1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 1 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0101 40.07 38.07 43.78 G0270 25.65 24.37 28.03 G0102 22.42 21.30 24.50 # G0270 23.32 22.15 25.47 # G0102 9.38 8.91 10.25 G0271 14.21 13.50 15.53 G0104 150.98 143.43 164.94 G0275 15.61 14.83 17.05 # G0104 65.77 62.48 71.85 G0278 15.61 14.83 17.05 G0105 435.76 413.97 476.07 G0281 13.01 12.36 14.21 # G0105 228.09 216.69 249.19 G0283 13.01 12.36 14.21 G0105 53 150.98 143.43 164.94 G0288 163.27 155.11 178.38 # G0105 53 65.77 62.48 71.85 G0289 93.29 88.63 101.92 G0106 243.50 231.33 266.03 G0329 9.49 9.02 10.37 G0106 TC 188.43 179.01 205.86 G0339 3,958.14 3,760.23 4,324.26 G0106 26 55.07 52.32 60.17 G0340 2,687.41 2,553.04 2,936.00 G0108 29.61 28.13 32.35 G0341 450.60 428.07 492.28 G0109 16.57 15.74 18.10 G0342 727.53 691.15 794.82 G0117 51.90 49.31 56.71 G0343 1,206.73 1,146.39 1,318.35 G0118 36.38 34.56 39.74 G0364 14.49 13.77 15.84 G0120 243.50 231.33 266.03 # G0364 10.30 9.79 11.26 G0120 TC 188.43 179.01 205.86 C G0365 207.18 196.82 226.34 G0120 26 55.07 52.32 60.17 C G0365 TC 194.09 184.39 212.05 G0121 435.76 413.97 476.07 G0365 26 13.09 12.44 14.31 # G0121 228.09 216.69 249.19 G0372 12.64 12.01 13.81 G0121 53 150.98 143.43 164.94 # G0372 8.91 8.46 9.73 # G0121 53 65.77 62.48 71.85 G0389 135.84 129.05 148.41 G0124 30.57 29.04 33.40 G0389 TC 102.78 97.64 112.29 G0127 22.42 21.30 24.50 G0389 26 33.06 31.41 36.12 # G0127 8.91 8.46 9.73 G0392 2,683.51 2,549.33 2,931.73 G0128 9.76 9.27 10.66 # G0392 478.80 454.86 523.09 G0130 38.69 36.76 42.27 G0393 2,038.37 1,936.45 2,226.92 G0130 TC 27.45 26.08 29.99 # G0393 342.58 325.45 374.27 G0130 26 11.23 10.67 12.27 G0396 33.71 32.02 36.82 G0141 30.57 29.04 33.40 # G0396 31.85 30.26 34.80 G0166 192.85 183.21 210.69 G0397 65.37 62.10 71.42 G0168 92.96 88.31 101.56 # G0397 63.51 60.33 69.38 # G0168 27.31 25.94 29.83 G0398 357.56 339.68 390.63 G0179 45.65 43.37 49.88 G0398 TC 264.83 251.59 289.33 G0180 59.68 56.70 65.21 G0398 26 92.74 88.10 101.32 G0181 111.76 106.17 122.10 G0399 253.42 240.75 276.86 G0182 114.56 108.83 125.15 G0399 TC 167.40 159.03 182.88 G0202 159.11 151.15 173.82 G0399 26 86.02 81.72 93.98 G0202 TC 121.13 115.07 132.33 G0400 228.07 216.67 249.17 G0202 26 37.98 36.08 41.49 G0400 TC 150.66 143.13 164.60 G0204 186.65 177.32 203.92 G0400 26 77.41 73.54 84.57 G0204 TC 139.75 132.76 152.67 G0402 105.10 99.85 114.83 G0204 26 46.89 44.55 51.23 G0403 24.83 23.59 27.13 G0206 148.12 140.71 161.82 G0404 17.31 16.44 18.91 G0206 TC 110.14 104.63 120.32 G0405 8.91 8.46 9.73 G0206 26 37.98 36.08 41.49 G0406 40.21 38.20 43.93 G0237 13.12 12.46 14.33 G0407 72.24 68.63 78.92 G0238 14.05 13.35 15.35 G0408 103.35 98.18 112.91 G0239 14.52 13.79 15.86 G0409 10.98 10.43 11.99 G0245 72.41 68.79 79.11 G0412 754.82 717.08 824.64 # G0245 48.66 46.23 53.16 G0413 1,100.26 1,045.25 1,202.04 G0246 42.86 40.72 46.83 G0414 1,043.87 991.68 1,140.43 # G0246 24.70 23.47 26.99 G0415 1,416.78 1,345.94 1,547.83 G0247 47.98 45.58 52.42 G0416 779.56 740.58 851.67 # G0247 27.02 25.67 29.52 G0416 TC 573.53 544.85 626.58 G0248 191.65 182.07 209.38 G0416 26 206.03 195.73 225.09 G0249 162.78 154.64 177.84 G0417 1,515.97 1,440.17 1,656.20 G0250 10.68 10.15 11.67 G0417 TC 1,120.52 1,064.49 1,224.16 G0268 53.92 51.22 58.90 G0417 26 395.45 375.68 432.03 # G0268 33.43 31.76 36.52 G0418 2,599.78 2,469.79 2,840.26 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 2 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ G0418 TC 1,914.14 1,818.43 2,091.19 # 10040 89.78 85.29 98.08 G0418 26 685.64 651.36 749.06 10060 113.12 107.46 123.58 G0419 3,091.35 2,936.78 3,377.30 # 10060 95.89 91.10 104.77 G0419 TC 2,296.80 2,181.96 2,509.25 10061 189.63 180.15 207.17 G0419 26 794.54 754.81 868.03 # 10061 166.82 158.48 182.25 G9041 24.99 23.74 27.30 10080 174.77 166.03 190.93 G9042 8.64 8.21 9.44 # 10080 98.41 93.49 107.51 G9043 8.18 7.77 8.94 10081 267.77 254.38 292.54 G9044 7.71 7.32 8.42 # 10081 167.19 158.83 182.65 M0064 48.46 46.04 52.95 10120 141.15 134.09 154.20 # M0064 17.73 16.84 19.37 # 10120 93.19 88.53 101.81 P3001 30.57 29.04 33.40 10121 270.77 257.23 295.81 Q0035 22.50 21.38 24.59 # 10121 187.89 178.50 205.28 Q0035 TC 13.59 12.91 14.85 10140 160.54 152.51 175.39 Q0035 26 8.91 8.46 9.73 # 10140 122.36 116.24 133.68 Q0091 47.81 45.42 52.23 10160 131.08 124.53 143.21 # Q0091 19.40 18.43 21.19 # 10160 98.96 94.01 108.11 Q0092 20.76 19.72 22.68 10180 241.49 229.42 263.83 R0070 169.28 160.82 184.94 # 10180 180.49 171.47 197.19 R0075 169.28 160.82 184.94 11000 55.86 53.07 61.03 0067T 729.28 692.82 796.74 # 11000 32.58 30.95 35.59 C 0067T TC 242.80 230.66 265.26 11001 22.95 21.80 25.07 0067T 26 137.92 131.02 150.67 # 11001 16.43 15.61 17.95 0073T 664.76 631.52 726.25 11004 585.04 555.79 639.16 0075T 1,230.35 1,168.83 1,344.15 11005 761.20 723.14 831.61 0075T 26 914.45 868.73 999.04 11006 723.52 687.34 790.44 0076T 406.02 385.72 443.58 11008 275.01 261.26 300.45 0076T 26 91.44 86.87 99.90 11010 492.64 468.01 538.21 0078T 1,398.98 1,329.03 1,528.38 # 11010 289.63 275.15 316.42 0079T 1,289.10 1,224.65 1,408.35 11011 545.96 518.66 596.46 0080T 247.44 235.07 270.33 # 11011 306.63 291.30 335.00 0081T 247.44 235.07 270.33 11012 743.70 706.52 812.50 0145T 759.19 721.23 829.41 # 11012 447.10 424.75 488.46 C 0145T TC 353.07 335.42 385.73 11040 49.08 46.63 53.62 0145T 26 111.24 105.68 121.53 # 11040 28.13 26.72 30.73 0146T 759.19 721.23 829.41 11041 57.15 54.29 62.43 C 0146T TC 353.07 335.42 385.73 # 11041 35.27 33.51 38.54 0146T 26 111.24 105.68 121.53 11042 77.51 73.63 84.67 0147T 759.19 721.23 829.41 # 11042 47.24 44.88 51.61 C 0147T TC 353.07 335.42 385.73 11043 281.81 267.72 307.88 0147T 26 111.24 105.68 121.53 # 11043 242.24 230.13 264.65 0148T 759.19 721.23 829.41 11044 385.55 366.27 421.21 C 0148T TC 353.07 335.42 385.73 # 11044 334.33 317.61 365.25 0148T 26 111.24 105.68 121.53 11055 51.33 48.76 56.07 0149T 759.19 721.23 829.41 # 11055 23.39 22.22 25.55 C 0149T TC 353.07 335.42 385.73 11056 61.82 58.73 67.54 0149T 26 111.24 105.68 121.53 # 11056 32.95 31.30 36.00 0150T 759.19 721.23 829.41 11057 73.98 70.28 80.82 C 0150T TC 353.07 335.42 385.73 # 11057 42.78 40.64 46.74 0150T 26 111.24 105.68 121.53 11100 110.51 104.98 120.73 0151T 239.49 227.52 261.65 # 11100 49.51 47.03 54.08 C 0151T TC 131.12 124.56 143.24 11101 34.39 32.67 37.57 0151T 26 73.48 69.81 80.28 # 11101 25.55 24.27 27.91 0171T 806.30 765.99 880.89 11200 85.36 81.09 93.25 0172T 403.16 383.00 440.45 # 11200 70.93 67.38 77.49 0177T 1,412.74 1,342.10 1,543.42 11201 18.76 17.82 20.49 10021 150.00 142.50 163.88 # 11201 16.90 16.06 18.47 # 10021 69.91 66.41 76.37 11300 72.37 68.75 79.06 10022 154.57 146.84 168.87 # 11300 30.00 28.50 32.78 # 10022 69.36 65.89 75.77 11301 97.83 92.94 106.88 10040 104.21 99.00 113.85 # 11301 51.27 48.71 56.02 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 3 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 11302 116.71 110.87 127.50 # 11462 227.07 215.72 248.08 # 11302 63.63 60.45 69.52 11463 486.42 462.10 531.42 11303 136.88 130.04 149.55 # 11463 315.07 299.32 344.22 # 11303 74.49 70.77 81.39 11470 395.96 376.16 432.58 11305 72.89 69.25 79.64 # 11470 266.52 253.19 291.17 # 11305 37.50 35.63 40.97 11471 495.28 470.52 541.10 11306 100.13 95.12 109.39 # 11471 332.78 316.14 363.56 # 11306 57.30 54.44 62.61 11600 186.65 177.32 203.92 11307 118.74 112.80 129.72 # 11600 113.08 107.43 123.54 # 11307 67.98 64.58 74.27 11601 230.07 218.57 251.36 11308 131.81 125.22 144.00 # 11601 146.72 139.38 160.29 # 11308 81.05 77.00 88.55 11602 252.85 240.21 276.24 11310 89.19 84.73 97.44 # 11602 161.59 153.51 176.54 # 11310 43.56 41.38 47.59 11603 284.61 270.38 310.94 11311 112.05 106.45 122.42 # 11603 190.56 181.03 208.18 # 11311 64.09 60.89 70.02 11604 313.60 297.92 342.61 11312 129.53 123.05 141.51 # 11604 208.37 197.95 227.64 # 11312 73.66 69.98 80.48 11606 435.09 413.34 475.34 11313 160.66 152.63 175.52 # 11606 304.72 289.48 332.90 # 11313 98.26 93.35 107.35 11620 190.93 181.38 208.59 11400 122.87 116.73 134.24 # 11620 115.04 109.29 125.68 # 11400 77.24 73.38 84.39 11621 232.30 220.69 253.79 11401 149.25 141.79 163.06 # 11621 148.49 141.07 162.23 # 11401 101.76 96.67 111.17 11622 262.33 249.21 286.59 11402 166.17 157.86 181.54 # 11622 171.06 162.51 186.89 # 11402 112.16 106.55 122.53 11623 303.00 287.85 331.03 11403 189.19 179.73 206.69 # 11623 208.94 198.49 228.26 # 11403 142.63 135.50 155.83 11624 339.22 322.26 370.60 11404 215.22 204.46 235.13 # 11624 236.31 224.49 258.16 # 11404 157.95 150.05 172.56 11626 410.25 389.74 448.20 11406 297.77 282.88 325.31 # 11626 294.31 279.59 321.53 # 11406 232.12 220.51 253.59 11640 200.05 190.05 218.56 11420 122.94 116.79 134.31 # 11640 121.82 115.73 133.09 # 11420 82.90 78.76 90.57 11641 244.66 232.43 267.29 11421 158.06 150.16 172.68 # 11641 158.98 151.03 173.68 # 11421 111.04 105.49 121.31 11642 280.81 266.77 306.79 11422 176.00 167.20 192.28 # 11642 186.75 177.41 204.02 # 11422 135.02 128.27 147.51 11643 326.40 310.08 356.59 11423 203.77 193.58 222.62 # 11643 231.41 219.84 252.82 # 11423 156.28 148.47 170.74 11644 401.29 381.23 438.41 11424 233.78 222.09 255.40 # 11644 287.21 272.85 313.78 # 11424 178.83 169.89 195.37 11646 522.46 496.34 570.79 11426 329.22 312.76 359.67 # 11646 401.86 381.77 439.04 # 11426 269.62 256.14 294.56 11719 22.69 21.56 24.79 11440 135.51 128.73 148.04 # 11719 9.19 8.73 10.04 # 11440 101.52 96.44 110.91 11720 32.53 30.90 35.54 11441 169.60 161.12 185.29 # 11720 17.17 16.31 18.76 # 11441 131.42 124.85 143.58 11721 45.72 43.43 49.94 11442 190.51 180.98 208.13 # 11721 29.42 27.95 32.14 # 11442 145.81 138.52 159.30 11730 101.95 96.85 111.38 11443 226.36 215.04 247.30 # 11730 59.58 56.60 65.09 # 11443 178.40 169.48 194.90 11732 46.83 44.49 51.16 11444 282.92 268.77 309.09 # 11732 31.00 29.45 33.87 # 11444 226.58 215.25 247.54 11740 47.89 45.50 52.33 11446 380.43 361.41 415.62 # 11740 33.46 31.79 36.56 # 11446 317.58 301.70 346.96 11750 220.85 209.81 241.28 11450 362.90 344.76 396.47 # 11750 179.87 170.88 196.51 # 11450 234.86 223.12 256.59 11752 313.40 297.73 342.39 11451 471.71 448.12 515.34 # 11752 270.10 256.60 295.09 # 11451 307.81 292.42 336.28 11755 139.55 132.57 152.46 11462 360.24 342.23 393.56 # 11755 87.86 83.47 95.99 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 4 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 11760 213.23 202.57 232.96 # 12014 144.94 137.69 158.34 # 11760 135.94 129.14 148.51 12015 258.89 245.95 282.84 11762 278.09 264.19 303.82 # 12015 180.67 171.64 197.39 # 11762 204.06 193.86 222.94 12016 308.21 292.80 336.72 11765 139.37 132.40 152.26 # 12016 220.21 209.20 240.58 # 11765 71.39 67.82 77.99 12017 261.69 248.61 285.90 11770 267.34 253.97 292.07 12018 327.07 310.72 357.33 # 11770 177.94 169.04 194.40 12020 277.59 263.71 303.27 11771 542.18 515.07 592.33 # 12020 190.06 180.56 207.64 # 11771 413.67 392.99 451.94 12021 161.32 153.25 176.24 11772 658.36 625.44 719.26 # 12021 138.50 131.58 151.32 # 11772 546.61 519.28 597.17 12031 247.72 235.33 270.63 11900 59.43 56.46 64.93 # 12031 160.18 152.17 175.00 # 11900 31.49 29.92 34.41 12032 322.64 306.51 352.49 11901 73.82 70.13 80.65 # 12032 199.26 189.30 217.70 # 11901 49.14 46.68 53.68 12034 312.49 296.87 341.40 11920 191.62 182.04 209.35 # 12034 204.00 193.80 222.87 # 11920 118.51 112.58 129.47 12035 382.40 363.28 417.77 11921 217.44 206.57 237.56 # 12035 238.99 227.04 261.10 # 11921 139.22 132.26 152.10 12036 415.87 395.08 454.34 11922 64.81 61.57 70.81 # 12036 274.32 260.60 299.69 # 11922 30.82 29.28 33.67 12037 467.99 444.59 511.28 11950 78.46 74.54 85.72 # 12037 319.92 303.92 349.51 # 11950 51.45 48.88 56.21 12041 258.30 245.39 282.20 11951 104.00 98.80 113.62 # 12041 170.76 162.22 186.55 # 11951 71.41 67.84 78.02 12042 301.74 286.65 329.65 11952 146.28 138.97 159.82 # 12042 200.24 190.23 218.76 # 11952 103.45 98.28 113.02 12044 348.21 330.80 380.42 11954 167.74 159.35 183.25 # 12044 213.18 202.52 232.90 # 11954 116.52 110.69 127.29 12045 383.76 364.57 419.26 11960 941.06 894.01 1,028.11 # 12045 247.33 234.96 270.20 11970 610.25 579.74 666.70 12046 455.14 432.38 497.24 11971 486.01 461.71 530.97 # 12046 291.71 277.12 318.69 # 11971 310.47 294.95 339.19 12047 487.39 463.02 532.47 11976 155.19 147.43 169.54 # 12047 319.30 303.34 348.84 # 11976 97.46 92.59 106.48 12051 278.58 264.65 304.35 11980 107.86 102.47 117.84 # 12051 183.60 174.42 200.58 # 11980 82.26 78.15 89.87 12052 316.17 300.36 345.41 11981 144.37 137.15 157.72 # 12052 216.99 206.14 237.06 # 11981 87.57 83.19 95.67 12053 346.83 329.49 378.91 11982 165.27 157.01 180.56 # 12053 216.93 206.08 236.99 # 11982 107.06 101.71 116.97 12054 365.20 346.94 398.98 11983 250.34 237.82 273.49 # 12054 228.77 217.33 249.93 # 11983 195.86 186.07 213.98 12055 437.00 415.15 477.42 12001 150.38 142.86 164.29 # 12055 276.36 262.54 301.92 # 12001 102.42 97.30 111.90 12056 515.61 489.83 563.30 12002 159.66 151.68 174.43 # 12056 339.14 322.18 370.51 # 12002 114.03 108.33 124.58 12057 575.50 546.73 628.74 12004 187.91 178.51 205.29 # 12057 389.25 369.79 425.26 # 12004 133.43 126.76 145.77 13100 328.57 312.14 358.96 12005 233.52 221.84 255.12 # 13100 241.03 228.98 263.33 # 12005 165.54 157.26 180.85 13101 415.63 394.85 454.08 12006 288.70 274.27 315.41 # 13101 291.77 277.18 318.76 # 12006 208.61 198.18 227.91 13102 110.60 105.07 120.83 12007 327.24 310.88 357.51 # 13102 75.68 71.90 82.69 # 12007 239.24 227.28 261.37 13120 340.84 323.80 372.37 12011 160.33 152.31 175.16 # 13120 251.44 238.87 274.70 # 12011 105.86 100.57 115.66 13121 460.18 437.17 502.75 12013 176.40 167.58 192.72 # 13121 332.13 315.52 362.85 # 12013 121.00 114.95 132.19 13122 123.23 117.07 134.63 12014 206.87 196.53 226.01 # 13122 86.44 82.12 94.44 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 5 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 13131 374.95 356.20 409.63 # 15121 175.13 166.37 191.33 # 13131 283.22 269.06 309.42 15130 690.99 656.44 754.91 13132 596.66 566.83 651.85 # 15130 569.93 541.43 622.64 # 13132 476.99 453.14 521.11 15131 100.10 95.10 109.37 13133 172.84 164.20 188.83 # 15131 88.93 84.48 97.15 # 13133 135.13 128.37 147.63 15135 876.94 833.09 958.05 13150 372.77 354.13 407.25 # 15135 775.90 737.11 847.68 # 13150 281.05 267.00 307.05 15136 90.98 86.43 99.39 13151 424.10 402.90 463.34 # 15136 83.53 79.35 91.25 # 13151 327.25 310.89 357.52 15150 706.68 671.35 772.05 13152 582.49 553.37 636.38 # 15150 642.43 610.31 701.86 # 13152 436.75 414.91 477.15 15151 128.97 122.52 140.90 13153 189.93 180.43 207.49 # 15151 117.33 111.46 128.18 # 13153 146.16 138.85 159.68 15152 169.01 160.56 184.64 13160 816.63 775.80 892.17 # 15152 155.97 148.17 170.40 14000 638.50 606.58 697.57 15155 741.82 704.73 810.44 # 14000 513.25 487.59 560.73 # 15155 688.27 653.86 751.94 14001 824.33 783.11 900.58 15156 179.49 170.52 196.10 # 14001 677.20 643.34 739.84 # 15156 168.78 160.34 184.39 14020 718.64 682.71 785.12 15157 198.45 188.53 216.81 # 14020 588.27 558.86 642.69 # 15157 183.08 173.93 200.02 14021 904.11 858.90 987.74 15170 428.83 407.39 468.50 # 14021 755.58 717.80 825.47 # 15170 363.64 345.46 397.28 14040 792.21 752.60 865.49 15171 93.96 89.26 102.65 # 14040 664.63 631.40 726.11 # 15171 88.83 84.39 97.05 14041 984.54 935.31 1,075.61 15175 541.22 514.16 591.28 # 14041 818.78 777.84 894.52 # 15175 479.76 455.77 524.14 14060 800.48 760.46 874.53 15176 150.60 143.07 164.53 # 14060 699.91 664.91 764.65 # 15176 140.82 133.78 153.85 14061 1,056.34 1,003.52 1,154.05 15200 824.59 783.36 900.86 # 14061 874.28 830.57 955.16 # 15200 664.88 631.64 726.39 14300 1,130.31 1,073.79 1,234.86 15201 155.73 147.94 170.13 # 14300 970.14 921.63 1,059.87 # 15201 80.76 76.72 88.23 14350 761.16 723.10 831.57 15220 791.26 751.70 864.46 15002 343.59 326.41 375.37 # 15220 634.81 603.07 693.53 # 15002 229.51 218.03 250.73 15221 145.42 138.15 158.87 15003 74.63 70.90 81.54 # 15221 74.18 70.47 81.04 # 15003 45.76 43.47 49.99 15240 944.02 896.82 1,031.34 15004 415.21 394.45 453.62 # 15240 811.79 771.20 886.88 # 15004 286.70 272.37 313.23 15241 191.77 182.18 209.51 15005 122.71 116.57 134.06 # 15241 115.88 110.09 126.60 # 15005 90.59 86.06 98.97 15260 1,020.96 969.91 1,115.40 15040 269.41 255.94 294.33 # 15260 877.08 833.23 958.21 # 15040 129.73 123.24 141.73 15261 223.11 211.95 243.74 15050 559.56 531.58 611.32 # 15261 147.22 139.86 160.84 # 15050 450.14 427.63 491.77 15300 345.78 328.49 377.76 15100 886.11 841.80 968.07 # 15300 290.37 275.85 317.23 # 15100 725.94 689.64 793.09 15301 63.79 60.60 69.69 15101 199.42 189.45 217.87 # 15301 58.20 55.29 63.58 # 15101 114.68 108.95 125.29 15320 388.58 369.15 424.52 15110 861.73 818.64 941.44 # 15320 327.58 311.20 357.88 # 15110 738.34 701.42 806.63 15321 94.98 90.23 103.76 15111 122.85 116.71 134.22 # 15321 87.53 83.15 95.62 # 15111 108.42 103.00 118.45 15330 322.69 306.56 352.54 15115 871.16 827.60 951.74 # 15330 265.88 252.59 290.48 # 15115 766.39 728.07 837.28 15331 63.79 60.60 69.69 15116 167.06 158.71 182.52 # 15331 58.66 55.73 64.09 # 15116 150.30 142.79 164.21 15335 336.75 319.91 367.90 15120 959.75 911.76 1,048.52 # 15335 281.34 267.27 307.36 # 15120 793.98 754.28 867.42 15336 88.38 83.96 96.55 15121 278.96 265.01 304.76 # 15336 80.00 76.00 87.40 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 6 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 15340 325.45 309.18 355.56 15776 459.74 436.75 502.26 # 15340 275.16 261.40 300.61 # 15776 336.82 319.98 367.98 15341 49.08 46.63 53.62 15780 863.79 820.60 943.69 # 15341 27.66 26.28 30.22 # 15780 662.18 629.07 723.43 15360 372.35 353.73 406.79 15781 559.90 531.91 611.70 # 15360 313.22 297.56 342.19 # 15781 443.49 421.32 484.52 15361 71.21 67.65 77.80 15782 600.95 570.90 656.54 # 15361 63.77 60.58 69.67 # 15782 429.60 408.12 469.34 15365 362.62 344.49 396.16 15783 511.11 485.55 558.38 # 15365 309.54 294.06 338.17 # 15783 383.53 364.35 419.00 15366 87.37 83.00 95.45 15786 251.39 238.82 274.64 # 15366 79.45 75.48 86.80 # 15786 139.64 132.66 152.56 15400 406.45 386.13 444.05 15787 52.46 49.84 57.32 # 15400 362.68 344.55 396.23 # 15787 18.94 17.99 20.69 15401 97.78 92.89 106.82 15788 463.34 440.17 506.20 # 15401 57.73 54.84 63.07 # 15788 251.01 238.46 274.23 15420 458.88 435.94 501.33 15789 597.94 568.04 653.25 # 15420 402.08 381.98 439.28 # 15789 442.43 420.31 483.36 15421 117.33 111.46 128.18 15792 457.68 434.80 500.02 # 15421 86.13 81.82 94.09 # 15792 280.28 266.27 306.21 15430 538.59 511.66 588.41 15793 499.95 474.95 546.19 # 15430 517.17 491.31 565.01 # 15793 369.57 351.09 403.75 15570 903.93 858.73 987.54 15819 745.61 708.33 814.58 # 15570 722.81 686.67 789.67 15820 547.61 520.23 598.26 15572 875.03 831.28 955.97 # 15820 489.87 465.38 535.19 # 15572 734.42 697.70 802.36 15821 580.38 551.36 634.06 15574 923.10 876.95 1,008.49 # 15821 517.06 491.21 564.89 # 15574 775.96 737.16 847.73 15822 431.34 409.77 471.24 15576 822.27 781.16 898.33 # 15822 376.39 357.57 411.21 # 15576 682.12 648.01 745.21 15823 671.80 638.21 733.94 15600 351.27 333.71 383.77 # 15823 611.73 581.14 668.31 # 15600 211.11 200.55 230.63 15830 1,179.61 1,120.63 1,288.72 15610 347.72 330.33 379.88 15832 900.28 855.27 983.56 # 15610 248.08 235.68 271.03 15833 851.96 809.36 930.76 15620 458.28 435.37 500.68 15834 844.33 802.11 922.43 # 15620 325.58 309.30 355.70 15835 891.72 847.13 974.20 15630 483.29 459.13 528.00 15836 745.94 708.64 814.94 # 15630 356.18 338.37 389.13 15837 787.21 747.85 860.03 15650 536.72 509.88 586.36 # 15837 675.93 642.13 738.45 # 15650 399.36 379.39 436.30 15838 584.14 554.93 638.17 15731 1,154.83 1,097.09 1,261.65 15839 871.53 827.95 952.14 # 15731 1,032.83 981.19 1,128.37 # 15839 730.45 693.93 798.02 15732 1,517.25 1,441.39 1,657.60 15840 1,023.23 972.07 1,117.88 # 15732 1,329.14 1,262.68 1,452.08 15841 1,700.23 1,615.22 1,857.50 15734 1,563.49 1,485.32 1,708.12 15842 2,680.93 2,546.88 2,928.91 # 15734 1,367.00 1,298.65 1,493.45 15845 959.18 911.22 1,047.90 15736 1,389.50 1,320.03 1,518.03 15851 98.29 93.38 107.39 # 15736 1,179.97 1,120.97 1,289.12 # 15851 45.68 43.40 49.91 15738 1,473.89 1,400.20 1,610.23 15852 47.90 45.51 52.34 # 15738 1,280.66 1,216.63 1,399.12 15860 113.33 107.66 123.81 15740 1,045.54 993.26 1,142.25 15920 592.34 562.72 647.13 # 15740 882.57 838.44 964.21 15922 753.57 715.89 823.27 15750 927.37 881.00 1,013.15 15931 667.16 633.80 728.87 15756 2,406.69 2,286.36 2,629.31 15933 828.59 787.16 905.23 15757 2,379.28 2,260.32 2,599.37 15934 916.87 871.03 1,001.68 15758 2,382.63 2,263.50 2,603.03 15935 1,097.04 1,042.19 1,198.52 15760 865.98 822.68 946.08 15936 889.85 845.36 972.16 # 15760 719.78 683.79 786.36 15937 1,043.03 990.88 1,139.51 15770 668.15 634.74 729.95 15940 687.42 653.05 751.01 15775 332.27 315.66 363.01 15941 902.76 857.62 986.26 # 15775 234.96 223.21 256.69 15944 886.84 842.50 968.88 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 7 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 15945 985.76 936.47 1,076.94 # 17280 91.64 87.06 100.12 15946 1,636.46 1,554.64 1,787.84 17281 184.31 175.09 201.35 15950 574.58 545.85 627.73 # 17281 127.04 120.69 138.79 15951 817.92 777.02 893.57 17282 213.22 202.56 232.94 15952 858.28 815.37 937.68 # 17282 147.10 139.75 160.71 15953 957.21 909.35 1,045.75 17283 255.87 243.08 279.54 15956 1,147.14 1,089.78 1,253.25 # 17283 183.23 174.07 200.18 15958 1,174.70 1,115.97 1,283.37 17284 296.20 281.39 323.60 16000 70.16 66.65 76.65 # 17284 217.98 207.08 238.14 # 16000 46.41 44.09 50.70 17286 370.77 352.23 405.06 16020 84.98 80.73 92.84 # 17286 291.62 277.04 318.60 # 16020 57.97 55.07 63.33 17311 732.60 695.97 800.37 16025 149.79 142.30 163.65 # 17311 388.50 369.08 424.44 # 16025 116.27 110.46 127.03 17312 443.14 420.98 484.13 16030 180.66 171.63 197.37 # 17312 206.61 196.28 225.72 # 16030 132.23 125.62 144.46 17313 669.65 636.17 731.60 16035 214.80 204.06 234.67 # 17313 348.83 331.39 381.10 16036 85.39 81.12 93.29 17314 410.68 390.15 448.67 17000 83.90 79.71 91.67 # 17314 191.84 182.25 209.59 # 17000 56.43 53.61 61.65 17315 86.20 81.89 94.17 17003 8.00 7.60 8.74 # 17315 54.53 51.80 59.57 # 17003 4.74 4.50 5.18 17340 48.67 46.24 53.18 17004 183.26 174.10 200.22 # 17340 46.81 44.47 51.14 # 17004 139.02 132.07 151.88 17360 137.04 130.19 149.72 17106 359.20 341.24 392.43 # 17360 102.12 97.01 111.56 # 17106 288.43 274.01 315.11 19000 123.24 117.08 134.64 17107 476.47 452.65 520.55 # 19000 47.35 44.98 51.73 # 17107 381.95 362.85 417.28 19001 28.80 27.36 31.46 17108 605.62 575.34 661.64 # 19001 23.67 22.49 25.86 # 17108 496.20 471.39 542.10 19020 454.32 431.60 496.34 17110 118.44 112.52 129.40 # 19020 289.02 274.57 315.76 # 17110 71.41 67.84 78.02 19030 186.84 177.50 204.13 17111 139.17 132.21 152.04 # 19030 85.80 81.51 93.74 # 17111 87.95 83.55 96.08 19100 147.92 140.52 161.60 17250 79.81 75.82 87.19 # 19100 68.77 65.33 75.13 # 17250 37.44 35.57 40.91 19101 333.91 317.21 364.79 17260 99.41 94.44 108.61 # 19101 215.18 204.42 235.08 # 17260 68.68 65.25 75.04 19102 244.77 232.53 267.41 17261 150.31 142.79 164.21 # 19102 112.07 106.47 122.44 # 17261 93.50 88.83 102.15 19103 630.39 598.87 688.70 17262 181.63 172.55 198.43 # 19103 205.28 195.02 224.27 # 17262 118.77 112.83 129.75 19105 2,530.12 2,403.61 2,764.15 17263 199.94 189.94 218.43 # 19105 205.74 195.45 224.77 # 17263 131.03 124.48 143.15 19110 465.83 442.54 508.92 17264 213.70 203.02 233.47 # 19110 324.75 308.51 354.79 # 17264 139.67 132.69 152.59 19112 439.50 417.53 480.16 17266 241.39 229.32 263.72 # 19112 293.76 279.07 320.93 # 17266 161.77 153.68 176.73 19120 468.27 444.86 511.59 17270 154.94 147.19 169.27 # 19120 392.83 373.19 429.17 # 17270 100.46 95.44 109.76 19125 517.12 491.26 564.95 17271 170.84 162.30 186.65 # 19125 434.70 412.97 474.92 # 17271 113.10 107.45 123.57 19126 158.79 150.85 173.48 17272 195.01 185.26 213.05 19260 1,204.77 1,144.53 1,316.21 # 17272 130.75 124.21 142.84 19271 1,658.54 1,575.61 1,811.95 17273 216.85 206.01 236.91 19272 1,831.20 1,739.64 2,000.59 # 17273 147.01 139.66 160.61 19290 183.63 174.45 200.62 17274 255.14 242.38 278.74 # 19290 70.95 67.40 77.51 # 17274 179.71 170.72 196.33 19291 78.49 74.57 85.76 17276 293.40 278.73 320.54 # 19291 35.19 33.43 38.44 # 17276 215.17 204.41 235.07 19295 109.70 104.22 119.85 17280 146.12 138.81 159.63 19296 4,544.28 4,317.07 4,964.63 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 8 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 19296 206.10 195.80 225.17 20250 386.30 366.99 422.04 19297 92.26 87.65 100.80 20251 428.64 407.21 468.29 19298 1,496.35 1,421.53 1,634.76 20500 123.27 117.11 134.68 # 19298 340.22 323.21 371.69 # 20500 99.05 94.10 108.22 19300 510.46 484.94 557.68 20501 146.18 138.87 159.70 # 19300 386.61 367.28 422.37 # 20501 42.81 40.67 46.77 19301 599.16 569.20 654.58 20520 199.04 189.09 217.45 19302 860.39 817.37 939.98 # 20520 146.43 139.11 159.98 19303 924.64 878.41 1,010.17 20525 496.79 471.95 542.74 19304 548.06 520.66 598.76 # 20525 253.74 241.05 277.21 19305 1,074.90 1,021.16 1,174.33 20526 78.51 74.58 85.77 19306 1,128.59 1,072.16 1,232.98 # 20526 59.42 56.45 64.92 19307 1,135.07 1,078.32 1,240.07 20550 60.58 57.55 66.18 19316 784.67 745.44 857.26 # 20550 42.89 40.75 46.86 19318 1,156.37 1,098.55 1,263.33 20551 59.84 56.85 65.38 19324 479.94 455.94 524.33 # 20551 44.01 41.81 48.08 19325 656.43 623.61 717.15 20552 54.74 52.00 59.80 19328 496.34 471.52 542.25 # 20552 37.05 35.20 40.48 19330 635.71 603.92 694.51 20553 61.06 58.01 66.71 19340 402.98 382.83 440.25 # 20553 41.04 38.99 44.84 19342 934.14 887.43 1,020.54 20555 343.01 325.86 374.74 19350 878.16 834.25 959.39 20600 57.43 54.56 62.74 # 19350 689.58 655.10 753.37 # 20600 41.60 39.52 45.45 19355 720.58 684.55 787.23 