1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 1 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 36.44 34.62 39.81 G0270 23.69 22.51 25.89 G0102 20.01 19.01 21.86 # G0270 21.69 20.61 23.70 # G0102 8.84 8.40 9.66 G0271 13.34 12.67 14.57 G0104 134.00 127.30 146.40 G0275 14.54 13.81 15.88 # G0104 61.00 57.95 66.64 G0278 14.54 13.81 15.88 G0105 391.20 371.64 427.39 G0281 12.00 11.40 13.11 # G0105 213.29 202.63 233.02 G0283 12.00 11.40 13.11 G0105 53 134.00 127.30 146.40 G0288 140.58 133.55 153.58 # G0105 53 61.00 57.95 66.64 G0289 87.64 83.26 95.75 G0106 213.76 203.07 233.53 G0329 8.44 8.02 9.22 G0106 TC 161.94 153.84 176.92 G0339 3,958.14 3,760.23 4,324.26 G0106 26 51.82 49.23 56.61 G0340 2,687.41 2,553.04 2,936.00 G0108 25.41 24.14 27.76 G0341 419.51 398.53 458.31 G0109 14.24 13.53 15.56 G0342 682.97 648.82 746.14 G0117 46.54 44.21 50.84 G0343 1,131.79 1,075.20 1,236.48 G0118 31.98 30.38 34.94 G0364 13.30 12.64 14.54 G0120 213.76 203.07 233.53 # G0364 9.71 9.22 10.60 G0120 TC 161.94 153.84 176.92 C G0365 179.49 170.52 196.10 G0120 26 51.82 49.23 56.61 C G0365 TC 167.06 158.71 182.52 G0121 391.20 371.64 427.39 G0365 26 12.42 11.80 13.57 # G0121 213.29 202.63 233.02 G0372 11.64 11.06 12.72 G0121 53 134.00 127.30 146.40 # G0372 8.44 8.02 9.22 # G0121 53 61.00 57.95 66.64 G0389 119.43 113.46 130.48 G0124 28.17 26.76 30.77 G0389 TC 88.37 83.95 96.54 G0127 20.01 19.01 21.86 G0389 26 31.07 29.52 33.95 # G0127 8.44 8.02 9.22 G0392 2,344.30 2,227.09 2,561.15 G0128 8.77 8.33 9.58 # G0392 455.53 432.75 497.66 G0130 34.38 32.66 37.56 G0393 1,774.89 1,686.15 1,939.07 G0130 TC 23.72 22.53 25.91 # G0393 322.11 306.00 351.90 G0130 26 10.66 10.13 11.65 G0396 31.86 30.27 34.81 G0141 28.17 26.76 30.77 # G0396 30.27 28.76 33.07 G0166 165.57 157.29 180.88 G0397 62.00 58.90 67.74 G0168 81.79 77.70 89.36 # G0397 60.41 57.39 66.00 # G0168 25.55 24.27 27.91 G0398 310.73 295.19 339.47 G0179 41.23 39.17 45.05 G0398 TC 223.94 212.74 244.65 G0180 54.28 51.57 59.31 G0398 26 86.79 82.45 94.82 G0181 103.85 98.66 113.46 G0399 223.45 212.28 244.12 G0182 106.25 100.94 116.08 G0399 TC 142.69 135.56 155.89 G0202 139.87 132.88 152.81 G0399 26 80.76 76.72 88.23 G0202 TC 104.05 98.85 113.68 G0400 201.11 191.05 219.71 G0202 26 35.82 34.03 39.13 G0400 TC 128.43 122.01 140.31 G0204 164.27 156.06 179.47 G0400 26 72.68 69.05 79.41 G0204 TC 120.00 114.00 131.10 G0402 96.50 91.68 105.43 G0204 26 44.27 42.06 48.37 G0403 22.16 21.05 24.21 G0206 130.42 123.90 142.49 G0404 14.91 14.16 16.28 G0206 TC 94.60 89.87 103.35 G0405 8.44 8.02 9.22 G0206 26 35.82 34.03 39.13 G0406 38.00 36.10 41.52 G0237 11.32 10.75 12.36 G0407 68.34 64.92 74.66 G0238 12.12 11.51 13.24 G0408 97.83 92.94 106.88 G0239 12.52 11.89 13.67 G0409 9.45 8.98 10.33 G0245 66.17 62.86 72.29 G0412 701.75 666.66 766.66 # G0245 45.83 43.54 50.07 G0413 1,024.19 972.98 1,118.93 G0246 38.83 36.89 42.42 G0414 970.13 921.62 1,059.86 # G0246 23.28 22.12 25.44 G0415 1,322.24 1,256.13 1,444.55 G0247 43.44 41.27 47.46 G0416 683.97 649.77 747.24 # G0247 25.49 24.22 27.85 G0416 TC 492.53 467.90 538.09 G0248 164.22 156.01 179.41 G0416 26 191.44 181.87 209.15 G0249 139.49 132.52 152.40 G0417 1,329.43 1,262.96 1,452.40 G0250 10.00 9.50 10.93 G0417 TC 962.32 914.20 1,051.33 G0268 49.03 46.58 53.57 G0417 26 367.11 348.75 401.06 # G0268 31.48 29.91 34.40 G0418 2,280.95 2,166.90 2,491.94 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 99 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 1,643.91 1,561.71 1,795.97 # 10040 82.49 78.37 90.13 G0418 26 637.03 605.18 695.96 10060 102.77 97.63 112.27 G0419 2,709.42 2,573.95 2,960.04 # 10060 88.01 83.61 96.15 G0419 TC 1,972.53 1,873.90 2,154.99 10061 174.44 165.72 190.58 G0419 26 736.89 700.05 805.06 # 10061 154.89 147.15 169.22 G9041 23.44 22.27 25.61 10080 155.55 147.77 169.94 G9042 7.90 7.51 8.64 # 10080 90.13 85.62 98.46 G9043 7.50 7.13 8.20 10081 241.52 229.44 263.86 G9044 7.10 6.75 7.76 # 10081 155.36 147.59 169.73 M0064 43.23 41.07 47.23 10120 126.96 120.61 138.70 # M0064 16.90 16.06 18.47 # 10120 85.87 81.58 93.82 P3001 28.17 26.76 30.77 10121 245.54 233.26 268.25 Q0035 20.16 19.15 22.02 # 10121 174.53 165.80 190.67 Q0035 TC 11.72 11.13 12.80 10140 145.30 138.04 158.75 Q0035 26 8.44 8.02 9.22 # 10140 112.59 106.96 123.00 Q0091 42.71 40.57 46.66 10160 118.37 112.45 129.32 # Q0091 18.38 17.46 20.08 # 10160 90.85 86.31 99.26 Q0092 17.83 16.94 19.48 10180 218.54 207.61 238.75 R0070 169.28 160.82 184.94 # 10180 166.28 157.97 181.67 R0075 169.28 160.82 184.94 11000 50.85 48.31 55.56 0067T 648.23 615.82 708.19 # 11000 30.90 29.36 33.76 C 0067T TC 209.70 199.22 229.10 11001 21.17 20.11 23.13 0067T 26 131.71 125.12 143.89 # 11001 15.59 14.81 17.03 0073T 570.02 541.52 622.75 11004 552.71 525.07 603.83 0075T 1,152.10 1,094.50 1,258.68 11005 720.35 684.33 786.98 0075T 26 914.45 868.73 999.04 11006 684.17 649.96 747.45 0076T 380.19 361.18 415.36 11008 260.63 247.60 284.74 0076T 26 91.44 86.87 99.90 11010 443.61 421.43 484.64 0078T 1,298.48 1,233.56 1,418.59 # 11010 269.69 256.21 294.64 0079T 1,196.12 1,136.31 1,306.76 11011 493.00 468.35 538.60 0080T 231.34 219.77 252.74 # 11011 287.96 273.56 314.59 0081T 231.34 219.77 252.74 11012 672.79 639.15 735.02 0145T 643.93 611.73 703.49 # 11012 418.70 397.77 457.44 C 0145T TC 304.96 289.71 333.17 11040 44.54 42.31 48.66 0145T 26 104.05 98.85 113.68 # 11040 26.59 25.26 29.05 0146T 643.93 611.73 703.49 11041 52.07 49.47 56.89 C 0146T TC 304.96 289.71 333.17 # 11041 33.32 31.65 36.40 0146T 26 104.05 98.85 113.68 11042 70.53 67.00 77.05 0147T 643.93 611.73 703.49 # 11042 44.60 42.37 48.73 C 0147T TC 304.96 289.71 333.17 11043 256.45 243.63 280.17 0147T 26 104.05 98.85 113.68 # 11043 222.54 211.41 243.12 0148T 643.93 611.73 703.49 11044 350.60 333.07 383.03 C 0148T TC 304.96 289.71 333.17 # 11044 306.72 291.38 335.09 0148T 26 104.05 98.85 113.68 11055 46.11 43.80 50.37 0149T 643.93 611.73 703.49 # 11055 22.18 21.07 24.23 C 0149T TC 304.96 289.71 333.17 11056 56.00 53.20 61.18 0149T 26 104.05 98.85 113.68 # 11056 31.26 29.70 34.16 0150T 643.93 611.73 703.49 11057 67.35 63.98 73.58 C 0150T TC 304.96 289.71 333.17 # 11057 40.62 38.59 44.38 0150T 26 104.05 98.85 113.68 11100 98.46 93.54 107.57 0151T 207.32 196.95 226.49 # 11100 46.20 43.89 50.47 C 0151T TC 113.24 107.58 123.72 11101 31.40 29.83 34.30 0151T 26 68.46 65.04 74.80 # 11101 23.82 22.63 26.02 0171T 752.44 714.82 822.04 11200 76.86 73.02 83.97 0172T 376.22 357.41 411.02 # 11200 64.50 61.28 70.47 0177T 1,281.34 1,217.27 1,399.86 11201 17.47 16.60 19.09 10021 134.64 127.91 147.10 # 11201 15.87 15.08 17.34 # 10021 66.03 62.73 72.14 11300 64.42 61.20 70.38 10022 138.48 131.56 151.29 # 11300 28.13 26.72 30.73 # 10022 65.48 62.21 71.54 11301 87.82 83.43 95.94 10040 94.86 90.12 103.64 # 11301 47.93 45.53 52.36 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 99 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 104.93 99.68 114.63 # 11462 209.01 198.56 228.34 # 11302 59.46 56.49 64.96 11463 438.53 416.60 479.09 11303 123.15 116.99 134.54 # 11463 291.74 277.15 318.72 # 11303 69.70 66.22 76.15 11470 357.36 339.49 390.41 11305 65.75 62.46 71.83 # 11470 246.47 234.15 269.27 # 11305 35.44 33.67 38.72 11471 448.36 425.94 489.83 11306 90.54 86.01 98.91 # 11471 309.15 293.69 337.74 # 11306 53.84 51.15 58.82 11600 167.44 159.07 182.93 11307 107.16 101.80 117.07 # 11600 104.42 99.20 114.08 # 11307 63.68 60.50 69.58 11601 206.71 196.37 225.83 11308 119.81 113.82 130.89 # 11601 135.31 128.54 147.82 # 11308 76.33 72.51 83.39 11602 227.14 215.78 248.15 11310 79.87 75.88 87.26 # 11602 148.96 141.51 162.74 # 11310 40.78 38.74 44.55 11603 256.99 244.14 280.76 11311 100.94 95.89 110.27 # 