 21083 1,593.56 1,513.88 1,740.96 21210 2,139.63 2,032.65 2,337.55 # 21083 1,306.45 1,241.13 1,427.30 # 21210 856.87 814.03 936.13 21084 1,822.80 1,731.66 1,991.41 21215 3,654.41 3,471.69 3,992.44 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 10 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 21215 890.67 846.14 973.06 21387 787.59 748.21 860.44 21230 796.38 756.56 870.04 21390 779.09 740.14 851.16 21235 769.00 730.55 840.13 21395 981.47 932.40 1,072.26 # 21235 585.25 555.99 639.39 21400 187.09 177.74 204.40 21240 1,148.58 1,091.15 1,254.82 # 21400 150.14 142.63 164.02 21242 1,060.66 1,007.63 1,158.77 21401 509.94 484.44 557.11 21243 1,715.94 1,630.14 1,874.66 # 21401 297.73 282.84 325.27 21244 1,088.06 1,033.66 1,188.71 21406 558.39 530.47 610.04 21245 1,194.63 1,134.90 1,305.14 21407 654.90 622.16 715.48 # 21245 941.47 894.40 1,028.56 21408 888.49 844.07 970.68 21246 892.81 848.17 975.40 21421 766.41 728.09 837.30 21247 1,665.68 1,582.40 1,819.76 # 21421 659.55 626.57 720.56 21248 1,097.29 1,042.43 1,198.79 21422 704.62 669.39 769.80 # 21248 901.56 856.48 984.95 21423 825.57 784.29 901.93 21249 1,526.31 1,449.99 1,667.49 21431 797.08 757.23 870.81 # 21249 1,272.66 1,209.03 1,390.38 21432 697.94 663.04 762.50 21255 1,451.50 1,378.93 1,585.77 21433 1,698.46 1,613.54 1,855.57 21256 1,180.43 1,121.41 1,289.62 21435 1,344.79 1,277.55 1,469.18 21260 1,283.87 1,219.68 1,402.63 21436 1,912.19 1,816.58 2,089.07 21261 2,242.44 2,130.32 2,449.87 21440 553.57 525.89 604.77 21263 1,966.34 1,868.02 2,148.22 # 21440 464.69 441.46 507.68 21267 1,651.88 1,569.29 1,804.68 21445 782.13 743.02 854.47 21268 1,866.71 1,773.37 2,039.38 # 21445 652.31 619.69 712.64 21270 954.22 906.51 1,042.49 21450 579.45 550.48 633.05 # 21270 713.05 677.40 779.01 # 21450 497.07 472.22 543.05 21275 823.25 782.09 899.40 21451 765.14 726.88 835.91 21280 540.37 513.35 590.35 # 21451 658.78 625.84 719.72 21282 365.37 347.10 399.17 21452 713.41 677.74 779.40 21295 186.34 177.02 203.57 # 21452 353.90 336.21 386.64 21296 429.42 407.95 469.14 21453 881.35 837.28 962.87 21310 128.34 121.92 140.21 # 21453 802.46 762.34 876.69 # 21310 27.98 26.58 30.57 21454 571.47 542.90 624.34 21315 289.42 274.95 316.19 21461 1,995.27 1,895.51 2,179.84 # 21315 157.10 149.25 171.64 # 21461 978.65 929.72 1,069.18 21320 274.89 261.15 300.32 21462 2,173.20 2,064.54 2,374.22 # 21320 144.07 136.87 157.40 # 21462 1,062.22 1,009.11 1,160.48 21325 539.07 512.12 588.94 21465 937.28 890.42 1,023.98 21330 645.65 613.37 705.38 21470 1,208.22 1,147.81 1,319.98 21335 781.72 742.63 854.02 21480 105.35 100.08 115.09 21336 699.39 664.42 764.08 # 21480 31.95 30.35 34.90 21337 427.46 406.09 467.00 21485 680.54 646.51 743.49 # 21337 299.13 284.17 326.80 # 21485 592.16 562.55 646.93 21338 855.95 813.15 935.12 21490 942.50 895.38 1,029.69 21339 911.09 865.54 995.37 21495 711.78 676.19 777.62 21340 816.57 775.74 