1HNPRDS08 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 1 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 37.00 35.15 40.42 G0270 25.17 23.91 27.50 G0102 21.22 20.16 23.18 # G0270 24.75 23.51 27.04 # G0102 8.58 8.15 9.37 G0271 14.21 13.50 15.53 G0104 136.10 129.30 148.70 # G0271 13.79 13.10 15.07 # G0104 58.59 55.66 64.01 G0275 13.79 13.10 15.07 G0105 397.76 377.87 434.55 G0278 13.79 13.10 15.07 # G0105 203.15 192.99 221.94 G0281 11.49 10.92 12.56 G0105 53 136.10 129.30 148.70 G0283 11.49 10.92 12.56 # G0105 53 58.59 55.66 64.01 G0288 250.98 238.43 274.19 G0106 196.43 186.61 214.60 G0289 86.72 82.38 94.74 G0106 TC 147.96 140.56 161.64 G0308 740.31 703.29 808.78 G0106 26 48.47 46.05 52.96 G0309 606.17 575.86 662.24 G0108 30.21 28.70 33.01 G0310 473.88 450.19 517.72 G0109 17.15 16.29 18.73 G0311 512.85 487.21 560.29 G0117 46.81 44.47 51.14 G0312 421.97 400.87 461.00 G0118 32.17 30.56 35.14 G0313 330.87 314.33 361.48 C G0120 192.64 183.01 210.46 G0314 451.98 429.38 493.79 C G0120 TC 144.17 136.96 157.50 G0315 371.51 352.93 405.87 G0120 26 48.47 46.05 52.96 G0316 288.38 273.96 315.05 G0121 397.76 377.87 434.55 G0317 284.76 270.52 311.10 # G0121 203.15 192.99 221.94 G0318 233.19 221.53 254.76 G0121 53 136.10 129.30 148.70 G0319 182.00 172.90 198.84 # G0121 53 58.59 55.66 64.01 G0320 575.42 546.65 628.65 G0124 25.74 24.45 28.12 G0321 406.80 386.46 444.43 G0127 19.53 18.55 21.33 G0322 353.40 335.73 386.09 # G0127 8.58 8.15 9.37 G0323 221.39 210.32 241.87 G0128 3.83 3.64 4.19 G0324 20.61 19.58 22.52 G0130 39.42 37.45 43.07 G0325 12.18 11.57 13.31 G0130 TC 28.88 27.44 31.56 G0326 14.14 13.43 15.44 G0130 26 10.54 10.01 11.51 G0327 7.85 7.46 8.58 G0141 25.74 24.45 28.12 G0329 8.54 8.11 9.33 G0166 172.78 164.14 188.76 G0332 82.98 78.83 90.65 G0168 90.38 85.86 98.74 G0339 3,915.07 3,719.32 4,277.22 # G0168 25.09 23.84 27.42 G0340 2,658.17 2,525.26 2,904.05 G0179 47.53 45.15 51.92 G0341 354.73 336.99 387.54 G0180 61.86 58.77 67.59 G0342 664.68 631.45 726.17 G0181 108.42 103.00 118.45 G0343 1,097.26 1,042.40 1,198.76 G0182 112.63 107.00 123.05 G0344 95.43 90.66 104.26 G0202 144.30 137.09 157.65 # G0344 67.21 63.85 73.43 G0202 TC 109.94 104.44 120.11 G0364 12.89 12.25 14.09 G0202 26 34.37 32.65 37.55 # G0364 9.10 8.65 9.95 G0204 162.99 154.84 178.07 C G0365 177.75 168.86 194.19 G0204 TC 120.05 114.05 131.16 C G0365 TC 165.35 157.08 180.64 G0204 26 42.95 40.80 46.92 G0365 26 12.41 11.79 13.56 G0206 130.10 123.60 142.14 G0366 24.34 23.12 26.59 G0206 TC 95.74 90.95 104.59 G0367 15.76 14.97 17.22 G0206 26 34.37 32.65 37.55 G0368 8.58 8.15 9.37 G0237 14.92 14.17 16.30 G0372 15.32 14.55 16.73 G0238 15.76 14.97 17.22 # G0372 8.16 7.75 8.91 G0239 14.08 13.38 15.39 G0389 124.38 118.16 135.88 G0245 64.85 61.61 70.85 G0389 TC 95.49 90.72 104.33 # G0245 43.37 41.20 47.38 G0389 26 28.88 27.44 31.56 G0246 39.11 37.15 42.72 G0392 2,546.57 2,419.24 2,782.13 # G0246 22.26 21.15 24.32 # G0392 485.01 460.76 529.87 G0247 42.75 40.61 46.70 G0393 1,939.26 1,842.30 2,118.65 # G0247 25.06 23.81 27.38 # G0393 310.31 294.79 339.01 G0248 211.34 200.77 230.89 G0396 30.16 28.65 32.95 G0249 155.32 147.55 169.68 # G0396 28.48 27.06 31.12 G0250 9.39 8.92 10.26 G0397 58.94 55.99 64.39 G0268 48.69 46.26 53.20 # G0397 56.84 54.00 62.10 # G0268 30.58 29.05 33.41 G9041 23.68 22.50 25.88 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 99 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 10.49 9.97 11.47 10121 249.41 236.94 272.48 G9043 10.49 9.97 11.47 # 10121 174.01 165.31 190.11 G9044 9.23 8.77 10.09 10140 142.95 135.80 156.17 M0064 39.07 37.12 42.69 # 10140 112.20 106.59 122.58 # M0064 16.75 15.91 18.30 10160 117.69 111.81 128.58 P3001 25.74 24.45 28.12 # 10160 90.73 86.19 99.12 Q0035 22.24 21.13 24.30 10180 218.63 207.70 238.86 Q0035 TC 14.08 13.38 15.39 # 10180 166.81 158.47 182.24 Q0035 26 8.16 7.75 8.91 11000 49.81 47.32 54.42 Q0091 43.16 41.00 47.15 # 11000 30.43 28.91 33.25 # Q0091 18.31 17.39 20.00 11001 20.86 19.82 22.79 Q0092 17.15 16.29 18.73 # 11001 15.38 14.61 16.80 R0070 157.76 149.87 172.35 11004 534.37 507.65 583.80 R0075 157.76 149.87 172.35 11005 706.45 671.13 771.80 0067T 641.18 609.12 700.49 11006 666.31 632.99 727.94 C 0067T TC 207.02 196.67 226.17 11008 256.97 244.12 280.74 0067T 26 130.28 123.77 142.34 11010 449.44 426.97 491.02 0073T 661.03 627.98 722.18 # 11010 265.78 252.49 290.36 0075T 1,139.56 1,082.58 1,244.97 11011 509.16 483.70 556.26 0076T 376.05 357.25 410.84 # 11011 280.85 266.81 306.83 0078T 1,284.35 1,220.13 1,403.15 11012 711.64 676.06 777.47 0079T 1,183.11 1,123.95 1,292.54 # 11012 412.98 392.33 451.18 0080T 228.82 217.38 249.99 11040 43.95 41.75 48.01 0081T 228.82 217.38 249.99 # 11040 26.26 24.95 28.69 0145T 636.92 605.07 695.83 11041 52.39 49.77 57.24 C 0145T TC 323.44 307.27 353.36 # 11041 34.28 32.57 37.46 0145T 26 102.92 97.77 112.44 11042 71.18 67.62 77.76 0146T 636.92 605.07 695.83 # 11042 45.07 42.82 49.24 C 0146T TC 323.44 307.27 353.36 11043 257.29 244.43 281.09 0146T 26 102.92 97.77 112.44 # 11043 221.90 210.81 242.43 0147T 636.92 605.07 695.83 11044 347.61 330.23 379.76 C 0147T TC 323.44 307.27 353.36 # 11044 306.32 291.00 334.65 0147T 26 102.92 97.77 112.44 11055 44.72 42.48 48.85 0148T 636.92 605.07 695.83 # 11055 21.97 20.87 24.00 C 0148T TC 323.44 307.27 353.36 11056 54.82 52.08 59.89 0148T 26 102.92 97.77 112.44 # 11056 30.81 29.27 33.66 0149T 636.92 605.07 695.83 11057 66.07 62.77 72.19 C 0149T TC 323.44 307.27 353.36 # 11057 40.38 38.36 44.11 0149T 26 102.92 97.77 112.44 11100 93.84 89.15 102.52 0150T 636.92 605.07 695.83 # 11100 44.14 41.93 48.22 C 0150T TC 323.44 307.27 353.36 11101 29.99 28.49 32.76 0150T 26 102.92 97.77 112.44 # 11101 22.41 21.29 24.48 0151T 205.06 194.81 224.03 11200 75.65 71.87 82.65 C 0151T TC 109.08 103.63 119.17 # 11200 63.01 59.86 68.84 0151T 26 67.72 64.33 73.98 11201 17.31 16.44 18.91 10021 137.36 130.49 150.06 # 11201 15.63 14.85 17.08 # 10021 65.33 62.06 71.37 11300 64.07 60.87 70.00 10022 144.35 137.13 157.70 # 11300 27.00 25.65 29.50 # 10022 62.62 59.49 68.41 