11603 176.42 167.60 192.74 # 11311 59.86 56.87 65.40 11604 283.57 269.39 309.80 11312 116.64 110.81 127.43 # 11604 193.42 183.75 211.31 # 11312 68.77 65.33 75.13 11606 396.66 376.83 433.35 11313 145.36 138.09 158.80 # 11606 284.96 270.71 311.32 # 11313 91.91 87.31 100.41 11620 171.12 162.56 186.94 11400 109.44 103.97 119.57 # 11620 106.10 100.80 115.92 # 11400 70.35 66.83 76.85 11621 208.67 198.24 227.98 11401 133.92 127.22 146.30 # 11621 136.87 130.03 149.53 # 11401 93.23 88.57 101.86 11622 235.97 224.17 257.80 11402 149.29 141.83 163.10 # 11622 157.78 149.89 172.37 # 11402 103.02 97.87 112.55 11623 274.21 260.50 299.58 11403 170.94 162.39 186.75 # 11623 193.63 183.95 211.54 # 11403 131.05 124.50 143.18 11624 307.83 292.44 336.31 11404 194.62 184.89 212.62 # 11624 219.67 208.69 239.99 # 11404 145.55 138.27 159.01 11626 373.87 355.18 408.46 11406 272.07 258.47 297.24 # 11626 274.55 260.82 299.94 # 11406 215.82 205.03 235.78 11640 179.14 170.18 195.71 11420 110.20 104.69 120.39 # 11640 112.13 106.52 122.50 # 11420 75.90 72.11 82.93 11641 219.82 208.83 240.15 11421 142.44 135.32 155.62 # 11641 146.43 139.11 159.98 # 11421 102.15 97.04 111.60 11642 252.95 240.30 276.35 11422 158.87 150.93 173.57 # 11642 172.37 163.75 188.31 # 11422 123.77 117.58 135.22 11643 295.90 281.11 323.28 11423 184.55 175.32 201.62 # 11643 214.52 203.79 234.36 # 11423 143.86 136.67 157.17 11644 364.65 346.42 398.38 11424 212.35 201.73 231.99 # 11644 266.92 253.57 291.61 # 11424 165.28 157.02 180.57 11646 478.10 454.20 522.33 11426 302.06 286.96 330.00 # 11646 374.78 356.04 409.45 # 11426 251.00 238.45 274.22 11719 20.29 19.28 22.17 11440 121.02 114.97 132.22 # 11719 8.72 8.28 9.52 # 11440 91.90 87.31 100.41 11720 29.48 28.01 32.21 11441 152.60 144.97 166.72 # 11720 16.31 15.49 17.81 # 11441 119.89 113.90 130.99 11721 41.88 39.79 45.76 11442 171.72 163.13 187.60 # 11721 27.92 26.52 30.50 # 11442 133.42 126.75 145.76 11730 92.87 88.23 101.46 11443 205.24 194.98 224.23 # 11730 56.57 53.74 61.80 # 11443 164.15 155.94 179.33 11732 42.97 40.82 46.94 11444 257.86 244.97 281.72 # 11732 29.41 27.94 32.13 # 11444 209.60 199.12 228.99 11740 42.86 40.72 46.83 11446 349.11 331.65 381.40 # 11740 30.50 28.98 33.33 # 11446 295.26 280.50 322.58 11750 200.93 190.88 219.51 11450 326.45 310.13 356.65 # 11750 165.83 157.54 181.17 # 11450 216.75 205.91 236.80 11752 285.62 271.34 312.04 11451 425.89 404.60 465.29 # 11752 248.52 236.09 271.50 # 11451 285.48 271.21 311.89 11755 126.03 119.73 137.69 11462 323.09 306.94 352.98 # 11755 81.75 77.66 89.31 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 99 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 190.75 181.21 208.39 # 12014 136.30 129.49 148.91 # 11760 124.53 118.30 136.05 12015 237.46 225.59 259.43 11762 252.83 240.19 276.22 # 12015 170.45 161.93 186.22 # 11762 189.40 179.93 206.92 12016 283.33 269.16 309.53 11765 122.93 116.78 134.30 # 12016 207.94 197.54 227.17 # 11765 64.69 61.46 70.68 12017 247.40 235.03 270.28 11770 242.23 230.12 264.64 12018 307.80 292.41 336.27 # 11770 165.64 157.36 180.96 12020 250.94 238.39 274.15 11771 494.47 469.75 540.21 # 12020 175.95 167.15 192.22 # 11771 384.37 365.15 419.92 12021 147.56 140.18 161.21 11772 600.24 570.23 655.76 # 12021 128.02 121.62 139.86 # 11772 504.51 479.28 551.17 12031 222.71 211.57 243.31 11900 53.34 50.67 58.27 # 12031 147.72 140.33 161.38 # 11900 29.41 27.94 32.13 12032 288.31 273.89 314.97 11901 66.98 63.63 73.17 # 12032 182.60 173.47 199.49 # 11901 45.84 43.55 50.08 12034 282.00 267.90 308.09 11920 172.39 163.77 188.34 # 12034 189.06 179.61 206.55 # 11920 109.76 104.27 119.91 12035 344.71 327.47 376.59 11921 196.16 186.35 214.30 # 12035 221.85 210.76 242.37 # 11921 129.15 122.69 141.09 12036 376.82 357.98 411.68 11922 58.02 55.12 63.39 # 12036 255.55 242.77 279.19 # 11922 28.90 27.46 31.58 12037 424.71 403.47 463.99 11950 71.25 67.69 77.84 # 12037 297.86 282.97 325.42 # 11950 48.12 45.71 52.57 12041 232.85 221.21 254.39 11951 94.92 90.17 103.70 # 12041 157.86 149.97 172.47 # 11951 66.99 63.64 73.19 12042 271.66 258.08 296.79 11952 133.60 126.92 145.96 # 12042 184.70 175.47 201.79 # 11952 96.90 92.06 105.87 12044 313.68 298.00 342.70 11954 153.06 145.41 167.22 # 12044 198.00 188.10 216.32 # 11954 109.18 103.72 119.28 12045 346.90 329.56 378.99 11960 861.19 818.13 940.85 # 12045 230.02 218.52 251.30 11970 562.51 534.38 614.54 12046 411.33 390.76 449.37 11971 432.15 410.54 472.12 # 12046 271.32 257.75 296.41 # 11971 281.77 267.68 307.83 12047 440.92 418.87 481.70 11976 141.84 134.75 154.96 # 12047 296.92 282.07 324.38 # 11976 92.37 87.75 100.91 12051 250.72 238.18 273.91 11980 99.62 94.64 108.84 # 12051 169.34 160.87 185.00 # 11980 77.68 73.80 84.87 12052 284.25 270.04 310.55 11981 130.85 124.31 142.96 # 12052 199.28 189.32 217.72 # 11981 82.19 78.08 89.79 12053 312.25 296.64 341.14 11982 150.31 142.79 164.21 # 12053 200.96 190.91 219.55 # 11982 100.45 95.43 109.74 12054 329.75 313.26 360.25 11983 230.30 218.79 251.61 # 12054 212.88 202.24 232.58 # 11983 183.63 174.45 200.62 12055 396.24 376.43 432.89 12001 137.21 130.35 149.90 # 12055 258.62 245.69 282.54 # 12001 96.12 91.31 105.01 12056 467.81 444.42 511.08 12002 145.96 138.66 159.46 # 12056 316.63 300.80 345.92 # 12002 106.87 101.53 116.76 12057 522.25 496.14 570.56 12004 172.03 163.43 187.94 # 12057 362.69 344.56 396.24 # 12004 125.36 119.09 136.95 13100 296.72 281.88 324.16 12005 214.16 203.45 233.97 # 13100 221.73 210.64 242.24 # 12005 155.92 148.12 170.34 13101 374.88 356.14 409.56 12006 265.36 252.09 289.90 # 13101 268.77 255.33 293.63 # 12006 196.75 186.91 214.95 13102 100.87 95.83 110.20 12007 300.81 285.77 328.64 # 13102 70.96 67.41 77.52 # 12007 225.42 214.15 246.27 13120 308.04 292.64 336.54 12011 146.04 138.74 159.55 # 13120 231.46 219.89 252.87 # 12011 99.37 94.40 108.56 13121 414.95 394.20 453.33 12013 160.93 152.88 175.81 # 13121 305.25 289.99 333.49 # 12013 113.46 107.79 123.96 13122 112.68 107.05 123.11 12014 189.35 179.88 206.86 # 13122 81.16 77.10 88.67 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 99 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 339.44 322.47 370.84 # 15121 163.53 155.35 178.65 # 13131 260.86 247.82 284.99 15130 629.33 597.86 687.54 13132 541.74 514.65 591.85 # 15130 525.62 499.34 574.24 # 13132 439.23 417.27 479.86 15131 93.37 88.70 102.01 13133 158.69 150.76 173.37 # 15131 83.80 79.61 91.55 # 13133 126.38 120.06 138.07 15135 805.50 765.23 880.01 13150 337.98 321.08 369.24 # 15135 718.93 682.98 785.43 # 13150 259.40 246.43 283.39 15136 85.52 81.24 93.43 13151 384.73 365.49 420.31 # 15136 79.14 75.18 86.46 # 13151 301.76 286.67 329.67 15150 652.00 619.40 712.31 13152 529.29 502.83 578.25 # 15150 596.95 567.10 652.17 # 13152 404.43 384.21 441.84 15151 120.64 114.61 131.80 13153 174.43 165.71 190.57 # 15151 110.67 105.14 120.91 # 13153 136.93 130.08 149.59 15152 157.48 149.61 172.05 13160 759.26 721.30 829.50 # 15152 146.31 138.99 159.84 14000 577.34 548.47 630.74 15155 685.13 650.87 748.50 # 14000 470.04 446.54 513.52 # 15155 639.26 607.30 698.40 14001 748.27 710.86 817.49 15156 167.64 159.26 183.15 # 14001 622.22 591.11 679.78 # 15156 158.46 150.54 173.12 14020 649.95 617.45 710.07 15157 185.12 175.86 202.24 # 14020 538.26 511.35 588.05 # 15157 171.96 163.36 187.86 14021 820.82 779.78 896.75 15170 396.65 376.82 433.34 # 14021 693.58 658.90 757.74 # 15170 340.81 323.77 372.34 14040 719.32 683.35 785.85 15171 88.26 83.85 96.43 # 14040 610.02 579.52 666.45 # 15171 83.87 79.68 91.63 14041 894.44 849.72 977.18 15175 503.06 477.91 549.60 # 14041 752.43 714.81 822.03 # 15175 450.40 427.88 492.06 14060 729.50 693.03 796.98 15176 141.25 134.19 154.32 # 14060 