892.10 21497 684.92 650.67 748.27 21343 1,237.25 1,175.39 1,351.70 # 21497 593.04 563.39 647.90 21344 1,548.83 1,471.39 1,692.10 21501 470.59 447.06 514.12 21345 841.47 799.40 919.31 # 21501 329.78 313.29 360.28 # 21345 676.70 642.87 739.30 21502 540.04 513.04 590.00 21346 1,001.05 951.00 1,093.65 21510 494.91 470.16 540.68 21347 1,202.90 1,142.76 1,314.17 21550 274.75 261.01 300.16 21348 1,226.12 1,164.81 1,339.53 # 21550 163.90 155.71 179.07 21355 462.21 439.10 504.97 21555 450.57 428.04 492.25 # 21355 327.39 311.02 357.67 # 21555 333.73 317.04 364.60 21356 528.06 501.66 576.91 21556 419.59 398.61 458.40 # 21356 390.75 371.21 426.89 21557 586.69 557.36 640.96 21360 547.89 520.50 598.58 21600 568.29 539.88 620.86 21365 1,119.02 1,063.07 1,222.53 21610 1,080.20 1,026.19 1,180.12 21366 1,256.66 1,193.83 1,372.90 21615 695.42 660.65 759.75 21385 740.52 703.49 809.01 21616 851.73 809.14 930.51 21386 682.10 648.00 745.20 21620 544.81 517.57 595.21 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 11 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21627 574.36 545.64 627.49 22522 252.51 239.88 275.86 21630 1,287.95 1,223.55 1,407.08 22523 633.54 601.86 692.14 21632 1,265.84 1,202.55 1,382.93 22524 607.24 576.88 663.41 21685 1,013.44 962.77 1,107.19 22525 277.86 263.97 303.57 21700 445.45 423.18 486.66 22526 2,577.77 2,448.88 2,816.21 21705 630.42 598.90 688.74 # 22526 346.81 329.47 378.89 21720 389.08 369.63 425.07 22527 2,139.28 2,032.32 2,337.17 21725 545.86 518.57 596.36 # 22527 156.98 149.13 171.50 21740 1,091.24 1,036.68 1,192.18 22532 1,735.74 1,648.95 1,896.29 21750 725.99 689.69 793.14 22533 1,622.58 1,541.45 1,772.67 21800 103.81 98.62 113.41 22534 376.83 357.99 411.69 # 21800 105.31 100.04 115.05 22548 1,862.99 1,769.84 2,035.32 21805 269.97 256.47 294.94 22554 1,313.41 1,247.74 1,434.90 21810 525.00 498.75 573.56 22556 1,667.31 1,583.94 1,821.53 21820 141.24 134.18 154.31 22558 1,517.37 1,441.50 1,657.73 21825 591.52 561.94 646.23 22585 349.27 331.81 381.58 21920 268.65 255.22 293.50 22590 1,547.43 1,470.06 1,690.57 # 21920 159.80 151.81 174.58 22595 1,474.27 1,400.56 1,610.64 21925 437.39 415.52 477.85 22600 1,264.80 1,201.56 1,381.79 # 21925 339.53 322.55 370.93 22610 1,250.49 1,187.97 1,366.17 21930 488.18 463.77 533.34 22612 1,608.03 1,527.63 1,756.77 # 21930 373.83 355.14 408.41 22614 407.99 387.59 445.73 21935 1,160.23 1,102.22 1,267.55 22630 1,550.50 1,472.98 1,693.93 22010 916.42 870.60 1,001.19 22632 331.39 314.82 362.04 22015 910.40 864.88 994.61 22800 1,376.65 1,307.82 1,503.99 22100 829.82 788.33 906.58 22802 2,175.01 2,066.26 2,376.20 22101 829.17 787.71 905.87 22804 2,516.88 2,391.04 2,749.70 22102 832.26 790.65 909.25 22808 1,848.80 1,756.36 2,019.81 22103 146.35 139.03 159.88 22810 2,065.36 1,962.09 2,256.40 22110 1,016.08 965.28 1,110.07 22812 2,267.49 2,154.12 2,477.24 22112 1,011.74 961.15 1,105.32 