11301 85.15 80.89 93.02 10040 91.06 86.51 99.49 # 11301 45.97 43.67 50.22 # 10040 78.84 74.90 86.14 11302 101.23 96.17 110.60 10060 101.16 96.10 110.52 # 11302 56.58 53.75 61.81 # 10060 86.41 82.09 94.40 11303 120.15 114.14 131.26 10061 171.63 163.05 187.51 # 11303 66.65 63.32 72.82 # 10061 152.67 145.04 166.80 11305 65.17 61.91 71.20 10080 165.31 157.04 180.60 # 11305 34.84 33.10 38.07 # 10080 90.33 85.81 98.68 11306 88.54 84.11 96.73 10081 250.03 237.53 273.16 # 11306 52.32 49.70 57.16 # 10081 152.73 145.09 166.85 11307 103.22 98.06 112.77 10120 131.79 125.20 143.98 # 11307 60.67 57.64 66.29 # 10120 85.46 81.19 93.37 11308 118.01 112.11 128.93 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 3 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 74.20 70.49 81.06 11602 219.08 208.13 239.35 11310 78.40 74.48 85.65 # 11602 140.31 133.29 153.28 # 11310 39.23 37.27 42.86 11603 248.34 235.92 271.31 11311 97.02 92.17 106.00 # 11603 165.78 157.49 181.11 # 11311 57.00 54.15 62.27 11604 274.07 260.37 299.43 11312 112.80 107.16 123.23 # 11604 181.39 172.32 198.17 # 11312 65.62 62.34 71.69 11606 380.13 361.12 415.29 11313 142.09 134.99 155.24 # 11606 267.24 253.88 291.96 # 11313 88.17 83.76 96.32 11620 170.97 162.42 186.78 11400 113.05 107.40 123.51 # 11620 101.47 96.40 110.86 # 11400 69.66 66.18 76.11 11621 202.83 192.69 221.59 11401 134.49 127.77 146.94 # 11621 130.80 124.26 142.90 # 11401 91.10 86.55 99.53 11622 228.46 217.04 249.60 11402 149.15 141.69 162.94 # 11622 150.11 142.60 163.99 # 11402 99.86 94.87 109.10 11623 266.29 252.98 290.93 11403 170.55 162.02 186.32 # 11623 183.73 174.54 200.72 # 11403 126.74 120.40 138.46 11624 300.81 285.77 328.64 11404 193.59 183.91 211.50 # 11624 209.82 199.33 229.23 # 11404 140.09 133.09 153.05 11626 369.87 351.38 404.09 11406 265.96 252.66 290.56 # 11626 267.08 253.73 291.79 # 11406 205.73 195.44 224.76 11640 178.62 169.69 195.14 11420 112.27 106.66 122.66 # 11640 108.69 103.26 118.75 # 11420 75.62 71.84 82.62 11641 216.79 205.95 236.84 11421 142.75 135.61 155.95 # 11641 142.65 135.52 155.85 # 11421 100.63 95.60 109.94 11642 249.08 236.63 272.12 11422 159.40 151.43 174.14 # 11642 167.36 158.99 182.84 # 11422 120.65 114.62 131.81 11643 291.89 277.30 318.90 11423 185.43 176.16 202.58 # 11643 207.64 197.26 226.85 # 11423 139.94 132.94 152.88 11644 361.63 343.55 395.08 11424 212.08 201.48 231.70 # 11644 259.69 246.71 283.72 # 11424 161.53 153.45 176.47 11646 473.66 449.98 517.48 11426 298.85 283.91 326.50 # 11646 367.09 348.74 401.05 # 11426 242.82 230.68 265.28 11719 19.41 18.44 21.21 11440 125.38 119.11 136.98 # 11719 8.88 8.44 9.71 # 11440 92.10 87.50 100.63 11720 28.79 27.35 31.45 11441 153.94 146.24 168.18 # 11720 16.15 15.34 17.64 # 11441 118.55 112.62 129.51 11721 41.15 39.09 44.95 11442 172.58 163.95 188.54 # 11721 27.67 26.29 30.23 # 11442 131.30 124.74 143.45 11730 91.11 86.55 99.53 11443 206.61 196.28 225.72 # 11730 56.56 53.73 61.79 # 11443 161.54 153.46 176.48 11732 41.92 39.82 45.79 11444 258.84 245.90 282.79 # 11732 28.86 27.42 31.53 # 11444 205.76 195.47 224.79 11740 42.08 39.98 45.98 11446 344.65 327.42 376.53 # 11740 30.28 28.77 33.09 # 11446 288.21 273.80 314.87 11750 195.36 185.59 213.43 11450 330.42 313.90 360.99 # 11750 164.19 155.98 179.38 # 11450 209.95 199.45 229.37 11752 276.55 262.72 302.13 11451 436.17 414.36 476.51 # 11752 249.17 236.71 272.22 # 11451 277.78 263.89 303.47 11755 124.13 117.92 135.61 11462 328.05 311.65 358.40 # 11755 80.32 76.30 87.75 # 11462 202.52 192.39 221.25 11760 187.17 177.81 204.48 11463 444.47 422.25 485.59 # 11760 128.19 121.78 140.05 # 11463 281.45 267.38 307.49 11762 247.56 235.18 270.46 11470 357.48 339.61 390.55 # 11762 193.65 183.97 211.57 # 11470 238.69 226.76 260.77 11765 120.50 114.48 131.65 11471 458.45 435.53 500.86 # 11765 63.63 60.45 69.52 # 11471 301.74 286.65 329.65 11770 245.04 232.79 267.71 11600 169.62 161.14 185.31 # 11770 162.48 154.36 177.51 # 11600 100.54 95.51 109.84 11771 482.95 458.80 527.62 11601 201.19 191.13 219.80 # 11771 371.74 353.15 406.12 # 11601 129.16 122.70 141.11 11772 598.29 568.38 653.64 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 99 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 494.67 469.94 540.43 12031 208.51 198.08 227.79 11900 51.10 48.55 55.83 # 12031 136.06 129.26 148.65 # 11900 27.93 26.53 30.51 12032 279.61 265.63 305.47 11901 62.71 59.57 68.51 # 12032 174.72 165.98 190.88 # 11901 43.33 41.16 47.33 12034 271.11 257.55 296.18 11920 188.87 179.43 206.34 # 12034 179.28 170.32 195.87 # 11920 107.57 102.19 117.52 12035 349.05 331.60 381.34 11921 213.32 202.65 233.05 # 12035 217.63 206.75 237.76 # 11921 126.97 120.62 138.71 12036 384.63 365.40 420.21 11922 61.98 58.88 67.71 # 12036 254.47 241.75 278.01 # 11922 28.70 27.27 31.36 12037 432.23 410.62 472.21 11950 72.73 69.09 79.45 # 12037 295.75 280.96 323.10 # 11950 45.77 43.48 50.00 12041 221.46 210.39 241.95 11951 94.12 89.41 102.82 # 12041 147.32 139.95 160.94 # 11951 61.68 58.60 67.39 12042 261.74 248.65 285.95 11952 135.24 128.48 147.75 # 12042 173.70 165.02 189.77 # 11952 92.27 87.66 100.81 12044 296.27 281.46 323.68 11954 159.31 151.34 174.04 # 12044 189.28 179.82 206.79 # 11954 104.97 99.72 114.68 12045 352.34 334.72 384.93 11960 853.18 810.52 932.10 # 12045 226.81 215.47 247.79 11970 555.94 528.14 607.36 12046 416.13 395.32 454.62 11971 466.08 442.78 509.20 # 12046 266.17 252.86 290.79 # 11971 282.84 268.70 309.01 12047 445.07 422.82 486.24 11976 138.96 132.01 151.81 # 12047 295.53 280.75 322.86 # 11976 90.94 86.39 99.35 12051 245.43 233.16 268.13 11980 99.25 94.29 108.43 # 12051 161.18 153.12 176.09 # 11980 75.24 71.48 82.20 12052 270.01 256.51 294.99 11981 129.28 122.82 141.24 # 12052 184.08 174.88 201.11 # 11981 79.99 75.99 87.39 12053 295.11 280.35 322.40 11982 148.72 141.28 162.47 # 12053 190.22 180.71 207.82 # 11982 97.33 92.46 106.33 12054 315.91 300.11 345.13 11983 222.13 211.02 242.67 # 12054 203.86 193.67 222.72 # 11983 177.06 168.21 193.44 12055 384.60 365.37 420.18 12001 140.76 133.72 153.78 # 12055 252.33 