643.33 611.16 702.83 # 15176 132.87 126.23 145.16 14061 958.87 910.93 1,047.57 15200 750.88 713.34 820.34 # 14061 802.90 762.76 877.17 # 15200 614.06 583.36 670.86 14300 1,032.92 981.27 1,128.46 15201 140.14 133.13 153.10 # 14300 895.70 850.92 978.56 # 15201 75.91 72.11 82.93 14350 706.33 671.01 771.66 15220 717.16 681.30 783.50 15002 312.81 297.17 341.75 # 15220 583.13 553.97 637.07 # 15002 215.08 204.33 234.98 15221 130.60 124.07 142.68 15003 67.99 64.59 74.28 # 15221 69.57 66.09 76.00 # 15003 43.26 41.10 47.27 15240 858.30 815.39 937.70 15004 378.88 359.94 413.93 # 15240 745.02 707.77 813.94 # 15004 268.79 255.35 293.65 15241 173.62 164.94 189.68 15005 113.24 107.58 123.72 # 15241 108.60 103.17 118.65 # 15005 85.71 81.42 93.63 15260 928.91 882.46 1,014.83 15040 240.80 228.76 263.07 # 15260 805.66 765.38 880.19 # 15040 121.14 115.08 132.34 15261 202.06 191.96 220.75 15050 505.92 480.62 552.71 # 15261 137.04 130.19 149.72 # 15050 412.18 391.57 450.31 15300 319.21 303.25 348.74 15100 808.26 767.85 883.03 # 15300 271.74 258.15 296.87 # 15100 671.04 637.49 733.11 15301 59.72 56.73 65.24 15101 179.58 170.60 196.19 # 15301 54.94 52.19 60.02 # 15101 106.98 101.63 116.87 15320 359.44 341.47 392.69 15110 792.65 753.02 865.97 # 15320 307.19 291.83 335.60 # 15110 686.94 652.59 750.48 15321 88.99 84.54 97.22 15111 114.64 108.91 125.25 # 15321 82.60 78.47 90.24 # 15111 102.28 97.17 111.75 15330 296.43 281.61 323.85 15115 801.49 761.42 875.63 # 15330 247.77 235.38 270.69 # 15115 711.74 676.15 777.57 15331 59.72 56.73 65.24 15116 155.74 147.95 170.14 # 15331 55.33 52.56 60.44 # 15116 141.38 134.31 154.46 15335 311.02 295.47 339.79 15120 876.39 832.57 957.46 # 15335 263.56 250.38 287.94 # 15120 734.38 697.66 802.31 15336 82.98 78.83 90.65 15121 252.49 239.87 275.85 # 15336 75.80 72.01 82.81 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 99 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 297.44 282.57 324.96 15776 421.73 400.64 460.74 # 15340 254.36 241.64 277.89 # 15776 316.42 300.60 345.69 15341 44.54 42.31 48.66 15780 781.12 742.06 853.37 # 15341 26.20 24.89 28.62 # 15780 608.40 577.98 664.68 15360 338.47 321.55 369.78 15781 503.22 478.06 549.77 # 15360 287.81 273.42 314.43 # 15781 403.50 383.33 440.83 15361 66.77 63.43 72.94 15782 535.90 509.11 585.48 # 15361 60.38 57.36 65.96 # 15782 389.11 369.65 425.10 15365 331.52 314.94 362.18 15783 458.56 435.63 500.97 # 15365 286.05 271.75 312.51 # 15783 349.27 331.81 381.58 15366 82.08 77.98 89.68 15786 225.08 213.83 245.90 # 15366 75.30 71.54 82.27 # 15786 129.34 122.87 141.30 15400 369.88 351.39 404.10 15787 46.59 44.26 50.90 # 15400 332.38 315.76 363.12 # 15787 17.87 16.98 19.53 15401 88.84 84.40 97.06 15788 406.83 386.49 444.46 # 15401 54.54 51.81 59.58 # 15788 224.93 213.68 245.73 15420 417.31 396.44 455.91 15789 535.27 508.51 584.79 # 15420 368.64 350.21 402.74 # 15789 402.03 381.93 439.22 15421 108.13 102.72 118.13 15792 401.02 380.97 438.12 # 15421 81.41 77.34 88.94 # 15792 249.04 236.59 272.08 15430 490.85 466.31 536.26 15793 446.34 424.02 487.62 # 15430 472.50 448.88 516.21 # 15793 334.65 317.92 365.61 15570 824.94 783.69 901.24 15819 689.88 655.39 753.70 # 15570 669.77 636.28 731.72 15820 498.27 473.36 544.36 15572 799.36 759.39 873.30 # 15820 448.81 426.37 490.33 # 15572 678.89 644.95 741.69 15821 529.12 502.66 578.06 15574 843.16 801.00 921.15 # 15821 474.87 451.13 518.80 # 15574 717.11 681.25 783.44 15822 391.39 371.82 427.59 15576 749.68 712.20 819.03 # 15822 344.32 327.10 376.17 # 15576 629.61 598.13 687.85 15823 614.24 583.53 671.06 15600 310.82 295.28 339.57 # 15823 562.79 534.65 614.85 # 15600 190.75 181.21 208.39 15830 1,098.61 1,043.68 1,200.23 15610 310.40 294.88 339.11 15832 835.06 793.31 912.31 # 15610 225.04 213.79 245.86 15833 788.70 749.27 861.66 15620 410.37 389.85 448.33 15834 783.86 744.67 856.37 # 15620 296.69 281.86 324.14 15835 828.12 786.71 904.72 15630 433.25 411.59 473.33 15836 691.44 656.87 755.40 # 15630 324.35 308.13 354.35 15837 721.46 685.39 788.20 15650 482.46 458.34 527.09 # 15837 626.12 594.81 684.03 # 15650 364.78 346.54 398.52 15838 539.24 512.28 589.12 15731 1,058.28 1,005.37 1,156.18 15839 798.15 758.24 871.98 # 15731 953.77 906.08 1,041.99 # 15839 677.29 643.43 739.94 15732 1,396.86 1,327.02 1,526.07 15840 948.60 901.17 1,036.35 # 15732 1,235.71 1,173.92 1,350.01 15841 1,582.90 1,503.76 1,729.32 15734 1,438.57 1,366.64 1,571.64 15842 2,500.33 2,375.31 2,731.61 # 15734 1,270.23 1,206.72 1,387.73 15845 888.45 844.03 970.63 15736 1,276.66 1,212.83 1,394.75 15851 88.33 83.91 96.50 # 15736 1,097.16 1,042.30 1,198.65 # 15851 43.26 41.10 47.27 15738 1,358.80 1,290.86 1,484.49 15852 45.28 43.02 49.47 # 15738 1,193.26 1,133.60 1,303.64 15860 106.98 101.63 116.87 15740 950.55 903.02 1,038.47 15920 548.44 521.02 599.17 # 15740 810.94 770.39 885.95 15922 697.48 662.61 762.00 15750 857.68 814.80 937.02 15931 621.56 590.48 679.05 15756 2,246.30 2,133.99 2,454.09 15933 768.34 729.92 839.41 15757 2,220.92 2,109.87 2,426.35 15934 853.82 811.13 932.80 15758 2,224.00 2,112.80 2,429.72 15935 1,018.62 967.69 1,112.84 15760 789.04 749.59 862.03 15936 828.33 786.91 904.95 # 15760 663.79 630.60 725.19 15937 969.61 921.13 1,059.30 15770 616.05 585.25 673.04 15940 639.83 607.84 699.02 15775 304.58 289.35 332.75 15941 835.33 793.56 912.59 # 15775 221.21 210.15 241.67 15944 821.79 780.70 897.81 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 99 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 913.20 867.54 997.67 # 17280 84.09 79.89 91.87 15946 1,522.16 1,446.05 1,662.96 17281 166.04 157.74 181.40 15950 532.14 505.53 581.36 # 17281 116.98 111.13 127.80 15951 758.22 720.31 828.36 17282 192.30 182.69 210.09 15952 796.54 756.71 870.22 # 17282 135.66 128.88 148.21 15953 887.74 843.35 969.85 17283 231.67 220.09 253.10 15956 1,066.59 1,013.26 1,165.25 # 17283 169.45 160.98 185.13 15958 1,090.17 1,035.66 1,191.01 17284 268.88 255.44 293.76 16000 64.45 61.23 70.41 # 17284 201.87 191.78 220.55 # 16000 44.10 41.90 48.19 17286 338.69 321.76 370.02 16020 76.73 72.89 83.82 # 17286 270.87 257.33 295.93 # 16020 53.60 50.92 58.56 17311 656.62 623.79 717.36 16025 137.45 130.58 150.17 # 17311 361.83 343.74 395.30 # 16025 108.73 103.29 118.78 17312 395.08 375.33 431.63 16030 165.13 156.87 180.40 # 17312 192.44 182.82 210.24 # 16030 123.64 117.46 135.08 17313 599.71 569.72 655.18 16035 202.76 192.62 221.51 # 17313 324.87 308.63 354.92 16036 80.73 76.69 88.19 17314 366.15 347.84 400.02 17000 74.80 71.06 81.72 # 17314 178.67 169.74 195.20 # 17000 51.27 48.71 56.02 17315 77.90 74.01 85.11 17003 7.21 6.85 7.88 # 17315 50.77 48.23 55.46 # 17003 4.41 4.19 4.82 17340 45.33 43.06 49.52 17004 165.66 157.38 180.99 # 17340 43.74 41.55 47.78 # 17004 127.77 121.38 139.59 17360 124.16 117.95 135.64 17106 325.45 309.18 355.56 # 17360 94.24 89.53 102.96 # 17106 264.81 251.57 289.31 19000 109.70 104.22 119.85 17107 431.86 410.27 471.81 # 19000 44.68 42.45 48.82 # 17107 350.88 333.34 383.34 19001 26.73 25.39 29.20 17108 549.79 522.30 600.65 # 19001 22.34 21.22 24.40 # 17108 456.05 433.25 498.24 19020 407.91 387.51 445.64 17110 104.69 99.46 114.38 # 19020 266.31 252.99 290.94 # 17110 64.40 61.18 70.36 19030 167.35 158.98 182.83 17111 123.67 117.49 135.11 # 19030 80.79 76.75 88.26 # 17111 79.80 75.81 87.18 19100 133.11 126.45 145.42 17250 70.87 67.33 77.43 # 19100 65.29 62.03 71.33 # 17250 34.57 32.84 37.77 19101 302.08 286.98 330.03 17260 89.53 85.05 97.81 # 19101 200.36 190.34 218.89 # 17260 63.20 60.04 69.05 19102 219.30 208.34 239.59 17261 134.35 127.63 146.77 # 19102 105.62 100.34 115.39 # 17261 85.68 81.40 93.61 19103 557.93 530.03 609.53 17262 163.08 154.93 178.17 # 19103 