22818 2,259.89 2,146.90 2,468.94 22114 1,014.04 963.34 1,107.84 22819 2,554.19 2,426.48 2,790.45 22116 146.37 139.05 159.91 22830 828.01 786.61 904.60 22206 2,348.90 2,231.46 2,566.18 22840 797.53 757.65 871.30 22207 2,320.86 2,204.82 2,535.54 22842 798.00 758.10 871.82 22208 581.81 552.72 635.63 22843 843.36 801.19 921.37 22210 1,779.45 1,690.48 1,944.05 22844 1,040.81 988.77 1,137.09 22212 1,475.46 1,401.69 1,611.94 22845 761.27 723.21 831.69 22214 1,492.42 1,417.80 1,630.47 22846 791.32 751.75 864.51 22216 383.09 363.94 418.53 22847 870.40 826.88 950.91 22220 1,609.40 1,528.93 1,758.27 22848 378.82 359.88 413.86 22222 1,451.20 1,378.64 1,585.44 22849 1,322.07 1,255.97 1,444.37 22224 1,591.31 1,511.74 1,738.50 22850 732.26 695.65 800.00 22226 381.09 362.04 416.35 22851 423.19 402.03 462.33 22305 194.76 185.02 212.77 22852 701.60 666.52 766.50 # 22305 176.28 167.47 192.59 22855 1,120.74 1,064.70 1,224.41 22310 287.16 272.80 313.72 22857 1,775.93 1,687.13 1,940.20 # 22310 263.69 250.51 288.09 22862 2,083.38 1,979.21 2,276.09 22315 886.73 842.39 968.75 22865 2,029.94 1,928.44 2,217.71 # 22315 766.89 728.55 837.83 22900 403.58 383.40 440.91 22318 1,602.41 1,522.29 1,750.63 23000 582.00 552.90 635.84 22319 1,752.98 1,665.33 1,915.13 # 23000 375.78 356.99 410.54 22325 1,398.71 1,328.77 1,528.09 23020 715.70 679.92 781.91 22326 1,462.95 1,389.80 1,598.27 23030 477.37 453.50 521.53 22327 1,444.95 1,372.70 1,578.61 # 23030 268.16 254.75 292.96 22328 287.27 272.91 313.85 23031 468.04 444.64 511.34 22505 126.39 120.07 138.08 # 23031 232.36 220.74 253.85 22520 3,003.14 2,852.98 3,280.93 23035 723.53 687.35 790.45 # 22520 609.89 579.40 666.31 23040 745.31 708.04 814.25 22521 2,866.71 2,723.37 3,131.88 23044 594.03 564.33 648.98 # 22521 576.82 547.98 630.18 23065 220.59 209.56 240.99 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 12 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 23065 168.66 160.23 184.26 23490 845.47 803.20 923.68 23066 549.76 522.27 600.61 23491 1,056.33 1,003.51 1,154.04 # 23066 354.03 336.33 386.78 23500 220.48 209.46 240.88 23075 277.03 263.18 302.66 # 23500 213.49 202.82 233.24 # 23075 180.66 171.63 197.37 23505 357.44 339.57 390.51 23076 573.57 544.89 626.62 # 23505 333.47 316.80 364.32 23077 1,189.40 1,129.93 1,299.42 23515 705.72 670.43 770.99 23100 507.38 482.01 554.31 23520 226.92 215.57 247.91 23101 469.83 446.34 513.29 # 23520 225.93 214.63 246.82 23105 661.06 628.01 722.21 23525 357.58 339.70 390.66 23106 499.53 474.55 545.73 # 23525 329.62 313.14 360.11 23107 687.86 653.47 751.49 23530 570.94 542.39 623.75 23120 584.61 555.38 638.69 23532 644.97 612.72 704.63 23125 725.51 689.23 792.61 23540 225.78 214.49 246.66 23130 632.38 600.76 690.87 # 23540 214.79 204.05 234.66 23140 527.34 500.97 576.12 23545 323.16 307.00 353.05 23145 712.88 677.24 778.83 # 23545 290.21 275.70 317.06 23146 640.76 608.72 700.03 23550 