20605 61.90 58.81 67.63 # 19355 561.34 533.27 613.26 # 20605 43.27 41.11 47.28 19357 1,572.65 1,494.02 1,718.12 20610 80.77 76.73 88.24 19361 1,679.11 1,595.15 1,834.42 # 20610 51.91 49.31 56.71 19364 2,833.20 2,691.54 3,095.27 20612 61.33 58.26 67.00 19366 1,389.38 1,319.91 1,517.90 # 20612 44.57 42.34 48.69 19367 1,841.27 1,749.21 2,011.59 20615 227.30 215.94 248.33 19368 2,273.51 2,159.83 2,483.80 # 20615 163.51 155.33 178.63 19369 2,070.32 1,966.80 2,261.82 20650 204.73 194.49 223.66 19370 690.47 655.95 754.34 # 20650 160.96 152.91 175.85 19371 795.47 755.70 869.06 20660 255.97 243.17 279.65 19380 778.52 739.59 850.53 # 20660 239.21 227.25 261.34 19396 229.42 217.95 250.64 20661 485.25 460.99 530.14 # 19396 134.43 127.71 146.87 20662 495.00 470.25 540.79 20000 213.42 202.75 233.16 20663 458.44 435.52 500.85 # 20000 159.88 151.89 174.67 20664 780.59 741.56 852.79 20005 312.98 297.33 341.93 20665 127.70 121.32 139.52 # 20005 242.20 230.09 264.60 # 20665 104.88 99.64 114.59 20100 588.06 558.66 642.46 20670 433.42 411.75 473.51 20101 417.98 397.08 456.64 # 20670 155.91 148.11 170.33 # 20101 204.26 194.05 223.16 20680 619.46 588.49 676.76 20102 487.43 463.06 532.52 # 20680 422.51 401.38 461.59 # 20102 249.03 236.58 272.07 20690 546.81 519.47 597.39 20103 588.37 558.95 642.79 20692 1,025.03 973.78 1,119.85 # 20103 357.89 340.00 391.00 20693 473.46 449.79 517.26 20150 976.14 927.33 1,066.43 20694 444.56 422.33 485.68 20200 203.93 193.73 222.79 # 20694 347.72 330.33 379.88 # 20200 94.51 89.78 103.25 20696 1,092.23 1,037.62 1,193.26 20205 274.64 260.91 300.05 20697 1,540.55 1,463.52 1,683.05 # 20205 150.32 142.80 164.22 # 20697 0.28 0.27 0.31 20206 295.69 280.91 323.05 20802 2,475.52 2,351.74 2,704.50 # 20206 67.07 63.72 73.28 20805 3,040.11 2,888.10 3,321.32 20220 197.40 187.53 215.66 20808 4,186.98 3,977.63 4,574.27 # 20220 83.33 79.16 91.03 20816 2,345.30 2,228.04 2,562.25 20225 777.62 738.74 849.55 20822 1,993.22 1,893.56 2,177.59 # 20225 126.68 120.35 138.40 20824 2,334.28 2,217.57 2,550.21 20240 234.71 222.97 256.42 20827 2,076.84 1,973.00 2,268.95 20245 641.41 609.34 700.74 20838 2,512.74 2,387.10 2,745.17 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 9 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 20900 454.33 431.61 496.35 # 21076 846.69 804.36 925.01 # 20900 278.79 264.85 304.58 21077 2,430.97 2,309.42 2,655.83 20902 380.40 361.38 415.59 # 21077 2,143.68 2,036.50 2,341.98 20910 448.03 425.63 489.47 21079 1,670.29 1,586.78 1,824.80 20912 499.40 474.43 545.59 # 21079 1,418.85 1,347.91 1,550.10 20920 420.48 399.46 459.38 21080 1,899.42 1,804.45 2,075.12 20922 635.39 603.62 694.16 # 21080 1,595.84 1,516.05 1,743.46 # 20922 513.40 487.73 560.89 21081 1,734.54 1,647.81 1,894.98 20924 520.94 494.89 569.12 # 21081 1,453.31 1,380.64 1,587.74 20926 449.70 427.22 491.30 21082 1,618.82 1,537.88 1,768.56 20931 115.34 109.57 126.01 # 21082 1,349.69 1,282.21 1,474.54 20937 175.69 166.91 191.95 21083 1,543.04 1,465.89 1,685.77 20938 190.71 181.17 208.35 # 21083 1,249.70 1,187.22 1,365.30 20950 270.18 256.67 295.17 21084 1,755.57 1,667.79 1,917.96 # 20950 94.18 89.47 102.89 # 21084 1,431.49 1,359.92 1,563.91 20955 2,609.70 2,479.22 2,851.10 21085 710.40 674.88 776.11 20956 2,725.92 2,589.62 2,978.06 # 21085 577.23 548.37 630.63 20957 2,565.26 2,437.00 2,802.55 21086 1,769.92 1,681.42 1,933.63 20962 2,681.53 2,547.45 2,929.57 # 21086 1,567.85 1,489.46 1,712.88 20969 2,884.32 2,740.10 3,151.12 21087 1,763.42 1,675.25 1,926.54 20970 2,903.86 2,758.67 3,172.47 # 21087 1,562.27 1,484.16 1,706.78 20972 2,612.14 2,481.53 2,853.76 21100 768.54 730.11 839.63 20973 2,735.15 2,598.39 2,988.15 # 21100 415.60 394.82 454.04 20974 69.34 65.87 75.75 21110 797.10 757.25 870.84 # 20974 49.79 47.30 54.40 # 21110 669.98 636.48 731.95 20975 183.65 174.47 200.64 21116 164.88 156.64 180.14 20979 55.75 52.96 60.90 # 21116 43.82 41.63 47.87 # 20979 36.66 34.83 40.05 21120 660.36 627.34 721.44 20982 4,318.29 4,102.38 4,717.74 # 21120 521.14 495.08 569.34 # 20982 424.32 403.10 463.57 21121 807.85 767.46 882.58 20985 155.36 147.59 169.73 # 21121 678.87 644.93 741.67 21010 739.16 702.20 807.53 21122 746.85 709.51 815.94 21015 439.07 417.12 479.69 21123 883.35 839.18 965.06 21025 919.98 873.98 1,005.08 21125 3,381.33 3,212.26 3,694.10 # 21025 769.58 731.10 840.77 # 21125 764.09 725.89 834.77 21026 619.78 588.79 677.11 21127 4,027.87 3,826.48 4,400.45 # 21026 503.84 478.65 550.45 # 21127 893.31 848.64 975.94 21029 776.65 737.82 848.49 21137 736.02 699.22 804.10 # 21029 645.35 613.08 705.04 21138 917.84 871.95 1,002.74 21030 516.63 490.80 564.42 21139 1,025.97 974.67 1,120.87 # 21030 416.52 395.69 455.04 21141 1,381.30 1,312.24 1,509.08 21031 401.94 381.84 439.12 21142 1,354.00 1,286.30 1,479.25 # 21031 299.97 284.97 327.72 21143 1,408.09 1,337.69 1,538.34 21032 407.53 387.15 445.22 21145 1,569.56 1,491.08 1,714.74 # 21032 294.85 280.11 322.13 21146 1,683.88 1,599.69 1,839.64 21034 1,364.89 1,296.65 1,491.15 21147 1,728.37 1,641.95 1,888.24 # 21034 1,196.80 1,136.96 1,307.50 21150 1,715.02 1,629.27 1,873.66 21040 521.28 495.22 569.50 21151 2,104.33 1,999.11 2,298.98 # 21040 413.72 393.03 451.98 21154 2,102.37 1,997.25 2,296.84 21044 898.35 853.43 981.44 21155 2,372.44 2,253.82 2,591.89 21045 1,246.94 1,184.59 1,362.28 21159 2,862.00 2,718.90 3,126.74 21046 1,122.87 1,066.73 1,226.74 21160 2,929.30 2,782.84 3,200.27 21047 1,326.37 1,260.05 1,449.06 21172 1,806.61 1,716.28 1,973.72 21048 1,134.76 1,078.02 1,239.72 21175 2,185.15 2,075.89 2,387.27 21049 1,285.52 1,221.24 1,404.43 21179 1,503.51 1,428.33 1,642.58 21050 889.70 845.22 972.00 21180 1,715.73 1,629.94 1,874.43 21060 808.44 768.02 883.22 21181 722.88 686.74 789.75 21070 660.55 627.52 721.65 21182 2,075.15 1,971.39 2,267.10 21073 386.87 367.53 422.66 21183 2,324.49 2,208.27 2,539.51 # 21073 243.92 231.72 266.48 21184 2,476.34 2,352.52 2,705.40 21076 988.70 939.27 1,080.16 21188 1,678.77 1,594.83 1,834.05 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 10 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 21193 1,265.59 1,202.31 1,382.66 21345 832.73 791.09 909.75 21194 1,444.35 1,372.13 1,577.95 # 21345 671.63 638.05 733.76 21195 1,374.00 1,305.30 1,501.10 21346 990.60 941.07 1,082.23 21196 1,496.52 1,421.69 1,634.94 21347 1,145.27 1,088.01 1,251.21 21198 1,185.50 1,126.23 1,295.16 21348 1,177.57 1,118.69 1,286.49 21199 1,042.97 990.82 1,139.44 21355 456.98 434.13 499.25 21206 1,166.84 1,108.50 1,274.78 # 21355 332.20 315.59 362.93 21208 1,865.38 1,772.11 2,037.93 21356 513.04 487.39 560.50 # 21208 848.93 806.48 927.45 # 21356 384.06 364.86 419.59 21209 859.27 816.31 938.76 21360 542.50 515.38 592.69 # 21209 663.24 630.08 724.59 21365 1,117.65 1,061.77 1,221.04 21210 2,252.94 2,140.29 2,461.33 21366 1,238.88 1,176.94 1,353.48 # 21210 844.44 802.22 922.55 21385 732.62 695.99 800.39 21215 3,915.97 3,720.17 4,278.20 21386 676.74 642.90 739.34 # 21215 879.20 835.24 960.53 21387 762.67 724.54 833.22 21230 782.65 743.52 855.05 21390 782.52 743.39 854.90 21235 757.45 719.58 827.52 21395 978.97 930.02 1,069.52 # 21235 583.30 554.14 637.26 21400 187.02 177.67 204.32 21240 1,132.90 1,076.26 1,237.70 # 21400 151.16 143.60 165.14 21242 1,040.34 988.32 1,136.57 21401 501.49 476.42 547.88 21243 1,701.03 1,615.98 1,858.38 # 21401 303.60 288.42 331.68 21244 1,080.26 1,026.25 1,180.19 21406 552.15 524.54 603.22 21245 1,181.76 1,122.67 1,291.07 21407 650.85 618.31 711.06 # 21245 938.70 891.77 1,025.54 21408 890.31 845.79 972.66 21246 867.70 824.32 947.97 21421 771.30 732.74 842.65 21247 1,648.29 1,565.88 1,800.76 # 21421 650.70 618.17 710.90 21248 1,105.96 1,050.66 1,208.26 21422 688.95 654.50 752.68 # 21248 896.89 852.05 979.86 21423 813.35 772.68 888.58 21249 1,520.48 1,444.46 1,661.13 21431 771.69 733.11 843.08 # 21249 1,263.45 1,200.28 1,380.32 21432 685.93 651.63 749.37 21255 1,494.78 1,420.04 1,633.05 21433 1,721.31 1,635.24 1,880.53 21256 1,192.10 1,132.50 1,302.38 21435 1,364.49 1,296.27 1,490.71 21260 1,368.17 1,299.76 1,494.72 21436 2,001.43 1,901.36 2,186.56 21261 2,294.31 2,179.59 2,506.53 21440 570.81 542.27 623.61 21263 2,062.79 1,959.65 2,253.60 # 21440 468.84 445.40 512.21 21267 1,597.62 1,517.74 1,745.40 21445 795.55 755.77 869.14 21268 1,963.11 1,864.95 2,144.69 # 21445 647.02 614.67 706.87 21270 942.47 895.35 1,029.65 21450 593.43 563.76 648.32 # 21270 710.59 675.06 776.32 # 21450 490.52 465.99 535.89 21275 822.71 781.57 898.81 21451 775.01 736.26 846.70 21280 538.92 511.97 588.77 # 21451 652.09 619.49 712.41 21282 361.31 343.24 394.73 21452 660.48 627.46 721.58 21295 183.24 174.08 200.19 # 21452 356.90 339.06 389.92 21296 442.97 420.82 483.94 21453 896.28 851.47 979.19 21310 116.03 110.23 126.76 # 21453 788.72 749.28 861.67 # 21310 28.49 27.07 31.13 21454 566.67 538.34 619.09 21315 279.91 265.91 305.80 21461 2,088.27 1,983.86 2,281.44 # 21315 153.26 145.60 167.44 # 21461 962.40 914.28 1,051.42 21320 267.69 254.31 292.46 21462 2,246.42 2,134.10 2,454.22 # 21320 141.04 133.99 154.09 # 21462 1,058.16 1,005.25 1,156.04 21325 499.03 474.08 545.19 21465 928.62 882.19 1,014.52 21330 604.31 574.09 660.20 21470 1,207.22 1,146.86 1,318.89 21335 764.07 725.87 834.75 21480 97.39 92.52 106.40 21336 672.55 638.92 734.76 # 21480 32.67 31.04 35.70 21337 412.73 392.09 450.90 21485 696.21 661.40 760.61 # 21337 295.39 280.62 322.71 # 21485 588.19 558.78 642.60 21338 777.74 738.85 849.68 21490 943.18 896.02 1,030.42 21339 857.46 814.59 936.78 21495 718.12 682.21 784.54 21340 823.27 782.11 899.43 21497 705.08 669.83 770.30 21343 1,190.89 1,131.35 1,301.05 # 21497 596.59 566.76 651.77 21344 1,532.78 1,456.14 1,674.56 21501 458.13 435.22 500.50 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 11 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 21501 324.03 307.83 354.00 22310 289.94 275.44 316.76 21502 530.63 504.10 579.72 # 22310 268.06 254.66 292.86 21510 474.63 450.90 518.54 22315 874.88 831.14 955.81 21550 271.58 258.00 296.70 # 22315 766.86 728.52 837.80 # 21550 164.02 155.82 179.19 22318 1,609.75 1,529.26 1,758.65 21555 445.53 423.25 486.74 22319 1,764.06 1,675.86 1,927.24 # 21555 337.97 321.07 369.23 22325 1,414.29 1,343.58 1,545.12 21556 421.48 400.41 460.47 22326 1,470.56 1,397.03 1,606.58 21557 586.26 556.95 640.49 22327 1,460.50 1,387.48 1,595.60 21600 567.91 539.51 620.44 22328 288.35 273.93 315.02 21610 1,080.90 1,026.86 1,180.89 22505 124.02 117.82 135.49 21615 681.00 646.95 743.99 22520 2,581.25 2,452.19 2,820.02 21616 875.91 832.11 956.93 # 22520 596.31 566.49 651.46 21620 535.78 508.99 585.34 22521 2,517.68 2,391.80 2,750.57 21627 566.50 538.18 618.91 # 22521 562.54 534.41 614.57 21630 1,294.18 1,229.47 1,413.89 22522 259.94 246.94 283.98 21632 1,272.29 1,208.68 1,389.98 22523 628.53 597.10 686.67 21685 1,012.98 962.33 1,106.68 22524 602.46 572.34 658.19 21700 431.86 410.27 471.81 22525 277.89 264.00 303.60 21705 657.52 624.64 718.34 22526 2,192.82 2,083.18 2,395.66 21720 417.55 396.67 456.17 # 22526 346.17 328.86 378.19 21725 545.48 518.21 595.94 22527 1,719.92 1,633.92 1,879.01 21740 1,102.45 1,047.33 1,204.43 # 22527 154.97 147.22 169.30 21750 733.41 696.74 801.25 22532 1,748.70 1,661.27 1,910.46 21800 101.24 96.18 110.61 22533 1,648.56 1,566.13 1,801.05 # 21800 103.11 97.95 112.64 22534 377.81 358.92 412.76 21805 268.97 255.52 293.85 22548 1,864.29 1,771.08 2,036.74 21810 510.87 485.33 558.13 22554 1,298.14 1,233.23 1,418.21 21820 134.98 128.23 147.46 22556 1,668.42 1,585.00 1,822.75 # 21820 136.84 130.00 149.50 22558 1,528.41 1,451.99 1,669.79 21825 582.23 553.12 636.09 22585 348.73 331.29 380.98 21920 271.02 257.47 296.09 22590 1,556.06 1,478.26 1,700.00 # 21920 163.93 155.73 179.09 22595 1,478.42 1,404.50 1,615.18 21925 433.20 411.54 473.27 22600 1,270.99 1,207.44 1,388.56 # 21925 342.40 325.28 374.07 22610 1,254.04 1,191.34 1,370.04 21930 483.49 459.32 528.22 22612 1,611.07 1,530.52 1,760.10 # 21930 379.19 360.23 414.26 22614 407.50 387.13 445.20 21935 1,170.45 1,111.93 1,278.72 22630 1,553.62 1,475.94 1,697.33 22010 919.07 873.12 1,004.09 22632 330.92 314.37 361.53 22015 914.44 868.72 999.03 22800 1,374.90 1,306.16 1,502.08 22100 833.68 792.00 910.80 22802 2,172.83 2,064.19 2,373.82 22101 831.24 789.68 908.13 22804 2,506.09 2,380.79 2,737.91 22102 827.62 786.24 904.18 22808 1,848.28 1,755.87 2,019.25 22103 146.93 139.58 160.52 22810 2,054.11 1,951.40 2,244.11 22110 1,031.28 979.72 1,126.68 22812 2,252.04 2,139.44 2,460.36 22112 993.74 944.05 1,085.66 22818 2,266.28 2,152.97 2,475.92 22114 1,023.32 972.15 1,117.97 22819 2,612.02 2,481.42 2,853.63 22116 145.97 138.67 159.47 22830 823.33 782.16 899.48 22206 2,412.75 2,292.11 2,635.93 22840 795.29 755.53 868.86 22207 2,381.87 2,262.78 2,602.20 22842 797.07 757.22 870.80 22208 601.33 571.26 656.95 22843 848.12 805.71 926.57 22210 1,790.83 1,701.29 1,956.48 22844 1,040.92 988.87 1,137.20 22212 1,484.16 1,409.95 1,621.44 22845 760.33 722.31 830.66 22214 1,494.39 1,419.67 1,632.62 22846 789.47 750.00 862.50 22216 383.19 364.03 418.63 22847 871.12 827.56 951.69 22220 1,611.11 1,530.55 1,760.13 22848 379.24 360.28 414.32 22222 1,448.96 1,376.51 1,582.99 22849 1,324.03 1,257.83 1,446.50 22224 1,594.02 1,514.32 1,741.47 22850 729.46 692.99 796.94 22226 381.33 362.26 416.60 22851 423.81 402.62 463.01 22305 190.38 180.86 207.99 22852 697.92 663.02 762.47 # 22305 174.08 165.38 190.19 22855 1,124.13 1,067.92 1,228.11 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 12 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 22856 1,676.49 1,592.67 1,831.57 23405 647.08 614.73 706.94 22857 1,738.23 1,651.32 1,899.02 23406 805.08 764.83 879.55 22861 2,014.23 1,913.52 2,200.55 23410 856.98 814.13 936.25 22862 1,990.08 1,890.58 2,174.17 23412 895.12 850.36 977.91 22864 1,848.52 1,756.09 2,019.50 23415 716.54 680.71 782.82 22865 2,161.99 2,053.89 2,361.97 23420 1,002.65 952.52 1,095.40 22900 412.71 392.07 450.88 23430 759.43 721.46 829.68 23000 558.72 530.78 610.40 23440 781.59 742.51 853.89 # 23000 367.81 349.42 401.83 23450 977.01 928.16 1,067.38 23020 706.63 671.30 772.00 23455 1,041.44 989.37 1,137.78 23030 446.49 424.17 487.80 23460 1,128.10 1,071.70 1,232.46 # 23030 262.57 249.44 286.86 23462 1,104.58 1,049.35 1,206.75 23031 411.71 391.12 449.79 23465 1,153.33 1,095.66 1,260.01 # 23031 218.47 207.55 238.68 23466 1,141.51 1,084.43 1,247.09 23035 702.40 667.28 767.37 23470 1,253.32 1,190.65 1,369.25 23040 735.80 699.01 803.86 23472 1,547.34 1,469.97 1,690.47 23044 585.09 555.84 639.22 23480 842.14 800.03 920.03 23065 221.43 210.36 241.91 23485 992.06 942.46 1,083.83 # 23065 170.21 161.70 185.96 23490 857.51 814.63 936.82 23066 531.20 504.64 580.34 23491 1,045.75 993.46 1,142.48 # 23066 347.28 329.92 379.41 23500 212.57 201.94 232.23 23075 269.69 256.21 294.64 # 23500 211.17 200.61 230.70 # 23075 180.76 171.72 197.48 23505 347.91 330.51 380.09 23076 572.33 543.71 625.27 # 23505 327.89 311.50 358.23 23077 1,199.70 1,139.72 1,310.68 23515 717.68 681.80 784.07 23100 500.52 475.49 546.81 23520 220.36 209.34 240.74 23101 459.82 436.83 502.35 # 23520 221.76 210.67 242.27 23105 652.04 619.44 712.36 23525 340.71 323.67 372.22 23106 487.70 463.32 532.82 # 23525 316.50 300.68 345.78 23107 676.83 642.99 739.44 23530 548.24 520.83 598.95 23120 589.04 559.59 643.53 23532 634.96 603.21 693.69 23125 717.83 681.94 784.23 23540 216.93 206.08 236.99 23130 619.31 588.34 676.59 # 23540 213.67 202.99 233.44 23140 522.26 496.15 570.57 23545 313.52 297.84 342.52 23145 705.81 670.52 771.10 # 23545 286.51 272.18 313.01 23146 613.85 583.16 670.63 23550 585.36 556.09 639.50 23150 668.04 634.64 729.84 23552 673.21 639.55 735.48 23155 808.11 767.70 882.86 23570 227.24 215.88 248.26 23156 687.87 653.48 751.50 # 23570 230.50 218.98 251.83 23170 540.21 513.20 590.18 23575 386.14 366.83 421.85 23172 555.32 527.55 606.68 # 23575 361.93 343.83 395.40 23174 770.94 732.39 842.25 23585 963.18 915.02 1,052.27 23180 703.27 668.11 768.33 23600 319.66 303.68 349.23 23182 679.42 645.45 742.27 # 23600 293.58 278.90 320.74 23184 764.73 726.49 835.46 23605 467.23 443.87 510.45 23190 568.46 540.04 621.05 # 23605 428.12 406.71 467.72 23195 768.45 730.03 839.53 23615 888.82 844.38 971.04 23200 901.10 856.05 984.46 23616 1,322.74 1,256.60 1,445.09 23210 943.84 896.65 1,031.15 23620 263.42 250.25 287.79 23220 1,091.71 1,037.12 1,192.69 # 23620 247.13 234.77 269.99 23221 1,269.03 1,205.58 1,386.42 23625 378.86 359.92 413.91 23222 1,724.87 1,638.63 1,884.42 # 23625 353.72 336.03 386.43 23330 235.26 223.50 257.03 23630 763.76 725.57 834.41 # 23330 152.38 144.76 166.47 23650 291.92 277.32 318.92 23331 602.39 572.27 658.11 # 23650 264.44 251.22 288.90 23332 906.53 861.20 990.38 23655 386.78 367.44 422.56 23350 174.26 165.55 190.38 23660 593.72 564.03 648.63 # 23350 55.99 53.19 61.17 23665 420.86 399.82 459.79 23395 1,316.22 1,250.41 1,437.97 # 23665 393.86 374.17 430.30 23397 1,176.09 1,117.29 1,284.88 23670 853.72 811.03 932.68 23400 1,000.37 950.35 1,092.90 23675 547.74 520.35 598.40 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 13 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 23675 503.04 477.89 549.57 24332 617.46 586.59 674.58 23680 924.97 878.72 1,010.53 24340 627.16 595.80 685.17 23700 199.51 189.53 217.96 24341 740.32 703.30 808.80 23800 1,051.63 999.05 1,148.91 24342 804.18 763.97 878.57 23802 1,273.30 1,209.64 1,391.09 24343 719.00 683.05 785.51 23900 1,346.72 1,279.38 1,471.29 24344 1,112.57 1,056.94 1,215.48 23920 1,097.40 1,042.53 1,198.91 24345 713.69 678.01 779.71 23921 399.65 379.67 436.62 24346 1,115.47 1,059.70 1,218.66 23930 369.88 351.39 404.10 24357 453.29 430.63 495.22 # 23930 219.95 208.95 240.29 24358 532.48 505.86 581.74 23931 293.73 279.04 320.90 24359 664.27 631.06 725.72 # 23931 161.96 153.86 176.94 24360 923.15 876.99 1,008.54 23935 507.94 482.54 554.92 24361 1,033.68 982.00 1,129.30 24000 482.77 458.63 527.42 24362 1,091.59 1,037.01 1,192.56 24006 725.69 689.41 792.82 24363 1,521.97 1,445.87 1,662.75 24065 264.68 251.45 289.17 24365 654.54 621.81 715.08 # 24065 171.09 162.54 186.92 24366 699.93 664.93 764.67 24066 609.31 578.84 665.67 24400 844.69 802.46 922.83 # 24066 404.43 384.21 441.84 24410 1,072.82 1,019.18 1,172.06 24075 497.18 472.32 543.17 24420 1,012.92 962.27 1,106.61 # 24075 317.91 302.01 347.31 24430 1,069.78 1,016.29 1,168.73 24076 481.99 457.89 526.57 24435 1,090.85 1,036.31 1,191.76 24077 825.01 783.76 901.32 24470 640.60 608.57 699.86 24100 413.11 392.45 451.32 24495 676.73 642.89 739.32 24101 508.61 483.18 555.66 24498 894.79 850.05 977.56 24102 626.87 595.53 684.86 24500 347.73 330.34 379.89 24105 346.24 328.93 378.27 # 24500 312.35 296.73 341.24 24110 595.23 565.47 650.29 24505 500.60 475.57 546.91 24115 746.15 708.84 815.17 # 24505 454.04 431.34 496.04 24116 883.81 839.62 965.56 24515 899.21 854.25 982.39 24120 532.63 506.00 581.90 24516 887.09 842.74 969.15 24125 613.67 582.99 670.44 24530 374.02 355.32 408.62 24126 651.47 618.90 711.74 # 24530 335.84 319.05 366.91 24130 516.13 490.32 563.87 24535 622.80 591.66 680.41 24134 770.17 731.66 841.41 # 24535 575.78 546.99 629.04 24136 605.50 575.23 661.51 24538 762.97 724.82 833.54 24138 678.06 644.16 740.78 24545 931.09 884.54 1,017.22 24140 735.67 698.89 803.72 24546 1,084.06 1,029.86 1,184.34 24145 618.67 587.74 675.90 24560 313.27 297.61 342.25 24147 645.75 613.46 705.48 # 24560 275.09 261.34 300.54 24149 1,179.41 1,120.44 1,288.51 24565 512.92 487.27 560.36 24150 996.36 946.54 1,088.52 # 24565 471.01 447.46 514.58 24151 1,142.41 1,085.29 1,248.08 24566 716.65 680.82 782.94 24152 750.47 712.95 819.89 24575 756.75 718.91 826.75 24153 798.88 758.94 872.78 24576 330.38 313.86 360.94 24155 867.12 823.76 947.32 # 24576 294.07 279.37 321.28 24160 618.25 587.34 675.44 24577 533.64 506.96 583.00 24164 506.26 480.95 553.09 # 24577 488.48 464.06 533.67 24200 204.74 194.50 223.68 24579 856.10 813.30 935.30 # 24200 137.69 130.81 150.43 24582 799.41 759.44 873.36 24201 575.06 546.31 628.26 24586 1,124.67 1,068.44 1,228.71 # 24201 370.66 352.13 404.95 24587 1,119.40 1,063.43 1,222.94 24220 189.11 179.65 206.60 24600 359.33 341.36 392.56 # 24220 74.10 70.40 80.96 # 24600 323.95 307.75 353.91 24300 407.01 386.66 444.66 24605 465.64 442.36 508.71 24301 770.14 731.63 841.37 24615 732.62 695.99 800.39 24305 591.17 561.61 645.85 24620 558.67 530.74 610.35 24310 484.91 460.66 529.76 24635 783.25 744.09 855.70 24320 791.56 751.98 864.78 24640 120.75 114.71 131.92 24330 732.62 695.99 800.39 # 24640 85.37 81.10 93.27 24331 809.04 768.59 883.88 24650 255.47 242.70 279.11 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 14 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 24650 228.93 217.48 250.10 25246 190.86 181.32 208.52 24655 435.12 413.36 475.36 # 25246 81.44 77.37 88.98 # 24655 395.55 375.77 432.14 25248 454.48 431.76 496.52 24665 664.26 631.05 725.71 25250 535.28 508.52 584.80 24666 750.67 713.14 820.11 25251 725.77 689.48 792.90 24670 286.12 271.81 312.58 25259 408.51 388.08 446.29 # 24670 254.46 241.74 278.00 25260 706.49 671.17 771.85 24675 458.97 436.02 501.42 25263 705.18 669.92 770.41 # 24675 419.40 398.43 458.19 25265 831.07 789.52 907.95 24685 667.39 634.02 729.12 25270 570.03 541.53 622.76 24800 808.66 768.23 883.46 25272 638.64 606.71 697.72 24802 1,024.86 973.62 1,119.66 25274 752.67 715.04 822.30 24900 731.86 695.27 799.56 25275 686.10 651.80 749.57 24920 726.33 690.01 793.51 25280 646.36 614.04 706.15 24925 569.71 541.22 622.40 25290 556.49 528.67 607.97 24930 769.61 731.13 840.80 25295 603.46 573.29 659.28 24931 847.02 804.67 925.37 25300 700.46 665.44 765.26 24935 1,027.09 975.74 1,122.10 25301 666.51 633.18 728.16 25000 363.53 345.35 397.15 25310 699.11 664.15 763.77 25001 339.84 322.85 371.28 25312 804.40 764.18 878.81 25020 599.66 569.68 655.13 25315 860.56 817.53 940.16 25023 1,131.87 1,075.28 1,236.57 25316 990.19 940.68 1,081.78 25024 781.29 742.23 853.56 25320 988.06 938.66 1,079.46 25025 1,192.30 1,132.69 1,302.59 25332 864.41 821.19 944.37 25028 534.24 507.53 583.66 25335 981.21 932.15 1,071.97 25031 389.93 370.43 425.99 25337 908.48 863.06 992.52 25035 671.13 637.57 733.21 25350 767.04 728.69 837.99 25040 586.06 556.76 640.27 25355 858.93 815.98 938.38 25065 263.58 250.40 287.96 25360 745.23 707.97 814.17 # 25065 169.53 161.05 185.21 25365 1,003.26 953.10 1,096.07 25066 390.68 371.15 426.82 25370 1,093.66 1,038.98 1,194.83 25075 340.76 323.72 372.28 25375 1,055.65 1,002.87 1,153.30 25076 461.86 438.77 504.59 25390 863.23 820.07 943.08 25077 767.86 729.47 838.89 25391 1,089.74 1,035.25 1,190.54 25085 476.64 452.81 520.73 25392 1,105.76 1,050.47 1,208.04 25100 355.71 337.92 388.61 25393 1,239.34 1,177.37 1,353.98 25101 418.21 397.30 456.90 25394 793.76 754.07 867.18 25105 506.83 481.49 553.71 25400 904.61 859.38 988.29 25107 629.23 597.77 687.44 25405 1,143.15 1,085.99 1,248.89 25109 532.95 506.30 582.25 25415 1,077.35 1,023.48 1,177.00 25110 374.51 355.78 409.15 25420 1,275.93 1,212.13 1,393.95 25111 324.79 308.55 354.83 25425 1,114.27 1,058.56 1,217.34 25112 393.21 373.55 429.58 25426 1,143.98 1,086.78 1,249.80 25115 829.65 788.17 906.40 25430 726.34 690.02 793.52 25116 676.97 643.12 739.59 25431 801.27 761.21 875.39 25118 396.03 376.23 432.66 25440 798.61 758.68 872.48 25119 521.97 495.87 570.25 25441 963.94 915.74 1,053.10 25120 578.84 549.90 632.39 25442 824.48 783.26 900.75 25125 670.26 636.75 732.26 25443 791.36 751.79 864.56 25126 676.32 642.50 738.88 25444 842.71 800.57 920.66 25130 463.47 440.30 506.35 25445 738.78 701.84 807.12 25135 575.56 546.78 628.80 25446 1,206.19 1,145.88 1,317.76 25136 509.66 484.18 556.81 25447 834.88 793.14 912.11 25145 593.33 563.66 648.21 25449 1,058.83 1,005.89 1,156.77 25150 595.96 566.16 651.08 25450 621.30 590.24 678.78 25151 664.53 631.30 726.00 25455 704.76 669.52 769.95 25170 916.43 870.61 1,001.20 25490 785.78 746.49 858.46 25210 506.18 480.87 553.00 25491 830.26 788.75 907.06 25215 649.38 616.91 709.45 25492 995.56 945.78 1,087.65 25230 448.67 426.24 490.18 25500 259.71 246.72 283.73 25240 456.31 433.49 498.51 # 25500 234.57 222.84 256.27 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 15 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 25505 502.73 477.59 549.23 25920 702.56 667.43 767.54 # 25505 460.82 437.78 503.45 25922 593.79 564.10 648.72 25515 684.35 650.13 747.65 25924 686.12 651.81 749.58 25520 549.45 521.98 600.28 25927 810.14 769.63 885.07 # 25520 521.05 495.00 569.25 25929 569.92 541.42 622.63 25525 827.22 785.86 903.74 25931 740.86 703.82 809.39 25526 1,014.67 963.94 1,108.53 26010 267.73 254.34 292.49 25530 254.46 241.74 278.00 # 26010 135.03 128.28 147.52 # 25530 226.52 215.19 247.47 26011 410.06 389.56 447.99 25535 486.45 462.13 531.45 # 26011 187.96 178.56 205.34 # 25535 452.92 430.27 494.81 26020 435.05 413.30 475.30 25545 643.33 611.16 702.83 26025 423.58 402.40 462.76 25560 263.53 250.35 287.90 26030 497.95 473.05 544.01 # 25560 233.26 221.60 254.84 26034 541.54 514.46 591.63 25565 524.83 498.59 573.38 26035 833.89 792.20 911.03 # 25565 476.40 452.58 520.47 26037 578.33 549.41 631.82 25574 672.94 639.29 735.18 26040 313.72 298.03 342.73 25575 911.75 866.16 996.08 26045 473.53 449.85 517.33 25600 287.41 273.04 314.00 26055 601.84 571.75 657.51 # 25600 257.14 244.28 280.92 # 26055 303.38 288.21 331.44 25605 614.02 583.32 670.82 26060 269.03 255.58 293.92 # 25605 577.70 548.82 631.14 26070 301.59 286.51 329.49 25606 678.96 645.01 741.76 26075 320.64 304.61 350.30 25607 727.64 691.26 794.95 26080 389.53 370.05 425.56 25608 827.17 785.81 903.68 26100 326.71 310.37 356.93 25609 1,053.37 1,000.70 1,150.81 26105 334.69 317.96 365.65 25622 295.61 280.83 322.95 26110 321.70 305.62 351.46 # 25622 263.48 250.31 287.86 26115 653.90 621.21 714.39 25624 463.86 440.67 