193.74 184.05 211.66 # 17262 109.23 103.77 119.34 19105 2,185.43 2,076.16 2,387.58 17263 179.76 170.77 196.39 # 19105 194.14 184.43 212.09 # 17263 120.72 114.68 131.88 19110 421.01 399.96 459.95 17264 192.26 182.65 210.05 # 19110 300.14 285.13 327.90 # 17264 128.84 122.40 140.76 19112 395.25 375.49 431.81 17266 217.83 206.94 237.98 # 19112 270.40 256.88 295.41 # 17266 149.62 142.14 163.46 19120 430.47 408.95 470.29 17270 139.00 132.05 151.86 # 19120 365.85 347.56 399.69 # 17270 92.33 87.71 100.87 19125 475.99 452.19 520.02 17271 153.43 145.76 167.62 # 19125 405.39 385.12 442.89 # 17271 103.96 98.76 113.57 19126 150.79 143.25 164.74 17272 175.44 166.67 191.67 19260 1,120.22 1,064.21 1,223.84 # 17272 120.39 114.37 131.53 19271 1,530.17 1,453.66 1,671.71 17273 195.46 185.69 213.54 19272 1,692.94 1,608.29 1,849.53 # 17273 135.62 128.84 148.17 19290 163.34 155.17 178.45 17274 230.78 219.24 252.13 # 19290 66.80 63.46 72.98 # 17274 166.16 157.85 181.53 19291 70.26 66.75 76.76 17276 266.55 253.22 291.20 # 19291 33.16 31.50 36.23 # 17276 199.54 189.56 217.99 19295 94.02 89.32 102.72 17280 130.76 124.22 142.85 19296 3,910.93 3,715.38 4,272.69 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 99 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 194.41 184.69 212.39 20250 358.32 340.40 391.46 19297 87.50 83.13 95.60 20251 397.50 377.63 434.27 19298 1,310.77 1,245.23 1,432.01 20500 111.73 106.14 122.06 # 19298 320.31 304.29 349.93 # 20500 90.99 86.44 99.41 19300 463.56 440.38 506.44 20501 128.83 122.39 140.75 # 19300 357.46 339.59 390.53 # 20501 40.27 38.26 44.00 19301 561.67 533.59 613.63 20520 179.81 170.82 196.44 19302 807.01 766.66 881.66 # 20520 134.73 127.99 147.19 19303 867.70 824.32 947.97 20525 443.50 421.33 484.53 19304 508.97 483.52 556.05 # 20525 235.27 223.51 257.04 19305 1,006.45 956.13 1,099.55 20526 72.03 68.43 78.69 19306 1,055.84 1,003.05 1,153.51 # 20526 55.67 52.89 60.82 19307 1,062.05 1,008.95 1,160.29 20550 55.65 52.87 60.80 19316 728.39 691.97 795.77 # 20550 40.49 38.47 44.24 19318 1,074.22 1,020.51 1,173.59 20551 54.97 52.22 60.05 19324 444.57 422.34 485.69 # 20551 41.41 39.34 45.24 19325 606.17 575.86 662.24 20552 50.08 47.58 54.72 19328 457.54 434.66 499.86 # 20552 34.92 33.17 38.15 19330 587.55 558.17 641.90 20553 55.87 53.08 61.04 19340 378.01 359.11 412.98 # 20553 38.71 36.77 42.29 19342 863.65 820.47 943.54 20555 322.71 306.57 352.56 19350 798.56 758.63 872.42 20600 52.50 49.88 57.36 # 19350 637.01 605.16 695.93 # 20600 38.94 36.99 42.54 19355 658.83 625.89 719.77 20605 56.42 53.60 61.64 # 19355 522.41 496.29 570.73 # 20605 40.46 38.44 44.21 19357 1,451.97 1,379.37 1,586.28 20610 73.21 69.55 79.98 19361 1,554.90 1,477.16 1,698.73 # 20610 48.48 46.06 52.97 19364 2,643.69 2,511.51 2,888.24 20612 56.10 53.30 61.30 19366 1,301.31 1,236.24 1,421.68 # 20612 41.74 39.65 45.60 19367 1,713.68 1,628.00 1,872.20 20615 205.92 195.62 224.96 19368 2,121.67 2,015.59 2,317.93 # 20615 151.27 143.71 165.27 19369 1,931.81 1,835.22 2,110.50 20650 186.79 177.45 204.07 19370 637.29 605.43 696.24 # 20650 149.30 141.84 163.12 19371 735.02 698.27 803.01 20660 239.72 227.73 261.89 19380 718.84 682.90 785.34 # 20660 225.36 214.09 246.20 19396 207.55 197.17 226.75 20661 443.47 421.30 484.50 # 19396 126.17 119.86 137.84 20662 454.60 431.87 496.65 20000 193.51 183.83 211.40 20663 421.88 400.79 460.91 # 20000 147.64 140.26 161.30 20664 720.26 684.25 786.89 20005 286.01 271.71 312.47 20665 116.17 110.36 126.91 # 20005 225.38 214.11 246.23 # 20665 96.62 91.79 105.56 20100 555.31 527.54 606.67 20670 380.38 361.36 415.56 20101 374.39 355.67 409.02 # 20670 142.64 135.51 155.84 # 20101 191.30 181.74 209.00 20680 559.60 531.62 611.36 20102 437.39 415.52 477.85 # 20680 390.87 371.33 427.03 # 20102 233.15 221.49 254.71 20690 509.92 484.42 557.08 20103 531.04 504.49 580.16 20692 954.68 906.95 1,042.99 # 20103 333.59 316.91 364.45 20693 436.50 414.68 476.88 20150 910.37 864.85 994.58 20694 402.67 382.54 439.92 20200 182.22 173.11 199.08 # 20694 319.70 303.72 349.28 # 20200 88.48 84.06 96.67 20696 1,025.37 974.10 1,120.22 20205 247.22 234.86 270.09 20697 1,319.83 1,253.84 1,441.92 # 20205 140.71 133.67 153.72 # 20697 0.28 0.27 0.31 20206 258.08 245.18 281.96 20802 2,327.26 2,210.90 2,542.54 # 20206 62.22 59.11 67.98 20805 2,855.01 2,712.26 3,119.10 20220 175.18 166.42 191.38 20808 3,898.17 3,703.26 4,258.75 # 20220 77.45 73.58 84.62 20816 2,170.72 2,062.18 2,371.51 20225 675.51 641.73 737.99 20822 1,843.68 1,751.50 2,014.23 # 20225 117.86 111.97 128.77 20824 2,161.63 2,053.55 2,361.58 20240 217.52 206.64 237.64 20827 1,916.97 1,821.12 2,094.29 20245 594.35 564.63 649.32 20838 2,349.66 2,232.18 2,567.01 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 9 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 406.51 386.18 444.11 # 21076 793.89 754.20 867.33 # 20900 256.12 243.31 279.81 21077 2,253.10 2,140.45 2,461.52 20902 351.75 334.16 384.28 # 21077 2,006.98 1,906.63 2,192.62 20910 411.11 390.55 449.13 21079 1,544.36 1,467.14 1,687.21 20912 459.61 436.63 502.12 # 21079 1,328.96 1,262.51 1,451.89 20920 387.36 367.99 423.19 21080 1,755.43 1,667.66 1,917.81 20922 578.05 549.15 631.52 # 21080 1,495.35 1,420.58 1,633.67 # 20922 473.54 449.86 517.34 21081 1,602.05 1,521.95 1,750.24 20924 480.21 456.20 524.63 # 21081 1,361.12 1,293.06 1,487.02 20926 414.48 393.76 452.82 21082 1,493.46 1,418.79 1,631.61 20931 108.70 103.27 118.76 # 21082 1,262.90 1,199.76 1,379.72 20937 165.27 157.01 180.56 21083 1,420.53 1,349.50 1,551.93 20938 179.57 170.59 196.18 # 21083 1,169.22 1,110.76 1,277.37 20950 237.96 226.06 259.97 21084 1,614.36 1,533.64 1,763.69 # 20950 87.17 82.81 95.23 # 21084 1,336.73 1,269.89 1,460.37 20955 2,436.16 2,314.35 2,661.50 21085 654.29 621.58 714.82 20956 2,548.25 2,420.84 2,783.97 # 21085 540.21 513.20 590.18 20957 2,417.10 2,296.25 2,640.69 21086 1,643.56 1,561.38 1,795.59 20962 2,500.63 2,375.60 2,731.94 # 21086 1,470.44 1,396.92 1,606.46 20969 2,694.06 2,559.36 2,943.26 21087 1,636.92 1,555.07 1,788.33 20970 2,714.14 2,578.43 2,965.19 # 21087 1,464.59 1,391.36 1,600.06 20972 2,458.78 2,335.84 2,686.22 21100 680.39 646.37 743.33 20973 2,577.60 2,448.72 2,816.03 # 21100 378.02 359.12 412.99 20974 62.65 59.52 68.45 21110 711.96 676.36 777.81 # 20974 45.89 43.60 50.14 # 21110 603.06 572.91 658.85 20975 171.11 162.55 186.93 21116 145.16 137.90 158.59 20979 50.93 48.38 55.64 # 21116 41.44 39.37 45.28 # 20979 34.57 32.84 37.77 21120 590.68 561.15 645.32 20982 3,735.10 3,548.35 4,080.60 # 21120 471.41 447.84 515.02 # 20982 399.13 379.17 436.05 21121 730.48 693.96 798.05 20985 146.31 138.99 159.84 # 21121 619.98 588.98 677.33 21010 686.94 652.59 750.48 21122 682.92 648.77 746.09 21015 404.21 384.00 441.60 21123 813.06 772.41 888.27 21025 838.02 796.12 915.54 21125 2,948.23 2,800.82 3,220.94 # 21025 709.17 673.71 774.77 # 21125 706.04 670.74 771.35 21026 558.40 530.48 610.05 21127 3,512.06 3,336.46 3,836.93 # 21026 459.07 436.12 501.54 # 21127 826.69 785.36 903.16 21029 706.44 671.12 771.79 21137 681.55 647.47 744.59 # 21029 593.96 564.26 648.90 21138 850.82 808.28 929.52 21030 466.44 443.12 509.59 21139 951.03 903.48 1,039.00 # 21030 380.68 361.65 415.90 21141 1,279.87 1,215.88 1,398.26 21031 360.99 342.94 394.38 21142 1,259.82 1,196.83 1,376.35 # 21031 273.63 259.95 298.94 21143 1,306.76 1,241.42 1,427.63 21032 365.83 347.54 399.67 21145 1,462.86 1,389.72 1,598.18 # 21032 269.30 255.84 294.22 21146 1,565.86 1,487.57 1,710.71 21034 1,253.78 1,191.09 1,369.75 21147 1,606.28 1,525.97 1,754.87 # 21034 1,109.78 1,054.29 1,212.43 21150 1,596.02 1,516.22 1,743.65 21040 470.43 446.91 513.95 21151 1,942.39 1,845.27 2,122.06 # 21040 378.29 