239.71 275.67 # 12001 94.00 89.30 102.70 12056 475.43 451.66 519.41 12002 149.64 142.16 163.48 # 12056 313.67 297.99 342.69 # 12002 105.41 100.14 115.16 12057 511.29 485.73 558.59 12004 175.29 166.53 191.51 # 12057 359.22 341.26 392.45 # 12004 123.48 117.31 134.91 13100 292.64 278.01 319.71 12005 217.98 207.08 238.14 # 13100 214.71 203.97 234.57 # 12005 153.11 145.45 167.27 13101 363.76 345.57 397.41 12006 270.82 257.28 295.87 # 13101 259.71 246.72 283.73 # 12006 193.73 184.04 211.65 13102 98.78 93.84 107.92 12007 304.32 289.10 332.47 # 13102 68.87 65.43 75.24 # 12007 222.18 211.07 242.73 13120 303.45 288.28 331.52 12011 150.10 142.60 163.99 # 13120 223.41 212.24 244.08 # 12011 97.45 92.58 106.47 13121 398.25 378.34 435.09 12013 164.69 156.46 179.93 # 13121 290.41 275.89 317.27 # 12013 111.61 106.03 121.93 13122 113.86 108.17 124.40 12014 192.87 183.23 210.71 # 13122 78.48 74.56 85.74 # 12014 133.47 126.80 145.82 13131 333.84 317.15 364.72 12015 241.92 229.82 264.29 # 13131 253.38 240.71 276.82 # 12015 166.94 158.59 182.38 13132 519.25 493.29 567.28 12016 285.71 271.42 312.13 # 13132 420.68 399.65 459.60 # 12016 203.15 192.99 221.94 13133 153.98 146.28 168.22 12017 245.67 233.39 268.40 # 13133 121.54 115.46 132.78 12018 294.39 279.67 321.62 13150 341.26 324.20 372.83 12020 256.36 243.54 280.07 # 13150 254.48 241.76 278.02 # 12020 175.48 166.71 191.72 13151 377.38 358.51 412.29 12021 147.60 140.22 161.25 # 13151 293.98 279.28 321.17 # 12021 127.80 121.41 139.62 13152 512.03 486.43 559.39 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 99 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 393.66 373.98 430.08 15151 121.81 115.72 133.08 13153 171.56 162.98 187.43 # 15151 107.91 102.51 117.89 # 13153 133.23 126.57 145.56 15152 149.63 142.15 163.47 13160 744.85 707.61 813.75 # 15152 134.89 128.15 147.37 14000 602.03 571.93 657.72 15155 696.94 662.09 761.40 # 14000 490.83 466.29 536.23 # 15155 650.61 618.08 710.79 14001 779.18 740.22 851.25 15156 160.47 152.45 175.32 # 14001 655.33 622.56 715.94 # 15156 149.52 142.04 163.35 14020 670.67 637.14 732.71 15157 178.66 169.73 195.19 # 14020 560.72 532.68 612.58 # 15157 163.07 154.92 178.16 14021 875.12 831.36 956.06 15170 383.74 364.55 419.23 # 14021 758.85 720.91 829.05 # 15170 323.08 306.93 352.97 14040 703.73 668.54 768.82 15171 84.82 80.58 92.67 # 14040 602.63 572.50 658.38 # 15171 80.60 76.57 88.06 14041 959.19 911.23 1,047.91 15175 503.10 477.95 549.64 # 14041 829.45 787.98 906.18 # 15175 444.97 422.72 486.13 14060 716.06 680.26 782.30 15176 136.61 129.78 149.25 # 14060 634.76 603.02 693.47 # 15176 129.03 122.58 140.97 14061 1,041.44 989.37 1,137.78 15200 739.29 702.33 807.68 # 14061 899.06 854.11 982.23 # 15200 596.91 567.06 652.12 14300 1,002.13 952.02 1,094.82 15201 146.65 139.32 160.22 # 14300 874.92 831.17 955.85 # 15201 72.93 69.28 79.67 14350 701.39 666.32 766.27 15220 707.73 672.34 773.19 15002 315.57 299.79 344.76 # 15220 575.46 546.69 628.69 # 15002 208.99 198.54 228.32 15221 136.06 129.26 148.65 15003 68.06 64.66 74.36 # 15221 67.39 64.02 73.62 # 15003 41.10 39.05 44.91 15240 838.88 796.94 916.48 15004 378.72 359.78 413.75 # 15240 725.56 689.28 792.67 # 15004 258.24 245.33 282.13 15241 174.68 165.95 190.84 15005 112.91 107.26 123.35 # 15241 106.02 100.72 115.83 # 15005 83.00 78.85 90.68 15260 894.85 850.11 977.63 15040 253.72 241.03 277.18 # 15260 782.80 743.66 855.21 # 15040 120.61 114.58 131.77 15261 201.10 191.05 219.71 15050 504.74 479.50 551.43 # 15261 135.39 128.62 147.91 # 15050 411.65 391.07 449.73 15300 311.41 295.84 340.22 15100 838.39 796.47 915.94 # 15300 263.81 250.62 288.21 # 15100 672.84 639.20 735.08 15301 57.32 54.45 62.62 15101 195.69 185.91 213.80 # 15301 53.11 50.45 58.02 # 15101 107.65 102.27 117.61 15320 354.27 336.56 387.04 15110 815.72 774.93 891.17 # 15320 301.62 286.54 329.52 # 15110 688.08 653.68 751.73 15321 85.99 81.69 93.94 15111 115.80 110.01 126.51 # 15321 80.09 76.09 87.50 # 15111 99.80 94.81 109.03 15330 290.00 275.50 316.83 15115 801.06 761.01 875.16 # 15330 241.14 229.08 263.44 # 15115 709.23 673.77 774.84 15331 57.75 54.86 63.09 15116 152.82 145.18 166.96 # 15331 53.95 51.25 58.94 # 15116 135.97 129.17 148.55 15335 311.59 296.01 340.41 15120 869.93 826.43 950.39 # 15335 262.30 249.19 286.57 # 15120 725.87 689.58 793.02 15336 84.23 80.02 92.02 15121 268.15 254.74 292.95 # 15336 77.07 73.22 84.20 # 15121 167.06 158.71 182.52 15340 301.00 285.95 328.84 15130 654.85 622.11 715.43 # 15340 252.98 240.33 276.38 # 15130 530.58 504.05 579.66 15341 44.79 42.55 48.93 15131 93.15 88.49 101.76 # 15341 25.84 24.55 28.23 # 15131 80.51 76.48 87.95 15360 341.89 324.80 373.52 15135 813.21 772.55 888.43 # 15360 285.02 270.77 311.39 # 15135 725.17 688.91 792.25 15361 65.68 62.40 71.76 15136 89.06 84.61 97.30 # 15361 59.36 56.39 64.85 # 15136 81.47 77.40 89.01 15365 340.58 323.55 372.08 15150 674.75 641.01 737.16 # 15365 288.77 274.33 315.48 # 15150 605.24 574.98 661.23 15366 82.83 78.69 90.49 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 99 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 76.51 72.68 83.58 # 15786 126.64 120.31 138.36 15400 351.69 334.11 384.23 15787 52.76 50.12 57.64 # 15400 326.00 309.70 356.16 # 15787 17.38 16.51 18.99 15401 99.03 94.08 108.19 15788 414.65 393.92 453.01 # 15401 54.38 51.66 59.41 # 15788 225.52 214.24 246.38 15420 396.15 376.34 432.79 15789 540.69 513.66 590.71 # 15420 348.55 331.12 380.79 # 15789 395.78 375.99 432.39 15421 109.16 103.70 119.26 15792 405.48 385.21 442.99 # 15421 80.09 76.09 87.50 # 15792 257.20 244.34 280.99 15430 504.75 479.51 551.44 15793 437.86 415.97 478.37 # 15430 487.06 462.71 532.12 # 15793 330.02 313.52 360.55 15570 828.79 787.35 905.45 15819 673.85 640.16 736.18 # 15570 652.71 620.07 713.08 15820 498.95 474.00 545.10 15572 777.64 738.76 849.57 # 15820 444.19 421.98 485.28 # 15572 647.90 615.51 707.84 15821 531.43 504.86 580.59 15574 838.48 796.56 916.04 # 15821 469.92 446.42 513.38 # 15574 703.69 668.51 768.79 15822 396.30 376.49 432.96 15576 747.72 710.33 816.88 # 15822 