506.77 # 26115 366.15 347.84 400.02 # 25624 420.09 399.09 458.95 26116 489.30 464.84 534.57 25628 729.66 693.18 797.16 26117 658.21 625.30 719.10 25630 300.77 285.73 328.59 26121 608.01 577.61 664.25 # 25630 269.11 255.65 294.00 26123 830.62 789.09 907.45 25635 437.72 415.83 478.20 26125 288.72 274.28 315.42 # 25635 386.50 367.18 422.26 26130 463.02 439.87 505.85 25645 577.21 548.35 630.60 26135 560.54 532.51 612.39 25650 313.04 297.39 342.00 26140 511.26 485.70 558.56 # 25650 286.04 271.74 312.50 26145 519.13 493.17 567.15 25651 481.74 457.65 526.30 26160 597.75 567.86 653.04 25652 629.93 598.43 688.19 # 26160 328.62 312.19 359.02 25660 401.88 381.79 439.06 26170 410.22 389.71 448.17 25670 621.98 590.88 679.51 26180 448.77 426.33 490.28 25671 529.37 502.90 578.34 26185 536.24 509.43 585.84 25675 428.04 406.64 467.64 26200 458.75 435.81 501.18 # 25675 391.26 371.70 427.46 26205 612.90 582.26 669.60 25676 645.11 612.85 704.78 26210 446.54 424.21 487.84 25680 458.99 436.04 501.45 26215 562.32 534.20 614.33 25685 745.62 708.34 814.59 26230 511.85 486.26 559.20 25690 469.27 445.81 512.68 26235 503.14 477.98 549.68 25695 645.18 612.92 704.86 26236 447.44 425.07 488.83 25800 763.14 724.98 833.73 26250 592.21 562.60 646.99 25805 878.58 834.65 959.85 26255 888.98 844.53 971.21 25810 886.99 842.64 969.04 26260 554.96 527.21 606.29 25820 630.26 598.75 688.56 26261 683.13 648.97 746.32 25825 774.25 735.54 845.87 26262 465.15 441.89 508.17 25830 980.96 931.91 1,071.70 26320 349.84 332.35 382.20 25900 772.44 733.82 843.89 26340 324.49 308.27 354.51 25905 761.97 723.87 832.45 26350 751.91 714.31 821.46 25907 668.70 635.27 730.56 26352 846.31 803.99 924.59 25909 750.35 712.83 819.75 26356 1,105.94 1,050.64 1,208.24 25915 1,298.74 1,233.80 1,418.87 26357 905.24 859.98 988.98 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 16 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 26358 956.64 908.81 1,045.13 26550 1,505.55 1,430.27 1,644.81 26370 807.74 767.35 882.45 26551 3,257.69 3,094.81 3,559.03 26372 930.51 883.98 1,016.58 26553 2,808.95 2,668.50 3,068.78 26373 886.33 842.01 968.31 26554 3,711.15 3,525.59 4,054.43 26390 857.63 814.75 936.96 26555 1,410.63 1,340.10 1,541.12 26392 1,008.19 957.78 1,101.45 26556 2,902.46 2,757.34 3,170.94 26410 599.36 569.39 654.80 26560 594.64 564.91 649.65 26412 720.84 684.80 787.52 26561 931.23 884.67 1,017.37 26415 741.51 704.43 810.09 26562 1,351.10 1,283.55 1,476.08 26416 790.70 751.17 863.85 26565 704.10 668.90 769.24 26418 605.67 575.39 661.70 26567 710.96 675.41 776.72 26420 746.72 709.38 815.79 26568 934.72 887.98 1,021.18 26426 593.75 564.06 648.67 26580 1,415.38 1,344.61 1,546.30 26428 783.99 744.79 856.51 26587 959.23 911.27 1,047.96 26432 524.42 498.20 572.93 26590 1,278.53 1,214.60 1,396.79 26433 560.16 532.15 611.97 26591 463.96 440.76 506.87 26434 665.94 632.64 727.54 26593 624.38 593.16 682.13 26437 650.16 617.65 710.30 26596 749.91 712.41 819.27 26440 661.87 628.78 723.10 26600 275.84 262.05 301.36 26442 984.42 935.20 1,075.48 # 26600 253.03 240.38 276.44 26445 617.87 586.98 675.03 26605 317.43 301.56 346.79 26449 782.93 743.78 855.35 # 26605 287.17 272.81 313.73 26450 420.28 399.27 459.16 26607 443.22 421.06 484.22 26455 417.49 396.62 456.11 26608 484.19 459.98 528.98 26460 406.73 386.39 444.35 26615 556.26 528.45 607.72 26471 640.49 608.47 699.74 26641 358.85 340.91 392.05 26474 616.38 585.56 673.39 # 26641 324.86 308.62 354.91 26476 599.91 569.91 655.40 26645 410.18 389.67 448.12 26477 605.87 575.58 661.92 # 26645 375.26 356.50 409.98 26478 655.75 622.96 716.40 26650 486.71 462.37 531.73 26479 648.49 616.07 708.48 26665 616.65 585.82 673.69 26480 792.10 752.50 865.38 26670 322.76 306.62 352.61 26483 886.96 842.61 969.00 # 26670 287.84 273.45 314.47 26485 852.26 809.65 931.10 26675 438.14 416.23 478.66 26489 908.38 862.96 992.40 # 26675 401.82 381.73 438.99 26490 813.68 773.00 888.95 26676 508.55 483.12 555.59 26492 904.23 859.02 987.87 26685 571.91 543.31 624.81 26494 823.88 782.69 900.09 26686 629.89 598.40 688.16 26496 889.69 845.21 971.99 26700 306.29 290.98 334.63 26497 890.64 846.11 973.03 # 26700 283.01 268.86 309.19 26498 1,177.70 1,118.82 1,286.64 26705 402.58 382.45 439.82 26499 852.66 810.03 931.53 # 26705 366.72 348.38 400.64 26500 652.84 620.20 713.23 26706 437.50 415.63 477.97 26502 732.77 696.13 800.55 26715 557.55 529.67 609.12 26508 655.97 623.17 716.65 26720 191.23 181.67 208.92 26510 625.02 593.77 682.84 # 26720 173.54 164.86 189.59 26516 730.45 693.93 798.02 26725 338.30 321.39 369.60 26517 855.16 812.40 934.26 # 26725 300.59 285.56 328.39 26518 862.42 819.30 942.20 26727 476.40 452.58 520.47 26520 691.24 656.68 755.18 26735 579.64 550.66 633.26 26525 694.03 659.33 758.23 26740 222.55 211.42 243.13 26530 544.01 516.81 594.33 # 26740 207.65 197.27 226.86 26531 632.35 600.73 690.84 26742 368.85 350.41 402.97 26535 405.77 385.48 443.30 # 26742 332.07 315.47 362.79 26536 700.81 665.77 765.64 26746 703.66 668.48 768.75 26540 688.59 654.16 752.28 26750 177.26 168.40 193.66 26541 834.11 792.40 911.26 # 26750 172.14 163.53 188.06 26542 710.79 675.25 776.54 26755 310.53 295.00 339.25 26545 723.24 687.08 790.14 # 26755 266.77 253.43 291.44 26546 1,008.77 958.33 1,102.08 26756 422.09 400.99 461.14 26548 792.31 752.69 865.59 26765 473.71 450.02 517.52 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 17 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 26770 261.06 248.01 285.21 27087 645.31 613.04 705.00 # 26770 236.38 224.56 258.24 27090 853.76 811.07 932.73 26775 377.73 358.84 412.67 27091 1,637.46 1,555.59 1,788.93 # 26775 335.83 319.04 366.90 27093 213.40 202.73 233.14 26776 447.80 425.41 489.22 # 27093 75.11 71.35 82.05 26785 514.76 489.02 562.37 27095 258.35 245.43 282.24 26820 816.64 775.81 892.18 # 27095 85.60 81.32 93.52 26841 761.06 723.01 831.46 27096 193.85 184.16 211.78 26842 821.47 780.40 897.46 # 27096 70.46 66.94 76.98 26843 761.47 723.40 831.91 27097 681.21 647.15 744.22 26844 846.45 804.13 924.75 27098 631.15 599.59 689.53 26850 724.07 687.87 791.05 27100 841.18 799.12 918.99 26852 825.02 783.77 901.34 27105 879.96 835.96 961.35 26860 589.75 560.26 644.30 27110 978.73 929.79 1,069.26 26861 108.80 103.36 118.86 27111 870.03 826.53 950.51 26862 753.89 716.20 823.63 27120 1,321.08 1,255.03 1,443.28 26863 242.68 230.55 265.13 27122 1,135.35 1,078.58 1,240.37 26910 738.47 701.55 806.78 27125 1,154.21 1,096.50 1,260.98 26951 646.88 614.54 706.72 27130 1,484.47 1,410.25 1,621.79 26952 675.12 641.36 737.56 27132 1,732.74 1,646.10 1,893.02 26990 630.96 599.41 689.32 27134 2,004.25 1,904.04 2,189.65 26991 723.68 687.50 790.63 27137 1,531.49 1,454.92 1,673.16 # 26991 529.05 502.60 577.99 27138 1,593.31 1,513.64 1,740.69 26992 983.89 934.70 1,074.91 27140 924.04 877.84 1,009.52 27000 458.23 435.32 500.62 27146 1,295.29 1,230.53 1,415.11 27001 553.76 526.07 604.98 27147 1,508.62 1,433.19 1,648.17 27003 594.14 564.43 649.09 27151 1,560.08 1,482.08 1,704.39 27005 746.97 709.62 816.06 27156 1,755.14 1,667.38 1,917.49 27006 755.64 717.86 825.54 27158 1,411.60 1,341.02 1,542.17 27025 910.54 865.01 994.76 27161 1,256.04 1,193.24 1,372.23 27027 883.30 839.14 965.01 27165 1,401.49 1,331.42 1,531.13 27030 970.14 921.63 1,059.87 27170 1,212.73 1,152.09 1,324.90 27033 1,004.79 954.55 1,097.73 27175 678.35 644.43 741.09 27035 1,110.58 1,055.05 1,213.31 27176 937.58 890.70 1,024.31 27036 1,028.82 977.38 1,123.99 27177 1,141.03 1,083.98 1,246.58 27040 359.15 341.19 392.37 27178 926.73 880.39 1,012.45 # 27040 206.89 196.55 226.03 27179 997.86 947.97 1,090.17 27041 700.07 665.07 764.83 27181 1,108.92 1,053.47 1,211.49 27047 635.36 603.59 694.13 27185 703.45 668.28 768.52 # 27047 522.21 496.10 570.52 27187 1,023.85 972.66 1,118.56 27048 484.59 460.36 529.41 27193 473.28 449.62 517.06 27049 1,012.27 961.66 1,105.91 # 27193 477.94 454.04 522.15 27050 355.33 337.56 388.19 27194 730.13 693.62 797.66 27052 568.23 539.82 620.79 27200 174.90 166.16 191.08 27054 695.88 661.09 760.25 # 27200 179.09 170.14 195.66 27057 977.43 928.56 1,067.84 27202 667.51 634.13 729.25 27060 437.70 415.82 478.19 27220 533.57 506.89 582.92 27062 460.58 437.55 503.18 # 27220 529.38 502.91 578.35 27065 512.68 487.05 560.11 27222 1,002.33 952.21 1,095.04 27066 827.44 786.07 903.98 27226 1,060.59 1,007.56 1,158.69 27067 1,046.15 993.84 1,142.92 27227 1,716.58 1,630.75 1,875.36 27070 868.57 825.14 948.91 27228 1,963.61 1,865.43 2,145.24 27071 932.45 885.83 1,018.70 27230 477.61 453.73 521.79 27075 2,349.86 2,232.37 2,567.23 # 27230 470.62 447.09 514.15 27076 1,632.66 1,551.03 1,783.68 27232 790.36 750.84 863.47 27077 2,716.91 2,581.06 2,968.22 27235 936.39 889.57 1,023.01 27078 1,039.68 987.70 1,135.86 27236 1,220.03 1,159.03 1,332.88 27079 986.09 936.79 1,077.31 27238 460.60 437.57 503.21 27080 501.49 476.42 547.88 27240 977.89 929.00 1,068.35 27086 259.09 246.14 283.06 27244 1,254.48 1,191.76 1,370.52 # 27086 152.00 144.40 166.06 27245 1,304.48 1,239.26 1,425.15 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 18 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 27246 389.97 370.47 426.04 27381 822.56 781.43 898.64 # 27246 390.90 371.36 427.06 27385 649.13 616.67 709.17 27248 773.29 734.63 844.82 27386 853.50 810.83 932.45 27250 238.94 226.99 261.04 27390 450.27 427.76 491.92 27252 771.36 732.79 842.71 27391 584.36 555.14 638.41 27253 972.21 923.60 1,062.14 27392 716.55 680.72 782.83 27254 1,308.23 1,242.82 1,429.24 27393 518.32 492.40 566.26 27256 296.12 281.31 323.51 27394 667.62 634.24 729.38 # 27256 243.97 231.77 266.54 27395 901.33 856.26 984.70 27257 339.56 322.58 370.97 27396 628.65 597.22 686.80 27258 1,137.65 1,080.77 1,242.89 27397 921.20 875.14 1,006.41 27259 1,590.81 1,511.27 1,737.96 27400 698.72 663.78 763.35 27265 397.35 377.48 434.10 27403 657.23 624.37 718.03 27266 592.12 562.51 646.89 27405 692.62 657.99 756.69 27267 423.47 402.30 462.65 27407 786.70 747.37 859.48 27268 521.30 495.24 569.53 27409 988.86 939.42 1,080.33 27269 1,237.09 1,175.24 1,351.53 27412 1,702.40 1,617.28 1,859.87 27275 184.67 175.44 201.76 27415 1,429.64 1,358.16 1,561.88 27280 1,055.68 1,002.90 1,153.34 27416 987.20 937.84 1,078.52 27282 824.16 782.95 900.39 27418 855.47 812.70 934.61 27284 1,578.94 1,499.99 1,724.99 27420 766.88 728.54 837.82 27286 1,684.84 1,600.60 1,840.69 27422 763.81 725.62 834.46 27290 1,602.10 1,522.00 1,750.30 27424 765.86 727.57 836.71 27295 1,294.71 1,229.97 1,414.47 27425 452.17 429.56 493.99 27301 682.22 648.11 745.33 27427 735.78 698.99 803.84 # 27301 503.42 478.25 549.99 27428 1,129.92 1,073.42 1,234.43 27303 653.13 620.47 713.54 27429 1,264.86 1,201.62 1,381.86 27305 477.34 453.47 521.49 27430 758.89 720.95 829.09 27306 388.67 369.24 424.63 27435 815.24 774.48 890.65 27307 476.51 452.68 520.58 27437 675.70 641.92 738.21 27310 743.49 706.32 812.27 27438 861.92 818.82 941.64 27323 278.69 264.76 304.47 27440 785.07 745.82 857.69 # 27323 182.77 173.63 199.67 27441 809.75 769.26 884.65 27324 389.22 369.76 425.22 27442 891.97 847.37 974.48 27325 537.15 510.29 586.83 27443 837.14 795.28 914.57 27326 497.12 472.26 543.10 27445 1,296.29 1,231.48 1,416.20 27327 465.69 442.41 508.77 27446 1,150.69 1,093.16 1,257.13 # 27327 355.80 338.01 388.71 27447 1,590.23 1,510.72 1,737.33 27328 427.74 406.35 467.30 27448 842.04 799.94 919.93 27329 1,052.78 1,000.14 1,150.16 27450 1,048.18 995.77 1,145.14 27330 409.29 388.83 447.15 27454 1,315.96 1,250.16 1,437.68 27331 483.79 459.60 528.54 27455 969.63 921.15 1,059.32 27332 653.90 621.21 714.39 27457 996.23 946.42 1,088.38 27333 593.56 563.88 648.46 27465 1,248.11 1,185.70 1,363.56 27334 694.37 659.65 758.60 27466 1,216.61 1,155.78 1,329.15 27335 784.05 744.85 856.58 27468 1,373.88 1,305.19 1,500.97 27340 373.32 354.65 407.85 27470 1,214.01 1,153.31 1,326.31 27345 490.21 465.70 535.56 27472 1,310.44 1,244.92 1,431.66 27347 524.50 498.28 573.02 27475 672.12 638.51 734.29 27350 664.96 631.71 726.47 27477 751.71 714.12 821.24 27355 616.48 585.66 673.51 27479 965.45 917.18 1,054.76 27356 753.52 715.84 823.22 27485 687.48 653.11 751.08 27357 835.48 793.71 912.77 27486 1,451.74 1,379.15 1,586.02 27358 297.78 282.89 325.32 27487 1,826.75 1,735.41 1,995.72 27360 871.52 827.94 952.13 27488 1,230.92 1,169.37 1,344.78 27365 1,257.09 1,194.24 1,373.38 27495 1,166.44 1,108.12 1,274.34 27370 184.04 174.84 201.07 27496 513.31 487.64 560.79 # 27370 54.59 51.86 59.64 27497 553.06 525.41 604.22 27372 621.51 590.43 678.99 27498 601.61 571.53 657.26 # 27372 412.45 391.83 450.60 27499 668.65 635.22 730.50 27380 607.36 576.99 663.54 27500 521.65 495.57 569.91 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 19 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 27500 481.61 457.53 526.16 27613 261.39 248.32 285.57 27501 510.45 484.93 557.67 # 27613 171.53 162.95 187.39 # 27501 502.54 477.41 549.02 27614 580.76 551.72 634.48 27502 804.51 764.28 878.92 # 27614 421.52 400.44 460.51 27503 821.64 780.56 897.64 27615 899.80 854.81 983.03 27506 1,367.43 1,299.06 1,493.92 27618 505.34 480.07 552.08 27507 1,012.62 961.99 1,106.29 # 27618 392.19 372.58 428.47 27508 528.02 501.62 576.86 27619 803.23 763.07 877.53 # 27508 495.43 470.66 541.26 # 27619 603.02 572.87 658.80 27509 661.43 628.36 722.61 27620 476.71 452.87 520.80 27510 713.37 677.70 779.36 27625 611.77 581.18 668.36 27511 1,048.59 996.16 1,145.58 27626 660.87 627.83 722.00 27513 1,316.03 1,250.23 1,437.76 27630 560.78 532.74 612.65 27514 1,064.25 1,011.04 1,162.70 # 27630 383.84 364.65 419.35 27516 496.50 471.68 542.43 27635 611.82 581.23 668.41 # 27516 465.77 442.48 508.85 27637 774.72 735.98 846.38 27517 688.17 653.76 751.82 27638 804.54 764.31 878.96 27519 962.64 914.51 1,051.69 27640 891.33 846.76 973.77 27520 317.72 301.83 347.10 27641 714.23 678.52 780.30 # 27520 285.12 270.86 311.49 27645 1,079.89 1,025.90 1,179.79 27524 774.58 735.85 846.23 27646 953.97 906.27 1,042.21 27530 396.19 376.38 432.84 27647 833.17 791.51 910.24 # 27530 366.40 348.08 400.29 27648 177.05 168.20 193.43 27532 623.83 592.64 681.54 # 27648 54.13 51.42 59.13 # 27532 587.04 557.69 641.34 27650 699.10 664.15 763.77 27535 937.13 890.27 1,023.81 27652 763.08 724.93 833.67 27536 1,219.59 1,158.61 1,332.40 27654 745.95 708.65 814.95 27538 472.26 448.65 515.95 27656 566.69 538.36 619.11 # 27538 440.13 418.12 480.84 # 27656 362.29 344.18 395.81 27540 856.95 814.10 936.22 27658 397.49 377.62 434.26 27550 494.24 469.53 539.96 27659 518.54 492.61 566.50 # 27550 456.99 434.14 499.26 27664 380.32 361.30 415.50 27552 634.79 603.05 693.51 27665 434.36 412.64 474.54 27556 946.86 899.52 1,034.45 27675 527.43 501.06 576.22 27557 1,129.83 1,073.34 1,234.34 27676 641.78 609.69 701.14 27558 1,263.46 1,200.29 1,380.33 27680 449.57 427.09 491.15 27560 365.94 347.64 399.79 27681 535.10 508.35 584.60 # 27560 328.69 312.26 359.10 27685 657.49 624.62 718.31 27562 469.21 445.75 512.61 # 27685 494.52 469.79 540.26 27566 918.92 872.97 1,003.92 27686 583.58 554.40 637.56 27570 151.81 144.22 165.85 27687 480.21 456.20 524.63 27580 1,485.73 1,411.44 1,623.16 27690 658.79 625.85 719.73 27590 837.95 796.05 915.46 27691 774.99 736.24 846.68 27591 937.14 890.28 1,023.82 27692 115.00 109.25 125.64 27592 715.38 679.61 781.55 27695 512.46 486.84 559.87 27594 523.75 497.56 572.19 27696 606.26 575.95 662.34 27596 751.34 713.77 820.84 27698 680.92 646.87 743.90 27598 765.84 727.55 836.68 27700 638.98 607.03 698.08 27600 435.05 413.30 475.30 27702 1,029.04 977.59 1,124.23 27601 453.42 430.75 495.36 27703 1,188.35 1,128.93 1,298.27 27602 529.24 502.78 578.20 27704 586.72 557.38 640.99 27603 542.39 515.27 592.56 27705 791.62 752.04 864.85 # 27603 396.65 376.82 433.34 27707 409.84 389.35 447.75 27604 475.54 451.76 519.52 27709 1,143.32 1,086.15 1,249.07 # 27604 349.36 331.89 381.67 27712 1,125.75 1,069.46 1,229.88 27605 386.28 366.97 422.02 27715 1,098.50 1,043.58 1,200.12 # 27605 207.49 197.12 226.69 27720 906.71 861.37 990.58 27606 305.73 290.44 334.01 27722 903.34 858.17 986.90 27607 630.37 598.85 688.68 27724 1,320.20 1,254.19 1,442.32 27610 673.75 640.06 736.07 27725 1,235.25 1,173.49 1,349.51 27612 586.83 557.49 641.11 27726 932.84 886.20 1,019.13 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 20 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 27727 994.69 944.96 1,086.70 27870 1,080.97 1,026.92 1,180.96 27730 607.33 576.96 663.50 27871 715.16 679.40 781.31 27732 411.88 391.29 449.98 27880 939.09 892.14 1,025.96 27734 610.86 580.32 667.37 27881 917.94 872.04 1,002.85 27740 679.47 645.50 742.33 27882 644.46 612.24 704.08 27742 710.37 674.85 776.08 27884 602.44 572.32 658.17 27745 778.84 739.90 850.89 27886 686.95 652.60 750.49 27750 342.41 325.29 374.08 27888 728.58 692.15 795.97 # 27750 311.68 296.10 340.52 27889 704.41 669.19 769.57 27752 543.36 516.19 593.62 27892 559.39 531.42 611.13 # 27752 503.32 478.15 549.87 27893 567.69 539.31 620.21 27756 583.18 554.02 637.12 27894 867.26 823.90 947.49 27758 913.12 867.46 997.58 28001 281.57 267.49 307.61 27759 1,032.29 980.68 1,127.78 # 28001 189.38 179.91 206.90 27760 330.45 313.93 361.02 28002 518.61 492.68 566.58 # 27760 297.39 282.52 324.90 # 28002 399.87 379.88 436.86 27762 488.03 463.63 533.17 28003 704.32 669.10 769.47 # 27762 447.52 425.14 488.91 # 28003 584.19 554.98 638.23 27766 628.75 597.31 686.91 28005 641.12 609.06 700.42 27767 262.15 249.04 286.40 28008 442.99 420.84 483.97 # 27767 263.55 250.37 287.93 # 28008 321.93 305.83 351.70 27768 412.67 392.04 450.85 28010 242.43 230.31 264.86 27769 706.28 670.97 771.62 # 28010 225.20 213.94 246.03 27780 296.16 281.35 323.55 28011 342.18 325.07 373.83 # 27780 265.90 252.61 290.50 # 28011 316.10 300.30 345.35 27781 423.94 402.74 463.15 28020 528.44 502.02 577.32 # 27781 392.74 373.10 429.07 # 28020 379.91 360.91 415.05 27784 707.64 672.26 773.10 28022 487.46 463.09 532.55 27786 313.44 297.77 342.44 # 28022 351.50 333.93 384.02 # 27786 279.45 265.48 305.30 28024 463.95 440.75 506.86 27788 427.47 406.10 467.02 # 28024 333.58 316.90 364.44 # 27788 391.15 371.59 427.33 28035 531.32 504.75 580.46 27792 715.80 680.01 782.01 # 28035 383.26 364.10 418.72 27808 329.27 312.81 359.73 28043 352.74 335.10 385.37 # 27808 292.95 278.30 320.05 # 28043 276.38 262.56 301.94 27810 477.72 453.83 521.90 28045 497.04 472.19 543.02 # 27810 436.28 414.47 476.64 # 28045 348.97 331.52 381.25 27814 799.84 759.85 873.83 28046 886.25 841.94 968.23 27816 309.81 294.32 338.47 # 28046 705.59 670.31 770.86 # 27816 276.29 262.48 301.85 28050 468.99 445.54 512.37 27818 490.52 465.99 535.89 # 28050 331.63 315.05 362.31 # 27818 443.50 421.33 484.53 28052 432.37 410.75 472.36 27822 880.38 836.36 961.81 # 28052 301.07 286.02 328.92 27823 998.91 948.96 1,091.30 28054 408.53 388.10 446.32 27824 309.03 293.58 337.62 # 28054 275.83 262.04 301.35 # 27824 296.45 281.63 323.87 28055 414.85 394.11 453.23 27825 556.15 528.34 607.59 28060 521.53 495.45 569.77 # 27825 506.79 481.45 553.67 # 28060 383.70 364.52 419.20 27826 842.48 800.36 920.41 28062 610.23 579.72 666.68 27827 1,122.10 1,066.00 1,225.90 # 28062 446.33 424.01 487.61 27828 1,334.71 1,267.97 1,458.17 28070 518.09 492.19 566.02 27829 674.63 640.90 737.04 # 28070 375.61 356.83 410.35 27830 357.98 340.08 391.09 28072 515.11 489.35 562.75 # 27830 333.30 316.64 364.14 # 28072 367.04 348.69 400.99 27831 386.67 367.34 422.44 28080 504.94 479.69 551.64 27832 719.29 683.33 785.83 # 28080 371.77 353.18 406.16 27840 353.34 335.67 386.02 28086 554.07 526.37 605.33 27842 495.19 470.43 540.99 # 28086 383.18 364.02 418.62 27846 761.76 723.67 832.22 28088 472.12 448.51 515.79 27848 861.77 818.68 941.48 # 28088 320.32 304.30 349.95 27860 184.94 175.69 202.04 28090 471.86 448.27 515.51 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 21 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 28090 331.71 315.12 362.39 # 28202 472.89 449.25 516.64 28092 429.35 407.88 469.06 28208 464.98 441.73 507.99 # 28092 293.39 278.72 320.53 # 28208 329.02 312.57 359.46 28100 608.77 578.33 665.08 28210 591.27 561.71 645.97 # 28100 431.37 409.80 471.27 # 28210 442.73 420.59 483.68 28102 588.62 559.19 643.07 28220 457.14 434.28 499.42 28103 472.94 449.29 516.68 # 28220 330.96 314.41 361.57 28104 519.87 493.88 567.96 28222 524.64 498.41 573.17 # 28104 375.99 357.19 410.77 # 28222 391.94 372.34 428.19 28106 496.67 471.84 542.62 28225 400.03 380.03 437.03 28107 578.18 549.27 631.66 # 28225 275.24 261.48 300.70 # 28107 410.55 390.02 448.52 28226 479.30 455.34 523.64 28108 439.04 417.09 479.65 # 28226 343.80 326.61 375.60 # 28108 311.00 295.45 339.77 28230 440.33 418.31 481.06 28110 463.82 440.63 506.72 # 28230 315.55 299.77 344.74 # 28110 311.10 295.55 339.88 28232 394.11 374.40 430.56 28111 524.27 498.06 572.77 # 28232 270.26 256.75 295.26 # 28111 361.30 343.24 394.73 28234 409.95 389.45 447.87 28112 498.66 473.73 544.79 # 28234 284.69 270.46 311.03 # 28112 339.89 322.90 371.34 28238 692.57 657.94 756.63 28113 592.25 562.64 647.04 # 28238 530.54 504.01 579.61 # 28113 445.11 422.85 486.28 28240 453.06 430.41 494.97 28114 1,066.93 1,013.58 1,165.62 # 28240 323.62 307.44 353.56 # 28114 857.87 814.98 937.23 28250 572.42 543.80 625.37 28116 756.41 718.59 826.38 # 28250 428.08 406.68 467.68 # 28116 601.82 571.73 657.49 28260 691.67 657.09 755.65 28118 594.85 565.11 649.88 # 28260 548.73 521.29 599.48 # 28118 439.80 417.81 480.48 28261 991.73 942.14 1,083.46 28119 529.33 502.86 578.29 # 28261 830.16 788.65 906.95 # 28119 387.78 368.39 423.65 28262 1,395.30 1,325.54 1,524.37 28120 591.39 561.82 646.09 # 28262 1,172.74 1,114.10 1,281.22 # 28120 419.57 398.59 458.38 28264 896.52 851.69 979.44 28122 677.74 643.85 740.43 # 28264 739.14 702.18 807.51 # 28122 535.26 508.50 584.78 28270 489.31 464.84 534.57 28124 485.86 461.57 530.81 # 28270 358.93 340.98 392.13 # 28124 359.21 341.25 392.44 28272 401.03 380.98 438.13 28126 396.42 376.60 433.09 # 28272 279.04 265.09 304.85 # 28126 271.17 257.61 296.25 28280 537.26 510.40 586.96 28130 666.22 632.91 727.85 # 28280 390.12 370.61 426.20 28140 638.73 606.79 697.81 28285 474.26 450.55 518.13 # 28140 485.54 461.26 530.45 # 28285 344.35 327.13 376.20 28150 440.17 418.16 480.88 28286 462.91 439.76 505.72 # 28150 308.87 293.43 337.44 # 28286 329.27 312.81 359.73 28153 411.85 391.26 449.95 28288 594.39 564.67 649.37 # 28153 281.48 267.41 307.52 # 28288 451.44 428.87 493.20 28160 422.82 401.68 461.93 28289 743.49 706.32 812.27 # 28160 294.31 279.59 321.53 # 28289 580.99 551.94 634.73 28171 645.26 613.00 704.95 28290 585.49 556.22 639.65 28173 754.59 716.86 824.39 # 28290 426.71 405.37 466.18 # 28173 588.36 558.94 642.78 28292 789.64 750.16 862.68 28175 558.27 530.36 609.91 # 28292 626.21 594.90 684.14 # 28175 417.19 396.33 455.78 28293 1,059.10 1,006.15 1,157.07 28190 255.55 242.77 279.19 # 28293 752.26 714.65 821.85 # 28190 142.87 135.73 156.09 28294 760.53 722.50 830.88 28192 481.88 457.79 526.46 # 28294 571.49 542.92 624.36 # 28192 342.66 325.53 374.36 28296 748.63 711.20 817.88 28193 548.82 521.38 599.59 # 28296 572.16 543.55 625.08 # 28193 405.41 385.14 442.91 28297 844.72 802.48 922.85 28200 482.26 458.15 526.87 # 28297 641.24 609.18 700.56 # 28200 342.11 325.00 373.75 28298 729.90 693.41 797.42 28202 633.52 601.84 692.12 # 28298 545.51 518.23 595.96 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 22 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 28299 927.01 880.66 1,012.76 # 28490 121.79 115.70 133.06 # 28299 732.85 696.21 800.64 28495 175.52 166.74 191.75 28300 696.15 661.34 760.54 # 28495 154.10 146.40 168.36 28302 689.03 654.58 752.77 28496 441.31 419.24 482.13 28304 806.74 766.40 881.36 # 28496 236.91 225.06 258.82 # 28304 628.88 597.44 687.06 28505 671.14 637.58 733.22 28305 724.24 688.03 791.23 # 28505 499.80 474.81 546.03 28306 614.98 584.23 671.86 28510 120.39 114.37 131.53 # 28306 429.66 408.18 469.41 # 28510 118.06 112.16 128.98 28307 730.83 694.29 798.43 28515 158.41 150.49 173.06 # 28307 487.31 462.94 532.38 # 28515 144.91 137.66 158.31 28308 557.18 529.32 608.72 28525 571.40 542.83 624.25 # 28308 394.68 374.95 431.19 # 28525 400.52 380.49 437.56 28309 929.85 883.36 1,015.86 28530 116.11 110.30 126.85 28310 546.74 519.40 597.31 # 28530 106.80 101.46 116.68 # 28310 382.37 363.25 417.74 28531 386.08 366.78 421.80 28312 504.70 479.47 551.39 # 28531 200.30 190.29 218.83 # 28312 343.59 326.41 375.37 28540 204.30 194.09 223.20 28313 527.79 501.40 576.61 # 28540 189.87 180.38 207.44 # 28313 395.55 375.77 432.14 28545 251.88 239.29 275.18 28315 482.21 458.10 526.82 # 28545 230.46 218.94 251.78 # 28315 349.05 331.60 381.34 28546 489.46 464.99 534.74 28320 656.94 624.09 717.70 # 28546 312.06 296.46 340.93 28322 789.92 750.42 862.98 28555 877.21 833.35 958.35 # 28322 607.86 577.47 664.09 # 28555 673.73 640.04 736.05 28340 626.65 595.32 684.62 28570 177.45 168.58 193.87 # 28340 469.74 446.25 513.19 # 28570 158.36 150.44 173.01 28341 717.17 681.31 783.51 28575 338.29 321.38 369.59 # 28341 553.27 525.61 604.45 # 28575 314.55 298.82 343.64 28344 492.03 467.43 537.54 28576 364.08 345.88 397.76 # 28344 336.04 319.24 367.13 28585 927.68 881.30 1,013.50 28345 585.74 556.45 639.92 # 28585 754.94 717.19 824.77 # 28345 435.35 413.58 475.62 28600 215.40 204.63 235.32 28360 1,006.58 956.25 1,099.69 # 28600 192.12 182.51 209.89 28400 249.88 237.39 273.00 28605 275.76 261.97 301.27 # 28400 228.00 216.60 249.09 # 28605 256.21 243.40 279.91 28405 398.22 378.31 435.06 28606 402.60 382.47 439.84 # 28405 370.74 352.20 405.03 28615 803.03 762.88 877.31 28406 545.70 518.42 596.18 28630 150.36 142.84 164.27 28415 1,182.26 1,123.15 1,291.62 # 28630 112.65 107.02 123.07 28420 1,240.13 1,178.12 1,354.84 28635 180.76 171.72 197.48 28430 233.24 221.58 254.82 # 28635 143.05 135.90 156.29 # 28430 205.76 195.47 224.79 28636 301.83 286.74 