593.34 563.67 648.22 23150 671.96 638.36 734.11 23552 683.01 648.86 746.19 23155 813.19 772.53 888.41 23570 234.37 222.65 256.05 23156 696.89 662.05 761.36 # 23570 234.87 223.13 256.60 23170 553.64 525.96 604.85 23575 396.63 376.80 433.32 23172 573.35 544.68 626.38 # 23575 369.66 351.18 403.86 23174 779.18 740.22 851.25 23585 935.19 888.43 1,021.69 23180 734.34 697.62 802.26 23600 333.06 316.41 363.87 23182 707.42 672.05 772.86 # 23600 297.61 282.73 325.14 23184 790.96 751.41 864.12 23605 483.77 459.58 528.52 23190 575.64 546.86 628.89 # 23605 437.83 415.94 478.33 23195 770.77 732.23 842.06 23615 888.66 844.23 970.86 23200 891.38 846.81 973.83 23616 1,352.92 1,285.27 1,478.06 23210 935.01 888.26 1,021.50 23620 272.30 258.69 297.49 23220 1,103.72 1,048.53 1,205.81 # 23620 250.33 237.81 273.48 23221 1,284.76 1,220.52 1,403.60 23625 391.83 372.24 428.08 23222 1,723.80 1,637.61 1,883.25 # 23625 362.37 344.25 395.89 23330 247.62 235.24 270.53 23630 746.19 708.88 815.21 # 23330 156.74 148.90 171.24 23650 304.00 288.80 332.12 23331 612.69 582.06 669.37 # 23650 267.05 253.70 291.76 23332 914.85 869.11 999.48 23655 388.69 369.26 424.65 23350 191.08 181.53 208.76 23660 600.88 570.84 656.47 # 23350 53.26 50.60 58.19 23665 432.20 410.59 472.18 23395 1,320.68 1,254.65 1,442.85 # 23665 402.24 382.13 439.45 23397 1,178.68 1,119.75 1,287.71 23670 827.44 786.07 903.98 23400 1,007.63 957.25 1,100.84 23675 565.47 537.20 617.78 23405 654.83 622.09 715.40 # 23675 516.04 490.24 563.78 23406 813.57 772.89 888.82 23680 909.05 863.60 993.14 23410 930.27 883.76 1,016.32 23700 202.84 192.70 221.61 23412 987.98 938.58 1,079.37 23800 1,055.70 1,002.92 1,153.36 23415 764.57 726.34 835.29 23802 1,242.57 1,180.44 1,357.51 23420 1,091.94 1,037.34 1,192.94 23900 1,358.12 1,290.21 1,483.74 23430 770.50 731.98 841.78 23920 1,105.77 1,050.48 1,208.05 23440 793.65 753.97 867.07 23921 465.15 441.89 508.17 23450 988.96 939.51 1,080.44 23930 397.30 377.44 434.06 23455 1,051.33 998.76 1,148.57 # 23930 222.53 211.40 243.11 23460 1,139.06 1,082.11 1,244.43 23931 327.36 310.99 357.64 23462 1,111.75 1,056.16 1,214.58 # 23931 168.57 160.14 184.16 23465 1,157.02 1,099.17 1,264.05 23935 522.94 496.79 571.31 23466 1,144.34 1,087.12 1,250.19 24000 489.27 464.81 534.53 23470 1,260.93 1,197.88 1,377.56 24006 735.43 698.66 803.46 23472 1,548.70 1,471.27 1,691.96 24065 261.35 248.28 285.52 23480 854.17 811.46 933.18 # 24065 168.98 160.53 184.61 23485 997.81 947.92 1,090.11 24066 635.35 603.58 694.12 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 13 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 24066 406.66 386.33 444.28 24410 1,081.82 1,027.73 1,181.89 24075 516.57 490.74 564.35 24420 1,009.93 959.43 1,103.34 # 24075 319.84 303.85 349.43 24430 1,060.47 1,007.45 1,158.57 24076 483.63 459.45 528.37 24435 1,093.84 1,039.15 1,195.02 24077 828.65 787.22 905.30 24470 682.53 648.40 