359.38 413.29 21154 1,951.43 1,853.86 2,131.94 21044 831.10 789.55 907.98 21155 2,217.05 2,106.20 2,422.13 21045 1,156.29 1,098.48 1,263.25 21159 2,678.36 2,544.44 2,926.11 21046 1,032.52 980.89 1,128.02 21160 2,738.32 2,601.40 2,991.61 21047 1,234.44 1,172.72 1,348.63 21172 1,688.79 1,604.35 1,845.00 21048 1,044.61 992.38 1,141.24 21175 2,042.39 1,940.27 2,231.31 21049 1,193.92 1,134.22 1,304.35 21179 1,401.10 1,331.05 1,530.71 21050 820.23 779.22 896.10 21180 1,598.85 1,518.91 1,746.75 21060 747.40 710.03 816.53 21181 670.57 637.04 732.60 21070 609.37 578.90 665.74 21182 1,935.70 1,838.92 2,114.76 21073 348.20 330.79 380.41 21183 2,170.03 2,061.53 2,370.76 # 21073 225.73 214.44 246.61 21184 2,318.23 2,202.32 2,532.67 21076 915.55 869.77 1,000.24 21188 1,548.85 1,471.41 1,692.12 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 10 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 1,177.46 1,118.59 1,286.38 21345 757.17 719.31 827.21 21194 1,342.85 1,275.71 1,467.07 # 21345 619.15 588.19 676.42 21195 1,269.01 1,205.56 1,386.39 21346 904.51 859.28 988.17 21196 1,383.27 1,314.11 1,511.23 21347 1,047.45 995.08 1,144.34 21198 1,091.34 1,036.77 1,192.29 21348 1,097.21 1,042.35 1,198.70 21199 974.21 925.50 1,064.33 21355 412.39 391.77 450.54 21206 1,074.38 1,020.66 1,173.76 # 21355 305.48 290.21 333.74 21208 1,652.82 1,570.18 1,805.71 21356 462.60 439.47 505.39 # 21208 782.03 742.93 854.37 # 21356 352.11 334.50 384.68 21209 773.99 735.29 845.58 21360 499.49 474.52 545.70 # 21209 606.05 575.75 662.11 21365 1,038.95 987.00 1,135.05 21210 1,986.81 1,887.47 2,170.59 21366 1,154.66 1,096.93 1,261.47 # 21210 780.15 741.14 852.31 21385 674.27 640.56 736.64 21215 3,414.88 3,244.14 3,730.76 21386 626.40 595.08 684.34 # 21215 813.28 772.62 888.51 21387 702.89 667.75 767.91 21230 725.64 689.36 792.76 21390 724.03 687.83 791.00 21235 684.39 650.17 747.70 21395 910.52 864.99 994.74 # 21235 535.20 508.44 584.71 21400 167.33 158.96 182.80 21240 1,050.80 998.26 1,148.00 # 21400 136.61 129.78 149.25 21242 963.12 914.96 1,052.20 21401 447.28 424.92 488.66 21243 1,578.87 1,499.93 1,724.92 # 21401 277.75 263.86 303.44 21244 990.80 941.26 1,082.45 21406 508.99 483.54 556.07 21245 1,075.39 1,021.62 1,174.86 21407 601.61 571.53 657.26 # 21245 867.17 823.81 947.38 21408 825.74 784.45 902.12 21246 806.51 766.18 881.11 21421 689.90 655.41 753.72 21247 1,532.12 1,455.51 1,673.84 # 21421 586.58 557.25 640.84 21248 1,010.33 959.81 1,103.78 21422 633.14 601.48 691.70 # 21248 831.23 789.67 908.12 21423 750.27 712.76 819.67 21249 1,396.45 1,326.63 1,525.62 21431 698.90 663.96 763.55 # 21249 1,176.26 1,117.45 1,285.07 21432 630.47 598.95 688.79 21255 1,372.09 1,303.49 1,499.01 21433 1,603.90 1,523.71 1,752.27 21256 1,106.02 1,050.72 1,208.33 21435 1,267.40 1,204.03 1,384.63 21260 1,256.21 1,193.40 1,372.41 21436 1,862.65 1,769.52 2,034.95 21261 2,131.93 2,025.33 2,329.13 21440 505.36 480.09 552.10 21263 1,916.58 1,820.75 2,093.86 # 21440 418.00 397.10 456.67 21267 1,467.97 1,394.57 1,603.76 21445 711.96 676.36 777.81 21268 1,817.42 1,726.55 1,985.53 # 21445 584.71 555.47 638.79 21270 857.85 814.96 937.20 21450 525.75 499.46 574.38 # 21270 659.20 626.24 720.18 # 21450 437.60 415.72 478.08 21275 762.62 724.49 833.16 21451 691.15 656.59 755.08 21280 494.66 469.93 540.42 # 21451 585.84 556.55 640.03 21282 329.16 312.70 359.61 21452 577.26 548.40 630.66 21295 165.85 157.56 181.19 # 21452 317.18 301.32 346.52 21296 401.96 381.86 439.14 21453 799.72 759.73 873.69 21310 102.22 97.11 111.68 # 21453 707.57 672.19 773.02 # 21310 27.23 25.87 29.75 21454 521.14 495.08 569.34 21315 248.41 235.99 271.39 21461 1,833.93 1,742.23 2,003.56 # 21315 139.91 132.91 152.85 # 21461 869.40 825.93 949.82 21320 238.45 226.53 260.51 21462 1,978.26 1,879.35 2,161.25 # 21320 129.95 123.45 141.97 # 21462 960.27 912.26 1,049.10 21325 447.16 424.80 488.52 21465 859.75 816.76 939.27 21330 545.63 518.35 596.10 21470 1,120.01 1,064.01 1,223.61 21335 697.81 662.92 762.36 21480 86.43 82.11 94.43 21336 608.03 577.63 664.27 # 21480 30.99 29.44 33.86 21337 369.44 350.97 403.62 21485 619.18 588.22 676.45 # 21337 268.92 255.47 293.79 # 21485 526.64 500.31 575.36 21338 700.12 665.11 764.88 21490 873.31 829.64 954.09 21339 776.34 737.52 848.15 21495 646.67 614.34 706.49 21340 761.10 723.05 831.51 21497 626.15 594.84 684.07 21343 1,089.88 1,035.39 1,190.70 # 21497 533.21 506.55 582.53 21344 1,419.41 1,348.44 1,550.71 21501 411.69 391.11 449.78 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 11 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 296.80 281.96 324.25 22310 267.06 253.71 291.77 21502 492.04 467.44 537.56 # 22310 248.32 235.90 271.29 21510 437.20 415.34 477.64 22315 801.69 761.61 875.85 21550 242.70 230.57 265.16 # 22315 709.15 673.69 774.74 # 21550 150.56 143.03 164.48 22318 1,501.99 1,426.89 1,640.92 21555 403.80 383.61 441.15 22319 1,648.96 1,566.51 1,801.49 # 21555 311.66 296.08 340.49 22325 1,315.72 1,249.93 1,437.42 21556 389.13 369.67 425.12 22326 1,370.71 1,302.17 1,497.50 21557 546.83 519.49 597.41 22327 1,359.82 1,291.83 1,485.60 21600 522.74 496.60 571.09 22328 271.55 257.97 296.67 21610 1,009.48 959.01 1,102.86 22505 116.13 110.32 126.87 21615 635.79 604.00 694.60 22520 2,259.64 2,146.66 2,468.66 21616 814.52 773.79 889.86 # 22520 559.15 531.19 610.87 21620 495.27 470.51 541.09 22521 2,202.13 2,092.02 2,405.82 21627 521.83 495.74 570.10 # 22521 527.16 500.80 575.92 21630 1,204.97 1,144.72 1,316.43 22522 245.38 233.11 268.08 21632 1,188.76 1,129.32 1,298.72 22523 586.93 557.58 641.22 21685 939.38 892.41 1,026.27 22524 562.31 534.19 614.32 21700 399.43 379.46 436.38 22525 261.53 248.45 285.72 21705 613.42 582.75 670.16 22526 1,910.63 1,815.10 2,087.37 21720 387.19 367.83 423.00 # 22526 328.61 312.18 359.01 21725 504.22 479.01 550.86 22527 1,489.46 1,414.99 1,627.24 21740 1,032.88 981.24 1,128.43 # 22527 148.77 141.33 162.53 21750 686.10 651.80 749.57 22532 1,632.07 1,550.47 1,783.04 21800 91.52 86.94 99.98 22533 1,536.15 1,459.34 1,678.24 # 21800 93.12 88.46 101.73 22534 355.71 337.92 388.61 21805 244.60 232.37 267.23 22548 1,740.82 1,653.78 1,901.85 21810 472.69 449.06 516.42 22554 1,209.09 1,148.64 1,320.94 21820 122.19 116.08 133.49 22556 1,557.37 1,479.50 1,701.43 # 21820 123.79 117.60 135.24 22558 1,427.43 1,356.06 1,559.47 21825 537.79 510.90 587.54 22585 328.67 312.24 359.08 21920 242.15 230.04 264.55 22590 1,449.55 1,377.07 1,583.63 # 21920 150.40 142.88 164.31 22595 1,376.46 1,307.64 1,503.79 21925 394.03 374.33 430.48 22600 1,181.41 1,122.34 1,290.69 # 21925 316.25 300.44 345.51 22610 1,165.56 1,107.28 1,273.37 21930 439.70 417.72 480.38 22612 1,503.64 1,428.46 1,642.73 # 21930 350.35 332.83 382.75 22614 383.65 364.47 419.14 21935 1,095.69 1,040.91 1,197.05 22630 1,448.71 1,376.27 1,582.71 22010 851.12 808.56 929.84 22632 311.70 296.12 340.54 22015 846.57 804.24 924.88 22800 1,280.05 1,216.05 1,398.46 22100 771.53 732.95 842.89 22802 2,030.22 1,928.71 2,218.02 22101 768.89 730.45 840.02 22804 2,343.38 2,226.21 2,560.14 22102 765.67 727.39 836.50 22808 1,726.46 1,640.14 1,886.16 22103 138.20 131.29 150.98 22810 1,921.72 1,825.63 2,099.47 22110 956.88 909.04 1,045.40 22812 2,104.09 1,998.89 2,298.72 22112 924.09 877.89 1,009.57 22818 2,121.72 2,015.63 2,317.97 22114 949.86 902.37 1,037.73 22819 2,445.28 2,323.02 2,671.47 22116 137.53 130.65 150.25 22830 764.79 726.55 835.53 22206 2,259.02 2,146.07 2,467.98 22840 748.99 711.54 818.27 22207 2,229.67 2,118.19 2,435.92 22842 750.54 713.01 819.96 22208 567.04 538.69 619.49 22843 798.69 758.76 872.57 22210 1,669.47 1,586.00 1,823.90 22844 978.64 929.71 1,069.17 22212 1,380.76 1,311.72 1,508.48 22845 716.69 