344.07 326.87 375.90 # 15576 620.51 589.48 677.90 15823 610.20 579.69 666.64 15600 346.18 328.87 378.20 # 15823 553.33 525.66 604.51 # 15600 196.64 186.81 214.83 15830 1,072.19 1,018.58 1,171.37 15610 309.82 294.33 338.48 15832 827.07 785.72 903.58 # 15610 230.20 218.69 251.49 15833 770.80 732.26 842.10 15620 433.18 411.52 473.25 15834 786.55 747.22 859.30 # 15620 296.70 281.87 324.15 15835 804.18 763.97 878.57 15630 441.06 419.01 481.86 15836 678.73 644.79 741.51 # 15630 321.85 305.76 351.62 15837 714.90 679.16 781.03 15650 473.17 449.51 516.94 # 15837 628.96 597.51 687.14 # 15650 350.59 333.06 383.02 15838 532.71 506.07 581.98 15731 1,016.38 965.56 1,110.39 15839 776.96 738.11 848.83 # 15731 908.54 863.11 992.58 # 15839 656.06 623.26 716.75 15732 1,414.54 1,343.81 1,545.38 15840 936.24 889.43 1,022.84 # 15732 1,216.55 1,155.72 1,329.08 15841 1,545.11 1,467.85 1,688.03 15734 1,453.60 1,380.92 1,588.06 15842 2,444.84 2,322.60 2,670.99 # 15734 1,251.83 1,189.24 1,367.63 15845 870.71 827.17 951.25 15736 1,311.61 1,246.03 1,432.93 15851 94.55 89.82 103.29 # 15736 1,083.72 1,029.53 1,183.96 # 15851 42.32 40.20 46.23 15738 1,387.64 1,318.26 1,516.00 15852 44.06 41.86 48.14 # 15738 1,180.38 1,121.36 1,289.56 15860 103.97 98.77 113.59 15740 909.30 863.84 993.42 15920 536.13 509.32 585.72 # 15740 782.09 742.99 854.44 15922 691.00 656.45 754.92 15750 849.52 807.04 928.10 15931 610.99 580.44 667.51 15756 2,203.59 2,093.41 2,407.42 15933 756.45 718.63 826.42 15757 2,196.46 2,086.64 2,399.64 15934 842.77 800.63 920.72 15758 2,191.47 2,081.90 2,394.19 15935 999.87 949.88 1,092.36 15760 783.18 744.02 855.62 15936 822.77 781.63 898.87 # 15760 653.86 621.17 714.35 15937 963.82 915.63 1,052.97 15770 606.96 576.61 663.10 15940 632.94 601.29 691.48 15775 299.02 284.07 326.68 15941 839.80 797.81 917.48 # 15775 202.13 192.02 220.82 15944 816.26 775.45 891.77 15776 423.62 402.44 462.81 15945 902.58 857.45 986.07 # 15776 312.41 296.79 341.31 15946 1,490.33 1,415.81 1,628.18 15780 786.73 747.39 859.50 15950 526.39 500.07 575.08 # 15780 618.65 587.72 675.88 15951 750.26 712.75 819.66 15781 504.45 479.23 551.11 15952 778.52 739.59 850.53 # 15781 407.98 387.58 445.72 15953 869.25 825.79 949.66 15782 548.80 521.36 599.56 15956 1,054.87 1,002.13 1,152.45 # 15782 400.10 380.10 437.12 15958 1,078.97 1,025.02 1,178.77 15783 466.24 442.93 509.37 16000 65.59 62.31 71.66 # 15783 347.45 330.08 379.59 # 16000 42.84 40.70 46.81 15786 225.63 214.35 246.50 16020 79.79 75.80 87.17 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 99 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 53.26 50.60 58.19 17311 667.75 634.36 729.51 16025 138.56 131.63 151.37 # 17311 345.08 327.83 377.00 # 16025 106.54 101.21 116.39 17312 405.74 385.45 443.27 16030 167.11 158.75 182.56 # 17312 183.75 174.56 200.74 # 16030 122.45 116.33 133.78 17313 610.71 580.17 667.20 16035 198.95 189.00 217.35 # 17313 309.95 294.45 338.62 16036 78.95 75.00 86.25 17314 375.10 356.35 409.80 17000 72.12 68.51 78.79 # 17314 169.95 161.45 185.67 # 17000 48.95 46.50 53.48 17315 78.45 74.53 85.71 17003 7.23 6.87 7.90 # 17315 48.54 46.11 53.03 # 17003 4.71 4.47 5.14 17340 42.36 40.24 46.28 17004 164.50 156.28 179.72 # 17340 42.78 40.64 46.74 # 17004 127.01 120.66 138.76 17360 120.01 114.01 131.11 17106 362.47 344.35 396.00 # 17360 90.10 85.60 98.44 # 17106 306.02 290.72 334.33 19000 112.92 107.27 123.36 17107 627.83 596.44 685.91 # 19000 43.00 40.85 46.98 # 17107 548.21 520.80 598.92 19001 25.92 24.62 28.31 17108 844.69 802.46 922.83 # 19001 21.29 20.23 23.26 # 17108 758.76 720.82 828.94 19020 412.64 392.01 450.81 17110 95.74 90.95 104.59 # 19020 260.15 247.14 284.21 # 17110 57.41 54.54 62.72 19030 171.16 162.60 186.99 17111 115.90 110.11 126.63 # 19030 76.38 72.56 83.44 # 17111 73.77 70.08 80.59 19100 135.37 128.60 147.89 17250 72.17 68.56 78.84 # 19100 63.34 60.17 69.20 # 17250 33.84 32.15 36.97 19101 306.88 291.54 335.27 17260 89.10 84.65 97.35 # 19101 197.78 187.89 216.07 # 17260 61.71 58.62 67.41 19102 225.45 214.18 246.31 17261 128.12 121.71 139.97 # 19102 99.92 94.92 109.16 # 17261 81.79 77.70 89.36 19103 588.58 559.15 643.02 17262 155.29 147.53 169.66 # 19103 184.61 175.38 201.69 # 17262 104.32 99.10 113.97 19105 2,092.84 1,988.20 2,286.43 17263 170.92 162.37 186.73 # 19105 175.77 166.98 192.03 # 17263 114.89 109.15 125.52 19110 413.78 393.09 452.05 17264 184.59 175.36 201.66 # 19110 289.51 275.03 316.28 # 17264 122.67 116.54 134.02 19112 399.25 379.29 436.18 17266 208.85 198.41 228.17 # 19112 262.77 249.63 287.07 # 17266 141.45 134.38 154.54 19120 421.64 400.56 460.64 17270 133.95 127.25 146.34 # 19120 354.24 336.53 387.01 # 17270 88.04 83.64 96.19 19125 464.21 441.00 507.15 17271 146.32 139.00 159.85 # 19125 392.60 372.97 428.92 # 17271 99.15 94.19 108.32 19126 146.99 139.64 160.59 17272 167.59 159.21 183.09 19260 1,107.25 1,051.89 1,209.67 # 17272 114.93 109.18 125.56 19271 1,529.04 1,452.59 1,670.48 17273 186.36 177.04 203.60 19272 1,684.46 1,600.24 1,840.28 # 17273 129.07 122.62 141.01 19290 165.95 157.65 181.30 17274 221.37 210.30 241.85 # 19290 63.17 60.01 69.01 # 17274 158.19 150.28 172.82 19291 71.58 68.00 78.20 17276 257.79 244.90 281.64 # 19291 31.14 29.58 34.02 # 17276 190.39 180.87 208.00 19295 105.19 99.93 114.92 17280 125.60 119.32 137.22 19296 4,588.16 4,358.75 5,012.56 # 17280 80.52 76.49 87.96 # 19296 190.81 181.27 208.46 17281 158.51 150.58 173.17 19297 85.76 81.47 93.69 # 17281 111.75 106.16 122.08 19298 1,567.58 1,489.20 1,712.58 17282 183.45 174.28 200.42 # 19298 310.60 295.07 339.33 # 17282 129.11 122.65 141.05 19300 516.49 490.67 564.27 17283 221.52 210.44 242.01 # 19300 349.25 331.79 381.56 # 17283 161.71 153.62 176.66 19301 530.91 504.36 580.01 17284 258.15 245.24 282.03 19302 785.49 746.22 858.15 # 17284 192.44 182.82 210.24 19303 817.82 776.93 893.47 17286 328.26 311.85 358.63 19304 499.35 474.38 545.54 # 17286 261.29 248.23 285.46 19305 978.35 929.43 1,068.84 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 99 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 