329.75 28435 325.25 308.99 355.34 # 28636 212.90 202.26 232.60 # 28435 299.18 284.22 326.85 28645 631.38 599.81 689.78 28436 441.37 419.30 482.20 # 28645 486.10 461.80 531.07 28445 1,110.09 1,054.59 1,212.78 28660 109.57 104.09 119.70 28446 1,212.86 1,152.22 1,325.05 # 28660 86.76 82.42 94.78 28450 216.05 205.25 236.04 28665 158.78 150.84 173.47 # 28450 191.83 182.24 209.58 # 28665 142.02 134.92 155.16 28455 295.72 280.93 323.07 28666 203.69 193.51 222.54 # 28455 274.30 260.59 299.68 28675 586.13 556.82 640.34 28456 286.46 272.14 312.96 # 28675 411.99 391.39 450.10 28465 634.53 602.80 693.22 28705 1,359.86 1,291.87 1,485.65 28470 215.29 204.53 235.21 28715 1,011.88 961.29 1,105.48 # 28470 192.47 182.85 210.28 28725 831.48 789.91 908.40 28475 269.02 255.57 293.91 28730 873.69 830.01 954.51 # 28475 246.67 234.34 269.49 28735 832.00 790.40 908.96 28476 354.21 336.50 386.98 28737 736.24 699.43 804.34 28485 549.61 522.13 600.45 28740 871.05 827.50 951.63 28490 140.41 133.39 153.40 # 28740 655.93 623.13 716.60 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 23 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 28750 853.02 810.37 931.93 29240 60.60 57.57 66.21 # 28750 627.19 595.83 685.20 # 29240 45.70 43.42 49.93 28755 516.03 490.23 563.76 29260 52.99 50.34 57.89 # 28755 356.32 338.50 389.28 # 29260 38.09 36.19 41.62 28760 797.00 757.15 870.72 29280 51.42 48.85 56.18 # 28760 611.69 581.11 668.28 # 29280 36.05 34.25 39.39 28800 595.77 565.98 650.88 29305 240.97 228.92 263.26 28805 773.92 735.22 845.50 # 29305 162.74 154.60 177.79 28810 460.30 437.29 502.88 29325 267.54 254.16 292.28 28820 547.97 520.57 598.66 # 29325 183.73 174.54 200.72 # 28820 365.91 347.61 399.75 29345 137.26 130.40 149.96 28825 588.95 559.50 643.43 # 29345 104.67 99.44 114.36 # 28825 414.81 394.07 453.18 29355 141.24 134.18 154.31 28890 359.03 341.08 392.24 # 29355 110.97 105.42 121.23 # 28890 236.57 224.74 258.45 29358 155.88 148.09 170.30 29000 280.12 266.11 306.03 # 29358 106.52 101.19 116.37 # 29000 176.75 167.91 193.10 29365 123.80 117.61 135.25 29010 255.08 242.33 278.68 # 29365 91.21 86.65 99.65 # 29010 162.89 154.75 177.96 29405 91.18 86.62 99.61 29015 244.29 232.08 266.89 # 29405 66.97 63.62 73.16 # 29015 164.67 156.44 179.91 29425 97.96 93.06 107.02 29020 235.49 223.72 257.28 # 29425 73.28 69.62 80.06 # 29020 148.42 141.00 162.15 29435 120.54 114.51 131.69 29025 266.95 253.60 291.64 # 29435 88.88 84.44 97.11 # 29025 182.21 173.10 199.07 29440 53.62 50.94 58.58 29035 251.74 239.15 275.02 # 29440 35.46 33.69 38.74 # 29035 145.58 138.30 159.05 29445 148.46 141.04 162.20 29040 238.05 226.15 260.07 # 29445 115.87 110.08 126.59 # 29040 160.29 152.28 175.12 29450 154.94 147.19 169.27 29044 270.85 257.31 295.91 # 29450 127.94 121.54 139.77 # 29044 168.88 160.44 184.51 29505 78.10 74.20 85.33 29046 294.71 279.97 321.97 # 29505 48.76 46.32 53.27 # 29046 193.67 183.99 211.59 29515 72.41 68.79 79.11 29049 87.83 83.44 95.96 # 29515 50.99 48.44 55.71 # 29049 62.22 59.11 67.98 29520 51.60 49.02 56.37 29055 213.55 202.87 233.30 # 29520 38.10 36.20 41.63 # 29055 139.05 132.10 151.92 29530 53.73 51.04 58.70 29058 111.97 106.37 122.33 # 29530 38.83 36.89 42.42 # 29058 84.03 79.83 91.80 29540 43.86 41.67 47.92 29065 96.49 91.67 105.42 # 29540 34.55 32.82 37.74 # 29065 69.95 66.45 76.42 29550 42.84 40.70 46.81 29075 89.90 85.41 98.22 # 29550 32.60 30.97 35.62 # 29075 63.36 60.19 69.22 29580 54.47 51.75 59.51 29085 95.28 90.52 104.10 # 29580 38.17 36.26 41.70 # 29085 67.81 64.42 74.08 29590 56.76 53.92 62.01 29086 73.36 69.69 80.14 # 29590 43.26 41.10 47.27 # 29086 50.08 47.58 54.72 29700 66.66 63.33 72.83 29105 87.74 83.35 95.85 # 29700 35.93 34.13 39.25 # 29105 60.27 57.26 65.85 29705 68.57 65.14 74.91 29125 68.99 65.54 75.37 # 29705 49.48 47.01 54.06 # 29125 43.38 41.21 47.39 29710 119.96 113.96 131.05 29126 78.46 74.54 85.72 # 29710 84.58 80.35 92.40 # 29126 52.86 50.22 57.75 29715 92.31 87.69 100.84 29130 40.70 38.67 44.47 # 29715 57.85 54.96 63.20 # 29130 29.06 27.61 31.75 29720 82.56 78.43 90.19 29131 51.04 48.49 55.76 # 29720 45.77 43.48 50.00 # 29131 32.88 31.24 35.93 29730 66.53 63.20 72.68 29200 54.09 51.39 59.10 # 29730 47.44 45.07 51.83 # 29200 41.06 39.01 44.86 29740 94.95 90.20 103.73 29220 56.05 53.25 61.24 # 29740 68.88 65.44 75.26 # 29220 43.01 40.86 46.99 29750 103.30 98.14 112.86 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 24 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 29750 79.09 75.14 86.41 # 29893 448.34 425.92 489.81 29800 532.67 506.04 581.95 29894 533.93 507.23 583.31 29804 657.41 624.54 718.22 29895 516.29 490.48 564.05 29805 483.23 459.07 527.93 29897 542.22 515.11 592.38 29806 1,093.53 1,038.85 1,194.68 29898 603.30 573.14 659.11 29807 1,065.97 1,012.67 1,164.57 29899 1,083.47 1,029.30 1,183.70 29819 603.56 573.38 659.39 29900 470.34 446.82 513.84 29820 556.74 528.90 608.24 29901 513.97 488.27 561.51 29821 608.01 577.61 664.25 29902 548.41 520.99 599.14 29822 591.22 561.66 645.91 29904 633.00 601.35 691.55 29823 646.38 614.06 706.17 29905 682.82 648.68 745.98 29824 688.67 654.24 752.38 29906 719.42 683.45 785.97 29825 602.63 572.50 658.38 29907 877.18 833.32 958.32 29826 689.15 654.69 752.89 30000 245.23 232.97 267.92 29827 1,119.66 1,063.68 1,223.23 # 30000 121.38 115.31 132.61 29828 936.17 889.36 1,022.76 30020 236.85 225.01 258.76 29830 465.56 442.28 508.62 # 30020 122.31 116.19 133.62 29834 507.27 481.91 554.20 30100 148.56 141.13 162.30 29835 520.26 494.25 568.39 # 30100 73.13 69.47 79.89 29836 597.28 567.42 652.53 30110 237.84 225.95 259.84 29837 544.77 517.53 595.16 # 30110 134.94 128.19 147.42 29838 608.68 578.25 664.99 30115 449.96 427.46 491.58 29840 457.83 434.94 500.18 30117 901.65 856.57 985.06 29843 491.44 466.87 536.90 # 30117 350.82 333.28 383.27 29844 509.04 483.59 556.13 30118 794.38 754.66 867.86 29845 579.58 550.60 633.19 30120 540.59 513.56 590.59 29846 535.15 508.39 584.65 # 30120 466.09 442.79 509.21 29847 555.12 527.36 606.46 30124 281.27 267.21 307.29 29848 508.58 483.15 555.62 30125 639.28 607.32 698.42 29850 582.01 552.91 635.85 30130 396.77 376.93 433.47 29851 962.26 914.15 1,051.27 30140 457.28 434.42 499.58 29855 809.42 768.95 884.29 30150 818.77 777.83 894.50 29856 1,030.64 979.11 1,125.98 30160 819.29 778.33 895.08 29860 665.78 632.49 727.36 30200 118.60 112.67 129.57 29861 737.15 700.29 805.33 # 30200 62.73 59.59 68.53 29862 825.19 783.93 901.52 30210 155.05 147.30 169.40 29863 815.95 775.15 891.42 # 30210 103.37 98.20 112.93 29866 1,073.80 1,020.11 1,173.13 30220 311.24 295.68 340.03 29867 1,295.89 1,231.10 1,415.77 # 30220 129.65 123.17 141.65 29868 1,726.00 1,639.70 1,885.66 30300 243.16 231.00 265.65 29870 419.80 398.81 458.63 # 30300 128.61 122.18 140.51 29871 525.93 499.63 574.57 30310 215.25 204.49 235.16 29873 530.32 503.80 579.37 30320 472.85 449.21 516.59 29874 550.18 522.67 601.07 30400 1,088.08 1,033.68 1,188.73 29875 509.12 483.66 556.21 30410 1,277.94 1,214.04 1,396.15 29876 665.89 632.60 727.49 30420 1,425.31 1,354.04 1,557.15 29877 631.08 599.53 689.46 30430 964.31 916.09 1,053.50 29879 674.15 640.44 736.51 30435 1,253.70 1,191.02 1,369.67 29880 703.20 668.04 768.25 30450 1,636.78 1,554.94 1,788.18 29881 656.33 623.51 717.04 30460 783.70 744.52 856.20 29882 709.13 673.67 774.72 30462 1,579.38 1,500.41 1,725.47 29883 864.93 821.68 944.93 30465 1,013.25 962.59 1,106.98 29884 629.13 597.67 687.32 30520 626.35 595.03 684.28 29885 761.73 723.64 832.19 30540 697.10 662.25 761.59 29886 643.34 611.17 702.85 30545 1,003.79 953.60 1,096.64 29887 757.27 719.41 827.32 30560 287.73 273.34 314.34 29888 1,021.22 970.16 1,115.68 # 30560 145.71 138.42 159.18 29889 1,249.29 1,186.83 1,364.85 30580 654.42 621.70 714.96 29891 713.83 678.14 779.86 # 30580 512.87 487.23 560.31 29892 725.94 689.64 793.09 30600 604.02 573.82 659.89 29893 614.57 583.84 671.42 # 30600 454.56 431.83 496.60 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 25 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 30620 647.75 615.36 707.66 31290 1,196.37 1,136.55 1,307.03 30630 647.86 615.47 707.79 31291 1,260.57 1,197.54 1,377.17 30801 241.56 229.48 263.90 31292 1,037.47 985.60 1,133.44 # 30801 140.52 133.49 153.51 31293 1,128.87 1,072.43 1,233.29 30802 306.32 291.00 334.65 31294 1,293.30 1,228.64 1,412.94 # 30802 195.96 186.16 214.08 31300 1,308.58 1,243.15 1,429.62 30901 108.00 102.60 117.99 31320 689.66 655.18 753.46 # 30901 62.84 59.70 68.66 31360 2,048.06 1,945.66 2,237.51 30903 204.61 194.38 223.54 31365 2,548.55 2,421.12 2,784.29 # 30903 82.15 78.04 89.75 31367 2,229.12 2,117.66 2,435.31 30905 254.27 241.56 277.79 31368 2,489.12 2,364.66 2,719.36 # 30905 105.73 100.44 115.51 31370 2,108.30 2,002.89 2,303.32 30906 290.60 276.07 317.48 31375 1,994.38 1,894.66 2,178.86 # 30906 139.27 132.31 152.16 31380 1,966.39 1,868.07 2,148.28 30915 595.04 565.29 650.08 31382 2,148.61 2,041.18 2,347.36 30920 852.78 810.14 931.66 31390 2,846.22 2,703.91 3,109.50 30930 127.17 120.81 138.93 31395 3,031.82 2,880.23 3,312.26 31000 189.78 180.29 207.33 31400 1,050.50 997.98 1,147.68 # 31000 109.23 103.77 119.34 31420 864.37 821.15 944.32 31002 211.72 201.13 231.30 31500 112.58 106.95 122.99 31020 515.67 489.89 563.37 31502 36.68 34.85 40.08 # 31020 372.25 353.64 406.69 31505 90.13 85.62 98.46 31030 735.57 698.79 803.61 # 31505 51.95 49.35 56.75 # 31030 543.26 516.10 593.52 31510 226.53 215.20 247.48 31032 592.63 563.00 647.45 # 31510 126.88 120.54 138.62 31040 771.27 732.71 842.62 31511 224.62 213.39 245.40 31050 515.55 489.77 563.24 # 31511 135.22 128.46 147.73 31051 671.60 638.02 733.72 31512 222.40 211.28 242.97 31070 456.22 433.41 498.42 # 31512 136.73 129.89 149.37 31075 813.73 773.04 889.00 31513 139.43 132.46 152.33 31080 1,046.39 994.07 1,143.18 31515 224.78 213.54 245.57 31081 1,288.02 1,223.62 1,407.16 # 31515 115.36 109.59 126.03 31084 1,221.82 1,160.73 1,334.84 31520 161.05 153.00 175.95 31085 1,292.11 1,227.50 1,411.63 31525 265.89 252.60 290.49 31086 1,154.72 1,096.98 1,261.53 # 31525 167.65 159.27 183.16 31087 1,139.46 1,082.49 1,244.86 31526 166.82 158.48 182.25 31090 1,044.77 992.53 1,141.41 31527 202.56 192.43 221.29 31200 564.37 536.15 616.57 31528 151.86 144.27 165.91 31201 760.46 722.44 830.81 31529 171.18 162.62 187.01 31205 888.02 843.62 970.16 31530 208.40 197.98 227.68 31225 1,875.75 1,781.96 2,049.25 31531 225.13 213.87 245.95 31230 2,093.96 1,989.26 2,287.65 31535 200.34 190.32 218.87 31231 206.27 195.96 225.35 31536 223.55 212.37 244.23 # 31231 81.02 76.97 88.52 31540 256.52 243.69 280.24 31233 284.30 270.09 310.60 31541 280.38 266.36 306.31 # 31233 144.15 136.94 157.48 31545 378.10 359.20 413.08 31235 325.38 309.11 355.48 31546 573.97 545.27 627.06 # 31235 171.72 163.13 187.60 31560 330.98 314.43 361.59 31237 349.26 331.80 381.57 31561 362.45 344.33 395.98 # 31237 190.95 181.40 208.61 31570 368.31 349.89 402.37 31238 357.98 340.08 391.09 # 31570 240.26 228.25 262.49 # 31238 207.12 196.76 226.27 31571 264.59 251.36 289.06 31239 685.57 651.29 748.98 31575 124.32 118.10 135.82 31240 170.06 161.56 185.79 # 31575 81.02 76.97 88.52 31254 289.37 274.90 316.14 31576 243.20 231.04 265.70 31255 426.11 404.80 465.52 # 31576 130.05 123.55 142.08 31256 210.35 199.83 229.80 31577 259.02 246.07 282.98 31267 337.08 320.23 368.26 # 31577 157.05 149.20 171.58 31276 536.41 509.59 586.03 31578 301.24 286.18 329.11 31287 246.65 234.32 269.47 # 31578 178.32 169.40 194.81 31288 285.65 271.37 312.08 31579 233.18 221.52 254.75 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 26 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 31579 147.97 140.57 161.66 31750 1,410.30 1,339.79 1,540.76 31580 1,254.72 1,191.98 1,370.78 31755 1,807.76 1,717.37 1,974.98 31582 1,995.66 1,895.88 2,180.26 31760 1,449.24 1,376.78 1,583.30 31584 1,576.03 1,497.23 1,721.81 31766 1,878.86 1,784.92 2,052.66 31587 1,012.51 961.88 1,106.16 31770 1,392.93 1,323.28 1,521.77 31588 1,173.84 1,115.15 1,282.42 31775 1,437.51 1,365.63 1,570.47 31590 954.92 907.17 1,043.25 31780 1,228.70 1,167.27 1,342.36 31595 804.90 764.66 879.36 31781 1,479.95 1,405.95 1,616.84 31600 410.13 389.62 448.06 31785 1,122.10 1,066.00 1,225.90 31601 274.51 260.78 299.90 31786 1,558.44 1,480.52 1,702.60 31603 230.49 218.97 251.82 31800 736.32 699.50 804.43 31605 188.21 178.80 205.62 31805 864.92 821.67 944.92 31610 736.25 699.44 804.36 31820 451.44 428.87 493.20 31611 562.51 534.38 614.54 # 31820 339.22 322.26 370.60 31612 85.80 81.51 93.74 31825 626.12 594.81 684.03 # 31612 49.48 47.01 54.06 # 31825 498.08 473.18 544.16 31613 467.90 444.51 511.19 31830 455.33 432.56 497.44 31614 768.94 730.49 840.06 # 31830 353.36 335.69 386.04 31615 195.12 185.36 213.16 32035 739.06 702.11 807.43 # 31615 133.66 126.98 146.03 32036 800.79 760.75 874.86 31620 324.58 308.35 354.60 32095 656.54 623.71 717.27 # 31620 73.61 69.93 80.42 32100 1,008.17 957.76 1,101.42 31622 352.58 334.95 385.19 32110 1,510.54 1,435.01 1,650.26 # 31622 152.83 145.19 166.97 32120 906.50 861.18 990.36 31623 387.98 368.58 423.87 32124 961.66 913.58 1,050.62 # 31623 154.23 146.52 168.50 32140 1,027.58 976.20 1,122.63 31624 358.64 340.71 391.82 32141 1,534.20 1,457.49 1,676.11 # 31624 154.70 146.97 169.02 32150 1,035.09 983.34 1,130.84 31625 383.89 364.70 419.41 32151 1,061.32 1,008.25 1,159.49 # 31625 179.94 170.94 196.58 32160 793.55 753.87 866.95 31628 463.54 440.36 506.41 32200 1,164.80 1,106.56 1,272.54 # 31628 200.47 190.45 219.02 32201 1,087.79 1,033.40 1,188.41 31629 727.05 690.70 794.31 # 32201 224.54 213.31 245.31 # 31629 214.40 203.68 234.23 32215 838.40 796.48 915.95 31630 216.33 205.51 236.34 32220 1,669.38 1,585.91 1,823.80 31631 243.35 231.18 265.86 32225 1,036.94 985.09 1,132.85 31632 81.83 77.74 89.40 32310 958.10 910.20 1,046.73 # 31632 55.29 52.53 60.41 32320 1,667.18 1,583.82 1,821.39 31633 98.10 93.20 107.18 32400 169.11 160.65 184.75 # 31633 69.23 65.77 75.64 # 32400 96.01 91.21 104.89 31635 391.92 372.32 428.17 32402 593.16 563.50 648.03 # 31635 200.09 190.09 218.60 32405 109.11 103.65 119.20 31636 237.50 225.63 259.47 # 32405 108.65 103.22 118.70 31637 83.64 79.46 91.38 32420 119.60 113.62 130.66 31638 266.33 253.01 290.96 32421 179.02 170.07 195.58 31640 276.19 262.38 301.74 # 32421 82.64 78.51 90.29 31641 271.85 258.26 297.00 32422 223.34 212.17 244.00 31643 186.25 176.94 203.48 # 32422 135.34 128.57 147.86 31645 342.39 325.27 374.06 32440 1,665.04 1,581.79 1,819.06 # 31645 169.18 160.72 184.83 32442 3,045.08 2,892.83 3,326.75 31646 312.47 296.85 341.38 32445 3,467.20 3,293.84 3,787.92 # 31646 146.71 139.37 160.28 32480 1,570.70 1,492.17 1,716.00 31656 366.37 348.05 400.26 32482 1,676.96 1,593.11 1,832.08 # 31656 119.12 113.16 130.13 32484 1,511.15 1,435.59 1,650.93 31715 58.49 55.57 63.91 32486 2,390.82 2,271.28 2,611.97 31717 343.28 326.12 375.04 32488 2,426.93 2,305.58 2,651.42 # 31717 116.99 111.14 127.81 32491 1,565.77 1,487.48 1,710.60 31720 54.77 52.03 59.83 32500 1,522.63 1,446.50 1,663.48 31725 98.02 93.12 107.09 32501 261.44 248.37 285.63 31730 1,008.34 957.92 1,101.61 32503 1,914.49 1,818.77 2,091.59 # 31730 151.60 144.02 165.62 32504 2,197.87 2,087.98 2,401.18 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 27 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 32540 1,731.55 1,644.97 1,891.72 33206 517.03 491.18 564.86 32550 917.84 871.95 1,002.74 33207 551.55 523.97 602.57 # 32550 242.69 230.56 265.14 33208 593.75 564.06 648.67 32551 186.56 177.23 203.81 33210 201.00 190.95 219.59 32560 337.19 320.33 368.38 33211 200.98 190.93 219.57 # 32560 117.88 111.99 128.79 33212 385.82 366.53 421.51 32601 329.07 312.62 359.51 33213 439.81 417.82 480.49 32602 356.54 338.71 389.52 33214 546.37 519.05 596.91 32603 461.04 437.99 503.69 33215 349.99 332.49 382.36 32604 517.77 491.88 565.66 33216 433.68 412.00 473.80 32605 408.69 388.26 446.50 33217 429.66 408.18 469.41 32606 494.46 469.74 540.20 33218 448.74 426.30 490.25 32650 713.76 678.07 779.78 33220 452.64 430.01 494.51 32651 1,111.97 1,056.37 1,214.83 33222 397.26 377.40 434.01 32652 1,682.76 1,598.62 1,838.41 33223 476.76 452.92 520.86 32653 1,077.78 1,023.89 1,177.47 33224 570.62 542.09 623.40 32654 1,188.10 1,128.70 1,298.01 33225 512.92 487.27 560.36 32655 987.53 938.15 1,078.87 33226 551.65 524.07 602.68 32656 851.60 809.02 930.37 33233 280.04 266.04 305.95 32657 841.18 799.12 918.99 33234 555.41 527.64 606.79 32658 770.22 731.71 841.47 33235 720.16 684.15 786.77 32659 782.79 743.65 855.20 33236 837.41 795.54 914.87 32660 1,095.92 1,041.12 1,197.29 33237 928.47 882.05 1,014.36 32661 857.63 814.75 936.96 33238 995.98 946.18 1,088.11 32662 959.37 911.40 1,048.11 33240 530.26 503.75 579.31 32663 1,463.04 1,389.89 1,598.37 33241 263.77 250.58 288.17 32664 909.96 864.46 994.13 33243 1,458.78 1,385.84 1,593.72 32665 1,265.33 1,202.06 1,382.37 33244 975.34 926.57 1,065.56 32800 977.05 928.20 1,067.43 33249 1,029.37 977.90 1,124.59 32810 947.93 900.53 1,035.61 33250 1,551.72 1,474.13 1,695.25 32815 2,753.98 2,616.28 3,008.72 33251 1,717.00 1,631.15 1,875.82 32820 1,411.08 1,340.53 1,541.61 33254 1,450.74 1,378.20 1,584.93 32851 2,749.66 2,612.18 3,004.01 33255 1,774.69 1,685.96 1,938.85 32852 3,051.26 2,898.70 3,333.51 33256 2,112.66 2,007.03 2,308.08 32853 3,272.12 3,108.51 3,574.79 33257 617.06 586.21 674.14 32854 3,572.15 3,393.54 3,902.57 33258 695.29 660.53 759.61 32855 257.29 244.43 281.09 33259 908.13 862.72 992.13 32856 310.42 294.90 339.14 33261 1,707.56 1,622.18 1,865.51 32900 1,429.09 1,357.64 1,561.29 33265 1,447.01 1,374.66 1,580.86 32905 1,410.73 1,340.19 1,541.22 33266 1,979.43 1,880.46 2,162.53 32906 1,747.63 1,660.25 1,909.29 33282 374.00 355.30 408.60 32940 1,292.74 1,228.10 1,412.32 33284 273.13 259.47 298.39 32960 151.85 144.26 165.90 33300 2,418.62 2,297.69 2,642.34 # 32960 106.22 100.91 116.05 33305 4,020.91 3,819.86 4,392.84 32997 373.05 354.40 407.56 33310 1,240.84 1,178.80 1,355.62 32998 3,396.71 3,226.87 3,710.90 33315 1,574.47 1,495.75 1,720.11 # 32998 330.14 313.63 360.67 33320 1,124.69 1,068.46 1,228.73 33010 133.55 126.87 145.90 33321 1,267.38 1,204.01 1,384.61 33011 130.10 123.60 142.14 33322 1,470.94 1,397.39 1,607.00 33015 577.45 548.58 630.87 33330 1,478.38 1,404.46 1,615.13 33020 917.62 871.74 1,002.50 33332 1,482.96 1,408.81 1,620.13 33025 847.47 805.10 925.87 33335 1,994.50 1,894.78 2,179.00 33030 1,352.21 1,284.60 1,477.29 33400 2,400.11 2,280.10 2,622.12 33031 1,505.52 1,430.24 1,644.78 33401 1,613.32 1,532.65 1,762.55 33050 1,049.17 996.71 1,146.22 33403 1,612.82 1,532.18 1,762.01 33120 1,648.91 1,566.46 1,801.43 33404 1,898.82 1,803.88 2,074.46 33130 1,453.22 1,380.56 1,587.64 33405 2,455.45 2,332.68 2,682.58 33140 1,651.90 1,569.31 1,804.71 33406 3,016.78 2,865.94 3,295.83 33141 161.24 153.18 176.16 33410 2,663.50 2,530.33 2,909.88 33202 828.95 787.50 905.63 33411 3,465.27 3,292.01 3,785.81 33203 874.79 831.05 955.71 33412 2,654.90 2,522.16 2,900.48 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 28 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 33413 3,425.12 3,253.86 3,741.94 33615 2,144.15 2,036.94 2,342.48 33414 2,295.08 2,180.33 2,507.38 33617 2,290.05 2,175.55 2,501.88 33415 2,119.62 2,013.64 2,315.69 33619 2,798.37 2,658.45 3,057.22 33416 2,137.25 2,030.39 2,334.95 33641 1,702.99 1,617.84 1,860.52 33417 1,793.40 1,703.73 1,959.29 33645 1,686.69 1,602.36 1,842.71 33420 1,440.51 1,368.48 1,573.75 33647 1,801.22 1,711.16 1,967.83 33422 1,797.87 1,707.98 1,964.18 33660 1,872.43 1,778.81 2,045.63 33425 2,772.58 2,633.95 3,029.04 33665 2,025.02 1,923.77 2,212.34 33426 2,532.03 2,405.43 2,766.24 33670 2,099.39 1,994.42 2,293.58 33427 2,642.51 2,510.38 2,886.94 33675 2,100.87 1,995.83 2,295.20 33430 2,923.10 2,776.95 3,193.49 33676 2,190.59 2,081.06 2,393.22 33460 2,464.82 2,341.58 2,692.82 33677 2,276.16 2,162.35 2,486.70 33463 3,110.46 2,954.94 3,398.18 33681 1,954.52 1,856.79 2,135.31 33464 2,516.07 2,390.27 2,748.81 33684 1,983.41 1,884.24 2,166.88 33465 2,809.13 2,668.67 3,068.97 33688 1,984.15 1,884.94 2,167.68 33468 2,006.26 1,905.95 2,191.84 33690 1,235.12 1,173.36 1,349.36 33470 1,266.62 1,203.29 1,383.78 33692 1,881.20 1,787.14 2,055.21 33471 1,414.23 1,343.52 1,545.05 33694 2,116.81 2,010.97 2,312.62 33472 1,429.15 1,357.69 1,561.34 33697 2,294.21 2,179.50 2,506.43 33474 2,159.82 2,051.83 2,359.60 33702 1,634.14 1,552.43 1,785.29 33475 2,447.72 2,325.33 2,674.13 33710 2,006.19 1,905.88 2,191.76 33476 1,555.28 1,477.52 1,699.15 33720 1,659.31 1,576.34 1,812.79 33478 1,678.35 1,594.43 1,833.59 33722 1,638.69 1,556.76 1,790.27 33496 1,790.99 1,701.44 1,956.66 33724 1,683.50 1,599.33 1,839.23 33500 1,681.09 1,597.04 1,836.60 33726 2,188.40 2,078.98 2,390.83 33501 1,168.11 1,109.70 1,276.16 33730 2,076.60 1,972.77 2,268.69 33502 1,354.65 1,286.92 1,479.96 33732 1,749.47 1,662.00 1,911.30 33503 1,466.69 1,393.36 1,602.36 33735 1,334.62 1,267.89 1,458.07 33504 1,541.39 1,464.32 1,683.97 33736 1,489.31 1,414.84 1,627.07 33505 2,092.18 1,987.57 2,285.71 33737 1,389.85 1,320.36 1,518.41 33506 2,180.33 2,071.31 2,382.01 33750 1,412.67 1,342.04 1,543.35 33507 1,850.39 1,757.87 2,021.55 33755 1,378.94 1,309.99 1,506.49 33508 17.26 16.40 18.86 33762 1,376.57 1,307.74 1,503.90 33510 2,090.31 1,985.79 2,283.66 33764 1,352.96 1,285.31 1,478.11 33511 2,279.57 2,165.59 2,490.43 33766 1,502.96 1,427.81 1,641.98 33512 2,561.86 2,433.77 2,798.84 33767 1,503.42 1,428.25 1,642.49 33513 2,611.79 2,481.20 2,853.38 33768 454.48 431.76 496.52 33514 2,769.40 2,630.93 3,025.57 33770 2,277.25 2,163.39 2,487.90 33516 2,881.24 2,737.18 3,147.76 33771 2,328.37 2,211.95 2,543.74 33517 195.94 186.14 214.06 33774 1,935.38 1,838.61 2,114.40 33518 423.37 402.20 462.53 33775 2,013.36 1,912.69 2,199.59 33519 565.57 537.29 617.88 33776 2,119.25 2,013.29 2,315.28 33521 685.19 650.93 748.57 33777 2,072.43 1,968.81 2,264.13 33522 780.55 741.52 852.75 33778 2,538.08 2,411.18 2,772.86 33523 891.07 846.52 973.50 33779 2,421.27 2,300.21 2,645.24 33530 538.02 511.12 587.79 33780 2,525.93 2,399.63 2,759.57 33533 2,038.09 1,936.19 2,226.62 33781 2,473.56 2,349.88 2,702.36 33534 2,364.90 2,246.66 2,583.66 33786 2,440.70 2,318.67 2,666.47 33535 2,621.31 2,490.24 2,863.78 33788 1,657.27 1,574.41 1,810.57 33536 2,803.18 2,663.02 3,062.47 33800 1,038.29 986.38 1,134.34 33542 2,688.23 2,553.82 2,936.89 33802 1,121.29 1,065.23 1,225.01 33545 3,169.46 3,010.99 3,462.64 33803 1,213.33 1,152.66 1,325.56 33548 3,128.58 2,972.15 3,417.97 33813 1,396.57 1,326.74 1,525.75 33572 249.74 237.25 272.84 33814 1,629.61 1,548.13 1,780.35 33600 1,822.76 1,731.62 1,991.36 33820 1,047.17 994.81 1,144.03 33602 1,732.98 1,646.33 1,893.28 33822 1,111.35 1,055.78 1,214.15 33606 1,891.51 1,796.93 2,066.47 33824 1,255.36 1,192.59 1,371.48 33608 1,946.65 1,849.32 2,126.72 33840 1,262.01 1,198.91 1,378.75 33610 1,896.40 1,801.58 2,071.82 33845 1,472.50 1,398.88 1,608.71 33611 2,074.51 1,970.78 2,266.40 33851 1,342.73 1,275.59 1,466.93 33612 2,140.97 2,033.92 2,339.01 33852 1,457.43 1,384.56 1,592.24 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 29 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 33853 2,017.34 1,916.47 2,203.94 34803 1,387.49 1,318.12 1,515.84 33860 3,316.99 3,151.14 3,623.81 34804 1,358.65 1,290.72 1,484.33 33861 2,601.53 2,471.45 2,842.17 34805 1,273.24 1,209.58 1,391.02 33863 3,317.31 3,151.44 3,624.16 34806 114.52 108.79 125.11 33864 3,413.28 3,242.62 3,729.01 34808 224.57 213.34 245.34 33870 2,714.86 2,579.12 2,965.99 34812 371.59 353.01 405.96 33875 2,107.53 2,002.15 2,302.47 34813 257.69 244.81 281.53 33877 3,700.40 3,515.38 4,042.69 34820 533.65 506.97 583.02 33880 1,929.06 1,832.61 2,107.50 34825 767.16 728.80 838.12 33881 1,657.42 1,574.55 1,810.73 34826 223.23 212.07 243.88 33883 1,214.75 1,154.01 1,327.11 34830 1,980.72 1,881.68 2,163.93 33884 438.37 416.45 478.92 34831 2,091.68 1,987.10 2,285.17 33886 1,044.12 991.91 1,140.70 34832 2,126.89 2,020.55 2,323.63 33889 860.90 817.86 940.54 34833 666.06 632.76 727.67 33891 1,075.89 1,022.10 1,175.42 34834 302.93 287.78 330.95 33910 1,768.17 1,679.76 1,931.72 34900 992.25 942.64 1,084.04 33915 1,406.78 1,336.44 1,536.91 35001 1,238.64 1,176.71 1,353.22 33916 1,785.12 1,695.86 1,950.24 35002 1,304.96 1,239.71 1,425.67 33917 1,619.31 1,538.34 1,769.09 35005 1,139.14 1,082.18 1,244.51 33920 1,931.86 1,835.27 2,110.56 35011 1,083.25 1,029.09 1,183.45 33922 1,467.90 1,394.51 1,603.69 35013 1,342.69 1,275.56 1,466.89 33924 305.50 290.23 333.76 35021 1,323.54 1,257.36 1,445.96 33925 1,883.72 1,789.53 2,057.96 35022 1,489.82 1,415.33 1,627.63 33926 2,473.07 2,349.42 2,701.83 35045 1,054.12 1,001.41 1,151.62 33933 355.82 338.03 388.73 35081 1,877.88 1,783.99 2,051.59 33935 3,704.66 3,519.43 4,047.34 35082 2,356.96 2,239.11 2,574.98 33944 250.75 238.21 273.94 35091 1,982.97 1,883.82 2,166.39 33945 4,873.94 4,630.24 5,324.78 35092 2,807.96 2,667.56 3,067.69 33960 1,059.62 1,006.64 1,157.64 35102 2,035.23 1,933.47 2,223.49 33961 591.18 561.62 645.86 35103 2,433.45 2,311.78 2,658.55 33967 296.83 281.99 324.29 35111 1,505.93 1,430.63 1,645.22 33968 37.79 35.90 41.29 35112 1,842.04 1,749.94 2,012.43 33970 394.73 374.99 431.24 35121 1,783.80 1,694.61 1,948.80 33971 770.26 731.75 841.51 35122 2,135.23 2,028.47 2,332.74 33973 575.83 547.04 629.10 35131 1,526.00 1,449.70 1,667.16 33974 983.38 934.21 1,074.34 35132 1,838.32 1,746.40 2,008.36 33975 1,181.33 1,122.26 1,290.60 35141 1,211.02 1,150.47 1,323.04 33976 1,316.66 1,250.83 1,438.45 35142 1,448.02 1,375.62 1,581.96 33977 1,297.68 1,232.80 1,417.72 35151 1,364.54 1,296.31 1,490.76 33978 1,423.89 1,352.70 1,555.61 35152 1,584.01 1,504.81 1,730.53 33979 2,590.41 2,460.89 2,830.02 35180 918.46 872.54 1,003.42 33980 3,840.46 3,648.44 4,195.71 35182 1,869.99 1,776.49 2,042.96 34001 1,029.32 977.85 