680.86 782.99 22214 1,389.70 1,320.22 1,518.25 22846 744.13 706.92 812.96 22216 360.66 342.63 394.02 22847 820.48 779.46 896.38 22220 1,502.97 1,427.82 1,641.99 22848 356.54 338.71 389.52 22222 1,360.97 1,292.92 1,486.86 22849 1,236.03 1,174.23 1,350.36 22224 1,485.49 1,411.22 1,622.90 22850 677.10 643.25 739.74 22226 359.06 341.11 392.28 22851 399.28 379.32 436.22 22305 174.05 165.35 190.15 22852 647.45 615.08 707.34 # 22305 160.09 152.09 174.90 22855 1,048.30 995.89 1,145.27 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 12 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 1,566.58 1,488.25 1,711.49 23405 598.23 568.32 653.57 22857 1,625.05 1,543.80 1,775.37 23406 746.45 709.13 815.50 22861 1,897.54 1,802.66 2,073.06 23410 793.56 753.88 866.96 22862 1,872.81 1,779.17 2,046.05 23412 829.27 787.81 905.98 22864 1,743.77 1,656.58 1,905.07 23415 661.77 628.68 722.98 22865 2,015.39 1,914.62 2,201.81 23420 928.54 882.11 1,014.43 22900 384.35 365.13 419.90 23430 702.95 667.80 767.97 23000 501.25 476.19 547.62 23440 724.46 688.24 791.48 # 23000 337.70 320.82 368.94 23450 907.65 862.27 991.61 23020 653.26 620.60 713.69 23455 967.90 919.51 1,057.44 23030 400.33 380.31 437.36 23460 1,047.93 995.53 1,144.86 # 23030 242.76 230.62 265.21 23462 1,027.14 975.78 1,122.15 23031 367.01 348.66 400.96 23465 1,072.11 1,018.50 1,171.28 # 23031 201.47 191.40 220.11 23466 1,058.05 1,005.15 1,155.92 23035 648.46 616.04 708.45 23470 1,165.84 1,107.55 1,273.68 23040 680.25 646.24 743.18 23472 1,441.76 1,369.67 1,575.12 23044 539.99 512.99 589.94 23480 780.83 741.79 853.06 23065 200.81 190.77 219.39 23485 921.53 875.45 1,006.77 # 23065 156.93 149.08 171.44 23490 794.91 755.16 868.43 23066 476.62 452.79 520.71 23491 970.80 922.26 1,060.60 # 23066 319.05 303.10 348.57 23500 192.93 183.28 210.77 23075 243.29 231.13 265.80 # 23500 191.73 182.14 209.46 # 23075 167.10 158.75 182.56 23505 317.39 301.52 346.75 23076 529.94 503.44 578.96 # 23505 300.23 285.22 328.00 23077 1,118.83 1,062.89 1,222.32 23515 663.01 629.86 724.34 23100 460.46 437.44 503.06 23520 200.13 190.12 218.64 23101 423.20 402.04 462.35 # 23520 201.32 191.25 219.94 23105 602.04 571.94 657.73 23525 310.31 294.79 339.01 23106 448.96 426.51 490.49 # 23525 289.57 275.09 316.35 23107 625.31 594.04 683.15 23530 507.76 482.37 554.73 23120 542.20 515.09 592.35 23532 585.98 556.68 640.18 23125 664.44 631.22 725.90 23540 197.30 187.44 215.56 23130 570.22 541.71 622.97 # 23540 194.51 184.78 212.50 23140 483.41 459.24 528.13 23545 285.00 270.75 311.36 23145 652.54 619.91 712.90 # 23545 261.86 248.77 286.09 23146 567.23 538.87 619.70 23550 540.26 513.25 590.24 23150 617.29 586.43 674.39 23552 621.87 590.78 679.40 23155 747.96 710.56 817.14 23570 206.41 196.09 225.50 23156 635.90 604.11 694.73 # 23570 209.21 198.75 228.56 23170 499.34 474.37 545.53 23575 351.78 334.19 384.32 23172 512.31 486.69 559.69 # 23575 331.04 314.49 361.66 23174 711.78 676.19 777.62 23585 894.90 850.16 977.68 23180 648.34 615.92 708.31 23600 289.32 274.85 316.08 23182 625.80 594.51 683.69 # 23600 266.98 253.63 291.67 23184 705.74 670.45 771.02 23605 425.94 404.64 465.34 23190 524.92 498.67 573.47 # 23605 392.44 372.82 428.74 23195 711.42 675.85 777.23 23615 822.69 781.56 898.79 23200 837.05 795.20 914.48 23616 1,230.10 1,168.60 1,343.89 23210 876.15 832.34 957.19 23620 238.39 226.47 260.44 23220 1,014.60 963.87 1,108.45 # 23620 224.42 213.20 245.18 23221 1,182.56 1,123.43 1,291.94 23625 345.27 328.01 377.21 23222 1,608.41 1,527.99 1,757.19 # 23625 323.73 307.54 353.67 23330 210.95 200.40 230.46 23630 706.34 671.02 771.67 # 23330 139.95 132.95 152.89 23650 266.83 253.49 291.51 23331 555.07 527.32 606.42 # 23650 243.30 231.14 265.81 23332 839.98 797.98 917.68 23655 355.07 337.32 387.92 23350 154.05 146.35 168.30 23660 547.90 520.51 598.59 # 23350 52.73 50.09 57.60 23665 383.90 364.71 419.42 23395 1,221.97 1,160.87 1,335.00 # 23665 360.76 342.72 394.13 23397 1,093.58 1,038.90 1,194.74 23670 791.59 752.01 864.81 23400 928.22 881.81 1,014.08 23675 500.97 475.92 547.31 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 99 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 462.68 439.55 505.48 24332 568.99 540.54 621.62 23680 858.15 815.24 937.53 24340 578.68 549.75 632.21 23700 184.15 174.94 201.18 24341 681.41 647.34 744.44 23800 976.27 927.46 1,066.58 24342 744.88 707.64 813.79 23802 1,183.75 1,124.56 1,293.24 24343 662.29 629.18 723.56 23900 1,259.41 1,196.44 1,375.91 24344 1,030.24 978.73 1,125.54 23920 1,022.43 971.31 1,117.01 24345 657.78 624.89 718.62 23921 370.84 352.30 405.15 24346 1,032.60 980.97 1,128.12 23930 331.96 315.36 362.66 24357 415.84 395.05 454.31 # 23930 203.52 193.34 222.34 24358 489.99 465.49 535.31 23931 260.93 247.88 285.06 24359 614.74 584.00 671.60 # 23931 148.05 140.65 161.75 24360 855.69 812.91 934.85 23935 467.67 444.29 510.93 24361 958.77 910.83 1,047.45 24000 444.53 422.30 485.65 24362 1,014.16 963.45 1,107.97 24006 671.15 637.59 733.23 24363 1,417.47 1,346.60 1,548.59 24065 236.92 225.07 258.83 24365 604.82 574.58 660.77 # 24065 156.74 148.90 171.24 24366 647.49 615.12 707.39 24066 548.95 521.50 599.73 24400 781.90 742.81 854.23 # 24066 373.44 354.77 407.99 24410 996.97 947.12 1,089.19 24075 446.06 423.76 487.32 24420 937.82 890.93 1,024.57 # 24075 292.49 277.87 319.55 24430 993.44 943.77 1,085.34 24076 445.45 423.18 486.66 24435 1,010.23 959.72 1,103.68 24077 767.69 729.31 838.71 24470 594.51 564.78 649.50 24100 379.81 360.82 414.94 24495 621.97 590.87 679.50 24101 467.80 444.41 511.07 24498 829.76 788.27 906.51 24102 579.17 550.21 632.74 24500 314.77 299.03 343.88 24105 315.64 299.86 344.84 # 24500 284.45 270.23 310.76 24110 548.74 521.30 599.50 24505 456.13 433.32 498.32 24115 691.10 656.55 755.03 # 24505 416.24 395.43 454.74 24116 820.09 779.09 895.95 24515 832.53 790.90 909.54 24120 491.01 466.46 536.43 24516 822.60 781.47 898.69 24125 566.21 537.90 618.59 24530 338.83 321.89 370.17 24126 601.16 571.10 656.77 # 24530 306.12 290.81 334.43 24130 474.83 451.09 518.75 24535 569.71 541.22 622.40 24134 711.98 676.38 777.84 # 24535 529.42 502.95 578.39 24136 561.70 533.62 613.66 24538 703.69 668.51 768.79 24138 623.87 592.68 681.58 24545 863.67 820.49 943.56 24140 678.88 644.94 741.68 24546 1,006.19 955.88 1,099.26 24145 569.79 541.30 622.50 24560 283.10 268.95 309.29 24147 593.15 563.49 648.01 # 24560 250.39 237.87 273.55 24149 1,091.71 1,037.12 1,192.69 24565 468.61 445.18 511.96 24150 924.77 878.53 1,010.31 # 24565 432.71 411.07 472.73 24151 1,061.73 1,008.64 1,159.94 24566 659.17 626.21 720.14 24152 695.11 660.35 759.40 24575 698.82 663.88 763.46 24153 740.40 703.38 808.89 24576 298.16 283.25 325.74 24155 804.64 764.41 879.07 # 24576 267.05 253.70 291.76 24160 570.49 541.97 623.27 24577 487.48 463.11 532.58 24164 466.47 443.15 509.62 # 24577 448.79 426.35 490.30 24200 184.24 175.03 201.28 24579 792.38 752.76 865.67 # 24200 126.80 120.46 138.53 24582 735.45 698.68 803.48 24201 516.36 490.54 564.12 24586 1,044.73 992.49 1,141.36 # 24201 341.24 324.18 372.81 24587 1,039.80 987.81 1,135.98 24220 168.25 159.84 183.82 24600 329.18 312.72 359.63 # 24220 69.73 66.24 76.18 # 24600 298.86 283.92 326.51 24300 368.72 350.28 402.82 24605 427.32 405.95 466.84 24301 712.76 677.12 778.69 24615 677.93 644.03 740.63 24305 544.98 517.73 595.39 24620 514.83 489.09 562.45 24310 446.50 424.18 487.81 24635 719.15 683.19 785.67 24320 733.59 696.91 801.45 24640 109.44 103.97 119.57 24330 677.71 643.82 740.39 # 24640 79.13 75.17 86.45 24331 749.13 711.67 818.42 24650 230.29 218.78 251.60 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 14 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 207.55 