1,022.48 971.36 1,117.06 # 20526 55.11 52.35 60.20 19307 1,027.85 976.46 1,122.93 20550 56.23 53.42 61.43 19316 724.60 688.37 791.63 # 20550 38.96 37.01 42.56 19318 1,069.15 1,015.69 1,168.04 20551 55.51 52.73 60.64 19324 447.07 424.72 488.43 # 20551 40.77 38.73 44.54 19325 600.06 570.06 655.57 20552 51.12 48.56 55.84 19328 452.72 430.08 494.59 # 20552 33.01 31.36 36.06 19330 573.95 545.25 627.04 20553 57.26 54.40 62.56 19340 370.09 351.59 404.33 # 20553 36.62 34.79 40.01 19342 850.14 807.63 928.77 20555 307.23 291.87 335.65 19350 846.04 803.74 924.30 20600 52.45 49.83 57.30 # 19350 635.84 604.05 694.66 # 20600 38.54 36.61 42.10 19355 682.20 648.09 745.30 20605 57.00 54.15 62.27 # 19355 507.81 482.42 554.78 # 20605 39.73 37.74 43.40 19357 1,436.06 1,364.26 1,568.90 20610 72.69 69.06 79.42 19361 1,486.09 1,411.79 1,623.56 # 20610 47.42 45.05 51.81 19364 2,582.55 2,453.42 2,821.43 20612 56.26 53.45 61.47 19366 1,283.19 1,219.03 1,401.88 # 20612 41.10 39.05 44.91 19367 1,691.22 1,606.66 1,847.66 20615 214.86 204.12 234.74 19368 2,079.78 1,975.79 2,272.16 # 20615 152.52 144.89 166.62 19369 1,914.70 1,818.97 2,091.82 20650 186.75 177.41 204.02 19370 630.98 599.43 689.34 # 20650 148.42 141.00 162.15 19371 727.53 691.15 794.82 20660 248.73 236.29 271.73 19380 710.63 675.10 776.37 # 20660 217.98 207.08 238.14 19396 200.62 190.59 219.18 20661 438.75 416.81 479.33 # 19396 130.27 123.76 142.32 20662 445.90 423.61 487.15 20000 195.02 185.27 213.06 20663 421.91 400.81 460.93 # 20000 148.26 140.85 161.98 20664 698.35 663.43 762.94 20005 284.64 270.41 310.97 20665 124.71 118.47 136.24 # 20005 223.56 212.38 244.24 # 20665 99.43 94.46 108.63 20100 554.63 526.90 605.94 20670 450.33 427.81 491.98 20101 385.81 366.52 421.50 # 20670 147.46 140.09 161.10 # 20101 188.25 178.84 205.67 20680 573.02 544.37 626.03 20102 451.87 429.28 493.67 # 20680 380.09 361.09 415.25 # 20102 226.93 215.58 247.92 20690 466.22 442.91 509.35 20103 547.39 520.02 598.02 20692 857.90 815.01 937.26 # 20103 332.14 315.53 362.86 20693 440.47 418.45 481.22 20150 863.57 820.39 943.45 20694 425.62 404.34 464.99 20200 185.27 176.01 202.41 # 20694 322.42 306.30 352.25 # 20200 86.70 82.37 94.73 20802 2,263.50 2,150.33 2,472.88 20205 251.88 239.29 275.18 20805 2,974.41 2,825.69 3,249.54 # 20205 137.31 130.44 150.01 20808 3,855.10 3,662.35 4,211.70 20206 282.31 268.19 308.42 20816 2,348.91 2,231.46 2,566.18 # 20206 60.74 57.70 66.36 20822 2,064.45 1,961.23 2,255.41 20220 198.26 188.35 216.60 20824 2,322.12 2,206.01 2,536.91 # 20220 76.10 72.30 83.15 20827 2,109.33 2,003.86 2,304.44 20225 837.80 795.91 915.30 20838 2,236.04 2,124.24 2,442.88 # 20225 115.37 109.60 126.04 20900 594.97 565.22 650.00 20240 219.34 208.37 239.63 # 20900 445.85 423.56 487.09 20245 594.84 565.10 649.87 20902 579.45 550.48 633.05 20250 355.08 337.33 387.93 20910 409.41 388.94 447.28 20251 395.12 375.36 431.66 20912 463.59 440.41 506.47 20500 121.61 115.53 132.86 20920 383.02 363.87 418.45 # 20500 96.33 91.51 105.24 20922 569.91 541.41 622.62 20501 138.10 131.20 150.88 # 20922 459.54 436.56 502.04 # 20501 37.85 35.96 41.35 20924 482.36 458.24 526.98 20520 185.84 176.55 203.03 20926 413.23 392.57 451.46 # 20520 137.40 130.53 150.11 20931 107.57 102.19 117.52 20525 476.27 452.46 520.33 20937 163.61 155.43 178.74 # 20525 235.74 223.95 257.54 20938 178.07 169.17 194.55 20526 73.22 69.56 79.99 20950 281.94 267.84 308.02 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 99 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 88.16 83.75 96.31 # 21084 1,386.56 1,317.23 1,514.81 20955 2,400.76 2,280.72 2,622.83 21085 662.39 629.27 723.66 20956 2,542.89 2,415.75 2,778.11 # 21085 558.77 530.83 610.45 20957 2,375.55 2,256.77 2,595.29 21086 1,724.39 1,638.17 1,883.90 20962 2,529.32 2,402.85 2,763.28 # 21086 1,539.47 1,462.50 1,681.88 20969 2,673.21 2,539.55 2,920.48 21087 1,709.14 1,623.68 1,867.23 20970 2,669.05 2,535.60 2,915.94 # 21087 1,528.42 1,452.00 1,669.80 20972 2,399.93 2,279.93 2,621.92 21100 720.41 684.39 787.05 20973 2,580.78 2,451.74 2,819.50 # 21100 380.89 361.85 416.13 20974 59.35 56.38 64.84 21110 693.99 659.29 758.18 # 20974 45.88 43.59 50.13 # 21110 598.79 568.85 654.18 20975 169.67 161.19 185.37 21116 173.09 164.44 189.11 20979 53.70 51.02 58.67 # 21116 40.82 38.78 44.60 # 20979 35.17 33.41 38.42 21120 612.65 582.02 669.32 20982 4,261.63 4,048.55 4,655.83 # 21120 484.18 459.97 528.97 # 20982 385.36 366.09 421.00 21121 716.26 680.45 782.52 20985 140.47 133.45 153.47 # 21121 611.79 581.20 668.38 21010 683.28 649.12 746.49 21122 681.77 647.68 744.83 21015 405.98 385.68 443.53 21123 796.65 756.82 870.34 21025 935.85 889.06 1,022.42 21125 2,896.07 2,751.27 3,163.96 # 21025 794.74 755.00 868.25 # 21125 695.08 660.33 759.38 21026 556.89 529.05 608.41 21127 3,152.01 2,994.41 3,443.57 # 21026 463.37 440.20 506.23 # 21127 816.23 775.42 891.73 21029 705.92 670.62 771.21 21137 701.02 665.97 765.87 # 21029 592.19 562.58 646.97 21138 847.20 804.84 925.57 21030 463.18 440.02 506.02 21139 918.95 873.00 1,003.95 # 21030 383.15 363.99 418.59 21141 1,259.11 1,196.15 1,375.57 21031 357.83 339.94 390.93 21142 1,229.02 1,167.57 1,342.71 # 21031 274.00 260.30 299.35 21143 1,300.62 1,235.59 1,420.93 21032 365.04 346.79 398.81 21145 1,450.10 1,377.60 1,584.24 # 21032 269.84 256.35 294.80 21146 1,438.19 1,366.28 1,571.22 21034 1,260.80 1,197.76 1,377.42 21147 1,556.74 1,478.90 1,700.74 # 21034 1,111.68 1,056.10 1,214.52 21150 1,657.15 1,574.29 1,810.43 21040 464.87 441.63 507.87 21151 1,771.75 1,683.16 1,935.63 # 21040 375.56 356.78 410.30 21154 1,987.61 1,888.23 2,171.46 21044 827.46 786.09 904.00 21155 2,267.21 2,153.85 2,476.93 21045 1,145.87 1,088.58 1,251.87 21159 2,626.58 2,495.25 2,869.54 21046 1,020.36 969.34 1,114.74 21160 2,778.32 2,639.40 3,035.31 21047 1,231.83 1,170.24 1,345.78 21172 1,634.02 1,552.32 1,785.17 21048 1,037.48 985.61 1,133.45 21175 1,934.29 1,837.58 2,113.22 21049 1,183.17 1,124.01 1,292.61 21179 1,379.30 1,310.34 1,506.89 21050 805.69 765.41 880.22 21180 1,562.24 1,484.13 1,706.75 21060 742.72 