1,124.53 35184 1,100.64 1,045.61 1,202.45 34051 1,040.48 988.46 1,136.73 35188 929.56 883.08 1,015.54 34101 659.43 626.46 720.43 35189 1,717.91 1,632.01 1,876.81 34111 659.16 626.20 720.13 35190 810.18 769.67 885.12 34151 1,512.19 1,436.58 1,652.07 35201 1,014.92 964.17 1,108.80 34201 1,061.38 1,008.31 1,159.56 35206 829.46 787.99 906.19 34203 1,050.37 997.85 1,147.53 35207 767.52 729.14 838.51 34401 1,569.83 1,491.34 1,715.04 35211 1,473.76 1,400.07 1,610.08 34421 798.08 758.18 871.91 35216 2,033.22 1,931.56 2,221.29 34451 1,634.18 1,552.47 1,785.34 35221 1,503.87 1,428.68 1,642.98 34471 1,138.28 1,081.37 1,243.58 35226 915.72 869.93 1,000.42 34490 663.81 630.62 725.21 35231 1,273.11 1,209.45 1,390.87 34501 1,029.18 977.72 1,124.38 35236 1,057.76 1,004.87 1,155.60 34502 1,658.73 1,575.79 1,812.16 35241 1,539.52 1,462.54 1,681.92 34510 1,161.75 1,103.66 1,269.21 35246 1,669.31 1,585.84 1,823.72 34520 1,115.12 1,059.36 1,218.26 35251 1,784.93 1,695.68 1,950.03 34530 1,051.06 998.51 1,148.29 35256 1,110.71 1,055.17 1,213.45 34800 1,246.49 1,184.17 1,361.80 35261 1,126.01 1,069.71 1,230.17 34802 1,359.47 1,291.50 1,485.23 35266 932.47 885.85 1,018.73 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 30 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 35271 1,471.26 1,397.70 1,607.36 35511 1,292.23 1,227.62 1,411.76 35276 1,543.79 1,466.60 1,686.59 35512 1,333.38 1,266.71 1,456.72 35281 1,710.47 1,624.95 1,868.69 35515 1,434.14 1,362.43 1,566.79 35286 1,022.90 971.76 1,117.52 35516 1,310.80 1,245.26 1,432.05 35301 1,143.21 1,086.05 1,248.96 35518 1,314.57 1,248.84 1,436.17 35302 1,210.47 1,149.95 1,322.44 35521 1,380.64 1,311.61 1,508.35 35303 1,331.02 1,264.47 1,454.14 35522 1,304.52 1,239.29 1,425.18 35304 1,383.44 1,314.27 1,511.41 35523 1,385.95 1,316.65 1,514.15 35305 1,329.16 1,262.70 1,452.11 35525 1,224.26 1,163.05 1,337.51 35306 492.43 467.81 537.98 35526 1,809.01 1,718.56 1,976.34 35311 1,635.07 1,553.32 1,786.32 35531 2,197.01 2,087.16 2,400.23 35321 973.19 924.53 1,063.21 35533 1,705.69 1,620.41 1,863.47 35331 1,602.82 1,522.68 1,751.08 35535 2,186.70 2,077.37 2,388.98 35341 1,506.75 1,431.41 1,646.12 35536 1,893.92 1,799.22 2,069.10 35351 1,398.46 1,328.54 1,527.82 35537 2,348.22 2,230.81 2,565.43 35355 1,137.32 1,080.45 1,242.52 35538 2,636.33 2,504.51 2,880.19 35361 1,722.11 1,636.00 1,881.40 35539 2,438.32 2,316.40 2,663.86 35363 1,881.74 1,787.65 2,055.80 35540 2,732.06 2,595.46 2,984.78 35371 899.84 854.85 983.08 35548 1,311.33 1,245.76 1,432.62 35372 1,077.54 1,023.66 1,177.21 35549 1,426.81 1,355.47 1,558.79 35390 174.37 165.65 190.50 35551 1,626.11 1,544.80 1,776.52 35400 165.09 156.84 180.37 35556 1,503.12 1,427.96 1,642.15 35450 560.61 532.58 612.47 35558 1,336.22 1,269.41 1,459.82 35452 389.54 370.06 425.57 35560 1,937.97 1,841.07 2,117.23 35454 341.82 324.73 373.44 35563 1,485.73 1,411.44 1,623.16 35456 413.28 392.62 451.51 35565 1,441.53 1,369.45 1,574.87 35458 529.96 503.46 578.98 35566 1,800.45 1,710.43 1,966.99 35459 487.35 462.98 532.43 35570 1,693.86 1,609.17 1,850.55 35460 338.39 321.47 369.69 35571 1,461.91 1,388.81 1,597.13 35470 3,453.45 3,280.78 3,772.90 35572 379.19 360.23 414.26 # 35470 503.29 478.13 549.85 35583 1,551.01 1,473.46 1,694.48 35471 3,790.00 3,600.50 4,140.58 35585 1,816.39 1,725.57 1,984.41 # 35471 604.70 574.47 660.64 35587 1,508.62 1,433.19 1,648.17 35472 2,629.03 2,497.58 2,872.22 35600 279.81 265.82 305.69 # 35472 401.97 381.87 439.15 35601 1,573.05 1,494.40 1,718.56 35473 2,516.12 2,390.31 2,748.86 35606 1,277.66 1,213.78 1,395.85 # 35473 356.57 338.74 389.55 35612 1,008.33 957.91 1,101.60 35474 3,363.44 3,195.27 3,674.56 35616 1,220.85 1,159.81 1,333.78 # 35474 430.50 408.98 470.33 35621 1,207.65 1,147.27 1,319.36 35475 2,683.51 2,549.33 2,931.73 35623 1,481.77 1,407.68 1,618.83 # 35475 536.53 509.70 586.16 35626 1,706.82 1,621.48 1,864.70 35476 2,038.37 1,936.45 2,226.92 35631 2,020.31 1,919.29 2,207.18 # 35476 343.04 325.89 374.77 35632 2,076.91 1,973.06 2,269.02 35480 606.84 576.50 662.98 35633 2,241.45 2,129.38 2,448.79 35481 440.31 418.29 481.03 35634 2,033.01 1,931.36 2,221.06 35482 385.49 366.22 421.15 35636 1,797.26 1,707.40 1,963.51 35483 464.16 440.95 507.09 35637 1,856.27 1,763.46 2,027.98 35484 575.36 546.59 628.58 35638 1,898.44 1,803.52 2,074.05 35485 537.09 510.24 586.78 35642 1,136.75 1,079.91 1,241.90 35490 676.34 642.52 738.90 35645 1,071.27 1,017.71 1,170.37 35491 450.98 428.43 492.69 35646 1,877.05 1,783.20 2,050.68 35492 412.40 391.78 450.55 35647 1,700.45 1,615.43 1,857.74 35493 502.38 477.26 548.85 35650 1,164.73 1,106.49 1,272.46 35494 635.78 603.99 694.59 35651 1,508.98 1,433.53 1,648.56 35495 580.83 551.79 634.56 35654 1,500.60 1,425.57 1,639.41 35500 348.44 331.02 380.67 35656 1,184.96 1,125.71 1,294.57 35501 1,703.84 1,618.65 1,861.45 35661 1,188.55 1,129.12 1,298.49 35506 1,446.13 1,373.82 1,579.89 35663 1,374.53 1,305.80 1,501.67 35508 1,495.60 1,420.82 1,633.94 35665 1,287.99 1,223.59 1,407.13 35509 1,636.63 1,554.80 1,788.02 35666 1,393.82 1,324.13 1,522.75 35510 1,369.16 1,300.70 1,495.81 35671 1,229.07 1,167.62 1,342.76 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 31 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 35681 87.14 82.78 95.20 # 36215 268.29 254.88 293.11 35682 388.34 368.92 424.26 36216 1,508.79 1,433.35 1,648.35 35683 458.04 435.14 500.41 # 36216 302.37 287.25 330.34 35685 218.07 207.17 238.25 36217 2,480.54 2,356.51 2,709.99 35686 183.00 173.85 199.93 # 36217 361.97 343.87 395.45 35691 1,081.39 1,027.32 1,181.42 36218 229.39 217.92 250.61 35693 965.68 917.40 1,055.01 # 36218 57.57 54.69 62.89 35694 1,115.32 1,059.55 1,218.48 36245 1,528.90 1,452.46 1,670.33 35695 1,162.13 1,104.02 1,269.62 # 36245 277.78 263.89 303.47 35697 162.68 154.55 177.73 36246 1,495.36 1,420.59 1,633.68 35700 167.41 159.04 182.90 # 36246 301.04 285.99 328.89 35701 587.80 558.41 642.17 36247 2,367.29 2,248.93 2,586.27 35721 499.84 474.85 546.08 # 36247 358.14 340.23 391.26 35741 545.03 517.78 595.45 36248 195.86 186.07 213.98 35761 408.29 387.88 446.06 # 36248 57.57 54.69 62.89 35800 520.13 494.12 568.24 36260 622.56 591.43 680.14 35820 1,987.90 1,888.51 2,171.79 36261 384.04 364.84 419.57 35840 675.01 641.26 737.45 36262 294.16 279.45 321.37 35860 439.91 417.91 480.60 36400 27.97 26.57 30.56 35870 1,394.60 1,324.87 1,523.60 # 36400 18.65 17.72 20.38 35875 648.85 616.41 708.87 36405 25.83 24.54 28.22 35876 1,031.35 979.78 1,126.75 # 36405 16.52 15.69 18.04 35879 1,010.51 959.98 1,103.98 36406 19.06 18.11 20.83 35881 1,123.28 1,067.12 1,227.19 # 36406 9.75 9.26 10.65 35883 1,302.15 1,237.04 1,422.60 36410 21.39 20.32 23.37 35884 1,370.86 1,302.32 1,497.67 # 36410 9.28 8.82 10.14 35901 551.49 523.92 602.51 36420 51.05 48.50 55.78 35903 622.70 591.57 680.31 36425 40.57 38.54 44.32 35905 1,893.73 1,799.04 2,068.90 36430 45.42 43.15 49.62 35907 2,082.45 1,978.33 2,275.08 36440 54.02 51.32 59.02 36000 29.31 27.84 32.02 36450 125.80 119.51 137.44 # 36000 10.22 9.71 11.17 36455 137.62 130.74 150.35 36002 190.57 181.04 208.20 36460 355.37 337.60 388.24 # 36002 120.73 114.69 131.89 36470 156.90 149.06 171.42 36005 411.92 391.32 450.02 # 36470 74.96 71.21 81.89 # 36005 53.86 51.17 58.85 36471 190.80 181.26 208.45 36010 703.33 668.16 768.38 # 36471 104.66 99.43 114.34 # 36010 134.81 128.07 147.28 36475 2,122.54 2,016.41 2,318.87 36011 1,120.40 1,064.38 1,224.04 # 36475 362.03 343.93 395.52 # 36011 174.26 165.55 190.38 36476 436.31 414.49 476.66 36012 1,048.29 995.88 1,145.26 # 36476 176.03 167.23 192.31 # 36012 197.13 187.27 215.36 36478 1,737.47 1,650.60 1,898.19 36013 975.31 926.54 1,065.52 # 36478 366.22 347.91 400.10 # 36013 141.39 134.32 154.47 36479 460.52 437.49 503.11 36014 1,014.10 963.40 1,107.91 # 36479 177.43 168.56 193.84 # 36014 171.79 163.20 187.68 36481 452.53 429.90 494.39 36015 1,110.13 1,054.62 1,212.81 36500 197.24 187.38 215.49 # 36015 198.44 188.52 216.80 36510 123.76 117.57 135.21 36100 633.75 602.06 692.37 # 36510 60.90 57.86 66.54 # 36100 174.19 165.48 190.30 36511 95.65 90.87 104.50 36120 529.17 502.71 578.12 36512 97.51 92.63 106.52 # 36120 108.72 103.28 118.77 36513 100.92 95.87 110.25 36140 586.53 557.20 640.78 36514 621.33 590.26 678.80 # 36140 112.53 106.90 122.94 # 36514 94.72 89.98 103.48 36145 580.96 551.91 634.70 36515 2,364.61 2,246.38 2,583.34 # 36145 109.75 104.26 119.90 # 36515 92.39 87.77 100.94 36160 642.20 610.09 701.60 36516 2,684.29 2,550.08 2,932.59 # 36160 147.25 139.89 160.87 # 36516 66.57 63.24 72.73 36200 780.80 741.76 853.02 36522 1,664.96 1,581.71 1,818.97 # 36200 168.05 159.65 183.60 # 36522 110.73 105.19 120.97 36215 1,382.05 1,312.95 1,509.89 36555 311.56 295.98 340.38 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 32 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 36555 133.69 127.01 146.06 36625 111.55 105.97 121.87 36556 263.31 250.14 287.66 36640 128.42 122.00 140.30 # 36556 126.89 120.55 138.63 36660 70.25 66.74 76.75 36557 986.20 936.89 1,077.42 36680 62.47 59.35 68.25 # 36557 324.55 308.32 354.57 36800 172.50 163.88 188.46 36558 955.51 907.73 1,043.89 36810 223.16 212.00 243.80 # 36558 311.09 295.54 339.87 36815 159.49 151.52 174.25 36560 1,362.26 1,294.15 1,488.27 36818 725.33 689.06 792.42 # 36560 382.13 363.02 417.47 36819 850.20 807.69 928.84 36561 1,349.72 1,282.23 1,474.56 36820 853.65 810.97 932.62 # 36561 370.06 351.56 404.29 36821 710.19 674.68 775.88 36563 1,362.26 1,294.15 1,488.27 36822 412.04 391.44 450.16 # 36563 383.52 364.34 418.99 36823 1,360.03 1,292.03 1,485.83 36565 1,132.28 1,075.67 1,237.02 36825 620.65 589.62 678.06 # 36565 363.54 345.36 397.16 36830 703.41 668.24 768.48 36566 4,385.49 4,166.22 4,791.15 36831 488.88 464.44 534.11 # 36566 388.61 369.18 424.56 36832 621.20 590.14 678.66 36568 364.83 346.59 398.58 36833 700.82 665.78 765.65 # 36568 104.09 98.89 113.72 36834 659.60 626.62 720.61 36569 315.37 299.60 344.54 36835 495.98 471.18 541.86 # 36569 104.91 99.66 114.61 36838 1,249.52 1,187.04 1,365.10 36570 1,395.26 1,325.50 1,524.33 36860 215.92 205.12 235.89 # 36570 343.89 326.70 375.71 # 36860 109.29 103.83 119.40 36571 1,449.46 1,376.99 1,583.54 36861 162.89 154.75 177.96 # 36571 332.90 316.26 363.70 36870 2,230.90 2,119.36 2,437.26 36575 191.48 181.91 209.20 # 36870 336.75 319.91 367.90 # 36575 42.02 39.92 45.91 37140 1,429.34 1,357.87 1,561.55 36576 410.72 390.18 448.71 37145 1,548.95 1,471.50 1,692.23 # 36576 202.59 192.46 221.33 37160 1,342.60 1,275.47 1,466.79 36578 584.36 555.14 638.41 37180 1,501.14 1,426.08 1,639.99 # 36578 233.75 222.06 255.37 37181 1,623.28 1,542.12 1,773.44 36580 273.16 259.50 298.43 37182 974.44 925.72 1,064.58 # 36580 75.27 71.51 82.24 37183 464.07 440.87 507.00 36581 900.62 855.59 983.93 37184 2,915.62 2,769.84 3,185.32 # 36581 219.88 208.89 240.22 # 37184 498.59 473.66 544.71 36582 1,252.75 1,190.11 1,368.63 37185 959.58 911.60 1,048.34 # 36582 321.52 305.44 351.26 # 37185 182.46 173.34 199.34 36583 1,252.75 1,190.11 1,368.63 37186 1,974.74 1,876.00 2,157.40 # 36583 321.51 305.43 351.24 # 37186 281.74 267.65 307.80 36584 270.01 256.51 294.99 37187 2,796.61 2,656.78 3,055.30 # 36584 79.10 75.15 86.42 # 37187 463.39 440.22 506.25 36585 1,291.92 1,227.32 1,411.42 37188 2,388.17 2,268.76 2,609.07 # 36585 302.95 287.80 330.97 # 37188 336.65 319.82 367.79 36589 183.52 174.34 200.49 37195 399.71 379.72 436.68 # 36589 151.85 144.26 165.90 37200 258.25 245.34 282.14 36590 302.03 286.93 329.97 37201 309.76 294.27 338.41 # 36590 213.56 202.88 233.31 37202 375.93 357.13 410.70 36591 28.21 26.80 30.82 37203 1,614.44 1,533.72 1,763.78 36592 31.01 29.46 33.88 # 37203 295.34 280.57 322.66 36593 43.25 41.09 47.25 37204 1,023.92 972.72 1,118.63 36595 718.72 682.78 785.20 37205 4,046.55 3,844.22 4,420.85 # 36595 209.33 198.86 228.69 # 37205 484.56 460.33 529.38 36596 161.91 153.81 176.88 37206 2,426.22 2,304.91 2,650.65 # 36596 50.63 48.10 55.32 # 37206 235.01 223.26 256.75 36597 146.94 139.59 160.53 37207 464.88 441.64 507.89 # 36597 69.65 66.17 76.10 37208 223.64 212.46 244.33 36598 135.47 128.70 148.01 37209 126.09 119.79 137.76 # 36598 69.82 66.33 76.28 37210 4,275.97 4,062.17 4,671.50 36600 34.78 33.04 38.00 # 37210 613.40 582.73 670.14 # 36600 16.15 15.34 17.64 37215 1,216.26 1,155.45 1,328.77 36620 52.52 49.89 57.37 37250 120.04 114.04 131.15 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 33 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 37251 88.83 84.39 97.05 38550 480.62 456.59 525.08 37500 743.57 706.39 812.35 38555 990.94 941.39 1,082.60 37565 734.18 697.47 802.09 38562 713.98 678.28 780.02 37600 749.65 712.17 819.00 38564 703.08 667.93 768.12 37605 855.62 812.84 934.77 38570 572.50 543.88 625.46 37606 563.78 535.59 615.93 38571 901.78 856.69 985.19 37607 403.08 382.93 440.37 38572 980.53 931.50 1,071.23 37609 320.82 304.78 350.50 38700 799.13 759.17 873.05 # 37609 210.00 199.50 229.43 38720 1,320.14 1,254.13 1,442.25 37615 500.34 475.32 546.62 38724 1,430.09 1,358.59 1,562.38 37616 1,151.26 1,093.70 1,257.76 38740 667.05 633.70 728.76 37617 1,356.90 1,289.06 1,482.42 38745 845.91 803.61 924.15 37618 401.78 381.69 438.94 38746 274.05 260.35 299.40 37620 720.63 684.60 787.29 38747 265.79 252.50 290.38 37650 545.29 518.03 595.73 38760 834.86 793.12 912.09 37660 1,271.52 1,207.94 1,389.13 38765 1,290.12 1,225.61 1,409.45 37700 271.48 257.91 296.60 38770 873.10 829.45 953.87 37718 440.57 418.54 481.32 38780 1,099.55 1,044.57 1,201.26 37722 507.95 482.55 554.93 38790 86.84 82.50 94.88 37735 673.85 640.16 736.18 38792 43.30 41.14 47.31 37760 663.17 630.01 724.51 38794 334.51 317.78 365.45 37765 479.38 455.41 523.72 39000 514.35 488.63 561.92 37766 580.16 551.15 633.82 39010 844.21 802.00 922.30 37780 280.22 266.21 306.14 39200 929.80 883.31 1,015.81 37785 389.45 369.98 425.48 39220 1,196.85 1,137.01 1,307.56 # 37785 280.96 266.91 306.95 39400 527.16 500.80 575.92 37788 1,478.21 1,404.30 1,614.95 39501 851.36 808.79 930.11 37790 537.35 510.48 587.05 39502 1,016.72 965.88 1,110.76 38100 1,098.16 1,043.25 1,199.74 39503 5,835.80 5,544.01 6,375.61 38101 1,104.54 1,049.31 1,206.71 39520 1,020.20 969.19 1,114.57 38102 260.78 247.74 284.90 39530 973.47 924.80 1,063.52 38115 1,220.05 1,159.05 1,332.91 39531 1,013.98 963.28 1,107.77 38120 1,027.51 976.13 1,122.55 39540 866.54 823.21 946.69 38200 147.47 140.10 161.12 39541 934.59 887.86 1,021.04 38205 85.53 81.25 93.44 39545 930.31 883.79 1,016.36 38206 85.53 81.25 93.44 39560 799.41 759.44 873.36 38220 178.82 169.88 195.36 39561 1,247.94 1,185.54 1,363.37 # 38220 64.74 61.50 70.73 40490 138.38 131.46 151.18 38221 196.65 186.82 214.84 # 40490 75.52 71.74 82.50 # 38221 82.11 78.00 89.70 40500 524.85 498.61 573.40 38230 338.04 321.14 369.31 # 40500 374.92 356.17 409.60 38240 133.19 126.53 145.51 40510 502.78 477.64 549.29 38241 134.12 127.41 146.52 # 40510 366.35 348.03 400.23 38242 101.52 96.44 110.91 40520 518.32 492.40 566.26 38300 289.39 274.92 316.16 # 40520 371.19 352.63 405.52 # 38300 187.42 178.05 204.76 40525 573.58 544.90 626.64 38305 466.62 443.29 509.78 40527 675.47 641.70 737.96 38308 443.14 420.98 484.13 40530 569.43 540.96 622.10 38380 575.76 546.97 629.02 # 40530 419.96 398.96 458.80 38381 846.11 803.80 924.37 40650 432.84 411.20 472.88 38382 686.69 652.36 750.21 # 40650 296.41 281.59 323.83 38500 327.19 310.83 357.45 40652 509.44 483.97 556.57 # 38500 249.89 237.40 273.01 # 40652 363.23 345.07 396.83 38505 142.57 135.44 155.76 40654 598.10 568.20 653.43 # 38505 80.64 76.61 88.10 # 40654 439.79 417.80 480.47 38510 523.28 497.12 571.69 40700 949.26 901.80 1,037.07 # 38510 420.85 399.81 459.78 40701 1,179.90 1,120.91 1,289.05 38520 464.07 440.87 507.00 40702 906.49 861.17 990.35 38525 419.74 398.75 458.56 40720 1,008.74 958.30 1,102.05 38530 538.56 511.63 588.37 40761 1,092.99 1,038.34 1,194.09 38542 516.93 491.08 564.74 40800 215.37 204.60 235.29 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 34 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 40800 134.35 127.63 146.77 41019 508.70 483.27 555.76 40801 322.76 306.62 352.61 41100 177.25 168.39 193.65 # 40801 228.24 216.83 249.35 # 41100 113.92 108.22 124.45 40804 219.28 208.32 239.57 41105 177.15 168.29 193.53 # 40804 135.47 128.70 148.01 # 41105 115.23 109.47 125.89 40805 337.82 320.93 369.07 41108 153.75 146.06 167.97 # 40805 235.85 224.06 257.67 # 41108 93.68 89.00 102.35 40806 117.37 111.50 128.23 41110 221.47 210.40 241.96 # 40806 36.35 34.53 39.71 # 41110 137.19 130.33 149.88 40808 194.64 184.91 212.65 41112 345.66 328.38 377.64 # 40808 113.16 107.50 123.63 # 41112 261.84 248.75 286.06 40810 214.05 203.35 233.85 41113 376.95 358.10 411.82 # 40810 132.56 125.93 144.82 # 41113 289.42 274.95 316.19 40812 296.27 281.46 323.68 41114 657.15 624.29 717.93 # 40812 203.14 192.98 221.93 41115 257.92 245.02 281.77 40814 395.43 375.66 432.01 # 41115 154.56 146.83 168.85 # 40814 315.34 299.57 344.51 41116 341.06 324.01 372.61 40816 416.07 395.27 454.56 # 41116 228.84 217.40 250.01 # 40816 329.00 312.55 359.43 41120 1,109.26 1,053.80 1,211.87 40818 371.67 353.09 406.05 41130 1,349.03 1,281.58 1,473.82 # 40818 286.46 272.14 312.96 41135 2,209.12 2,098.66 2,413.46 40819 317.76 301.87 347.15 41140 2,289.29 2,174.83 2,501.05 # 40819 244.19 231.98 266.78 41145 2,852.87 2,710.23 3,116.76 40820 283.62 269.44 309.86 41150 2,258.40 2,145.48 2,467.30 # 40820 183.98 174.78 201.00 41153 2,436.85 2,315.01 2,662.26 40830 255.22 242.46 278.83 41155 3,004.80 2,854.56 3,282.74 # 40830 165.35 157.08 180.64 41250 238.16 226.25 260.19 40831 337.12 320.26 368.30 # 41250 145.03 137.78 158.45 # 40831 232.35 220.73 253.84 41251 243.31 231.14 265.81 40840 836.56 794.73 913.94 # 41251 168.34 159.92 183.91 # 40840 650.31 617.79 710.46 41252 319.17 303.21 348.69 40842 822.12 781.01 898.16 # 41252 217.67 206.79 237.81 # 40842 634.48 602.76 693.17 41500 478.59 454.66 522.86 40843 1,064.47 1,011.25 1,162.94 41510 439.46 417.49 480.11 # 40843 815.37 774.60 890.79 41512 656.82 623.98 717.58 40844 1,413.19 1,342.53 1,543.91 41520 363.07 344.92 396.66 # 40844 1,151.05 1,093.50 1,257.53 # 41520 265.76 252.47 290.34 40845 1,527.10 1,450.75 1,668.36 41530 3,575.71 3,396.92 3,906.46 # 40845 1,284.51 1,220.28 1,403.32 # 41530 430.45 408.93 470.27 41000 167.77 159.38 183.29 41800 243.77 231.58 266.32 # 41000 115.62 109.84 126.32 # 41800 136.21 129.40 148.81 41005 241.25 229.19 263.57 41805 251.30 238.74 274.55 # 41005 134.16 127.45 146.57 # 41805 175.87 167.08 192.14 41006 374.89 356.15 409.57 41806 358.29 340.38 391.44 # 41006 267.80 254.41 292.57 # 41806 266.10 252.80 290.72 41007 377.44 358.57 412.36 41822 300.16 285.15 327.92 # 41007 260.57 247.54 284.67 # 41822 180.03 171.03 196.68 41008 386.40 367.08 422.14 41823 445.67 423.39 486.90 # 41008 277.44 263.57 303.11 # 41823 331.59 315.01 362.26 41009 410.28 389.77 448.24 41825 218.13 207.22 238.30 # 41009 301.79 286.70 329.71 # 41825 132.46 125.84 144.72 41010 217.55 206.67 237.67 41826 301.75 286.66 329.66 # 41010 115.58 109.80 126.27 # 41826 211.42 200.85 230.98 41015 440.50 418.48 481.25 41827 445.70 423.42 486.93 # 41015 348.30 330.89 380.52 # 41827 311.60 296.02 340.42 41016 452.10 429.50 493.93 41828 313.79 298.10 342.82 # 41016 361.77 343.68 395.23 # 41828 221.13 210.07 241.58 41017 455.82 433.03 497.98 41830 402.04 381.94 439.23 # 41017 363.63 345.45 397.27 # 41830 288.89 274.45 315.62 41018 517.74 491.85 565.63 41872 380.36 361.34 415.54 # 41018 421.82 400.73 460.84 # 41872 271.41 257.84 296.52 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 35 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 41874 383.72 364.53 419.21 42425 870.25 826.74 950.75 # 41874 263.13 249.97 287.47 42426 1,404.63 1,334.40 1,534.56 42000 166.10 157.80 181.47 42440 483.70 459.52 528.45 # 42000 106.97 101.62 116.86 42450 474.13 450.42 517.98 42100 156.31 148.49 170.76 # 42450 375.42 356.65 410.15 # 42100 113.47 107.80 123.97 42500 453.13 430.47 495.04 42104 219.67 208.69 239.99 # 42500 358.15 340.24 391.28 # 42104 142.84 135.70 156.06 42505 582.08 552.98 635.93 42106 278.33 264.41 304.07 # 42505 474.99 451.24 518.93 # 42106 187.54 178.16 204.88 42507 542.91 515.76 593.12 42107 475.45 451.68 519.43 42508 766.61 728.28 837.52 # 42107 357.19 339.33 390.23 42509 867.73 824.34 947.99 42120 1,016.60 965.77 1,110.64 42510 661.84 628.75 723.06 42140 265.97 252.67 290.57 42550 165.66 157.38 180.99 # 42140 163.06 154.91 178.15 # 42550 70.20 66.69 76.69 42145 726.85 690.51 794.09 42600 509.77 484.28 556.92 42160 254.75 242.01 278.31 # 42600 369.62 351.14 403.81 # 42160 159.77 151.78 174.55 42650 87.78 83.39 95.90 42180 252.03 239.43 275.34 # 42650 62.17 59.06 67.92 # 42180 190.57 181.04 208.20 42660 111.47 105.90 121.79 42182 340.71 323.67 372.22 # 42660 81.67 77.59 89.23 # 42182 275.99 262.19 301.52 42665 327.54 311.16 357.83 42200 917.88 871.99 1,002.79 # 42665 217.66 206.78 237.80 42205 974.13 925.42 1,064.23 42700 198.55 188.62 216.91 42210 1,102.04 1,046.94 1,203.98 # 42700 142.67 135.54 155.87 42215 732.56 695.93 800.32 42720 472.13 448.52 515.80 42220 568.39 539.97 620.97 # 42720 407.87 387.48 445.60 42225 1,003.81 953.62 1,096.66 42725 837.95 796.05 915.46 42226 989.89 940.40 1,081.46 42800 166.18 157.87 181.55 42227 963.79 915.60 1,052.94 # 42800 117.29 111.43 128.14 42235 788.24 748.83 861.15 42802 259.56 246.58 283.57 42260 864.47 821.25 944.44 # 42802 144.08 136.88 157.41 # 42260 702.43 667.31 767.41 42804 217.14 206.28 237.22 42280 163.70 155.52 178.85 # 42804 122.62 116.49 133.96 # 42280 106.43 101.11 116.28 42806 243.16 231.00 265.65 42281 212.55 201.92 232.21 # 42806 142.58 135.45 155.77 # 42281 158.54 150.61 173.20 42808 239.87 227.88 262.06 42300 217.86 206.97 238.02 # 42808 171.42 162.85 187.28 # 42300 158.73 150.79 173.41 42809 177.55 168.67 193.97 42305 445.95 423.65 487.20 # 42809 134.25 127.54 146.67 42310 168.85 160.41 184.47 42810 409.83 389.34 447.74 # 42310 129.73 123.24 141.73 # 42810 300.88 285.84 328.72 42320 261.83 248.74 286.05 42815 581.27 552.21 635.04 # 42320 185.00 175.75 202.11 42820 303.45 288.28 331.52 42330 243.51 231.33 266.03 42821 317.20 301.34 346.54 # 42330 171.34 162.77 187.19 42825 274.61 260.88 300.01 42335 390.27 370.76 426.37 42826 264.46 251.24 288.93 # 42335 270.14 256.63 295.12 42830 217.48 206.61 237.60 42340 485.96 461.66 530.91 42831 235.24 223.48 257.00 # 42340 352.80 335.16 385.43 42835 196.09 186.29 214.23 42400 118.14 112.23 129.06 42836 254.34 241.62 277.86 # 42400 61.80 58.71 67.52 42842 1,017.88 966.99 1,112.04 42405 316.81 300.97 346.12 42844 1,423.44 1,352.27 1,555.11 # 42405 236.72 224.88 258.61 42845 2,291.43 2,176.86 2,503.39 42408 475.25 451.49 519.21 42860 197.88 187.99 216.19 # 42408 341.15 324.09 372.70 42870 617.71 586.82 674.84 42409 348.81 331.37 381.08 42890 1,437.91 1,366.01 1,570.91 # 42409 234.27 222.56 255.94 42892 1,876.80 1,782.96 2,050.40 42410 641.56 609.48 700.90 42894 2,397.74 2,277.85 2,619.53 42415 1,149.40 1,091.93 1,255.72 42900 357.99 340.09 391.10 42420 1,314.96 1,249.21 1,436.59 42950 847.90 805.51 926.34 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 36 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 42953 1,050.31 997.79 1,147.46 43245 198.75 188.81 217.13 42955 795.56 755.78 869.15 43246 265.61 252.33 290.18 42960 176.73 167.89 193.07 43247 212.97 202.32 232.67 42961 440.08 418.08 480.79 43248 201.93 191.83 220.60 42962 542.43 515.31 592.61 43249 185.86 176.57 203.06 42970 402.85 382.71 440.12 43250 198.56 188.63 216.92 42971 477.01 453.16 521.13 43251 231.54 219.96 252.95 42972 534.01 507.31 583.41 43255 301.30 286.24 329.18 43020 543.98 516.78 594.30 43256 270.46 256.94 295.48 43030 541.00 513.95 591.04 43257 330.44 313.92 361.01 43045 1,353.50 1,285.83 1,478.70 43258 283.75 269.56 309.99 43100 645.45 613.18 705.16 43259 323.32 307.15 353.22 43101 1,055.79 1,003.00 1,153.45 43260 370.03 351.53 404.26 43107 2,592.92 2,463.27 2,832.76 43261 388.88 369.44 424.86 43108 4,295.31 4,080.54 4,692.62 43262 456.39 433.57 498.61 43112 2,767.88 2,629.49 3,023.91 43263 451.75 429.16 493.53 43113 4,318.93 4,102.98 4,718.43 43264 547.59 520.21 598.24 43116 4,899.80 4,654.81 5,353.03 43265 614.27 583.56 671.09 43117 2,529.21 2,402.75 2,763.16 43267 454.07 431.37 496.08 43118 3,545.39 3,368.12 3,873.34 43268 462.91 439.76 505.72 43121 2,833.72 2,692.03 3,095.83 43269 505.71 480.42 552.48 43122 2,557.37 2,429.50 2,793.93 43271 455.93 433.13 498.10 43123 4,319.83 4,103.84 4,719.42 43272 455.00 432.25 497.09 43124 3,712.61 3,526.98 4,056.03 43273 137.83 130.94 150.58 43130 814.27 773.56 889.59 43279 1,264.42 1,201.20 1,381.38 43135 1,492.31 1,417.69 1,630.34 43280 1,058.65 1,005.72 1,156.58 43200 238.13 226.22 260.15 43300 643.19 611.03 702.68 # 43200 110.08 104.58 120.27 43305 1,138.09 1,081.19 1,243.37 43201 328.48 312.06 358.87 43310 1,570.69 1,492.16 1,715.98 # 43201 137.57 130.69 150.29 43312 1,730.76 1,644.22 1,890.85 43202 315.00 299.25 344.14 43313 2,740.23 2,603.22 2,993.70 # 43202 120.84 114.80 132.02 43314 3,162.44 3,004.32 3,454.97 43204 237.67 225.79 259.66 43320 1,379.50 1,310.53 1,507.11 43205 238.33 226.41 260.37 43324 1,333.26 1,266.60 1,456.59 43215 162.62 154.49 177.66 43325 1,312.98 1,247.33 1,434.43 43216 212.38 201.76 232.02 43326 1,345.71 1,278.42 1,470.18 # 43216 151.85 144.26 165.90 43330 1,287.41 1,223.04 1,406.50 43217 417.91 397.01 456.56 43331 1,406.00 1,335.70 1,536.06 # 43217 178.11 169.20 194.58 43340 1,338.03 1,271.13 1,461.80 43219 181.77 172.68 198.58 43341 1,484.26 1,410.05 1,621.56 43220 134.30 127.59 146.73 43350 1,146.43 1,089.11 1,252.48 43226 149.82 142.33 163.68 43351 1,351.85 1,284.26 1,476.90 43227 221.97 210.87 242.50 43352 1,107.76 1,052.37 1,210.23 43228 237.38 225.51 259.34 43360 2,347.83 2,230.44 2,565.01 43231 202.49 192.37 221.23 