745.66 24100 412.74 392.10 450.92 24495 700.34 665.32 765.12 24101 518.59 492.66 566.56 24498 904.71 859.47 988.39 24102 637.83 605.94 696.83 24500 360.83 342.79 394.21 24105 355.09 337.34 387.94 # 24500 315.89 300.10 345.12 24110 603.44 573.27 659.26 24505 518.32 492.40 566.26 24115 683.74 649.55 746.98 # 24505 464.39 441.17 507.35 24116 897.96 853.06 981.02 24515 909.33 863.86 993.44 24120 541.72 514.63 591.82 24516 895.88 851.09 978.75 24125 612.05 581.45 668.67 24530 388.31 368.89 424.22 24126 653.87 621.18 714.36 # 24530 340.87 323.83 372.40 24130 527.70 501.32 576.52 24535 641.62 609.54 700.97 24134 791.04 751.49 864.21 # 24535 587.19 557.83 641.50 24136 652.02 619.42 712.33 24538 778.46 739.54 850.47 24138 684.35 650.13 747.65 24545 921.14 875.08 1,006.34 24140 762.02 723.92 832.51 24546 1,100.75 1,045.71 1,202.57 24145 645.22 612.96 704.90 24560 327.05 310.70 357.31 24147 675.79 642.00 738.30 # 24560 277.62 263.74 303.30 24149 1,179.14 1,120.18 1,288.21 24565 536.23 509.42 585.83 24150 1,004.36 954.14 1,097.26 # 24565 486.80 462.46 531.83 24151 1,162.66 1,104.53 1,270.21 24566 718.15 682.24 784.58 24152 744.90 707.66 813.81 24575 768.85 730.41 839.97 24153 687.67 653.29 751.28 24576 344.48 327.26 376.35 24155 865.89 822.60 945.99 # 24576 300.54 285.51 328.34 24160 628.92 597.47 687.09 24577 555.15 527.39 606.50 24164 516.20 490.39 563.95 # 24577 504.22 479.01 550.86 24200 221.32 210.25 241.79 24579 863.56 820.38 943.44 # 24200 141.92 134.82 155.04 24582 817.63 776.75 893.26 24201 620.60 589.57 678.01 24586 1,132.40 1,075.78 1,237.15 # 24201 377.93 359.03 412.88 24587 1,123.70 1,067.52 1,227.65 24220 204.75 194.51 223.69 24600 380.44 361.42 415.63 # 24220 69.94 66.44 76.41 # 24600 332.01 315.41 362.72 24300 424.36 403.14 463.61 24605 473.02 449.37 516.78 24301 778.65 739.72 850.68 24615 742.45 705.33 811.13 24305 602.61 572.48 658.35 24620 569.34 540.87 622.00 24310 494.53 469.80 540.27 24635 881.69 837.61 963.25 24320 786.41 747.09 859.15 24640 129.92 123.42 141.93 24330 744.38 707.16 813.23 # 24640 85.98 81.68 93.93 24331 817.71 776.82 893.34 24650 266.67 253.34 291.34 24332 622.01 590.91 679.55 # 24650 230.22 218.71 251.52 24340 638.56 606.63 697.62 24655 453.91 431.21 495.89 24341 745.26 708.00 814.20 # 24655 405.48 385.21 442.99 24342 815.48 774.71 890.92 24665 676.03 642.23 738.56 24343 731.25 694.69 798.89 24666 759.81 721.82 830.09 24344 1,123.85 1,067.66 1,227.81 24670 297.77 282.88 325.31 24345 727.05 690.70 794.31 # 24670 257.33 244.46 281.13 24346 1,120.46 1,064.44 1,224.11 24675 473.78 450.09 517.60 24357 466.64 443.31 509.81 # 24675 427.84 406.45 467.42 24358 543.93 516.73 594.24 24685 679.44 645.47 742.29 24359 657.54 624.66 718.36 24800 828.11 786.70 904.71 24360 926.44 880.12 1,012.14 24802 1,020.72 969.68 1,115.13 24361 1,041.12 989.06 1,137.42 24900 728.86 692.42 796.28 24362 996.19 946.38 1,088.34 24920 717.99 