197.17 226.75 25246 170.42 161.90 186.19 24655 395.81 376.02 432.42 # 25246 76.68 72.85 83.78 # 24655 361.90 343.81 395.38 25248 415.73 394.94 454.18 24665 611.84 581.25 668.44 25250 492.70 468.07 538.28 24666 693.57 658.89 757.72 25251 670.63 637.10 732.67 24670 258.50 245.58 282.42 25259 369.89 351.40 404.11 # 24670 231.38 219.81 252.78 25260 645.65 613.37 705.38 24675 418.07 397.17 456.75 25263 644.54 612.31 704.16 # 24675 384.17 364.96 419.70 25265 762.85 724.71 833.42 24685 614.90 584.16 671.78 25270 519.51 493.53 567.56 24800 750.21 712.70 819.61 25272 583.63 554.45 637.62 24802 951.56 903.98 1,039.58 25274 690.09 655.59 753.93 24900 678.45 644.53 741.21 25275 632.87 601.23 691.41 24920 673.95 640.25 736.29 25280 590.94 561.39 645.60 24925 525.10 498.85 573.68 25290 504.14 478.93 550.77 24930 714.46 678.74 780.55 25295 550.84 523.30 601.80 24931 793.41 753.74 866.80 25300 645.24 612.98 704.93 24935 962.11 914.00 1,051.10 25301 614.42 583.70 671.26 25000 329.17 312.71 359.62 25310 639.64 607.66 698.81 25001 309.96 294.46 338.63 25312 738.59 701.66 806.91 25020 544.42 517.20 594.78 25315 791.26 751.70 864.46 25023 1,039.67 987.69 1,135.84 25316 912.94 867.29 997.38 25024 722.75 686.61 789.60 25320 908.85 863.41 992.92 25025 1,109.07 1,053.62 1,211.66 25332 800.29 760.28 874.32 25028 484.86 460.62 529.71 25335 908.17 862.76 992.17 25031 355.46 337.69 388.34 25337 836.41 794.59 913.78 25035 613.97 583.27 670.76 25350 703.48 668.31 768.56 25040 540.15 513.14 590.11 25355 789.82 750.33 862.88 25065 235.50 223.73 257.29 25360 683.01 648.86 746.19 # 25065 154.92 147.17 169.25 25365 925.80 879.51 1,011.44 25066 356.13 338.32 389.07 25370 1,009.01 958.56 1,102.34 25075 311.20 295.64 339.99 25375 974.01 925.31 1,064.11 25076 421.09 400.04 460.05 25390 793.91 754.21 867.34 25077 708.23 672.82 773.74 25391 1,006.33 956.01 1,099.41 25085 436.81 414.97 477.22 25392 1,020.98 969.93 1,115.42 25100 324.90 308.66 354.96 25393 1,146.97 1,089.62 1,253.06 25101 382.69 363.56 418.09 25394 734.75 698.01 802.71 25105 464.57 441.34 507.54 25400 832.70 791.07 909.73 25107 576.91 548.06 630.27 25405 1,055.82 1,003.03 1,153.48 25109 491.18 466.62 536.61 25415 993.38 943.71 1,085.27 25110 341.21 324.15 372.77 25420 1,179.86 1,120.87 1,289.00 25111 295.91 281.11 323.28 25425 1,024.29 973.08 1,119.04 25112 360.35 342.33 393.68 25426 1,063.92 1,010.72 1,162.33 25115 760.68 722.65 831.05 25430 670.57 637.04 732.60 25116 617.74 586.85 674.88 25431 742.63 705.50 811.33 25118 361.96 343.86 395.44 25440 738.39 701.47 806.69 25119 478.56 454.63 522.82 25441 893.52 848.84 976.17 25120 527.72 501.33 576.53 25442 762.05 723.95 832.54 25125 612.56 581.93 669.22 25443 730.97 694.42 798.58 25126 618.90 587.96 676.15 25444 779.78 740.79 851.91 25130 424.28 403.07 463.53 25445 683.19 649.03 746.38 25135 528.60 502.17 577.50 25446 1,120.78 1,064.74 1,224.45 25136 467.98 444.58 511.27 25447 771.15 732.59 842.48 25145 541.39 514.32 591.47 25449 982.83 933.69 1,073.74 25150 547.95 520.55 598.63 25450 573.56 544.88 626.61 25151 608.22 577.81 664.48 25455 650.86 618.32 711.07 25170 843.45 801.28 921.47 25490 722.31 686.19 789.12 25210 464.31 441.09 507.25 25491 762.99 724.84 833.57 25215 597.31 567.44 652.56 25492 918.04 872.14 1,002.96 25230 411.39 390.82 449.44 25500 235.23 223.47 256.99 25240 417.74 396.85 456.38 # 25500 213.69 203.01 233.46 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 15 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 458.22 435.31 500.61 25920 647.57 615.19 707.47 # 25505 422.32 401.20 461.38 25922 547.24 519.88 597.86 25515 631.65 600.07 690.08 25924 632.37 600.75 690.86 25520 503.71 478.52 550.30 25927 739.69 702.71 808.12 # 25520 479.38 455.41 523.72 25929 527.63 501.25 576.44 25525 764.01 725.81 834.68 25931 675.12 641.36 737.56 25526 936.59 889.76 1,023.22 26010 237.13 225.27 259.06 25530 229.06 217.61 250.25 # 26010 123.45 117.28 134.87 # 25530 205.13 194.87 224.10 26011 362.60 344.47 396.14 25535 443.87 421.68 484.93 # 26011 172.33 163.71 188.27 # 25535 415.15 394.39 453.55 26020 398.07 378.17 434.90 25545 592.38 562.76 647.17 26025 388.46 369.04 424.40 25560 238.46 226.54 260.52 26030 458.10 435.20 500.48 # 25560 212.53 201.90 232.19 26034 497.29 472.43 543.29 25565 479.13 455.17 523.45 26035 770.60 732.07 841.88 # 25565 437.64 415.76 478.12 26037 533.76 507.07 583.13 25574 620.38 589.36 677.76 26040 286.15 271.84 312.62 25575 843.03 800.88 921.01 26045 434.77 413.03 474.98 25600 260.05 247.05 284.11 26055 530.87 504.33 579.98 # 25600 234.13 222.42 255.78 # 26055 275.18 261.42 300.63 25605 561.74 533.65 613.70 26060 245.15 232.89 267.82 # 25605 530.63 504.10 579.72 26070 277.14 263.28 302.77 25606 623.29 592.13 680.95 26075 294.12 279.41 321.32 25607 671.04 637.49 733.11 26080 356.04 338.24 388.98 25608 765.04 726.79 835.81 26100 298.81 283.87 326.45 25609 975.71 926.92 1,065.96 26105 306.03 290.73 334.34 25622 266.99 253.64 291.69 26110 293.85 279.16 321.03 # 25622 239.47 227.50 261.63 26115 580.26 551.25 633.94 25624 421.29 400.23 460.26 # 26115 333.74 317.05 364.61 # 25624 383.80 364.61 419.30 26116 447.88 425.49 489.31 25628 673.54 639.86 735.84 26117 607.87 577.48 664.10 25630 272.75 259.11 297.98 26121 559.93 531.93 611.72 # 25630 245.63 233.35 268.35 26123 765.34 727.07 836.13 25635 398.14 378.23 434.96 26125 270.92 257.37 295.98 # 25635 354.26 336.55 387.03 26130 425.18 403.92 464.51 25645 532.31 505.69 581.54 26135 516.20 490.39 563.95 25650 284.08 269.88 310.36 26140 469.81 446.32 513.27 # 25650 260.94 247.89 285.07 26145 477.44 453.57 521.61 25651 441.80 419.71 482.67 26160 529.69 503.21 578.69 25652 580.27 551.26 633.95 # 26160 299.12 284.16 326.78 25660 368.48 350.06 402.57 26170 375.97 357.17 410.75 25670 574.01 545.31 627.11 26180 411.25 390.69 449.29 25671 486.06 461.76 531.02 26185 491.19 466.63 536.62 25675 390.64 371.11 426.78 26200 421.64 400.56 460.64 # 25675 359.13 341.17 392.35 26205 565.19 536.93 617.47 25676 594.93 565.18 649.96 26210 409.24 388.78 447.10 25680 423.81 402.62 463.01 26215 518.01 492.11 565.93 25685 690.20 655.69 754.04 26230 471.36 447.79 514.96 25690 430.74 409.20 470.58 26235 463.03 439.88 505.86 25695 595.95 566.15 651.07 26236 410.82 390.28 448.82 25800 705.01 669.76 770.22 26250 546.01 518.71 596.52 25805 812.27 771.66 887.41 26255 826.18 784.87 902.60 25810 819.68 778.70 895.51 26260 511.51 485.93 558.82 25820 578.78 549.84 632.32 26261 631.73 600.14 690.16 25825 712.03 676.43 777.89 26262 427.85 406.46 467.43 25830 894.88 850.14 977.66 26320 320.22 304.21 349.84 25900 709.69 674.21 775.34 26340 291.39 276.82 318.34 25905 701.20 666.14 766.06 26350 675.30 641.54 737.77 25907 613.33 582.66 670.06 26352 764.56 726.33 835.28 25909 690.14 655.63 753.97 26356 998.48 948.56 1,090.84 25915 1,202.88 1,142.74 1,314.15 26357 819.91 778.91 895.75 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 16 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 866.72 823.38 946.89 26550 1,396.98 1,327.13 1,526.20 26370 728.86 692.42 796.28 26551 3,040.60 2,888.57 3,321.86 26372 842.92 800.77 920.89 26553 2,632.81 2,501.17 2,876.35 26373 801.69 761.61 875.85 26554 3,473.31 3,299.64 3,794.59 26390 782.39 743.27 854.76 26555 1,294.97 1,230.22 1,414.75 26392 916.88 871.04 1,001.70 26556 2,720.38 2,584.36 2,972.01 26410 537.53 510.65 587.25 26560 537.36 510.49 587.06 26412 650.20 617.69 710.34 26561 853.19 810.53 932.11 26415 677.13 643.27 739.76 26562 1,240.54 1,178.51 1,355.29 26416 723.23 687.07 790.13 26565 637.92 606.02 696.92 26418 541.11 514.05 591.16 26567 644.32 612.10 703.92 26420 674.84 641.10 737.27 26568 848.06 805.66 926.51 26426 540.52 513.49 590.51 26580 1,309.83 1,244.34 1,430.99 