43361 2,616.28 2,485.47 2,858.29 43232 278.16 264.25 303.89 43400 1,642.28 1,560.17 1,794.20 43234 311.16 295.60 339.94 43401 1,524.22 1,448.01 1,665.21 # 43234 125.84 119.55 137.48 43405 1,488.05 1,413.65 1,625.70 43235 334.19 317.48 365.10 43410 1,025.01 973.76 1,119.82 # 43235 154.46 146.74 168.75 43415 1,732.78 1,646.14 1,893.06 43236 416.81 395.97 455.37 43420 1,022.84 971.70 1,117.46 # 43236 187.72 178.33 205.08 43425 1,526.20 1,449.89 1,667.37 43237 255.01 242.26 278.60 43450 176.24 167.43 192.54 43238 315.49 299.72 344.68 # 43450 95.22 90.46 104.03 43239 385.89 366.60 421.59 43453 342.17 325.06 373.82 # 43239 182.42 173.30 199.30 # 43453 103.30 98.14 112.86 43240 422.37 401.25 461.44 43456 697.35 662.48 761.85 43241 165.70 157.42 181.03 # 43456 165.15 156.89 180.42 43242 450.82 428.28 492.52 43458 433.54 411.86 473.64 43243 284.49 270.27 310.81 # 43458 192.35 182.73 210.14 43244 315.51 299.73 344.69 43460 232.54 220.91 254.05 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 37 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 43496 2,228.42 2,117.00 2,434.55 44021 950.46 902.94 1,038.38 43500 759.36 721.39 829.60 44025 955.45 907.68 1,043.83 43501 1,298.99 1,234.04 1,419.15 44050 905.50 860.23 989.26 43502 1,469.37 1,395.90 1,605.29 44055 1,442.07 1,369.97 1,575.47 43510 947.52 900.14 1,035.16 44100 121.19 115.13 132.40 43520 690.04 655.54 753.87 44110 820.15 779.14 896.01 43600 111.99 106.39 122.35 44111 952.67 905.04 1,040.80 43605 804.45 764.23 878.86 44120 1,176.27 1,117.46 1,285.08 43610 948.38 900.96 1,036.10 44121 240.36 228.34 262.59 43611 1,180.21 1,121.20 1,289.38 44125 1,143.97 1,086.77 1,249.79 43620 1,913.31 1,817.64 2,090.29 44126 2,353.14 2,235.48 2,570.80 43621 2,171.41 2,062.84 2,372.27 44127 2,737.01 2,600.16 2,990.18 43622 2,203.65 2,093.47 2,407.49 44128 241.65 229.57 264.01 43631 1,408.11 1,337.70 1,538.36 44130 1,230.72 1,169.18 1,344.56 43632 1,902.73 1,807.59 2,078.73 44137 1,095.92 1,041.12 1,197.29 43633 1,813.20 1,722.54 1,980.92 44139 120.28 114.27 131.41 43634 2,002.22 1,902.11 2,187.43 44140 1,304.00 1,238.80 1,424.62 43635 111.36 105.79 121.66 44141 1,719.52 1,633.54 1,878.57 43640 1,134.45 1,077.73 1,239.39 44143 1,608.61 1,528.18 1,757.41 43641 1,143.45 1,086.28 1,249.22 44144 1,682.98 1,598.83 1,838.65 43644 1,674.65 1,590.92 1,829.56 44145 1,620.51 1,539.48 1,770.40 43645 1,790.24 1,700.73 1,955.84 44146 2,033.67 1,931.99 2,221.79 43651 637.03 605.18 695.96 44147 1,814.72 1,723.98 1,982.58 43652 742.92 705.77 811.64 44150 1,791.83 1,702.24 1,957.58 43653 546.97 519.62 597.56 44151 2,043.94 1,941.74 2,233.00 43752 43.65 41.47 47.69 44155 2,000.97 1,900.92 2,186.06 43760 393.01 373.36 429.36 44156 2,202.01 2,091.91 2,405.70 # 43760 53.11 50.45 58.02 44157 2,089.39 1,984.92 2,282.66 43761 130.79 124.25 142.89 44158 2,140.33 2,033.31 2,338.31 # 43761 113.10 107.45 123.57 44160 1,201.08 1,141.03 1,312.18 43770 1,082.26 1,028.15 1,182.37 44180 898.55 853.62 981.66 43771 1,231.11 1,169.55 1,344.98 44186 638.42 606.50 697.48 43772 930.88 884.34 1,016.99 44187 1,077.68 1,023.80 1,177.37 43773 1,232.32 1,170.70 1,346.31 44188 1,191.01 1,131.46 1,301.18 43774 932.02 885.42 1,018.23 44202 1,349.19 1,281.73 1,473.99 43800 901.06 856.01 984.41 44203 239.15 227.19 261.27 43810 974.94 926.19 1,065.12 44204 1,503.26 1,428.10 1,642.32 43820 1,257.70 1,194.82 1,374.04 44205 1,313.43 1,247.76 1,434.92 43825 1,254.08 1,191.38 1,370.09 44206 1,708.10 1,622.70 1,866.11 43830 675.99 642.19 738.52 44207 1,787.06 1,697.71 1,952.37 43831 571.73 543.14 624.61 44208 1,951.16 1,853.60 2,131.64 43832 1,032.70 981.07 1,128.23 44210 1,748.40 1,660.98 1,910.13 43840 1,275.90 1,212.11 1,393.93 44211 2,144.42 2,037.20 2,342.78 43843 1,222.61 1,161.48 1,335.70 44212 2,014.35 1,913.63 2,200.67 43845 1,886.75 1,792.41 2,061.27 44213 188.58 179.15 206.02 43846 1,576.20 1,497.39 1,722.00 44227 1,627.27 1,545.91 1,777.80 43847 1,718.05 1,632.15 1,876.97 44300 816.08 775.28 891.57 43848 1,865.57 1,772.29 2,038.13 44310 1,015.90 965.11 1,109.88 43850 1,560.30 1,482.29 1,704.63 44312 585.33 556.06 639.47 43855 1,631.88 1,550.29 1,782.83 44314 987.80 938.41 1,079.17 43860 1,585.67 1,506.39 1,732.35 44316 1,344.59 1,277.36 1,468.96 43865 1,648.67 1,566.24 1,801.18 44320 1,160.76 1,102.72 1,268.13 43870 685.68 651.40 749.11 44322 950.92 903.37 1,038.88 43880 1,549.84 1,472.35 1,693.20 44340 591.57 561.99 646.29 43886 333.69 317.01 364.56 44345 1,018.48 967.56 1,112.69 43887 312.49 296.87 341.40 44346 1,140.27 1,083.26 1,245.75 43888 437.57 415.69 478.04 44360 168.41 159.99 183.99 44005 1,060.32 1,007.30 1,158.40 44361 185.40 176.13 202.55 44010 836.85 795.01 914.26 44363 218.45 207.53 238.66 44015 143.20 136.04 156.45 44364 235.73 223.94 257.53 44020 938.47 891.55 1,025.28 44365 210.01 199.51 229.44 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 38 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 44366 277.81 263.92 303.51 45005 264.57 251.34 289.04 44369 283.56 269.38 309.79 # 45005 154.68 146.95 168.99 44370 306.23 290.92 334.56 45020 529.16 502.70 578.11 44372 268.86 255.42 293.73 45100 286.67 272.34 313.19 44373 218.45 207.53 238.66 45108 346.25 328.94 378.28 44376 321.89 305.80 351.67 45110 1,801.69 1,711.61 1,968.35 44377 342.07 324.97 373.72 45111 1,058.56 1,005.63 1,156.47 44378 438.28 416.37 478.83 45112 1,841.18 1,749.12 2,011.49 44379 465.29 442.03 508.33 45113 1,896.47 1,801.65 2,071.90 44380 74.23 70.52 81.10 45114 1,727.09 1,640.74 1,886.85 44382 89.09 84.64 97.34 45116 1,551.97 1,474.37 1,695.53 44383 188.93 179.48 206.40 45119 1,897.41 1,802.54 2,072.92 44385 276.55 262.72 302.13 45120 1,519.73 1,443.74 1,660.30 # 44385 111.72 106.13 122.05 45121 1,660.50 1,577.48 1,814.10 44386 388.70 369.27 424.66 45123 1,077.71 1,023.82 1,177.39 # 44386 131.22 124.66 143.36 45126 2,810.51 2,669.98 3,070.48 44388 380.02 361.02 415.17 45130 1,053.10 1,000.45 1,150.52 # 44388 174.21 165.50 190.33 45135 1,292.63 1,228.00 1,412.20 44389 443.02 420.87 484.00 45136 1,791.83 1,702.24 1,957.58 # 44389 194.84 185.10 212.87 45150 393.91 374.21 430.34 44390 509.58 484.10 556.72 45160 963.95 915.75 1,053.11 # 44390 233.00 221.35 254.55 45170 755.06 717.31 824.91 44391 570.69 542.16 623.48 45190 663.06 629.91 724.40 # 44391 266.17 252.86 290.79 45300 116.47 110.65 127.25 44392 475.77 451.98 519.78 # 45300 50.35 47.83 55.00 # 44392 228.53 217.10 249.67 45303 951.97 904.37 1,040.03 44393 548.89 521.45 599.67 # 45303 84.52 80.29 92.33 # 44393 291.40 276.83 318.35 45305 190.04 180.54 207.62 44394 557.25 529.39 608.80 # 45305 76.89 73.05 84.01 # 44394 270.43 256.91 295.45 45307 208.60 198.17 227.90 44397 292.73 278.09 319.80 # 45307 95.92 91.12 104.79 44500 27.39 26.02 29.92 45308 192.73 183.09 210.55 44602 1,324.88 1,258.64 1,447.44 # 45308 81.91 77.81 89.48 44603 1,520.88 1,444.84 1,661.57 45309 217.25 206.39 237.35 44604 1,026.20 974.89 1,121.12 # 45309 96.19 91.38 105.09 44605 1,268.65 1,205.22 1,386.00 45315 232.51 220.88 254.01 44615 1,045.59 993.31 1,142.31 # 45315 108.65 103.22 118.70 44620 836.32 794.50 913.68 45317 222.23 211.12 242.79 44625 988.05 938.65 1,079.45 # 45317 113.28 107.62 123.76 44626 1,564.91 1,486.66 1,709.66 45320 225.99 214.69 246.89 44640 1,367.07 1,298.72 1,493.53 # 45320 109.12 103.66 119.21 44650 1,422.11 1,351.00 1,553.65 45321 105.31 100.04 115.05 44660 1,386.63 1,317.30 1,514.90 45327 123.33 117.16 134.73 44661 1,546.73 1,469.39 1,689.80 45330 150.98 143.43 164.94 44680 1,032.51 980.88 1,128.01 # 45330 65.77 62.48 71.85 44700 999.11 949.15 1,091.52 45331 192.76 183.12 210.59 44701 166.22 157.91 181.60 # 45331 80.08 76.08 87.49 44715 355.62 337.84 388.52 45332 317.62 301.74 347.00 44720 274.45 260.73 299.84 # 45332 116.01 110.21 126.74 44721 383.36 364.19 418.82 45333 319.67 303.69 349.24 44800 743.45 706.28 812.22 # 45333 115.26 109.50 125.93 44820 816.46 775.64 891.99 45334 174.81 166.07 190.98 44850 720.37 684.35 787.00 45335 274.19 260.48 299.55 44900 737.19 700.33 805.38 # 45335 96.79 91.95 105.74 44901 1,148.51 1,091.08 1,254.74 45337 149.25 141.79 163.06 # 44901 188.87 179.43 206.34 45338 353.29 335.63 385.97 44950 623.94 592.74 681.65 # 45338 149.82 142.33 163.68 44955 83.71 79.52 91.45 45339 359.30 341.34 392.54 44960 838.31 796.39 915.85 # 45339 197.73 187.84 216.02 44970 577.23 548.37 630.63 45340 496.13 471.32 542.02 45000 407.86 387.47 445.59 # 45340 121.30 115.24 132.53 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 39 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 45341 166.91 158.56 182.34 46070 231.27 219.71 252.67 45342 254.49 241.77 278.04 46080 235.15 223.39 256.90 45345 185.01 175.76 202.12 # 46080 154.59 146.86 168.89 45355 210.96 200.41 230.47 46083 183.02 173.87 199.95 45378 435.76 413.97 476.07 # 46083 106.65 101.32 116.52 # 45378 228.09 216.69 249.19 46200 402.04 381.94 439.23 45378 53 150.98 143.43 164.94 # 46200 303.33 288.16 331.38 # 45378 53 65.77 62.48 71.85 46210 373.87 355.18 408.46 45379 553.20 525.54 604.37 # 46210 257.46 244.59 281.28 # 45379 285.01 270.76 311.37 46211 499.58 474.60 545.79 45380 523.27 497.11 571.68 # 46211 371.54 352.96 405.90 # 45380 275.09 261.34 300.54 46220 194.63 184.90 212.64 45381 510.65 485.12 557.89 # 46220 113.61 107.93 124.12 # 45381 260.62 247.59 284.73 46221 252.24 239.63 275.57 45382 691.44 656.87 755.40 # 46221 182.40 173.28 199.27 # 45382 351.54 333.96 384.05 46230 262.23 249.12 286.49 45383 616.70 585.87 673.75 # 46230 167.25 158.89 182.72 # 45383 351.77 334.18 384.31 46250 438.05 416.15 478.57 45384 510.46 484.94 557.68 # 46250 299.29 284.33 326.98 # 45384 284.64 270.41 310.97 46255 486.24 461.93 531.22 45385 586.82 557.48 641.10 # 46255 339.11 322.15 370.47 # 45385 326.07 309.77 356.24 46257 396.99 377.14 433.71 45386 744.22 707.01 813.06 46258 433.40 411.73 473.49 # 45386 279.99 265.99 305.89 46260 448.87 426.43 490.39 45387 365.82 347.53 399.66 46261 500.03 475.03 546.28 45391 315.95 300.15 345.17 46262 523.74 497.55 572.18 45392 399.10 379.15 436.02 46270 470.56 447.03 514.08 45395 1,950.19 1,852.68 2,130.58 # 46270 361.60 343.52 395.05 45397 2,105.40 2,000.13 2,300.15 46275 495.89 471.10 541.77 45400 1,121.79 1,065.70 1,225.56 # 46275 386.00 366.70 421.71 45402 1,494.42 1,419.70 1,632.66 46280 439.83 417.84 480.52 45500 503.03 477.88 549.56 46285 480.65 456.62 525.11 45505 553.38 525.71 604.57 # 46285 380.54 361.51 415.74 45520 139.13 132.17 152.00 46288 517.25 491.39 565.10 # 45520 39.48 37.51 43.14 46320 173.57 164.89 189.62 45540 1,033.11 981.45 1,128.67 # 46320 106.52 101.19 116.37 45541 895.85 851.06 978.72 46500 214.74 204.00 234.60 45550 1,421.72 1,350.63 1,553.22 # 46500 123.01 116.86 134.39 45560 711.98 676.38 777.84 46505 270.42 256.90 295.44 45562 1,087.80 1,033.41 1,188.42 # 46505 223.85 212.66 244.56 45563 1,569.57 1,491.09 1,714.75 46600 87.44 83.07 95.53 45800 1,220.64 1,159.61 1,333.55 # 46600 39.02 37.07 42.63 45805 1,375.21 1,306.45 1,502.42 46604 569.08 540.63 621.72 45820 1,210.96 1,150.41 1,322.97 # 46604 66.68 63.35 72.85 45825 1,459.73 1,386.74 1,594.75 46606 225.81 214.52 246.70 45900 194.48 184.76 212.47 # 46606 73.09 69.44 79.86 45905 167.11 158.75 182.56 46608 232.38 220.76 253.87 45910 197.20 187.34 215.44 # 46608 80.59 76.56 88.04 45915 321.10 305.05 350.81 46610 229.97 218.47 251.24 # 45915 220.99 209.94 241.43 # 46610 80.04 76.04 87.45 45990 107.34 101.97 117.27 46611 178.27 169.36 194.76 46020 255.48 242.71 279.12 # 46611 82.82 78.68 90.48 # 46020 220.09 209.09 240.45 46612 275.71 261.92 301.21 46030 130.90 124.36 143.01 # 46612 98.31 93.39 107.40 # 46030 86.66 82.33 94.68 46614 136.68 129.85 149.33 46040 503.31 478.14 549.86 # 46614 71.03 67.48 77.60 # 46040 394.35 374.63 430.82 46615 153.70 146.02 167.92 46045 402.51 382.38 439.74 # 46615 100.15 95.14 109.41 46050 187.52 178.14 204.86 46700 618.43 587.51 675.64 # 46050 92.53 87.90 101.09 46705 516.51 490.68 564.28 46060 444.21 422.00 485.30 46706 165.14 156.88 180.41 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 40 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 46710 1,048.32 995.90 1,145.29 47142 4,428.33 4,206.91 4,837.95 46712 2,119.55 2,013.57 2,315.61 47143 301.07 286.02 328.92 46715 507.26 481.90 554.19 47144 451.59 429.01 493.36 46716 1,257.01 1,194.16 1,373.28 47145 451.59 429.01 493.36 46730 1,859.17 1,766.21 2,031.14 47146 326.56 310.23 356.76 46735 2,165.72 2,057.43 2,366.04 47147 381.04 361.99 416.29 46740 1,984.93 1,885.68 2,168.53 47300 1,084.09 1,029.89 1,184.37 46742 2,343.23 2,226.07 2,559.98 47350 1,327.25 1,260.89 1,450.02 46744 3,316.77 3,150.93 3,623.57 47360 1,798.80 1,708.86 1,965.19 46746 3,858.11 3,665.20 4,214.98 47361 2,943.43 2,796.26 3,215.70 46748 4,013.35 3,812.68 4,384.58 47362 1,375.65 1,306.87 1,502.90 46750 744.60 707.37 813.48 47370 1,210.62 1,150.09 1,322.60 46751 626.78 595.44 684.76 47371 1,237.14 1,175.28 1,351.57 46753 564.72 536.48 616.95 47380 1,413.18 1,342.52 1,543.90 46754 283.93 269.73 310.19 47381 1,442.95 1,370.80 1,576.42 # 46754 211.76 201.17 231.35 47382 899.36 854.39 982.55 46760 1,051.29 998.73 1,148.54 47400 2,048.26 1,945.85 2,237.73 46761 906.08 860.78 989.90 47420 1,298.98 1,234.03 1,419.13 46762 896.72 851.88 979.66 47425 1,311.42 1,245.85 1,432.73 46900 233.88 222.19 255.52 47460 1,244.87 1,182.63 1,360.02 # 46900 137.50 130.63 150.22 47480 833.82 792.13 910.95 46910 244.96 232.71 267.62 47490 570.89 542.35 623.70 # 46910 130.88 124.34 142.99 47500 110.97 105.42 121.23 46916 242.75 230.61 265.20 47505 42.81 40.67 46.77 # 46916 146.37 139.05 159.91 47510 537.36 510.49 587.06 46917 484.84 460.60 529.69 47511 667.11 633.75 728.81 # 46917 131.90 125.31 144.11 47525 710.66 675.13 776.40 46922 256.03 243.23 279.71 # 47525 144.00 136.80 157.32 # 46922 130.78 124.24 142.88 47530 1,695.76 1,610.97 1,852.62 46924 542.90 515.76 593.12 # 47530 403.67 383.49 441.01 # 46924 181.11 172.05 197.86 47550 165.01 156.76 180.27 46930 227.13 215.77 248.14 47552 359.68 341.70 392.96 # 46930 159.62 151.64 174.39 47553 356.77 338.93 389.77 46937 256.32 243.50 280.03 47554 523.43 497.26 571.85 # 46937 172.97 164.32 188.97 47555 428.56 407.13 468.20 46938 446.50 424.18 487.81 47556 484.74 460.50 529.58 # 46938 360.36 342.34 393.69 47560 266.53 253.20 291.18 46940 214.80 204.06 234.67 47561 290.61 276.08 317.49 # 46940 143.10 135.95 156.34 47562 719.56 683.58 786.12 46942 200.05 190.05 218.56 47563 734.92 698.17 802.90 # 46942 127.41 121.04 139.20 47564 845.78 803.49 924.01 46945 286.36 272.04 312.85 47570 756.51 718.68 826.48 # 46945 215.59 204.81 235.53 47600 1,025.95 974.65 1,120.85 46946 306.94 291.59 335.33 47605 950.20 902.69 1,038.09 # 46946 224.06 212.86 244.79 47610 1,213.60 1,152.92 1,325.86 46947 366.89 348.55 400.83 47612 1,225.49 1,164.22 1,338.85 47000 375.54 356.76 410.27 47620 1,329.62 1,263.14 1,452.61 # 47000 107.81 102.42 117.78 47630 606.82 576.48 662.95 47001 103.01 97.86 112.54 47700 1,020.12 969.11 1,114.48 47010 1,162.67 1,104.54 1,270.22 47701 1,750.24 1,662.73 1,912.14 47011 208.66 198.23 227.96 47711 1,507.91 1,432.51 1,647.39 47015 1,101.69 1,046.61 1,203.60 47712 1,924.82 1,828.58 2,102.87 47100 813.52 772.84 888.77 47715 1,270.05 1,206.55 1,387.53 47120 2,259.16 2,146.20 2,468.13 47720 1,100.40 1,045.38 1,202.19 47122 3,344.65 3,177.42 3,654.03 47721 1,294.46 1,229.74 1,414.20 47125 2,998.18 2,848.27 3,275.51 47740 1,251.12 1,188.56 1,366.84 47130 3,222.04 3,060.94 3,520.08 47741 1,415.39 1,344.62 1,546.31 47135 4,750.30 4,512.79 5,189.71 47760 2,114.55 2,008.82 2,310.14 47136 4,058.32 3,855.40 4,433.71 47765 2,777.79 2,638.90 3,034.74 47140 3,388.92 3,219.47 3,702.39 47780 2,308.51 2,193.08 2,522.04 47141 4,027.97 3,826.57 4,400.56 47785 2,999.96 2,849.96 3,277.45 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 41 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 47800 1,522.49 1,446.37 1,663.33 49320 325.55 309.27 355.66 47801 1,090.07 1,035.57 1,190.91 49321 342.25 325.14 373.91 47802 1,463.89 1,390.70 1,599.31 49322 371.13 352.57 405.46 47900 1,319.59 1,253.61 1,441.65 49323 630.19 598.68 688.48 48000 1,820.66 1,729.63 1,989.07 49324 385.51 366.23 421.16 48001 2,232.04 2,120.44 2,438.51 49325 413.24 392.58 451.47 48020 1,129.72 1,073.23 1,234.21 49326 186.25 176.94 203.48 48100 857.69 814.81 937.03 49400 198.23 188.32 216.57 48102 613.50 582.83 670.25 # 49400 105.57 100.29 115.33 # 48102 277.32 263.45 302.97 49402 830.92 789.37 907.78 48105 2,748.83 2,611.39 3,003.10 49419 449.91 427.41 491.52 48120 1,067.33 1,013.96 1,166.05 49420 143.12 135.96 156.35 48140 1,508.52 1,433.09 1,648.05 49421 387.24 367.88 423.06 48145 1,565.86 1,487.57 1,710.71 49422 384.17 364.96 419.70 48146 1,794.39 1,704.67 1,960.37 49423 678.27 644.36 741.01 48148 1,191.03 1,131.48 1,301.20 # 49423 84.60 80.37 92.43 48150 3,014.85 2,864.11 3,293.73 49424 180.63 171.60 197.34 48152 2,789.79 2,650.30 3,047.85 # 49424 44.21 42.00 48.30 48153 3,010.11 2,859.60 3,288.54 49425 751.49 713.92 821.01 48154 2,795.71 2,655.92 3,054.31 49426 640.28 608.27 699.51 48155 1,743.51 1,656.33 1,904.78 49427 50.79 48.25 55.49 48400 109.56 104.08 119.69 49428 432.81 411.17 472.85 48500 1,095.71 1,040.92 1,197.06 49429 453.97 431.27 495.96 48510 1,041.63 989.55 1,137.98 49435 119.16 113.20 130.18 48511 1,105.95 1,050.65 1,208.25 49436 182.51 173.38 199.39 # 48511 225.93 214.63 246.82 49440 1,305.68 1,240.40 1,426.46 48520 1,055.65 1,002.87 1,153.30 # 49440 257.57 244.69 281.39 48540 1,258.49 1,195.57 1,374.91 49441 1,416.12 1,345.31 1,547.11 48545 1,275.49 1,211.72 1,393.48 # 49441 283.73 269.54 309.97 48547 1,715.10 1,629.35 1,873.75 49442 1,272.09 1,208.49 1,389.76 48548 1,609.96 1,529.46 1,758.88 # 49442 233.75 222.06 255.37 48551 204.63 194.40 223.56 49446 1,192.67 1,133.04 1,303.00 48552 228.19 216.78 249.30 # 49446 187.40 178.03 204.73 48554 2,439.13 2,317.17 2,664.75 49450 903.36 858.19 986.92 48556 1,207.65 1,147.27 1,319.36 # 49450 74.56 70.83 81.45 49000 755.46 717.69 825.34 49451 854.49 811.77 933.54 49002 980.55 931.52 1,071.25 # 49451 104.38 99.16 114.03 49010 931.73 885.14 1,017.91 49452 1,070.74 1,017.20 1,169.78 49020 1,540.12 1,463.11 1,682.58 # 49452 162.79 154.65 177.85 49021 1,061.35 1,008.28 1,159.52 49460 995.72 945.93 1,087.82 # 49021 190.65 181.12 208.29 # 49460 53.30 50.64 58.24 49040 967.36 918.99 1,056.84 49465 204.03 193.83 222.90 49041 1,078.02 1,024.12 1,177.74 # 49465 35.01 33.26 38.25 # 49041 225.47 214.20 246.33 49491 753.74 716.05 823.46 49060 1,082.91 1,028.76 1,183.07 49492 918.76 872.82 1,003.74 49061 1,061.68 1,008.60 1,159.89 49495 385.06 365.81 420.68 # 49061 208.66 198.23 227.96 49496 584.44 555.22 638.50 49062 739.54 702.56 807.94 49500 386.99 367.64 422.79 49080 194.32 184.60 212.29 49501 579.67 550.69 633.29 # 49080 76.05 72.25 83.09 49505 503.82 478.63 550.42 49081 181.48 172.41 198.27 49507 617.33 586.46 674.43 # 49081 71.59 68.01 78.21 49520 612.58 581.95 669.24 49180 191.28 181.72 208.98 49521 744.18 706.97 813.02 # 49180 97.69 92.81 106.73 49525 555.14 527.38 606.49 49203 1,178.69 1,119.76 1,287.72 49540 654.54 621.81 715.08 49204 1,500.38 1,425.36 1,639.16 49550 557.65 529.77 609.24 49205 1,715.52 1,629.74 1,874.20 49553 609.35 578.88 665.71 49215 2,150.19 2,042.68 2,349.08 49555 580.20 551.19 633.87 49220 942.52 895.39 1,029.70 49557 702.06 666.96 767.00 49250 567.91 539.51 620.44 49560 717.37 681.50 783.73 49255 768.17 729.76 839.22 49561 901.13 856.07 984.48 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 42 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 49565 743.84 706.65 812.65 50360 2,460.41 2,337.39 2,688.00 49566 910.51 864.98 994.73 50365 2,770.03 2,631.53 3,026.26 49568 264.86 251.62 289.36 50370 1,153.02 1,095.37 1,259.68 49570 399.14 379.18 436.06 50380 1,971.72 1,873.13 2,154.10 49572 490.76 466.22 536.15 50382 1,567.04 1,488.69 1,711.99 49580 313.76 298.07 342.78 # 50382 315.46 299.69 344.64 49582 460.03 437.03 502.58 50384 1,345.12 1,277.86 1,469.54 49585 428.10 406.70 467.71 # 50384 287.23 272.87 313.80 49587 504.75 479.51 551.44 50385 1,543.00 1,465.85 1,685.73 49590 553.10 525.45 604.27 # 50385 272.33 258.71 297.52 49600 713.49 677.82 779.49 50386 995.90 946.11 1,088.03 49605 4,847.63 4,605.25 5,296.04 # 50386 206.21 195.90 225.29 49606 1,104.27 1,049.06 1,206.42 50387 730.80 694.26 798.40 49610 662.36 629.24 723.63 # 50387 114.32 108.60 124.89 49611 602.62 572.49 658.36 50389 424.56 403.33 463.83 49650 416.35 395.53 454.86 # 50389 62.77 59.63 68.57 49651 536.96 510.11 586.63 50390 110.97 105.42 121.23 49652 773.06 734.41 844.57 50391 148.30 140.89 162.02 49653 964.78 916.54 1,054.02 # 50391 113.38 107.71 123.87 49654 885.56 841.28 967.47 50392 206.01 195.71 225.07 49655 1,065.84 1,012.55 1,164.43 50393 250.77 238.23 273.96 49656 888.71 844.27 970.91 50394 126.90 120.56 138.64 49657 1,279.10 1,215.15 1,397.42 # 50394 58.45 55.53 63.86 49900 798.10 758.20 871.93 50395 207.68 197.30 226.90 49904 1,496.06 1,421.26 1,634.45 50396 135.16 128.40 147.66 49905 353.71 336.02 386.42 50398 659.18 626.22 720.15 50010 782.64 743.51 855.04 # 50398 84.60 80.37 92.43 50020 1,110.24 1,054.73 1,212.94 50400 1,314.93 1,249.18 1,436.56 50021 1,118.63 1,062.70 1,222.11 50405 1,594.18 1,514.47 1,741.64 # 50021 190.18 180.67 207.77 50500 1,264.13 1,200.92 1,381.06 50040 1,051.14 998.58 1,148.37 50520 1,180.38 1,121.36 1,289.56 50045 1,060.25 1,007.24 1,158.33 50525 1,466.96 1,393.61 1,602.65 50060 1,303.44 1,238.27 1,424.01 50526 1,527.37 1,451.00 1,668.65 50065 1,366.21 1,297.90 1,492.59 50540 1,285.26 1,221.00 1,404.15 50070 1,362.32 1,294.20 1,488.33 50541 1,050.78 998.24 1,147.98 50075 1,672.04 1,588.44 1,826.71 50542 1,334.20 1,267.49 1,457.61 50080 998.64 948.71 1,091.02 50543 1,700.68 1,615.65 1,858.00 50081 1,462.45 1,389.33 1,597.73 50544 1,429.57 1,358.09 1,561.80 50100 1,058.54 1,005.61 1,156.45 50545 1,534.80 1,458.06 1,676.77 50120 1,080.42 1,026.40 1,180.36 50546 1,365.07 1,296.82 1,491.34 50125 1,116.10 1,060.30 1,219.35 50547 1,633.58 1,551.90 1,784.69 50130 1,182.82 1,123.68 1,292.23 50548 1,546.20 1,468.89 1,689.22 50135 1,278.54 1,214.61 1,396.80 50551 432.20 410.59 472.18 50200 161.15 153.09 176.05 # 50551 340.47 323.45 371.97 50205 746.18 708.87 815.20 50553 449.66 427.18 491.26 50220 1,162.11 1,104.00 1,269.60 # 50553 358.86 340.92 392.06 50225 1,343.67 1,276.49 1,467.96 50555 490.44 465.92 535.81 50230 1,456.07 1,383.27 1,590.76 # 50555 393.13 373.47 429.49 50234 1,479.77 1,405.78 1,616.65 50557 500.85 475.81 547.18 50236 1,678.13 1,594.22 1,833.35 # 50557 399.35 379.38 436.29 50240 1,507.43 1,432.06 1,646.87 50561 567.18 538.82 619.64 50250 1,401.31 1,331.24 1,530.93 # 50561 455.90 433.11 498.08 50280 1,076.34 1,022.52 1,175.90 50562 674.21 640.50 736.58 50290 987.92 938.52 1,079.30 50570 568.45 540.03 621.03 50320 1,471.59 1,398.01 1,607.71 50572 618.65 587.72 675.88 50323 183.98 174.78 201.00 50574 652.95 620.30 713.35 50325 183.98 174.78 201.00 50575 825.21 783.95 901.54 50327 213.71 203.02 233.47 50576 652.11 619.50 712.43 50328 187.81 178.42 205.18 50580 697.42 662.55 761.93 50329 186.72 177.38 203.99 50590 1,119.74 1,063.75 1,223.31 50340 905.34 860.07 989.08 # 50590 648.06 615.66 708.01 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 43 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 50592 4,538.42 4,311.50 4,958.23 50980 412.35 391.73 450.49 # 50592 413.96 393.26 452.25 51020 536.58 509.75 586.21 50593 5,854.26 5,561.55 6,395.78 51030 529.16 502.70 578.11 # 50593 520.12 494.11 568.23 51040 338.25 321.34 369.54 50600 1,066.30 1,012.99 1,164.94 51045 533.09 506.44 582.41 50605 1,023.30 972.14 1,117.96 51050 542.58 515.45 592.77 50610 1,090.10 1,035.60 1,190.94 51060 666.95 633.60 728.64 50620 1,034.39 982.67 1,130.07 51065 661.64 628.56 722.84 50630 1,006.28 955.97 1,099.37 51080 466.23 442.92 509.36 50650 1,178.43 1,119.51 1,287.44 51100 71.77 68.18 78.41 50660 1,300.53 1,235.50 1,420.83 # 51100 43.36 41.19 47.37 50684 224.68 213.45 245.47 51101 152.82 145.18 166.96 # 50684 57.99 55.09 63.35 # 51101 58.30 55.39 63.70 50686 104.70 99.47 114.39 51102 281.13 267.07 307.13 50688 92.75 88.11 101.33 # 51102 172.17 163.56 188.09 50690 118.55 112.62 129.51 51500 707.43 672.06 772.87 # 50690 80.83 76.79 88.31 51520 669.69 636.21 731.64 50700 1,056.72 1,003.88 1,154.46 51525 980.26 931.25 1,070.94 50715 1,235.67 1,173.89 1,349.97 51530 873.29 829.63 954.07 50722 1,075.02 1,021.27 1,174.46 51535 886.70 842.37 968.73 50725 1,235.78 1,173.99 1,350.09 51550 1,073.95 1,020.25 1,173.29 50727 578.44 549.52 631.95 51555 1,425.37 1,354.10 1,557.22 50728 788.13 748.72 861.03 51565 1,458.11 1,385.20 1,592.98 50740 1,212.16 1,151.55 1,324.28 51570 1,660.66 1,577.63 1,814.27 50750 1,325.18 1,258.92 1,447.76 51575 2,077.79 1,973.90 2,269.99 50760 1,232.25 1,170.64 1,346.24 51580 2,168.40 2,059.98 2,368.98 50770 1,275.43 1,211.66 1,393.41 51585 2,412.63 2,292.00 2,635.80 50780 1,237.87 1,175.98 1,352.38 51590 2,195.07 2,085.32 2,398.12 50782 1,214.03 1,153.33 1,326.33 51595 2,494.49 2,369.77 2,725.24 50783 1,255.00 1,192.25 1,371.09 51596 2,683.54 2,549.36 2,931.76 50785 1,373.44 1,304.77 1,500.49 51597 2,585.65 2,456.37 2,824.83 50800 1,048.60 996.17 1,145.60 51600 241.05 229.00 263.35 50810 1,365.25 1,296.99 1,491.54 # 51600 50.14 47.63 54.77 50815 1,394.27 1,324.56 1,523.24 51605 44.41 42.19 48.52 50820 1,479.56 1,405.58 1,616.42 51610 134.49 127.77 146.94 50825 1,877.16 1,783.30 2,050.80 # 51610 73.49 69.82 80.29 50830 2,032.23 1,930.62 2,220.21 51700 105.09 99.84 114.82 50840 1,403.69 1,333.51 1,533.54 # 51700 50.14 47.63 54.77 50845 1,426.74 1,355.40 1,558.71 51701 74.14 70.43 80.99 50860 1,079.19 1,025.23 1,179.01 # 51701 30.83 29.29 33.68 50900 949.53 902.05 1,037.36 51702 96.95 92.10 105.92 50920 1,005.72 955.43 1,098.74 # 51702 34.56 32.83 37.75 50930 1,205.51 