705.58 811.42 21181 684.40 650.18 747.71 21070 607.15 576.79 663.31 21182 1,904.91 1,809.66 2,081.11 21073 356.95 339.10 389.97 21183 2,179.27 2,070.31 2,380.86 # 21073 222.57 211.44 243.16 21184 2,262.77 2,149.63 2,472.07 21076 941.77 894.68 1,028.88 21188 1,554.34 1,476.62 1,698.11 # 21076 822.13 781.02 898.17 21193 1,170.39 1,111.87 1,278.65 21077 2,323.49 2,207.32 2,538.42 21194 1,333.92 1,267.22 1,457.30 # 21077 2,072.43 1,968.81 2,264.13 21195 1,274.61 1,210.88 1,392.51 21079 1,595.65 1,515.87 1,743.25 21196 1,381.25 1,312.19 1,509.02 # 21079 1,380.40 1,311.38 1,508.09 21198 1,084.05 1,029.85 1,184.33 21080 1,815.25 1,724.49 1,983.16 21199 954.90 907.16 1,043.23 # 21080 1,557.03 1,479.18 1,701.06 21206 1,054.59 1,001.86 1,152.14 21081 1,654.35 1,571.63 1,807.37 21208 1,578.67 1,499.74 1,724.70 # 21081 1,413.40 1,342.73 1,544.14 # 21208 780.00 741.00 852.15 21082 1,518.90 1,442.96 1,659.40 21209 767.22 728.86 838.19 # 21082 1,303.22 1,238.06 1,423.77 # 21209 608.42 578.00 664.70 21083 1,447.70 1,375.32 1,581.62 21210 1,864.26 1,771.05 2,036.71 # 21083 1,205.49 1,145.22 1,317.00 # 21210 782.09 742.99 854.44 21084 1,652.79 1,570.15 1,805.67 21215 3,145.75 2,988.46 3,436.73 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 99 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 814.17 773.46 889.48 21387 716.11 680.30 782.35 21230 729.43 692.96 796.90 21390 713.07 677.42 779.03 21235 685.68 651.40 749.11 21395 902.83 857.69 986.34 # 21235 530.66 504.13 579.75 21400 165.26 157.00 180.55 21240 1,053.01 1,000.36 1,150.41 # 21400 134.08 127.38 146.49 21242 969.91 921.41 1,059.62 21401 448.59 426.16 490.08 21243 1,574.84 1,496.10 1,720.52 # 21401 269.57 256.09 294.50 21244 985.99 936.69 1,077.19 21406 508.57 483.14 555.61 21245 1,073.40 1,019.73 1,172.69 21407 598.43 568.51 653.79 # 21245 859.83 816.84 939.37 21408 815.34 774.57 890.76 21246 819.05 778.10 894.82 21421 677.02 643.17 739.65 21247 1,530.58 1,454.05 1,672.16 # 21421 586.88 557.54 641.17 21248 991.38 941.81 1,083.08 21422 639.24 607.28 698.37 # 21248 826.26 784.95 902.69 21423 752.32 714.70 821.91 21249 1,385.82 1,316.53 1,514.01 21431 711.80 676.21 777.64 # 21249 1,171.82 1,113.23 1,280.21 21432 633.39 601.72 691.98 21255 1,320.22 1,254.21 1,442.34 21433 1,567.68 1,489.30 1,712.70 21256 1,084.04 1,029.84 1,184.32 21435 1,237.10 1,175.25 1,351.54 21260 1,170.30 1,111.79 1,278.56 21436 1,767.54 1,679.16 1,931.03 21261 2,065.25 1,961.99 2,256.29 21440 484.08 459.88 528.86 21263 1,814.30 1,723.59 1,982.13 # 21440 409.10 388.65 446.95 21267 1,496.87 1,422.03 1,635.33 21445 691.63 657.05 755.61 21268 1,716.72 1,630.88 1,875.51 # 21445 582.11 553.00 635.95 21270 857.37 814.50 936.68 21450 506.95 481.60 553.84 # 21270 653.91 621.21 714.39 # 21450 437.45 415.58 477.92 21275 754.85 717.11 824.68 21451 673.89 640.20 736.23 21280 490.06 465.56 535.39 # 21451 584.17 554.96 638.20 21282 328.61 312.18 359.01 21452 613.81 583.12 670.59 21295 166.42 158.10 181.82 # 21452 310.51 294.98 339.23 21296 385.61 366.33 421.28 21453 776.84 738.00 848.70 21310 111.20 105.64 121.49 # 21453 710.29 674.78 776.00 # 21310 26.54 25.21 28.99 21454 519.34 493.37 567.38 21315 253.13 240.47 276.54 21461 1,730.13 1,643.62 1,890.16 # 21315 141.50 134.43 154.59 # 21461 872.48 828.86 953.19 21320 241.43 229.36 263.76 21462 1,889.49 1,795.02 2,064.27 # 21320 131.06 124.51 143.19 # 21462 952.22 904.61 1,040.30 21325 475.17 451.41 519.12 21465 857.75 814.86 937.09 21330 573.77 545.08 626.84 21470 1,108.84 1,053.40 1,211.41 21335 704.48 669.26 769.65 21480 92.01 87.41 100.52 21336 623.19 592.03 680.83 # 21480 30.09 28.59 32.88 21337 377.11 358.25 411.99 21485 597.83 567.94 653.13 # 21337 268.85 255.41 293.72 # 21485 523.27 497.11 571.68 21338 757.43 719.56 827.49 21490 863.55 820.37 943.43 21339 812.22 771.61 887.35 21495 633.16 601.50 691.73 21340 747.07 709.72 816.18 21497 600.90 570.86 656.49 21343 1,116.43 1,060.61 1,219.70 # 21497 523.39 497.22 571.80 21344 1,417.59 1,346.71 1,548.72 21501 417.06 396.21 455.64 21345 755.52 717.74 825.40 # 21501 298.27 283.36 325.86 # 21345 616.51 585.68 673.53 21502 494.74 470.00 540.50 21346 902.78 857.64 986.29 21510 449.52 427.04 491.10 21347 1,083.96 1,029.76 1,184.22 21550 242.22 230.11 264.63 21348 1,126.96 1,070.61 1,231.20 # 21550 148.70 141.27 162.46 21355 411.63 391.05 449.71 21555 403.22 383.06 440.52 # 21355 297.89 283.00 325.45 # 21555 304.65 289.42 332.83 21356 469.55 446.07 512.98 21556 383.27 364.11 418.73 # 21356 353.71 336.02 386.42 21557 541.54 514.46 591.63 21360 498.43 473.51 544.54 21600 517.35 491.48 565.20 21365 1,028.98 977.53 1,124.16 21610 999.15 949.19 1,091.57 21366 1,157.80 1,099.91 1,264.90 21615 641.51 609.43 700.84 21385 673.34 639.67 735.62 21616 785.72 746.43 858.39 21386 624.05 592.85 681.78 21620 497.59 472.71 543.62 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 99 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 522.77 496.63 571.12 22522 236.92 225.07 258.83 21630 1,187.25 1,127.89 1,297.07 22523 585.44 556.17 639.60 21632 1,171.26 1,112.70 1,279.61 22524 560.84 532.80 612.72 21685 929.29 882.83 1,015.25 22525 259.10 246.15 283.07 21700 406.34 386.02 443.92 22526 2,208.43 2,098.01 2,412.71 21705 584.36 555.14 638.41 # 22526 326.32 310.00 356.50 21720 359.17 341.21 392.39 22527 1,821.61 1,730.53 1,990.11 21725 499.24 474.28 545.42 # 22527 149.28 141.82 163.09 21740 1,013.08 962.43 1,106.79 22532 1,604.96 1,524.71 1,753.42 21750 672.96 639.31 735.21 22533 1,498.31 1,423.39 1,636.90 21800 92.55 87.92 101.11 22534 351.64 334.06 384.17 # 21800 93.81 89.12 102.49 22548 1,723.09 1,636.94 1,882.48 21805 242.61 230.48 265.05 22554 1,210.68 1,150.15 1,322.67 21810 479.53 455.55 523.88 22556 1,541.10 1,464.05 1,683.66 21820 125.99 119.69 137.64 22558 1,403.58 1,333.40 1,533.41 21825 539.89 512.90 589.84 22585 326.23 309.92 356.41 21920 236.98 225.13 258.90 22590 1,428.37 1,356.95 1,560.49 # 21920 145.15 137.89 158.57 22595 1,359.64 1,291.66 1,485.41 21925 392.97 373.32 429.32 22600 1,164.65 1,106.42 1,272.38 # 21925 310.41 