682.09 784.40 24363 1,512.74 1,437.10 1,652.67 24925 557.88 529.99 609.49 24365 664.86 631.62 726.36 24930 755.87 718.08 825.79 24366 711.00 675.45 776.77 24931 786.30 746.99 859.04 24400 852.33 809.71 931.17 24935 1,088.42 1,034.00 1,189.10 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2007 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 12/27/07 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25000 406.37 386.05 443.96 25310 795.05 755.30 868.60 25001 347.69 330.31 379.86 25312 892.76 848.12 975.34 25020 646.46 614.14 706.26 25315 949.11 901.65 1,036.90 25023 1,189.90 1,130.41 1,299.97 25316 1,093.65 1,038.97 1,194.82 25024 770.71 732.17 842.00 25320 1,006.22 955.91 1,099.30 25025 1,159.53 1,101.55 1,266.78 25332 874.73 830.99 955.64 25028 565.82 537.53 618.16 25335 1,012.04 961.44 1,105.66 25031 448.22 425.81 489.68 25337 935.25 888.49 1,021.76 25035 777.25 738.39 849.15 25350 861.18 818.12 940.84 25040 607.46 577.09 663.65 25355 944.82 897.58 1,032.22 25065 262.61 249.48 286.90 25360 842.04 799.94 919.93 # 25065 170.73 162.19 186.52 25365 1,100.84 1,045.80 1,202.67 25066 435.54 413.76 475.82 25370 1,176.17 1,117.36 1,284.96 25075 376.68 357.85 411.53 25375 1,150.05 1,092.55 1,256.43 25076 534.88 508.14 584.36 25390 955.49 907.72 1,043.88 25077 840.69 798.66 918.46 25391 1,184.62 1,125.39 1,294.20 25085 510.23 484.72 557.43 25392 1,182.92 1,123.77 1,292.34 25100 379.87 360.88 415.01 25393 1,327.82 1,261.43 1,450.64 25101 441.56 419.48 482.40 25394 792.23 752.62 865.51 25105 537.96 511.06 587.72 25400 1,000.84 950.80 1,093.42 25107 652.34 619.72 712.68 25405 1,237.47 1,175.60 1,351.94 25109 525.57 499.29 574.18 25415 1,168.96 1,110.51 1,277.09 25110 422.00 400.90 461.04 25420 1,365.85 1,297.56 1,492.19 25111 342.35 325.23 374.01 25425 1,277.36 1,213.49 1,395.51 25112 412.11 391.50 450.23 25426 1,282.35 1,218.23 1,400.96 25115 914.40 868.68 998.98 25430 727.46 691.09 794.75 25116 770.86 732.32 842.17 25431 816.87 776.03 892.43 25118 420.00 399.00 458.85 25440 820.29 779.28 896.17 25119 555.30 527.54 606.67 25441 968.57 920.14 1,058.16 25120 671.81 638.22 733.95 25442 834.29 792.58 911.47 25125 755.27 717.51 825.14 25443 803.43 763.26 877.75 25126 772.40 733.78 843.85 25444 852.17 809.56 930.99 25130 486.02 461.72 530.98 25445 750.12 712.61 819.50 25135 598.87 568.93 654.27 25446 1,213.78 1,153.09 1,326.05 25136 531.08 504.53 580.21 25447 839.00 797.05 916.61 25145 683.51 649.33 746.73 25449 1,067.54 1,014.16 1,166.28 25150 628.03 596.63 686.12 25450 665.24 631.98 726.78 25151 755.65 717.87 825.55 25455 801.56 761.48 875.70 25170 1,007.11 956.75 1,100.26 25490 881.73 837.64 963.29 25210 529.30 502.84 578.27 25491 924.80 878.56 1,010.34 25215 681.86 647.77 744.94 25492 1,086.92 1,032.57 1,187.46 25230 471.56 447.98 515.18 25500 268.87 255.43 293.74 25240 489.67 465.19 534.97 # 25500 236.41 224.59 258.28 25246 207.15 196.79