1,145.23 1,317.01 51703 169.06 160.61 184.70 50940 1,010.54 960.01 1,104.01 # 51703 93.63 88.95 102.29 50945 1,117.87 1,061.98 1,221.28 51705 137.47 130.60 150.19 50947 1,580.91 1,501.86 1,727.14 # 51705 77.87 73.98 85.08 50948 1,469.69 1,396.21 1,605.64 51710 193.26 183.60 211.14 50951 451.63 429.05 493.41 # 51710 110.38 104.86 120.59 # 50951 355.24 337.48 388.10 51715 348.03 330.63 380.22 50953 475.87 452.08 519.89 # 51715 226.51 215.18 247.46 # 50953 392.99 373.34 429.34 51720 137.75 130.86 150.49 50955 527.84 501.45 576.67 # 51720 95.38 90.61 104.20 # 50955 424.47 403.25 463.74 51725 271.84 258.25 296.99 50957 511.16 485.60 558.44 51725 TC 185.95 176.65 203.15 # 50957 409.19 388.73 447.04 51725 26 85.89 81.60 93.84 50961 462.21 439.10 504.97 51726 400.41 380.39 437.45 # 50961 366.76 348.42 400.68 51726 TC 302.63 287.50 330.63 50970 429.34 407.87 469.05 51726 26 97.78 92.89 106.82 50972 413.18 392.52 451.40 51736 63.87 60.68 69.78 50974 546.63 519.30 597.20 51736 TC 28.68 27.25 31.34 50976 538.16 511.25 587.94 51736 26 35.19 33.43 38.44 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 44 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 51741 99.35 94.38 108.54 52270 505.20 479.94 551.93 51741 TC 33.61 31.93 36.72 # 52270 210.47 199.95 229.94 51741 26 65.74 62.45 71.82 52275 690.21 655.70 754.06 51772 305.06 289.81 333.28 # 52275 287.45 273.08 314.04 51772 TC 214.17 203.46 233.98 52276 307.05 291.70 335.46 51772 26 90.89 86.35 99.30 52277 374.37 355.65 409.00 51784 247.90 235.51 270.84 52281 377.16 358.30 412.05 51784 TC 161.28 153.22 176.20 # 52281 178.80 169.86 195.34 51784 26 86.63 82.30 94.65 52282 385.98 366.68 421.68 51785 270.44 256.92 295.46 52283 336.50 319.68 367.63 51785 TC 183.63 174.45 200.62 # 52283 231.27 219.71 252.67 51785 26 86.82 82.48 94.85 52285 340.52 323.49 372.01 51792 288.46 274.04 315.15 # 52285 224.12 212.91 244.85 51792 TC 226.15 214.84 247.07 52290 282.63 268.50 308.78 51792 26 62.31 59.19 68.07 52300 324.04 307.84 354.02 51795 378.07 359.17 413.05 52301 341.11 324.05 372.66 51795 TC 290.97 276.42 317.88 52305 321.71 305.62 351.46 51795 26 87.09 82.74 95.15 52310 305.82 290.53 334.11 51797 186.17 176.86 203.39 # 52310 174.98 166.23 191.16 51797 TC 135.94 129.14 148.51 52315 538.89 511.95 588.74 51797 26 50.22 47.71 54.87 # 52315 317.26 301.40 346.61 51798 26.42 25.10 28.87 52317 1,194.42 1,134.70 1,304.91 51800 1,189.10 1,129.65 1,299.10 # 52317 401.47 381.40 438.61 51820 1,206.72 1,146.38 1,318.34 52318 546.71 519.37 597.28 51840 723.95 687.75 790.91 52320 284.66 270.43 310.99 51841 856.92 814.07 936.18 52325 369.81 351.32 404.02 51845 662.76 629.62 724.06 52327 651.30 618.74 711.55 51860 807.46 767.09 882.15 # 52327 301.15 286.09 329.00 51865 998.93 948.98 1,091.33 52330 976.04 927.24 1,066.33 51880 527.13 500.77 575.89 # 52330 304.62 289.39 332.80 51900 926.93 880.58 1,012.67 52332 606.70 576.37 662.83 51920 858.01 815.11 937.38 # 52332 180.66 171.63 197.37 51925 1,115.91 1,060.11 1,219.13 52334 296.55 281.72 323.98 51940 1,812.97 1,722.32 1,980.67 52341 338.45 321.53 369.76 51960 1,578.01 1,499.11 1,723.98 52342 367.61 349.23 401.61 51980 813.17 772.51 888.39 52343 408.47 388.05 446.26 51990 828.88 787.44 905.56 52344 443.49 421.32 484.52 51992 901.30 856.24 984.68 52345 472.65 449.02 516.37 52000 253.78 241.09 277.25 52346 532.83 506.19 582.12 # 52000 143.89 136.70 157.21 52351 363.44 345.27 397.06 52001 453.36 430.69 495.29 52352 426.78 405.44 466.26 # 52001 330.91 314.36 361.51 52353 490.39 465.87 535.75 52005 357.11 339.25 390.14 52354 453.52 430.84 495.47 # 52005 153.64 145.96 167.85 52355 539.88 512.89 589.82 52007 682.47 648.35 745.60 52400 558.51 530.58 610.17 # 52007 191.71 182.12 209.44 52402 308.58 293.15 337.12 52010 500.61 475.58 546.92 52450 539.70 512.72 589.63 # 52010 184.92 175.67 202.02 52500 563.57 535.39 615.70 52204 558.04 530.14 609.66 52601 940.75 893.71 1,027.77 # 52204 162.27 154.16 177.28 52630 508.42 483.00 555.45 52214 730.23 693.72 797.78 52640 351.93 334.33 384.48 # 52214 254.37 241.65 277.90 52647 2,748.98 2,611.53 3,003.26 52224 1,064.08 1,010.88 1,162.51 # 52647 739.83 702.84 808.27 # 52224 195.70 185.92 213.81 52648 2,801.27 2,661.21 3,060.39 52234 284.85 270.61 311.20 # 52648 788.40 748.98 861.33 52235 333.70 317.02 364.57 52649 1,127.00 1,070.65 1,231.25 52240 581.45 552.38 635.24 52700 497.48 472.61 543.50 52250 280.22 266.21 306.14 53000 172.65 164.02 188.62 52260 241.29 229.23 263.61 53010 340.33 323.31 371.81 52265 529.11 502.65 578.05 53020 112.11 106.50 122.48 # 52265 181.76 172.67 198.57 53025 73.94 70.24 80.78 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 45 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 53040 451.61 429.03 493.38 53852 3,054.78 2,902.04 3,337.35 53060 200.58 190.55 219.13 # 53852 710.85 675.31 776.61 # 53060 174.51 165.78 190.65 54000 190.37 180.85 207.98 53080 504.44 479.22 551.10 # 54000 125.18 118.92 136.76 53085 699.45 664.48 764.15 54001 230.96 219.41 252.32 53200 178.93 169.98 195.48 # 54001 159.25 151.29 173.98 # 53200 160.77 152.73 175.64 54015 355.88 338.09 388.80 53210 879.49 835.52 960.85 54050 142.56 135.43 155.74 53215 1,066.16 1,012.85 1,164.78 # 54050 110.89 105.35 121.15 53220 517.85 491.96 565.75 54055 135.85 129.06 148.42 53230 687.24 652.88 750.81 # 54055 101.40 96.33 110.78 53235 732.52 695.89 800.27 54056 149.45 141.98 163.28 53240 495.01 470.26 540.80 # 54056 115.00 109.25 125.64 53250 459.90 436.91 502.45 54057 165.65 157.37 180.98 53260 230.91 219.36 252.26 # 54057 106.98 101.63 116.87 # 53260 200.64 190.61 219.20 54060 221.22 210.16 241.68 53265 258.64 245.71 282.57 # 54060 147.19 139.83 160.80 # 53265 211.15 200.59 230.68 54065 239.41 227.44 261.56 53270 234.50 222.78 256.20 # 54065 179.35 170.38 195.94 # 53270 206.10 195.80 225.17 54100 223.20 212.04 243.85 53275 304.89 289.65 333.10 # 54100 132.40 125.78 144.65 53400 916.00 870.20 1,000.73 54105 328.99 312.54 359.42 53405 1,007.76 957.37 1,100.98 # 54105 248.90 236.46 271.93 53410 1,122.56 1,066.43 1,226.39 54110 715.02 679.27 781.16 53415 1,291.18 1,226.62 1,410.61 54111 920.44 874.42 1,005.58 53420 912.89 867.25 997.34 54112 1,079.84 1,025.85 1,179.73 53425 1,080.74 1,026.70 1,180.71 54115 524.77 498.53 573.31 53430 1,073.70 1,020.02 1,173.02 # 54115 485.66 461.38 530.59 53431 1,319.40 1,253.43 1,441.44 54120 723.78 687.59 790.73 53440 1,005.04 954.79 1,098.01 54125 928.62 882.19 1,014.52 53442 887.39 843.02 969.47 54130 1,370.96 1,302.41 1,497.77 53444 912.75 867.11 997.18 54135 1,735.47 1,648.70 1,896.01 53445 1,011.28 960.72 1,104.83 54150 202.04 191.94 220.73 53446 741.55 704.47 810.14 # 54150 109.84 104.35 120.00 53447 934.06 887.36 1,020.46 54160 281.47 267.40 307.51 53448 1,467.04 1,393.69 1,602.74 # 54160 166.46 158.14 181.86 53449 704.28 669.07 769.43 54161 227.15 215.79 248.16 53450 471.25 447.69 514.84 54162 322.70 306.57 352.56 53460 527.70 501.32 576.52 # 54162 225.86 214.57 246.76 53500 842.34 800.22 920.25 54163 253.79 241.10 277.27 53502 556.92 529.07 608.43 54164 224.63 213.40 245.41 53505 560.31 532.29 612.13 54200 134.01 127.31 146.41 53510 726.83 690.49 794.06 # 54200 100.02 95.02 109.27 53515 911.77 866.18 996.11 54205 619.15 588.19 676.42 53520 639.46 607.49 698.61 54220 256.07 243.27 279.76 53600 101.86 96.77 111.29 # 54220 154.56 146.83 168.85 # 53600 73.93 70.23 80.76 54230 115.54 109.76 126.22 53601 101.16 96.10 110.52 # 54230 92.72 88.08 101.29 # 53601 62.05 58.95 67.79 54231 166.26 157.95 181.64 53605 73.73 70.04 80.55 # 54231 135.99 129.19 148.57 53620 146.96 139.61 160.55 54235 107.36 101.99 117.29 # 53620 100.87 95.83 110.20 # 54235 85.48 81.21 93.39 53621 140.86 133.82 153.89 54240 120.82 114.78 132.00 # 53621 83.59 79.41 91.32 54240 TC 44.96 42.71 49.12 53660 89.19 84.73 97.44 54240 26 75.86 72.07 82.88 # 53660 47.75 45.36 52.16 54250 144.62 137.39 158.00 53661 88.63 84.20 96.83 54250 TC 15.92 15.12 17.39 # 53661 46.72 44.38 51.04 54250 26 128.70 122.27 140.61 53665 42.90 40.76 46.87 54300 747.00 709.65 816.10 53850 3,185.82 3,026.53 3,480.51 54304 873.13 829.47 953.89 # 53850 650.99 618.44 711.21 54308 831.71 790.12 908.64 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 46 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 54312 961.02 912.97 1,049.92 55040 388.82 369.38 424.79 54316 1,158.15 1,100.24 1,265.28 55041 581.95 552.85 635.78 54318 839.53 797.55 917.18 55060 434.63 412.90 474.84 54322 907.66 862.28 991.62 55100 258.58 245.65 282.50 54324 1,126.03 1,069.73 1,230.19 # 55100 186.41 177.09 203.65 54326 1,052.45 999.83 1,149.80 55110 441.41 419.34 482.24 54328 1,071.98 1,018.38 1,171.14 55120 406.03 385.73 443.59 54332 1,172.36 1,113.74 1,280.80 55150 558.08 530.18 609.71 54336 1,318.95 1,253.00 1,440.95 55175 416.64 395.81 455.18 54340 649.01 616.56 709.04 55180 784.68 745.45 857.27 54344 1,112.81 1,057.17 1,215.75 55200 598.88 568.94 654.28 54348 1,180.37 1,121.35 1,289.55 # 55200 318.11 302.20 347.53 54352 1,658.78 1,575.84 1,812.22 55250 535.19 508.43 584.69 54360 837.64 795.76 915.12 # 55250 264.67 251.44 289.16 54380 928.12 881.71 1,013.97 55300 204.30 194.09 223.20 54385 1,128.88 1,072.44 1,233.31 55400 580.52 551.49 634.21 54390 1,340.37 1,273.35 1,464.35 55450 458.30 435.39 500.70 54400 615.27 584.51 672.19 # 55450 292.07 277.47 319.09 54401 761.74 723.65 832.20 55500 429.46 407.99 469.19 54405 929.46 882.99 1,015.44 55520 438.27 416.36 478.81 54406 839.95 797.95 917.64 55530 407.49 387.12 445.19 54408 904.52 859.29 988.18 55535 490.73 466.19 536.12 54410 993.02 943.37 1,084.88 55540 528.58 502.15 577.47 54411 1,171.38 1,112.81 1,279.73 55550 484.54 460.31 529.36 54415 607.98 577.58 664.22 55600 490.98 466.43 536.39 54416 813.29 772.63 888.52 55605 575.38 546.61 628.60 54417 1,027.48 976.11 1,122.53 55650 816.40 775.58 891.92 54420 815.36 774.59 890.78 55680 389.90 370.41 425.97 54430 740.70 703.67 809.22 55700 278.51 264.58 304.27 54435 483.44 459.27 528.16 # 55700 155.59 147.81 169.98 54450 85.68 81.40 93.61 55705 310.56 295.03 339.28 # 54450 67.05 63.70 73.26 55706 443.40 421.23 484.41 54500 87.23 82.87 95.30 55720 532.00 505.40 581.21 54505 247.04 234.69 269.89 55725 675.39 641.62 737.86 54512 614.77 584.03 671.63 55801 1,242.33 1,180.21 1,357.24 54520 375.78 356.99 410.54 55810 1,498.73 1,423.79 1,637.36 54522 665.22 631.96 726.75 55812 1,841.42 1,749.35 2,011.75 54530 585.10 555.85 639.23 55815 2,018.36 1,917.44 2,205.06 54535 839.59 797.61 917.25 55821 1,001.35 951.28 1,093.97 54550 561.66 533.58 613.62 55831 1,083.90 1,029.71 1,184.17 54560 758.65 720.72 828.83 55840 1,531.46 1,454.89 1,673.12 54600 521.10 495.05 569.31 55842 1,640.12 1,558.11 1,791.83 54620 348.83 331.39 381.10 55845 1,871.68 1,778.10 2,044.82 54640 536.89 510.05 586.56 55860 1,004.13 953.92 1,097.01 54650 814.48 773.76 889.82 55862 1,267.66 1,204.28 1,384.92 54660 411.41 390.84 449.47 55865 1,533.51 1,456.83 1,675.35 54670 467.24 443.88 510.46 55866 1,990.49 1,890.97 2,174.62 54680 895.55 850.77 978.39 55870 206.32 196.00 225.40 54690 718.89 682.95 785.39 # 55870 165.81 157.52 181.15 54692 885.20 840.94 967.08 55873 1,311.05 1,245.50 1,432.33 54700 243.41 231.24 265.93 55875 874.69 830.96 955.60 54800 151.94 144.34 165.99 55876 169.23 160.77 184.89 54830 426.19 404.88 465.61 # 55876 123.14 116.98 134.53 54840 373.87 355.18 408.46 55920 483.63 459.45 528.37 54860 481.74 457.65 526.30 56405 115.67 109.89 126.37 54861 648.17 615.76 708.12 # 56405 112.88 107.24 123.33 54865 411.89 391.30 450.00 56420 136.36 129.54 148.97 54900 856.23 813.42 935.43 # 56420 96.32 91.50 105.23 54901 1,229.39 1,167.92 1,343.11 56440 191.41 181.84 209.12 55000 145.50 138.23 158.96 56441 160.85 152.81 175.73 # 55000 97.08 92.23 106.06 # 56441 151.07 143.52 165.05 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 47 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 56442 52.12 49.51 56.94 57200 312.50 296.88 341.41 56501 140.71 133.67 153.72 57210 384.80 365.56 420.39 # 56501 120.22 114.21 131.34 57220 335.89 319.10 366.97 56515 236.09 224.29 257.93 57230 418.00 397.10 456.67 # 56515 205.36 195.09 224.35 57240 685.36 651.09 748.75 56605 89.57 85.09 97.85 57250 667.56 634.18 729.31 # 56605 62.57 59.44 68.36 57260 830.19 788.68 906.98 56606 40.97 38.92 44.76 57265 928.56 882.13 1,014.45 # 56606 30.72 29.18 33.56 57267 278.37 264.45 304.12 56620 518.28 492.37 566.23 57268 503.41 478.24 549.98 56625 616.74 585.90 673.79 57270 823.98 782.78 900.20 56630 894.67 849.94 977.43 57280 1,001.14 951.08 1,093.74 56631 1,136.70 1,079.87 1,241.85 57282 534.18 507.47 583.59 56632 1,317.65 1,251.77 1,439.54 57283 712.56 676.93 778.47 56633 1,163.60 1,105.42 1,271.23 57284 869.43 825.96 949.85 56634 1,230.07 1,168.57 1,343.86 57285 694.47 659.75 758.71 56637 1,449.86 1,377.37 1,583.98 57287 742.03 704.93 810.67 56640 1,443.32 1,371.15 1,576.82 57288 774.67 735.94 846.33 56700 195.16 185.40 213.21 57289 813.01 772.36 888.21 56740 307.83 292.44 336.31 57291 567.00 538.65 619.45 56800 254.18 241.47 277.69 57292 859.17 816.21 938.64 56805 1,182.87 1,123.73 1,292.29 57295 516.27 490.46 564.03 56810 272.18 258.57 297.36 57296 977.51 928.63 1,067.92 56820 118.37 112.45 129.32 57300 552.39 524.77 603.49 # 56820 87.63 83.25 95.74 57305 912.66 867.03 997.08 56821 157.93 150.03 172.53 57307 1,021.17 970.11 1,115.63 # 56821 118.82 112.88 129.81 57308 656.42 623.60 717.14 57000 199.60 189.62 218.06 57310 521.37 495.30 569.60 57010 448.50 426.08 489.99 57311 593.05 563.40 647.91 57020 98.81 93.87 107.95 57320 590.71 561.17 645.35 # 57020 83.91 79.71 91.67 57330 831.91 790.31 908.86 57022 173.02 164.37 189.03 57335 1,203.80 1,143.61 1,315.15 57023 323.24 307.08 353.14 57400 141.23 134.17 154.30 57061 123.44 117.27 134.86 57410 111.35 105.78 121.65 # 57061 103.42 98.25 112.99 57415 167.94 159.54 183.47 57065 204.39 194.17 223.30 57420 124.21 118.00 135.70 # 57065 178.78 169.84 195.32 # 57420 93.02 88.37 101.63 57100 94.49 89.77 103.24 57421 166.85 158.51 182.29 # 57100 67.48 64.11 73.73 # 57421 126.80 120.46 138.53 57105 145.80 138.51 159.29 57423 956.35 908.53 1,044.81 # 57105 132.76 126.12 145.04 57425 1,007.87 957.48 1,101.10 57106 495.44 470.67 541.27 57452 116.97 111.12 127.79 57107 1,437.92 1,366.02 1,570.92 # 57452 96.02 91.22 104.90 57109 1,640.03 1,558.03 1,791.73 57454 163.10 154.95 178.19 57110 929.30 882.84 1,015.27 # 57454 142.15 135.04 155.30 57111 1,660.81 1,577.77 1,814.44 57455 153.57 145.89 167.77 57112 1,760.48 1,672.46 1,923.33 # 57455 114.92 109.17 125.55 57120 532.98 506.33 582.28 57456 145.49 138.22 158.95 57130 193.07 183.42 210.93 # 57456 107.31 101.94 117.23 # 57130 169.32 160.85 184.98 57460 331.84 315.25 362.54 57135 206.25 195.94 225.33 # 57460 170.27 161.76 186.02 # 57135 182.04 172.94 198.88 57461 369.54 351.06 403.72 57150 55.87 53.08 61.04 # 57461 194.93 185.18 212.96 # 57150 30.72 29.18 33.56 57500 147.48 140.11 161.13 57155 442.64 420.51 483.59 # 57500 78.11 74.20 85.33 57160 84.21 80.00 92.00 57505 110.23 104.72 120.43 # 57160 49.29 46.83 53.85 # 57505 97.20 92.34 106.19 57170 74.52 70.79 81.41 57510 141.11 134.05 154.16 # 57170 49.84 47.35 54.45 # 57510 121.09 115.04 132.30 57180 154.95 147.20 169.28 57511 155.35 147.58 169.72 # 57180 112.57 106.94 122.98 # 57511 138.59 131.66 151.41 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 48 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 57513 153.02 145.37 167.18 58353 1,343.31 1,276.14 1,467.56 # 57513 139.52 132.54 152.42 # 58353 230.01 218.51 251.29 57520 329.01 312.56 359.44 58356 2,463.34 2,340.17 2,691.20 # 57520 287.10 272.75 313.66 # 58356 359.20 341.24 392.43 57522 280.21 266.20 306.13 58400 467.53 444.15 510.77 # 57522 254.60 241.87 278.15 58410 825.91 784.61 902.30 57530 360.39 342.37 393.73 58520 806.20 765.89 880.77 57531 1,744.25 1,657.04 1,905.60 58540 935.03 888.28 1,021.52 57540 803.42 763.25 877.74 58541 883.62 839.44 965.36 57545 846.88 804.54 925.22 58542 979.47 930.50 1,070.08 57550 425.12 403.86 464.44 58543 995.33 945.56 1,087.39 57555 621.05 590.00 678.50 58544 1,074.04 1,020.34 1,173.39 57556 594.84 565.10 649.87 58545 919.97 873.97 1,005.07 57558 133.42 126.75 145.76 58546 1,163.15 1,104.99 1,270.74 # 57558 118.98 113.03 129.98 58548 1,808.96 1,718.51 1,976.29 57700 324.83 308.59 354.88 58550 911.48 865.91 995.80 57720 321.77 305.68 351.53 58552 1,003.80 953.61 1,096.65 57800 65.05 61.80 71.07 58553 1,169.00 1,110.55 1,277.13 # 57800 51.08 48.53 55.81 58554 1,339.85 1,272.86 1,463.79 58100 117.62 111.74 128.50 58555 257.06 244.21 280.84 # 58100 91.08 86.53 99.51 # 58555 197.47 187.60 215.74 58110 51.54 48.96 56.30 58558 344.81 327.57 376.71 # 58110 42.70 40.57 46.66 # 58558 277.76 263.87 303.45 58120 264.58 251.35 289.05 58559 356.56 338.73 389.54 # 58120 223.61 212.43 244.29 58560 402.69 382.56 439.94 58140 939.29 892.33 1,026.18 58561 568.93 540.48 621.55 58145 562.29 534.18 614.31 58562 362.60 344.47 396.14 58146 1,193.91 1,134.21 1,304.34 # 58562 302.54 287.41 330.52 58150 1,016.08 965.28 1,110.07 58563 2,183.19 2,074.03 2,385.13 58152 1,282.21 1,218.10 1,400.82 # 58563 356.56 338.73 389.54 58180 976.50 927.68 1,066.83 58565 2,315.13 2,199.37 2,529.28 58200 1,340.58 1,273.55 1,464.58 # 58565 461.96 438.86 504.69 58210 1,784.61 1,695.38 1,949.69 58570 947.57 900.19 1,035.22 58240 2,802.33 2,662.21 3,061.54 58571 1,039.14 987.18 1,135.26 58260 852.26 809.65 931.10 58572 1,174.12 1,115.41 1,282.72 58262 950.64 903.11 1,038.58 58573 1,326.35 1,260.03 1,449.03 58263 1,023.60 972.42 1,118.28 58600 377.21 358.35 412.10 58267 1,087.01 1,032.66 1,187.56 58605 343.80 326.61 375.60 58270 910.98 865.43 995.24 58611 80.19 76.18 87.61 58275 1,013.96 963.26 1,107.75 58615 260.50 247.48 284.60 58280 1,083.56 1,029.38 1,183.79 58660 692.22 657.61 756.25 58285 1,354.26 1,286.55 1,479.53 58661 663.03 629.88 724.36 58290 1,188.16 1,128.75 1,298.06 58662 728.45 692.03 795.83 58291 1,290.73 1,226.19 1,410.12 58670 380.28 361.27 415.46 58292 1,359.03 1,291.08 1,484.74 58671 380.09 361.09 415.25 58293 1,410.07 1,339.57 1,540.51 58672 764.69 726.46 835.43 58294 1,253.78 1,191.09 1,369.75 58673 831.92 790.32 908.87 58301 103.42 98.25 112.99 58700 786.33 747.01 859.06 # 58301 69.89 66.40 76.36 58720 738.99 702.04 807.35 58321 85.79 81.50 93.73 58740 900.34 855.32 983.62 # 58321 51.33 48.76 56.07 58750 935.29 888.53 1,021.81 58322 94.69 89.96 103.45 58752 943.50 896.33 1,030.78 # 58322 60.70 57.67 66.32 58760 848.57 806.14 927.06 58323 21.00 19.95 22.94 58770 865.52 822.24 945.58 # 58323 13.09 12.44 14.31 58800 338.65 321.72 369.98 58340 146.42 139.10 159.97 # 58800 312.11 296.50 340.98 # 58340 63.08 59.93 68.92 58805 421.93 400.83 460.95 58345 288.91 274.46 315.63 58820 328.73 312.29 359.13 58346 473.69 450.01 517.51 58822 729.16 692.70 796.61 58350 105.79 100.50 115.58 58823 1,074.10 1,020.40 1,173.46 # 58350 83.44 79.27 91.16 # 58823 189.88 180.39 207.45 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 49 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 58825 718.76 682.82 785.24 59412 107.08 101.73 116.99 58900 430.10 408.60 469.89 59414 93.97 89.27 102.66 58920 722.52 686.39 789.35 59425 462.00 438.90 504.74 58925 753.94 716.24 823.68 # 59425 347.00 329.65 379.10 58940 519.66 493.68 567.73 59426 827.93 786.53 904.51 58943 1,146.29 1,088.98 1,252.33 # 59426 613.74 583.05 670.51 58950 1,096.14 1,041.33 1,197.53 59430 145.91 138.61 159.40 58951 1,407.63 1,337.25 1,537.84 # 59430 129.61 123.13 141.60 58952 1,588.38 1,508.96 1,735.30 59510 2,073.47 1,969.80 2,265.27 58953 1,967.17 1,868.81 2,149.13 59514 934.12 887.41 1,020.52 58954 2,134.44 2,027.72 2,331.88 59515 1,109.96 1,054.46 1,212.63 58956 1,385.98 1,316.68 1,514.18 59525 496.95 472.10 542.92 58957 1,514.99 1,439.24 1,655.13 59610 1,928.07 1,831.67 2,106.42 58958 1,682.72 1,598.58 1,838.37 59612 884.32 840.10 966.12 58960 948.14 900.73 1,035.84 59614 993.88 944.19 1,085.82 58970 235.61 223.83 257.40 59618 2,168.49 2,060.07 2,369.08 # 58970 206.27 195.96 225.35 59620 1,025.59 974.31 1,120.46 58976 271.59 258.01 296.71 59622 1,204.33 1,144.11 1,315.73 # 58976 232.94 221.29 254.48 59812 328.79 312.35 359.20 59000 142.00 134.90 155.14 # 59812 303.18 288.02 331.22 # 59000 84.26 80.05 92.06 59820 394.96 375.21 431.49 59001 192.36 182.74 210.15 # 59820 363.76 345.57 397.41 59012 210.33 199.81 229.78 59821 399.44 379.47 436.39 59015 164.89 156.65 180.15 # 59821 366.38 348.06 400.27 # 59015 137.42 130.55 150.13 59830 451.23 428.67 492.97 59020 77.75 73.86 84.94 59840 228.12 216.71 249.22 59020 TC 39.07 37.12 42.69 # 59840 219.74 208.75 240.06 59020 26 38.68 36.75 42.26 59841 393.14 373.48 429.50 59025 50.81 48.27 55.51 # 59841 367.53 349.15 401.52 59025 TC 19.64 18.66 21.46 59850 403.23 383.07 440.53 59025 26 31.17 29.61 34.05 59851 415.62 394.84 454.07 59030 116.14 110.33 126.88 59852 584.40 555.18 638.46 59050 51.85 49.26 56.65 59855 428.99 407.54 468.67 59051 42.86 40.72 46.83 59856 504.20 478.99 550.84 59070 425.68 404.40 465.06 59857 603.35 573.18 659.16 # 59070 300.43 285.41 328.22 59866 247.48 235.11 270.38 59072 492.17 467.56 537.69 59870 492.23 467.62 537.76 59074 400.54 380.51 437.59 59871 139.39 132.42 152.28 # 59074 297.17 282.31 324.66 60000 169.37 160.90 185.04 59076 479.13 455.17 523.45 # 60000 153.07 145.42 167.23 59100 847.18 804.82 925.54 60100 124.44 118.22 135.95 59120 810.95 770.40 885.96 # 60100 86.73 82.39 94.75 59121 814.18 773.47 889.49 60200 663.35 630.18 724.71 59130 947.35 899.98 1,034.98 60210 703.32 668.15 768.37 59135 963.42 915.25 1,052.54 60212 1,006.30 955.99 1,099.39 59136 896.62 851.79 979.56 60220 770.46 731.94 841.73 59140 407.61 387.23 445.31 60225 926.74 880.40 1,012.46 59150 788.16 748.75 861.06 60240 974.41 925.69 1,064.54 59151 768.93 730.48 840.05 60252 1,316.34 1,250.52 1,438.10 59160 227.91 216.51 248.99 60254 1,696.87 1,612.03 1,853.83 # 59160 186.93 177.58 204.22 60260 1,100.19 1,045.18 1,201.96 59200 81.12 77.06 88.62 60270 1,385.08 1,315.83 1,513.20 # 59200 46.19 43.88 50.46 60271 1,063.76 1,010.57 1,162.16 59300 205.72 195.43 224.74 60280 453.13 430.47 495.04 # 59300 151.24 143.68 165.23 60281 598.52 568.59 653.88 59320 159.05 151.10 173.77 60300 121.74 115.65 133.00 59325 249.42 236.95 272.49 # 60300 53.29 50.63 58.22 59350 283.56 269.38 309.79 60500 1,010.97 960.42 1,104.48 59400 1,831.09 1,739.54 2,000.47 60502 1,268.32 1,204.90 1,385.64 59409 788.75 749.31 861.71 60505 1,395.41 1,325.64 1,524.49 59410 920.07 874.07 1,005.18 60512 243.64 231.46 266.18 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 50 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 60520 1,042.42 990.30 1,138.85 61519 2,915.12 2,769.36 3,184.76 60521 1,200.86 1,140.82 1,311.94 61520 3,719.77 3,533.78 4,063.85 60522 1,445.39 1,373.12 1,579.09 61521 3,129.18 2,972.72 3,418.63 60540 1,102.63 1,047.50 1,204.63 61522 2,154.65 2,046.92 2,353.96 60545 1,249.52 1,187.04 1,365.10 61524 2,033.25 1,931.59 2,221.33 60600 1,444.37 1,372.15 1,577.97 61526 3,366.68 3,198.35 3,678.10 60605 1,813.30 1,722.64 1,981.04 61530 2,862.62 2,719.49 3,127.41 60650 1,219.85 1,158.86 1,332.69 61531 1,189.61 1,130.13 1,299.65 61000 114.83 109.09 125.45 61533 1,492.55 1,417.92 1,630.61 61001 112.79 107.15 123.22 61534 1,609.46 1,528.99 1,758.34 61020 136.65 129.82 149.29 61535 970.76 922.22 1,060.55 61026 134.67 127.94 147.13 61536 2,552.61 2,424.98 2,788.73 61050 114.95 109.20 125.58 61537 2,339.27 2,222.31 2,555.66 61055 146.41 139.09 159.95 61538 2,506.02 2,380.72 2,737.83 61070 88.00 83.60 96.14 61539 2,309.62 2,194.14 2,523.26 61105 443.98 421.78 485.05 61540 2,172.19 2,063.58 2,373.12 61107 318.05 302.15 347.47 61541 2,082.86 1,978.72 2,275.53 61108 873.80 830.11 954.63 61542 2,260.53 2,147.50 2,469.63 61120 715.69 679.91 781.90 61543 2,108.15 2,002.74 2,303.15 61140 1,233.79 1,172.10 1,347.92 61544 1,725.16 1,638.90 1,884.74 61150 1,315.43 1,249.66 1,437.11 61545 3,104.69 2,949.46 3,391.88 61151 954.98 907.23 1,043.31 61546 2,252.16 2,139.55 2,460.48 61154 1,237.97 1,176.07 1,352.48 61548 1,528.04 1,451.64 1,669.39 61156 1,228.68 1,167.25 1,342.34 61550 1,004.64 954.41 1,097.57 61210 371.31 352.74 405.65 61552 1,320.67 1,254.64 1,442.84 61215 484.46 460.24 529.28 61556 1,606.91 1,526.56 1,755.54 61250 833.63 791.95 910.74 61557 1,665.16 1,581.90 1,819.19 61253 911.17 865.61 995.45 61558 1,707.30 1,621.94 1,865.23 61304 1,617.62 1,536.74 1,767.25 61559 2,374.78 2,256.04 2,594.45 61305 1,949.00 1,851.55 2,129.28 61563 1,903.74 1,808.55 2,079.83 61312 2,016.66 1,915.83 2,203.20 61564 2,384.26 2,265.05 2,604.81 61313 1,934.50 1,837.78 2,113.45 61566 2,200.89 2,090.85 2,404.48 61314 1,790.15 1,700.64 1,955.74 61567 2,475.88 2,352.09 2,704.90 61315 2,035.98 1,934.18 2,224.31 61570 1,800.37 1,710.35 1,966.90 61316 87.31 82.94 95.38 61571 1,957.79 1,859.90 2,138.89 61320 1,882.65 1,788.52 2,056.80 61575 2,315.85 2,200.06 2,530.07 61321 2,059.25 1,956.29 2,249.73 61576 3,745.35 3,558.08 4,091.79 61322 2,283.82 2,169.63 2,495.07 61580 2,481.53 2,357.45 2,711.07 61323 2,319.87 2,203.88 2,534.46 61581 2,782.05 2,642.95 3,039.39 61330 1,590.32 1,510.80 1,737.42 61582 2,890.47 2,745.95 3,157.84 61332 1,841.27 1,749.21 2,011.59 61583 2,885.69 2,741.41 3,152.62 61333 1,860.15 1,767.14 2,032.21 61584 2,811.33 2,670.76 3,071.37 61334 1,204.48 1,144.26 1,315.90 61585 2,960.10 2,812.10 3,233.92 61340 1,405.86 1,335.57 1,535.91 61586 2,167.92 2,059.52 2,368.45 61343 2,163.36 2,055.19 2,363.47 61590 3,123.86 2,967.67 3,412.82 61345 2,004.98 1,904.73 2,190.44 61591 3,147.94 2,990.54 3,439.12 61440 1,962.28 1,864.17 2,143.80 61592 3,154.89 2,997.15 3,446.72 61450 1,855.83 1,763.04 2,027.50 61595 2,382.23 2,263.12 2,602.59 61458 1,982.78 1,883.64 2,166.19 61596 2,598.83 2,468.89 2,839.22 61460 2,003.74 1,903.55 2,189.08 61597 2,844.26 2,702.05 3,107.36 61470 1,862.78 