294.89 339.12 22610 1,151.07 1,093.52 1,257.55 21930 438.53 416.60 479.09 22612 1,486.47 1,412.15 1,623.97 # 21930 342.07 324.97 373.72 22614 380.61 361.58 415.82 21935 1,076.08 1,022.28 1,175.62 22630 1,432.22 1,360.61 1,564.70 22010 839.84 797.85 917.53 22632 309.35 293.88 337.96 22015 834.14 792.43 911.29 22800 1,268.94 1,205.49 1,386.31 22100 760.41 722.39 830.75 22802 2,012.49 1,911.87 2,198.65 22101 759.15 721.19 829.37 22804 2,329.91 2,213.41 2,545.42 22102 761.62 723.54 832.07 22808 1,710.05 1,624.55 1,868.23 22103 136.43 129.61 149.05 22810 1,912.34 1,816.72 2,089.23 22110 934.46 887.74 1,020.90 22812 2,096.16 1,991.35 2,290.05 22112 929.99 883.49 1,016.01 22818 2,096.08 1,991.28 2,289.97 22114 932.45 885.83 1,018.70 22819 2,373.26 2,254.60 2,592.79 22116 136.62 129.79 149.26 22830 761.16 723.10 831.57 22206 2,183.16 2,074.00 2,385.10 22840 744.25 707.04 813.10 22207 2,156.44 2,048.62 2,355.91 22842 744.62 707.39 813.50 22208 545.56 518.28 596.02 22843 787.52 748.14 860.36 22210 1,643.87 1,561.68 1,795.93 22844 969.51 921.03 1,059.18 22212 1,359.68 1,291.70 1,485.46 22845 711.24 675.68 777.03 22214 1,374.18 1,305.47 1,501.29 22846 739.23 702.27 807.61 22216 357.32 339.45 390.37 22847 812.53 771.90 887.69 22220 1,487.25 1,412.89 1,624.82 22848 352.86 335.22 385.50 22222 1,350.03 1,282.53 1,474.91 22849 1,222.50 1,161.38 1,335.59 22224 1,468.51 1,395.08 1,604.34 22850 672.75 639.11 734.98 22226 355.64 337.86 388.54 22851 395.21 375.45 431.77 22305 175.81 167.02 192.07 22852 644.07 611.87 703.65 # 22305 160.23 152.22 175.05 22855 1,035.47 983.70 1,131.26 22310 261.80 248.71 286.02 22857 1,640.35 1,558.33 1,792.08 # 22310 242.00 229.90 264.39 22862 1,933.82 1,837.13 2,112.70 22315 802.98 762.83 877.25 22865 1,883.77 1,789.58 2,058.02 # 22315 701.88 666.79 766.81 22900 372.65 354.02 407.12 22318 1,481.70 1,407.62 1,618.76 23000 514.65 488.92 562.26 22319 1,624.41 1,543.19 1,774.67 # 23000 340.68 323.65 372.20 22325 1,289.60 1,225.12 1,408.89 23020 654.07 621.37 714.58 22326 1,351.13 1,283.57 1,476.11 23030 421.43 400.36 460.41 22327 1,333.30 1,266.64 1,456.64 # 23030 244.93 232.68 267.58 22328 268.18 254.77 292.99 23031 409.86 389.37 447.78 22505 117.04 111.19 127.87 # 23031 211.03 200.48 230.55 22520 2,584.35 2,455.13 2,823.40 23035 659.39 626.42 720.38 # 22520 565.33 537.06 617.62 23040 681.13 647.07 744.13 22521 2,465.99 2,342.69 2,694.09 23044 541.82 514.73 591.94 # 22521 534.17 507.46 583.58 23065 197.66 187.78 215.95 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 99 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 153.85 146.16 168.08 23490 776.23 737.42 848.03 23066 486.37 462.05 531.36 23491 969.81 921.32 1,059.52 # 23066 321.25 305.19 350.97 23500 197.36 187.49 215.61 23075 246.52 234.19 269.32 # 23500 191.46 181.89 209.17 # 23075 165.22 156.96 180.50 23505 321.81 305.72 351.58 23076 525.37 499.10 573.97 # 23505 301.59 286.51 329.49 23077 1,098.60 1,043.67 1,200.22 23515 645.76 613.47 705.49 23100 461.27 438.21 503.94 23520 203.35 193.18 222.16 23101 427.10 405.75 466.61 # 23520 202.51 192.38 221.24 23105 603.29 573.13 659.10 23525 320.91 304.86 350.59 23106 454.10 431.40 496.11 # 23525 297.32 282.45 324.82 23107 628.08 596.68 686.18 23530 521.62 495.54 569.87 23120 532.66 506.03 581.93 23532 588.25 558.84 642.67 23125 663.99 630.79 725.41 23540 202.47 192.35 221.20 23130 575.14 546.38 628.34 # 23540 193.20 183.54 211.07 23140 482.58 458.45 527.22 23545 289.72 275.23 316.51 23145 651.62 619.04 711.90 # 23545 261.91 248.81 286.13 23146 583.97 554.77 637.99 23550 541.28 514.22 591.35 23150 614.02 583.32 670.82 23552 623.57 592.39 681.25 23155 744.46 707.24 813.33 23570 210.04 199.54 229.47 23156 636.85 605.01 695.76 # 23570 210.46 199.94 229.93 23170 505.39 480.12 552.14 23575 356.58 338.75 389.56 23172 521.97 495.87 570.25 # 23575 333.83 317.14 364.71 23174 711.21 675.65 777.00 23585 861.73 818.64 941.44 23180 667.61 634.23 729.36 23600 297.20 282.34 324.69 23182 642.69 610.56 702.14 # 23600 267.29 253.93 292.02 23184 720.36 684.34 786.99 23605 435.07 413.32 475.32 23190 525.39 499.12 573.99 # 23605 396.32 376.50 432.98 23195 705.98 670.68 771.28 23615 813.74 773.05 889.01 23200 820.18 779.17 896.05 23616 1,243.46 1,181.29 1,358.48 23210 859.63 816.65 939.15 23620 243.07 230.92 265.56 23220 1,014.38 963.66 1,108.21 # 23620 224.54 213.31 245.31 23221 1,183.96 1,124.76 1,293.47 23625 352.27 334.66 384.86 23222 1,591.27 1,511.71 1,738.47 # 23625 327.41 311.04 357.70 23330 218.75 207.81 238.98 23630 683.87 649.68 747.13 # 23330 142.09 134.99 155.24 23650 273.90 260.21 299.24 23331 557.81 529.92 609.41 # 23650 242.73 230.59 265.18 23332 838.29 796.38 915.84 23655 352.79 335.15 385.42 23350 166.13 157.82 181.49 23660 548.15 520.74 598.85 # 23350 49.87 47.38 54.49 23665 389.11 369.65 425.10 23395 1,213.18 1,152.52 1,325.40 # 23665 363.83 345.64 397.49 23397 1,084.67 1,030.44 1,185.01 23670 760.88 722.84 831.27 23400 924.81 878.57 1,010.36 23675 510.35 484.83 557.55 23405 598.48 568.56 653.84 # 23675 468.65 445.22 512.00 23406 745.95 708.65 814.95 23680 835.68 793.90 912.99 23410 853.81 811.12 932.79 23700 185.03 175.78 202.15 23412 907.48 862.11 991.43 23800 969.66 921.18 1,059.36 23415 700.20 665.19 764.97 23802 1,145.62 1,088.34 1,251.59 23420 1,000.79 950.75 1,093.36 23900 1,256.52 1,193.69 1,372.74 23430 704.99 669.74 770.20 23920 1,019.14 968.18 1,113.41 23440 727.17 690.81 794.43 23921 422.20 401.09 461.25 23450 908.51 863.08 992.54 23930 350.99 333.44 383.46 23455 966.43 918.11 1,055.83 # 23930 203.56 193.38 222.39 23460 1,046.52 994.19 1,143.32 23931 285.89 271.60 312.34 23462 1,022.78 971.64 1,117.39 # 23931 151.94 144.34 165.99 23465 1,064.37 1,011.15 1,162.82 23935 475.29 451.53 519.26 23466 1,049.41 996.94 1,146.48 24000 445.19 422.93 486.37 23470 1,160.46 1,102.44 1,267.81 24006 672.27 638.66 734.46 23472 1,428.43 1,357.01 1,560.56 24065 231.07 219.52 252.45 23480 782.97 743.82 855.39 # 24065 153.14 145.48 167.30 23485 916.98 871.13 1,001.80 24066 564.25 536.04 616.45 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 