1,769.64 2,035.09 61598 2,528.50 2,402.08 2,762.39 61480 1,794.06 1,704.36 1,960.01 61600 2,148.23 2,040.82 2,346.94 61490 1,876.05 1,782.25 2,049.59 61601 2,352.04 2,234.44 2,569.61 61500 1,330.56 1,264.03 1,453.63 61605 2,242.29 2,130.18 2,449.71 61501 1,142.81 1,085.67 1,248.52 61606 2,994.26 2,844.55 3,271.23 61510 2,142.95 2,035.80 2,341.17 61607 2,763.42 2,625.25 3,019.04 61512 2,519.77 2,393.78 2,752.85 61608 3,223.39 3,062.22 3,521.55 61514 1,874.61 1,780.88 2,048.01 61609 609.49 579.02 665.87 61516 1,828.95 1,737.50 1,998.13 61610 1,875.13 1,781.37 2,048.58 61517 87.40 83.03 95.48 61611 474.22 450.51 518.09 61518 2,712.98 2,577.33 2,963.93 61612 1,661.36 1,578.29 1,815.03 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 51 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 61613 3,133.64 2,976.96 3,423.50 62141 1,133.98 1,077.28 1,238.87 61615 2,485.40 2,361.13 2,715.30 62142 869.08 825.63 949.47 61616 3,256.59 3,093.76 3,557.82 62143 1,014.26 963.55 1,108.08 61618 1,283.28 1,219.12 1,401.99 62145 1,383.18 1,314.02 1,511.12 61619 1,475.12 1,401.36 1,611.56 62146 1,187.60 1,128.22 1,297.45 61623 584.45 555.23 638.51 62147 1,408.59 1,338.16 1,538.88 61624 1,160.64 1,102.61 1,268.00 62148 124.70 118.47 136.24 61626 944.97 897.72 1,032.38 62160 191.69 182.11 209.43 61630 1,331.51 1,264.93 1,454.67 62161 1,490.42 1,415.90 1,628.29 61635 1,456.94 1,384.09 1,591.70 62162 1,851.07 1,758.52 2,022.30 61680 2,233.08 2,121.43 2,439.64 62163 1,206.64 1,146.31 1,318.26 61682 4,168.75 3,960.31 4,554.36 62164 1,968.81 1,870.37 2,150.93 61684 2,782.60 2,643.47 3,039.99 62165 1,528.32 1,451.90 1,669.69 61686 4,468.86 4,245.42 4,882.23 62180 1,559.87 1,481.88 1,704.16 61690 2,123.66 2,017.48 2,320.10 62190 894.80 850.06 977.57 61692 3,609.09 3,428.64 3,942.94 62192 949.78 902.29 1,037.63 61697 4,073.91 3,870.21 4,450.74 62194 386.08 366.78 421.80 61698 4,375.27 4,156.51 4,779.99 62200 1,350.17 1,282.66 1,475.06 61700 3,420.38 3,249.36 3,736.76 62201 1,166.05 1,107.75 1,273.91 61702 3,813.76 3,623.07 4,166.53 62220 996.49 946.67 1,088.67 61703 1,323.18 1,257.02 1,445.57 62223 1,028.89 977.45 1,124.07 61705 2,513.11 2,387.45 2,745.57 62225 496.47 471.65 542.40 61708 2,153.13 2,045.47 2,352.29 62230 826.03 784.73 902.44 61710 1,974.00 1,875.30 2,156.60 62252 110.08 104.58 120.27 61711 2,565.22 2,436.96 2,802.50 62252 TC 62.94 59.79 68.76 61720 1,145.68 1,088.40 1,251.66 62252 26 47.13 44.77 51.49 61735 1,402.73 1,332.59 1,532.48 62256 579.99 550.99 633.64 61750 1,380.06 1,311.06 1,507.72 62258 1,107.69 1,052.31 1,210.16 61751 1,351.03 1,283.48 1,476.00 62263 702.70 667.57 767.71 61760 1,512.52 1,436.89 1,652.42 # 62263 387.01 367.66 422.81 61770 1,488.81 1,414.37 1,626.53 62264 425.24 403.98 464.58 61790 840.21 798.20 917.93 # 62264 231.54 219.96 252.95 61791 1,084.66 1,030.43 1,184.99 62267 275.05 261.30 300.50 61795 248.16 235.75 271.11 # 62267 171.22 162.66 187.06 61796 792.14 752.53 865.41 62268 508.67 483.24 555.73 61797 211.38 200.81 230.93 # 62268 277.72 263.83 303.40 61798 792.14 752.53 865.41 62269 553.26 525.60 604.44 61799 292.21 277.60 319.24 # 62269 280.87 266.83 306.85 61800 150.89 143.35 164.85 62270 170.85 162.31 186.66 61850 965.44 917.17 1,054.75 # 62270 80.52 76.49 87.96 61860 1,528.73 1,452.29 1,670.13 62272 203.59 193.41 222.42 61863 1,490.49 1,415.97 1,628.37 # 62272 85.79 81.50 93.73 61864 404.73 384.49 442.16 62273 174.64 165.91 190.80 61867 2,181.46 2,072.39 2,383.25 # 62273 112.71 107.07 123.13 61868 598.70 568.77 654.09 62280 335.89 319.10 366.97 61870 1,167.98 1,109.58 1,276.02 # 62280 157.09 149.24 171.63 61875 1,135.44 1,078.67 1,240.47 62281 309.29 293.83 337.90 61880 544.69 517.46 595.08 # 62281 150.52 142.99 164.44 61885 637.21 605.35 696.15 62282 324.90 308.66 354.96 61886 799.52 759.54 873.47 # 62282 140.05 133.05 153.01 61888 395.86 376.07 432.48 62284 250.24 237.73 273.39 62000 857.23 814.37 936.53 # 62284 95.19 90.43 103.99 62005 1,218.65 1,157.72 1,331.38 62287 564.38 536.16 616.58 62010 1,488.08 1,413.68 1,625.73 62290 357.47 339.60 390.54 62100 1,579.63 1,500.65 1,725.75 # 62290 175.88 167.09 192.15 62115 1,381.12 1,312.06 1,508.87 62291 333.54 316.86 364.39 62116 1,745.73 1,658.44 1,907.21 # 62291 169.64 161.16 185.33 62117 1,878.57 1,784.64 2,052.34 62292 495.44 470.67 541.27 62120 1,817.11 1,726.25 1,985.19 62294 814.94 774.19 890.32 62121 1,646.63 1,564.30 1,798.95 62310 236.69 224.86 258.59 62140 1,033.26 981.60 1,128.84 # 62310 102.59 97.46 112.08 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 52 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 62311 210.49 199.97 229.97 63180 1,372.81 1,304.17 1,499.80 # 62311 85.71 81.42 93.63 63182 1,457.55 1,384.67 1,592.37 62318 253.16 240.50 276.58 63185 1,121.53 1,065.45 1,225.27 # 62318 101.83 96.74 111.25 63190 1,289.59 1,225.11 1,408.88 62319 228.88 217.44 250.06 63191 1,207.84 1,147.45 1,319.57 # 62319 95.71 90.92 104.56 63194 1,460.95 1,387.90 1,596.09 62350 394.66 374.93 431.17 63195 1,479.58 1,405.60 1,616.44 62351 842.29 800.18 920.21 63196 1,742.75 1,655.61 1,903.95 62355 298.35 283.43 325.94 63197 1,661.95 1,578.85 1,815.68 62360 286.94 272.59 313.48 63198 1,808.44 1,718.02 1,975.72 62361 397.50 377.63 434.27 63199 1,940.81 1,843.77 2,120.34 62362 416.75 395.91 455.30 63200 1,487.03 1,412.68 1,624.58 62365 331.31 314.74 361.95 63250 2,862.40 2,719.28 3,127.17 62367 40.99 38.94 44.78 63251 2,975.74 2,826.95 3,250.99 # 62367 24.23 23.02 26.47 63252 2,977.52 2,828.64 3,252.94 62368 57.89 55.00 63.25 63265 1,645.85 1,563.56 1,798.09 # 62368 37.87 35.98 41.38 63266 1,690.11 1,605.60 1,846.44 63001 1,215.62 1,154.84 1,328.07 63267 1,366.65 1,298.32 1,493.07 63003 1,223.06 1,161.91 1,336.20 63268 1,369.53 1,301.05 1,496.21 63005 1,166.78 1,108.44 1,274.71 63270 2,019.70 1,918.72 2,206.53 63011 1,097.83 1,042.94 1,199.38 63271 2,032.41 1,930.79 2,220.41 63012 1,185.10 1,125.85 1,294.73 63272 1,873.87 1,780.18 2,047.21 63015 1,462.79 1,389.65 1,598.10 63273 1,764.85 1,676.61 1,928.10 63016 1,499.38 1,424.41 1,638.07 63275 1,764.81 1,676.57 1,928.06 63017 1,230.05 1,168.55 1,343.83 63276 1,758.87 1,670.93 1,921.57 63020 1,164.71 1,106.47 1,272.44 63277 1,546.29 1,468.98 1,689.33 63030 971.14 922.58 1,060.97 63278 1,513.07 1,437.42 1,653.03 63035 202.00 191.90 220.69 63280 2,088.19 1,983.78 2,281.35 63040 1,407.30 1,336.94 1,537.48 63281 2,064.05 1,960.85 2,254.98 63042 1,321.16 1,255.10 1,443.37 63282 1,949.55 1,852.07 2,129.88 63043 389.76 370.27 425.81 63283 1,846.93 1,754.58 2,017.77 63044 354.43 336.71 387.22 63285 2,552.47 2,424.85 2,788.58 63045 1,261.59 1,198.51 1,378.29 63286 2,546.65 2,419.32 2,782.22 63046 1,206.07 1,145.77 1,317.64 63287 2,683.88 2,549.69 2,932.14 63047 1,104.85 1,049.61 1,207.05 63290 2,714.66 2,578.93 2,965.77 63048 217.07 206.22 237.15 63295 319.14 303.18 348.66 63050 1,512.02 1,436.42 1,651.88 63300 1,818.35 1,727.43 1,986.54 63051 1,703.37 1,618.20 1,860.93 63301 2,028.48 1,927.06 2,216.12 63055 1,617.92 1,537.02 1,767.57 63302 2,017.68 1,916.80 2,204.32 63056 1,493.57 1,418.89 1,631.72 63303 2,102.88 1,997.74 2,297.40 63057 332.76 316.12 363.54 63304 2,245.50 2,133.23 2,453.21 63064 1,764.90 1,676.66 1,928.16 63305 2,277.19 2,163.33 2,487.83 63066 205.19 194.93 224.17 63306 2,407.59 2,287.21 2,630.29 63075 1,386.09 1,316.79 1,514.31 63307 2,222.91 2,111.76 2,428.52 63076 256.94 244.09 280.70 63308 333.38 316.71 364.22 63077 1,510.20 1,434.69 1,649.89 63600 821.41 780.34 897.39 63078 204.17 193.96 223.05 63610 1,496.47 1,421.65 1,634.90 63081 1,772.14 1,683.53 1,936.06 # 63610 432.53 410.90 472.54 63082 277.45 263.58 303.12 63615 1,132.48 1,075.86 1,237.24 63085 1,884.49 1,790.27 2,058.81 63620 792.14 752.53 865.41 63086 196.57 186.74 214.75 63621 243.03 230.88 265.51 63087 2,405.15 2,284.89 2,627.62 63650 411.73 391.14 449.81 63088 269.53 256.05 294.46 63655 844.37 802.15 922.47 63090 1,970.07 1,871.57 2,152.31 63660 440.35 418.33 481.08 63091 184.81 175.57 201.91 63685 401.54 381.46 438.68 63101 2,265.95 2,152.65 2,475.55 63688 361.38 343.31 394.81 63102 2,254.78 2,142.04 2,463.35 63700 1,219.18 1,158.22 1,331.95 63103 295.68 280.90 323.04 63702 1,372.90 1,304.26 1,499.90 63170 1,520.30 1,444.29 1,660.93 63704 1,521.60 1,445.52 1,662.35 63172 1,370.66 1,302.13 1,497.45 63706 1,777.02 1,688.17 1,941.40 63173 1,689.55 1,605.07 1,845.83 63707 903.79 858.60 987.39 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 53 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 63709 1,094.90 1,040.16 1,196.18 64484 147.48 140.11 161.13 63710 1,095.09 1,040.34 1,196.39 # 64484 68.33 64.91 74.65 63740 933.71 887.02 1,020.07 64505 106.31 100.99 116.14 63741 598.41 568.49 653.76 # 64505 86.75 82.41 94.77 63744 634.00 602.30 692.65 64508 156.17 148.36 170.61 63746 558.93 530.98 610.63 # 64508 71.90 68.31 78.56 64400 114.83 109.09 125.45 64510 154.30 146.59 168.58 # 64400 64.08 60.88 70.01 # 64510 68.62 65.19 74.97 64402 116.39 110.57 127.16 64517 178.27 169.36 194.76 # 64402 73.08 69.43 79.84 # 64517 120.07 114.07 131.18 64405 108.46 103.04 118.50 64520 204.56 194.33 223.48 # 64405 74.47 70.75 81.36 # 64520 77.92 74.02 85.12 64408 126.32 120.00 138.00 64530 209.46 198.99 228.84 # 64408 91.87 87.28 100.37 # 64530 92.12 87.51 100.64 64410 149.14 141.68 162.93 64550 16.73 15.89 18.27 # 64410 79.76 75.77 87.14 # 64550 9.28 8.82 10.14 64412 150.76 143.22 164.70 64553 215.29 204.53 235.21 # 64412 72.07 68.47 78.74 # 64553 164.07 155.87 179.25 64413 121.21 115.15 132.42 64555 230.37 218.85 251.68 # 64413 77.44 73.57 84.61 # 64555 161.46 153.39 176.40 64415 138.89 131.95 151.74 64560 227.09 215.74 248.10 # 64415 73.70 70.02 80.52 # 64560 166.10 157.80 181.47 64416 92.48 87.86 101.04 64561 1,302.66 1,237.53 1,423.16 64417 140.75 133.71 153.77 # 64561 445.92 423.62 487.16 # 64417 73.24 69.58 80.02 64565 182.32 173.20 199.18 64418 144.97 137.72 158.38 # 64565 123.19 117.03 134.58 # 64418 74.20 70.49 81.06 64573 593.80 564.11 648.73 64420 176.37 167.55 192.68 64575 289.81 275.32 316.62 # 64420 66.95 63.60 73.14 64577 365.69 347.41 399.52 64421 260.94 247.89 285.07 64580 304.65 289.42 332.83 # 64421 90.99 86.44 99.41 64581 860.92 817.87 940.55 64425 133.72 127.03 146.08 64585 376.05 357.25 410.84 # 64425 94.14 89.43 102.84 # 64585 170.24 161.73 185.99 64430 170.09 161.59 185.83 64590 348.34 330.92 380.56 # 64430 91.40 86.83 99.85 # 64590 189.57 180.09 207.10 64435 156.47 148.65 170.95 64595 367.25 348.89 401.22 # 64435 86.62 82.29 94.63 # 64595 151.20 143.64 165.19 64445 144.75 137.51 158.14 64600 437.64 415.76 478.12 # 64445 81.43 77.36 88.96 # 64600 217.40 206.53 237.51 64446 92.71 88.07 101.28 64605 607.49 577.12 663.69 64447 69.32 65.85 75.73 # 64605 343.95 326.75 375.76 64448 81.75 77.66 89.31 64610 733.35 696.68 801.18 64449 91.79 87.20 100.28 # 64610 488.90 464.46 534.13 64450 108.92 103.47 118.99 64612 161.72 153.63 176.67 # 64450 73.53 69.85 80.33 # 64612 139.84 132.85 152.78 64455 54.53 51.80 59.57 64613 158.93 150.98 173.63 # 64455 41.49 39.42 45.33 # 64613 130.99 124.44 143.11 64470 289.60 275.12 316.39 64614 178.46 169.54 194.97 # 64470 105.68 100.40 115.46 # 64614 145.86 138.57 159.36 64472 120.39 114.37 131.53 64620 289.52 275.04 316.30 # 64472 66.38 63.06 72.52 # 64620 168.46 160.04 184.05 64475 261.82 248.73 286.04 64622 350.78 333.24 383.23 # 64475 83.49 79.32 91.22 # 64622 178.97 170.02 195.52 64476 102.09 96.99 111.54 64623 131.52 124.94 143.68 # 64476 49.47 47.00 54.05 # 64623 49.10 46.65 53.65 64479 304.26 289.05 332.41 64626 405.23 384.97 442.72 # 64479 125.00 118.75 136.56 # 64626 238.08 226.18 260.11 64480 148.38 140.96 162.10 64627 181.41 172.34 198.19 # 64480 80.40 76.38 87.84 # 64627 57.55 54.67 62.87 64483 298.44 283.52 326.05 64630 245.26 233.00 267.95 # 64483 110.33 104.81 120.53 # 64630 199.16 189.20 217.58 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 54 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 64632 90.15 85.64 98.49 64823 777.46 738.59 849.38 # 64632 75.25 71.49 82.21 64831 692.28 657.67 756.32 64640 242.93 230.78 265.40 64832 352.77 335.13 385.40 # 64640 181.94 172.84 198.77 64834 757.93 720.03 828.03 64650 71.87 68.28 78.52 64835 821.61 780.53 897.61 # 64650 40.20 38.19 43.92 64836 821.36 780.29 897.33 64653 82.82 78.68 90.48 64837 391.85 372.26 428.10 # 64653 50.23 47.72 54.88 64840 929.65 883.17 1,015.65 64680 333.88 317.19 364.77 64856 1,029.88 978.39 1,125.15 # 64680 164.86 156.62 180.11 64857 1,076.03 1,022.23 1,175.56 64681 427.37 406.00 466.90 64858 1,242.11 1,180.00 1,357.00 # 64681 219.24 208.28 239.52 64859 265.59 252.31 290.16 64702 471.81 448.22 515.45 64861 1,391.80 1,322.21 1,520.54 64704 345.28 328.02 377.22 64862 1,355.74 1,287.95 1,481.14 64708 490.10 465.60 535.44 64864 890.94 846.39 973.35 64712 555.61 527.83 607.00 64865 1,196.12 1,136.31 1,306.76 64713 773.94 735.24 845.53 64866 1,240.60 1,178.57 1,355.36 64714 654.45 621.73 714.99 64868 1,084.55 1,030.32 1,184.87 64716 536.89 510.05 586.56 64870 1,033.65 981.97 1,129.27 64718 581.03 551.98 634.78 64872 124.68 118.45 136.22 64719 402.91 382.76 440.17 64874 182.70 173.57 199.61 64721 428.82 407.38 468.49 64876 198.08 188.18 216.41 # 64721 426.96 405.61 466.45 64885 1,158.61 1,100.68 1,265.78 64722 340.00 323.00 371.45 64886 1,374.60 1,305.87 1,501.75 64726 298.70 283.77 326.34 64890 1,109.19 1,053.73 1,211.79 64727 190.67 181.14 208.31 64891 1,141.23 1,084.17 1,246.80 64732 393.16 373.50 429.53 64892 1,078.83 1,024.89 1,178.62 64734 422.81 401.67 461.92 64893 1,132.54 1,075.91 1,237.30 64736 400.74 380.70 437.81 64895 1,323.53 1,257.35 1,445.95 64738 469.75 446.26 513.20 64896 1,464.83 1,391.59 1,600.33 64740 471.50 447.93 515.12 64897 1,284.76 1,220.52 1,403.60 64742 477.36 453.49 521.51 64898 1,402.91 1,332.76 1,532.67 64744 420.08 399.08 458.94 64901 621.17 590.11 678.63 64746 450.92 428.37 492.63 64902 712.89 677.25 778.84 64752 507.53 482.15 554.47 64905 1,032.25 980.64 1,127.74 64755 887.04 842.69 969.09 64907 1,352.50 1,284.88 1,477.61 64760 476.30 452.49 520.36 64910 838.34 796.42 915.88 64761 453.29 430.63 495.22 64911 1,005.11 954.85 1,098.08 64763 557.46 529.59 609.03 65091 611.47 580.90 668.04 64766 634.72 602.98 693.43 65093 612.05 581.45 668.67 64771 602.53 572.40 658.26 65101 706.03 670.73 771.34 64772 578.19 549.28 631.67 65103 735.47 698.70 803.51 64774 417.25 396.39 455.85 65105 809.71 769.22 884.60 64776 400.41 380.39 437.45 65110 1,166.84 1,108.50 1,274.78 64778 189.09 179.64 206.59 65112 1,372.64 1,304.01 1,499.61 64782 469.21 445.75 512.61 65114 1,423.99 1,352.79 1,555.71 64783 226.24 214.93 247.17 65125 458.50 435.58 500.92 64784 730.45 693.93 798.02 # 65125 277.84 263.95 303.54 64786 1,090.63 1,036.10 1,191.52 65130 696.52 661.69 760.94 64787 259.47 246.50 283.48 65135 709.06 673.61 774.65 64788 393.86 374.17 430.30 65140 771.70 733.12 843.09 64790 833.90 792.21 911.04 65150 562.97 534.82 615.04 64792 1,080.49 1,026.47 1,180.44 65155 812.64 772.01 887.81 64795 195.88 186.09 214.00 65175 629.43 597.96 687.65 64802 599.96 569.96 655.45 65205 54.65 51.92 59.71 64804 911.68 866.10 996.02 # 65205 42.08 39.98 45.98 64809 860.12 817.11 939.68 65210 67.20 63.84 73.42 64818 667.98 634.58 729.77 # 65210 50.90 48.36 55.61 64820 768.39 729.97 839.47 65220 56.13 53.32 61.32 64821 697.91 663.01 762.46 # 65220 41.23 39.17 45.05 64822 687.92 653.52 751.55 65222 73.80 70.11 80.63 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 55 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 65222 55.64 52.86 60.79 65875 592.50 562.88 647.31 65235 660.11 627.10 721.17 65880 623.05 591.90 680.69 65260 902.52 857.39 986.00 65900 911.29 865.73 995.59 65265 1,013.82 963.13 1,107.60 65920 739.22 702.26 807.60 65270 268.37 254.95 293.19 65930 606.08 575.78 662.15 # 65270 133.34 126.67 145.67 66020 183.95 174.75 200.96 65272 485.70 461.42 530.63 # 66020 124.81 118.57 136.36 # 65272 325.99 309.69 356.14 66030 164.26 156.05 179.46 65273 357.10 339.25 390.14 # 66030 105.13 99.87 114.85 65275 533.50 506.83 582.85 66130 680.00 646.00 742.90 # 65275 423.15 401.99 462.29 # 66130 542.17 515.06 592.32 65280 626.02 594.72 683.93 66150 818.39 777.47 894.09 65285 970.36 921.84 1,060.12 66155 815.71 774.92 891.16 65286 686.36 652.04 749.85 66160 923.44 877.27 1,008.86 # 65286 461.00 437.95 503.64 66165 799.92 759.92 873.91 65290 461.19 438.13 503.85 66170 1,118.33 1,062.41 1,221.77 65400 641.72 609.63 701.07 66172 1,405.81 1,335.52 1,535.85 # 65400 561.17 533.11 613.08 66180 1,096.49 1,041.67 1,197.92 65410 140.76 133.72 153.78 66185 700.25 665.24 765.03 # 65410 99.32 94.35 108.50 66220 685.59 651.31 749.01 65420 508.63 483.20 555.68 66225 873.64 829.96 954.45 # 65420 357.31 339.44 390.36 66250 729.77 693.28 797.27 65426 635.78 603.99 694.59 # 66250 519.78 493.79 567.86 # 65426 450.00 427.50 491.63 66500 339.23 322.27 370.61 65430 110.96 105.41 121.22 66505 371.11 352.55 405.43 # 65430 99.32 94.35 108.50 66600 774.20 735.49 845.81 65435 77.62 73.74 84.80 66605 993.94 944.24 1,085.88 # 65435 66.91 63.56 73.09 66625 406.98 386.63 444.62 65436 364.88 346.64 398.64 66630 532.79 506.15 582.07 # 65436 348.58 331.15 380.82 66635 537.99 511.09 587.75 65450 307.53 292.15 335.97 66680 483.47 459.30 528.20 # 65450 303.34 288.17 331.40 66682 592.38 562.76 647.17 65600 372.71 354.07 407.18 66700 428.14 406.73 467.74 # 65600 317.77 301.88 347.16 # 66700 371.34 352.77 405.69 65710 1,039.80 987.81 1,135.98 66710 419.95 398.95 458.79 65730 1,153.30 1,095.64 1,259.99 # 66710 370.13 351.62 404.36 65750 1,165.40 1,107.13 1,273.20 66711 597.62 567.74 652.90 65755 1,158.72 1,100.78 1,265.90 66720 445.02 422.77 486.19 65756 1,108.60 1,053.17 1,211.15 # 66720 396.59 376.76 433.27 65770 1,327.75 1,261.36 1,450.56 66740 416.69 395.86 455.24 65772 428.26 406.85 467.88 # 66740 371.99 353.39 406.40 # 65772 379.84 360.85 414.98 66761 431.17 409.61 471.05 65775 519.63 493.65 567.70 # 66761 387.86 368.47 423.74 65780 841.08 799.03 918.88 66762 450.29 427.78 491.95 65781 1,258.10 1,195.20 1,374.48 # 66762 398.60 378.67 435.47 65782 1,087.40 1,033.03 1,187.98 66770 498.69 473.76 544.82 65800 145.07 137.82 158.49 # 66770 451.66 429.08 493.44 # 65800 125.05 118.80 136.62 66820 383.90 364.71 419.42 65805 159.97 151.97 174.77 66821 310.63 295.10 339.37 # 65805 125.05 118.80 136.62 # 66821 291.07 276.52 318.00 65810 441.00 418.95 481.79 66825 724.35 688.13 791.35 65815 621.64 590.56 679.14 66830 667.78 634.39 729.55 # 65815 446.10 423.80 487.37 66840 651.33 618.76 711.57 65820 714.12 678.41 780.17 66850 742.75 705.61 811.45 65850 798.38 758.46 872.23 66852 793.47 753.80 866.87 65855 325.98 309.68 356.13 66920 708.45 673.03 773.98 # 65855 282.21 268.10 308.32 66930 804.15 763.94 878.53 65860 301.44 286.37 329.33 66940 732.26 695.65 800.00 # 65860 242.78 230.64 265.24 66982 998.90 948.96 1,091.30 65865 452.91 430.26 494.80 66983 690.18 655.67 754.02 65870 557.36 529.49 608.91 66984 719.30 683.34 785.84 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 56 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ 66985 716.98 681.13 783.30 67320 303.32 288.15 331.37 66986 873.36 829.69 954.14 67331 286.97 272.62 313.51 66990 86.84 82.50 94.88 67332 312.33 296.71 341.22 67005 444.42 422.20 485.53 67334 283.26 269.10 309.47 67010 511.85 486.26 559.20 67335 143.02 135.87 156.25 67015 550.39 522.87 601.30 67340 337.59 320.71 368.82 67025 692.65 658.02 756.72 67343 613.06 582.41 669.77 # 67025 590.22 560.71 644.82 67345 223.77 212.58 244.47 67027 802.26 762.15 876.47 # 67345 200.95 190.90 219.54 67028 206.25 195.94 225.33 67346 192.60 182.97 210.42 # 67028 160.15 152.14 174.96 67400 893.30 848.64 975.94 67030 495.54 470.76 541.37 67405 763.80 725.61 834.45 67031 366.71 348.37 400.63 67412 826.95 785.60 903.44 # 67031 332.72 316.08 363.49 67413 828.25 786.84 904.87 67036 904.55 859.32 988.22 67414 1,245.36 1,183.09 1,360.55 67039 1,162.37 1,104.25 1,269.89 67415 99.93 94.93 109.17 67040 1,337.75 1,270.86 1,461.49 67420 1,556.70 1,478.87 1,700.70 67041 1,240.55 1,178.52 1,355.30 67430 1,197.89 1,138.00 1,308.70 67042 1,417.38 1,346.51 1,548.49 67440 1,154.24 1,096.53 1,261.01 67043 1,489.98 1,415.48 1,627.80 67445 1,337.02 1,270.17 1,460.70 67101 740.51 703.48 809.00 67450 1,197.85 1,137.96 1,308.65 # 67101 630.15 598.64 688.44 67500 84.15 79.94 91.93 67105 681.41 647.34 744.44 # 67500 74.84 71.10 81.77 # 67105 603.18 573.02 658.97 67505 83.43 79.26 91.15 67107 1,138.62 1,081.69 1,243.94 # 67505 73.65 69.97 80.47 67108 1,508.58 1,433.15 1,648.12 67515 88.17 83.76 96.32 67110 825.40 784.13 901.75 # 67515 80.26 76.25 87.69 # 67110 724.36 688.14 791.36 67550 929.76 883.27 1,015.76 67112 1,245.85 1,183.56 1,361.09 67560 944.93 897.68 1,032.33 67113 1,632.70 1,551.07 1,783.73 67570 1,108.58 1,053.15 1,211.12 67115 464.90 441.66 507.91 67700 273.48 259.81 298.78 67120 627.99 596.59 686.08 # 67700 109.58 104.10 119.72 # 67120 521.37 495.30 569.60 67710 231.81 220.22 253.25 67121 850.61 808.08 929.29 # 67710 92.59 87.96 101.15 67141 492.91 468.26 538.50 67715 242.77 230.63 265.22 # 67141 455.20 432.44 497.31 # 67715 104.01 98.81 113.63 67145 495.77 470.98 541.63 67800 122.43 116.31 133.76 # 67145 465.04 441.79 508.06 # 67800 98.68 93.75 107.81 67208 564.02 535.82 616.19 67801 155.97 148.17 170.40 # 67208 541.67 514.59 591.78 # 67801 127.10 120.75 138.86 67210 652.93 620.28 713.32 67805 194.19 184.48 212.15 # 67210 628.25 596.84 686.37 # 67805 156.94 149.09 171.45 67218 1,312.16 1,246.55 1,433.53 67808 344.80 327.56 376.69 67220 1,004.10 953.90 1,096.99 67810 232.12 220.51 253.59 # 67220 951.02 903.47 1,038.99 # 67810 90.10 85.60 98.44 67221 289.53 275.05 316.31 67820 50.27 47.76 54.92 # 67221 207.12 196.76 226.27 # 67820 52.13 49.52 56.95 67225 28.70 27.27 31.36 67825 124.19 117.98 135.68 # 67225 26.84 25.50 29.33 # 67825 115.81 110.02 126.52 67227 576.79 547.95 630.14 67830 270.45 256.93 295.47 # 67227 535.35 508.58 584.87 # 67830 131.22 124.66 143.36 67228 1,146.29 1,088.98 1,252.33 67835 417.53 396.65 456.15 # 67228 994.96 945.21 1,086.99 67840 280.36 266.34 306.29 67229 1,078.98 1,025.03 1,178.78 # 67840 151.38 143.81 165.38 67250 748.64 711.21 817.89 67850 225.10 213.85 245.93 67255 802.13 762.02 876.32 # 67850 137.10 130.25 149.79 67311 562.87 534.73 614.94 67875 174.49 165.77 190.64 67312 669.12 635.66 731.01 # 67875 93.47 88.80 102.12 67314 630.33 598.81 688.63 67880 441.65 419.57 482.51 67316 750.22 712.71 819.62 # 67880 344.80 327.56 376.69 67318 660.36 627.34 721.44 67882 541.36 514.29 591.43 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 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 57 FSY09 LOCALITY FEE SCHEDULE FOR AREA 01 DATE 11/07/08 0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE ---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------ # 67882 443.11 420.95 484.09 # 68130 391.56 371.98 427.78 67900 626.59 595.26 684.55 68135 149.73 142.24 163.58 # 67900 487.37 463.00 532.45 # 68135 144.15 136.94 157.48 67901 673.92 640.22 736.25 68200 41.09 39.04 44.90 # 67901 546.80 519.46 597.38 # 68200 33.17 31.51 36.24 67902 672.85 639.21 735.09 68320 703.22 668.06 768.27 67903 598.57 568.64 653.94 # 68320 503.00 477.85 549.53 # 67903 472.85 449.21 516.59 68325 621.12 590.06 678.57 67904 706.05 670.75 771.36 68326 604.79 574.55 660.73 # 67904 558.91 530.96 610.60 68328 674.33 640.61 736.70 67906 488.16 463.75 533.31 68330 588.52 559.09 642.95 67908 476.44 452.62 520.51 # 68330 431.60 410.02 471.52 # 67908 412.19 391.58 450.32 68335 606.55 576.22 662.65 67909 525.47 499.20 574.08 68340 532.30 505.69 581.54 # 67909 420.24 399.23 459.11 # 68340 373.06 354.41 407.57 67911 522.23 496.12 570.54 68360 515.78 489.99 563.49 67912 918.73 872.79 1,003.71 # 68360 385.41 366.14 421.06 # 67912 474.06 450.36 517.91 68362 614.45 583.73 671.29 67914 385.14 365.88 420.76 68371 398.65 378.72 435.53 # 67914 275.72 261.93 301.22 68400 286.37 272.05 312.86 67915 346.11 328.80 378.12 # 68400 130.39 123.87 142.45 # 67915 244.14 231.93 266.72 68420 322.87 306.73 352.74 67916 527.36 500.99 576.14 # 68420 165.96 157.66 181.31 # 67916 412.81 392.17 451.00 68440 105.45 100.18 115.21 67917 574.07 545.37 627.18 # 68440 93.81 89.12 102.49 # 67917 454.87 432.13 496.95 68500 915.91 870.11 1,000.63 67921 367.68 349.30 401.70 68505 923.18 877.02 1,008.57 # 67921 258.26 245.35 282.15 68510 448.05 425.65 489.50 67922 335.32 318.55 366.33 # 68510 277.63 263.75 303.31 # 67922 235.22 223.46 256.98 68520 651.30 618.74 711.55 67923 553.25 525.59 604.43 68525 253.45 240.78 276.90 # 67923 443.83 421.64 484.89 68530 434.50 412.78 474.70 67924 575.62 546.84 628.87 # 68530 248.72 236.28 271.72 # 67924 428.01 406.61 467.60 68540 876.14 832.33 957.18 67930 362.15 344.04 395.65 68550 1,074.54 1,020.81 1,173.93 # 67930 231.78 220.19 253.22 68700 565.86 537.57 618.21 67935 583.81 554.62 637.81 68705 235.93 224.13 257.75 # 67935 426.90 405.56 466.39 # 68705 158.17 150.26 172.80 67938 248.71 236.27 271.71 68720 717.78 681.89 784.17 # 67938 110.42 104.90 120.64 68745 721.67 685.59 788.43 67950 565.72 537.43 618.04 68750 743.20 706.04 811.95 # 67950 447.45 425.08 488.84 68760 200.13 190.12 218.64 67961 566.12 537.81 618.48 # 68760 139.13 132.17 152.00 # 67961 437.14 415.28 477.57 68761 144.60 137.37 157.98 67966 733.68 697.00 801.55 # 68761 113.40 107.73 123.89 # 67966 612.61 581.98 669.28 68770 554.33 526.61 605.60 67971 692.40 657.78 756.45 68801 121.75 115.66 133.01 67973 895.09 850.34 977.89 # 68801 104.06 98.86 113.69 67974 891.19 846.63 973.62 68810 233.51 221.83 255.10 67975 654.98 622.23 715.56 # 68810 182.76 173.62 199.66 68020 114.24 108.53 124.81 68811 197.05 187.20 215.28 # 68020 105.39 100.12 115.14 68815 446.67 424.34 487.99 68040 62.91 59.76 68.72 # 68815 245.99 233.69 268.74 # 68040 50.81 48.27 55.51 68816 705.22 669.96 770.45 68100 173.09