99 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 371.32 352.75 405.66 24410 994.43 944.71 1,086.42 24075 456.88 434.04 499.15 24420 925.50 879.23 1,011.11 # 24075 290.91 276.36 317.81 24430 975.25 926.49 1,065.46 24076 442.08 419.98 482.98 24435 1,002.16 952.05 1,094.86 24077 762.84 724.70 833.41 24470 623.80 592.61 681.50 24100 375.41 356.64 410.14 24495 635.04 603.29 693.78 24101 471.16 447.60 514.74 24498 829.61 788.13 906.35 24102 582.31 553.19 636.17 24500 322.09 305.99 351.89 24105 319.51 303.53 349.06 # 24500 284.18 269.97 310.47 24110 549.84 522.35 600.70 24505 465.88 442.59 508.98 24115 631.31 599.74 689.70 # 24505 420.39 399.37 459.28 24116 823.60 782.42 899.78 24515 832.42 790.80 909.42 24120 493.43 468.76 539.07 24516 821.55 780.47 897.54 24125 558.66 530.73 610.34 24530 346.87 329.53 378.96 24126 596.69 566.86 651.89 # 24530 306.86 291.52 335.25 24130 479.47 455.50 523.83 24535 579.25 550.29 632.83 24134 722.06 685.96 788.85 # 24535 533.33 506.66 582.66 24136 595.15 565.39 650.20 24538 709.28 673.82 774.89 24138 622.45 591.33 680.03 24545 846.20 803.89 924.47 24140 693.85 659.16 758.03 24546 1,010.09 959.59 1,103.53 24145 586.06 556.76 640.27 24560 291.36 276.79 318.31 24147 612.02 581.42 668.63 # 24560 249.65 237.17 272.75 24149 1,079.95 1,025.95 1,179.84 24565 483.03 458.88 527.71 24150 922.03 875.93 1,007.32 # 24565 441.33 419.26 482.15 24151 1,067.96 1,014.56 1,166.74 24566 653.21 620.55 713.63 24152 683.08 648.93 746.27 24575 701.77 666.68 766.68 24153 638.26 606.35 697.30 24576 306.47 291.15 334.82 24155 795.30 755.54 868.87 # 24576 269.40 255.93 294.32 24160 573.43 544.76 626.47 24577 500.15 475.14 546.41 24164 469.83 446.34 513.29 # 24577 457.18 434.32 499.47 24200 195.95 186.15 214.07 24579 790.53 751.00 863.65 # 24200 128.98 122.53 140.91 24582 742.80 705.66 811.51 24201 548.41 520.99 599.14 24586 1,040.60 988.57 1,136.86 # 24201 343.69 326.51 375.49 24587 1,032.75 981.11 1,128.28 24220 179.20 170.24 195.78 24600 343.24 326.08 374.99 # 24220 65.46 62.19 71.52 # 24600 302.38 287.26 330.35 24300 379.04 360.09 414.10 24605 428.83 407.39 468.50 24301 712.44 676.82 778.34 24615 679.14 645.18 741.96 24305 548.74 521.30 599.50 24620 518.28 492.37 566.23 24310 449.79 427.30 491.40 24635 794.81 755.07 868.33 24320 721.65 685.57 788.41 24640 115.83 110.04 126.55 24330 680.55 646.52 743.50 # 24640 78.76 74.82 86.04 24331 748.66 711.23 817.91 24650 236.93 225.08 258.84 24332 566.70 538.37 619.13 # 24650 206.18 195.87 225.25 24340 582.17 553.06 636.02 24655 407.11 386.75 444.76 24341 678.16 644.25 740.89 # 24655 366.25 347.94 400.13 24342 746.73 709.39 815.80 24665 615.23 584.47 672.14 24343 665.50 632.23 727.06 24666 693.99 659.29 758.18 24344 1,028.95 977.50 1,124.13 24670 265.25 251.99 289.79 24345 662.01 628.91 723.25 # 24670 231.13 219.57 252.51 24346 1,025.95 974.65 1,120.85 24675 425.82 404.53 465.21 24357 422.51 401.38 461.59 # 24675 387.06 367.71 422.87 24358 494.36 469.64 540.09 24685 618.57 587.64 675.79 24359 602.59 572.46 658.33 24800 758.74 720.80 828.92 24360 849.58 807.10 928.17 24802 938.34 891.42 1,025.13 24361 955.09 907.34 1,043.44 24900 668.82 635.38 730.69 24362 923.38 877.21 1,008.79 24920 659.92 626.92 720.96 24363 1,395.05 1,325.30 1,524.10 24925 509.47 484.00 556.60 24365 607.13 576.77 663.29 24930 695.49 660.72 759.83 24366 650.06 617.56 710.19 24931 734.31 697.59 802.23 24400 780.21 741.20 852.38 24935 1,004.17 953.96 1,097.05 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 14 FSY08 LOCALITY FEE SCHEDULE FOR AREA 99 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 361.43 343.36 394.86 25310 714.86 679.12 780.99 25001 313.04 297.39 342.00 25312 804.95 764.70 879.41 25020 577.56 548.68 630.98 25315 857.30 814.44 936.61 25023 1,077.20 1,023.34 1,176.84 25316 990.30 940.79 1,081.91 25024 706.04 670.74 771.35 25320 914.09 868.39 998.65 25025 1,069.59 1,016.11 1,168.53 25332 800.59 760.56 874.64 25028 505.84 480.55 552.63 25335 924.57 878.34 1,010.09 25031 400.55 380.52 437.60 25337 849.82 807.33 928.43 25035 696.65 661.82 761.09 25350 775.16 736.40 846.86 25040 552.41 524.79 603.51 25355 853.74 811.05 932.71 25065 231.61 220.03 253.03 25360 757.14 719.28 827.17 # 25065 154.10 146.40 168.36 25365 998.34 948.42 1,090.68 25066 389.90 370.41 425.97 25370 1,067.90 1,014.51 1,166.69 25075 337.97 321.07 369.23 25375 1,043.34 991.17 1,139.85 25076 477.88 453.99 522.09 25390 863.12 819.96 942.95 25077 762.02 723.92 832.51 25391 1,075.65 1,021.87 1,175.15 25085 460.30 437.29 502.88 25392 1,075.13 1,021.37 1,174.58 25100 341.59 324.51 373.19 25393 1,209.67 1,149.19 1,321.57 25101 398.09 378.19 434.92 25394 725.69 689.41 792.82 25105 485.66 461.38 530.59 25400 904.92 859.67 988.62 25107 589.89 560.40 644.46 25405 1,124.14 1,067.93 1,228.12 25109 479.63 455.65 524.00 25415 1,060.03 1,007.03 1,158.08 25110 377.38 358.51 412.29 25420 1,243.22 1,181.06 1,358.22 25111 307.33 291.96 335.75 25425 1,150.69 1,093.16 1,257.13 25112 372.27 353.66 406.71 25426 1,169.75 1,111.26 1,277.95 25115 823.63 782.45 899.82 25430 664.26 631.05 725.71 25116 689.91 655.41 753.72 25431 748.19 710.78 817.40 25118 378.09 359.19 413.07 25440 748.86 711.42 818.13 25119 501.38 476.31 547.76 25441 888.13 843.72 970.28 25120 600.12 570.11 655.63 25442 762.16 724.05 832.66 25125 677.32 643.45 739.97 25443 733.21 696.55 801.03 25126 693.07 658.42 757.18 25444 779.51 740.53 851.61 25130 438.53 416.60 479.09 25445 685.53 651.25 748.94 25135 542.44 515.32 592.62 25446 1,115.54 1,059.76 1,218.72 25136 480.96 456.91 525.45 25447 766.36 728.04 837.25 25145 611.31 580.74 667.85 25449 979.95 930.95 1,070.59 25150 569.03 540.58 621.67 25450 604.57 574.34 660.49 25151 678.31 644.39 741.05 25455 725.32 689.05 792.41 25170 910.83 865.29 995.08 25490 795.32 755.55 868.88 25210 478.64 454.71 522.92 25491 834.40 792.68 911.58 25215 618.17 587.26 675.35 25492 985.39 936.12 1,076.54 25230 426.12 404.81 465.53 25500 240.16 228.15 262.37 25240 441.24 419.18 482.06 # 25500 212.78 202.14 232.46 25246 181.95 172.85