26428 708.89 673.45 774.47 26587 892.79 848.15 975.37 26432 470.21 446.70 513.71 26590 1,190.05 1,130.55 1,300.13 26433 503.60 478.42 550.18 26591 414.30 393.59 452.63 26434 602.01 571.91 657.70 26593 562.33 534.21 614.34 26437 587.11 557.75 641.41 26596 688.91 654.46 752.63 26440 592.93 563.28 647.77 26600 248.72 236.28 271.72 26442 891.08 846.53 973.51 # 26600 229.18 217.72 250.38 26445 551.62 524.04 602.65 26605 287.09 272.74 313.65 26449 712.66 677.03 778.58 # 26605 261.16 248.10 285.32 26450 379.17 360.21 414.24 26607 407.58 387.20 445.28 26455 376.61 357.78 411.45 26608 442.85 420.71 483.82 26460 366.45 348.13 400.35 26615 511.21 485.65 558.50 26471 578.38 549.46 631.88 26641 327.11 310.75 357.36 26474 555.40 527.63 606.77 # 26641 297.99 283.09 325.55 26476 540.77 513.73 590.79 26645 374.27 355.56 408.89 26477 545.82 518.53 596.31 # 26645 344.36 327.14 376.21 26478 591.85 562.26 646.60 26650 444.16 421.95 485.24 26479 585.43 556.16 639.58 26665 567.04 538.69 619.49 26480 713.21 677.55 779.18 26670 294.97 280.22 322.25 26483 802.66 762.53 876.91 # 26670 265.05 251.80 289.57 26485 769.83 731.34 841.04 26675 399.71 379.72 436.68 26489 827.25 785.89 903.77 # 26675 368.59 350.16 402.68 26490 740.22 703.21 808.69 26676 464.61 441.38 507.59 26492 824.07 782.87 900.30 26685 525.52 499.24 574.13 26494 749.52 712.04 818.85 26686 581.00 551.95 634.74 26496 811.63 771.05 886.71 26700 280.70 266.67 306.67 26497 812.20 771.59 887.33 # 26700 260.76 247.72 284.88 26498 1,080.93 1,026.88 1,180.91 26705 366.77 348.43 400.69 26499 776.75 737.91 848.60 # 26705 336.05 319.25 367.14 26500 590.08 560.58 644.67 26706 401.49 381.42 438.63 26502 664.80 631.56 726.29 26715 512.33 486.71 559.72 26508 593.30 563.64 648.19 26720 172.47 163.85 188.43 26510 563.41 535.24 615.53 # 26720 157.31 149.44 171.86 26516 662.75 629.61 724.05 26725 307.26 291.90 335.69 26517 778.72 739.78 850.75 # 26725 274.95 261.20 300.38 26518 785.57 746.29 858.23 26727 435.43 413.66 475.71 26520 619.60 588.62 676.91 26735 533.18 506.52 582.50 26525 622.16 591.05 679.71 26740 200.88 190.84 219.47 26530 500.75 475.71 547.07 # 26740 188.12 178.71 205.52 26531 582.51 553.38 636.39 26742 335.93 319.13 367.00 26535 374.41 355.69 409.04 # 26742 304.42 289.20 332.58 26536 633.32 601.65 691.90 26746 649.81 617.32 709.92 26540 623.19 592.03 680.83 26750 160.60 152.57 175.46 26541 758.95 721.00 829.15 # 26750 156.22 148.41 170.67 26542 643.91 611.71 703.47 26755 281.95 267.85 308.03 26545 655.37 622.60 715.99 # 26755 244.45 232.23 267.06 26546 917.55 871.67 1,002.42 26756 384.59 365.36 420.16 26548 720.16 684.15 786.77 26765 434.23 412.52 474.40 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 17 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 238.61 226.68 260.68 27087 597.63 567.75 652.91 # 26770 217.47 206.60 237.59 27090 791.47 751.90 864.69 26775 342.84 325.70 374.56 27091 1,527.29 1,450.93 1,668.57 # 26775 306.94 291.59 335.33 27093 189.21 179.75 206.71 26776 408.71 388.27 446.51 # 27093 70.74 67.20 77.28 26785 472.82 449.18 516.56 27095 228.67 217.24 249.83 26820 742.44 705.32 811.12 # 27095 80.67 76.64 88.14 26841 689.28 654.82 753.04 27096 172.72 164.08 188.69 26842 746.84 709.50 815.93 # 27096 67.01 63.66 73.21 26843 691.60 657.02 755.57 27097 631.24 599.68 689.63 26844 770.50 731.98 841.78 27098 586.09 556.79 640.31 26850 656.30 623.49 717.01 27100 778.70 739.77 850.74 26852 750.48 712.96 819.90 27105 814.54 773.81 889.88 26860 529.66 503.18 578.66 27110 908.80 863.36 992.86 26861 102.15 97.04 111.60 27111 809.43 768.96 884.30 26862 683.86 649.67 747.12 27120 1,230.39 1,168.87 1,344.20 26863 227.72 216.33 248.78 27122 1,055.17 1,002.41 1,152.77 26910 671.93 638.33 734.08 27125 1,073.36 1,019.69 1,172.64 26951 583.46 554.29 637.43 27130 1,383.38 1,314.21 1,511.34 26952 610.95 580.40 667.46 27132 1,615.77 1,534.98 1,765.23 26990 580.83 551.79 634.56 27134 1,872.91 1,779.26 2,046.15 26991 655.90 623.11 716.58 27137 1,428.59 1,357.16 1,560.73 # 26991 489.16 464.70 534.41 27138 1,486.75 1,412.41 1,624.27 26992 911.97 866.37 996.33 27140 857.28 814.42 936.58 27000 422.05 400.95 461.09 27146 1,206.10 1,145.80 1,317.67 27001 511.21 485.65 558.50 27147 1,405.53 1,335.25 1,535.54 27003 548.26 520.85 598.98 27151 1,460.23 1,387.22 1,595.30 27005 691.83 657.24 755.83 27156 1,638.07 1,556.17 1,789.60 27006 699.27 664.31 763.96 27158 1,316.35 1,250.53 1,438.11 27025 844.65 802.42 922.78 27161 1,167.96 1,109.56 1,275.99 27027 822.56 781.43 898.64 27165 1,303.70 1,238.52 1,424.30 27030 901.35 856.28 984.72 27170 1,129.08 1,072.63 1,233.52 27033 933.31 886.64 1,019.64 27175 628.94 597.49 687.11 27035 1,037.92 986.02 1,133.92 27176 869.85 826.36 950.31 27036 954.51 906.78 1,042.80 27177 1,059.99 1,006.99 1,158.04 27040 321.82 305.73 351.59 27178 860.01 817.01 939.56 # 27040 191.38 181.81 209.08 27179 926.37 880.05 1,012.06 27041 650.65 618.12 710.84 27181 1,028.52 977.09 1,123.65 27047 582.36 553.24 636.23 27185 655.88 623.09 716.55 # 27047 485.43 461.16 530.33 27187 950.28 902.77 1,038.19 27048 447.92 425.52 489.35 27193 436.31 414.49 476.66 27049 944.16 896.95 1,031.49 # 27193 440.30 418.29 481.03 27050 327.82 311.43 358.14 27194 677.63 643.75 740.31 27052 523.96 497.76 572.42 27200 159.40 151.43 174.14 27054 643.09 610.94 702.58 # 27200 162.99 154.84 178.07 27057 910.20 864.69 994.39 27202 608.85 578.41 665.17 27060 404.29 384.08 441.69 27220 491.74 467.15 537.22 27062 423.86 402.67 463.07 # 27220 488.15 463.74 533.30 27065 472.34 448.72 516.03 27222 930.60 884.07 1,016.68 27066 766.02 727.72 836.88 27226 988.35 938.93 1,079.77 27067 969.47 921.00 1,059.15 27227 1,600.69 1,520.66 1,748.76 27070 802.77 762.63 877.02 27228 1,832.47 1,740.85 2,001.98 27071 861.88 818.79 941.61 27230 438.66 416.73 479.24 27075 2,201.85 2,091.76 2,405.52 # 27230 432.68 411.05 472.71 27076 1,523.07 1,446.92 1,663.96 27232 737.21 700.35 805.40 27077 2,544.30 2,417.09 2,779.65 27235 868.86 825.42 949.23 27078 965.29 917.03 1,054.58 27236 1,134.81 1,078.07 1,239.78 27079 919.95 873.95 1,005.04 27238 423.63 402.45 462.82 27080 464.07 440.87 507.00 27240 908.14 862.73 992.14 27086 231.50 219.93 252.92 27244 1,167.14 1,108.78 1,275.10 # 27086 139.75 132.76 152.67 27245 1,212.93 1,152.28 1,325.12 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 18 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 358.78 340.84 391.97 27381 759.94 721.94 830.23 # 27246 359.58 341.60 392.84 27385 597.68 567.80 652.97 27248 717.81 681.92 784.21 27386 788.26 748.85 861.18 27250 224.43 213.21 245.19 27390 414.00 393.30 452.30 27252 716.79 680.95 783.09 27391 538.87 511.93 588.72 27253 902.68 857.55 986.18 27392 663.10 629.95 724.44 27254 1,218.38 1,157.46 1,331.08 27393 477.80 453.91 522.00 27256 274.73 260.99 300.14 27394 617.03 586.18 674.11 # 27256 230.06 218.56 251.34 27395 835.01 793.26 912.25 27257 317.83 301.94 347.23 27396 580.23 551.22 633.90 27258 1,057.67 1,004.79 1,155.51 27397 852.79 810.15 931.67 27259 1,481.86 1,407.77 1,618.94 27400 645.44 613.17 705.15 27265 366.06 347.76 399.92 27403 607.24 576.88 663.41 27266 547.07 519.72 597.68 27405 639.87 607.88 699.06 27267 390.65 371.12 426.79 27407 729.49 693.02 796.97 27268 482.85 458.71 527.52 27409 917.45 871.58 1,002.32 27269 1,156.23 1,098.42 1,263.18 27412 1,586.65 1,507.32 1,733.42 27275 170.11 161.60 185.84 27415 1,331.53 1,264.95 1,454.69 27280 979.99 930.99 1,070.64 27416 918.24 872.33 1,003.18 27282 766.42 728.10 837.32 27418 792.20 752.59 865.48 27284 1,480.90 1,406.86 1,617.89 27420 709.66 674.18 775.31 27286 1,568.74 1,490.30 1,713.85 27422 706.77 671.43 772.14 27290 1,496.42 1,421.60 1,634.84 27424 708.65 673.22 774.20 27295 1,209.28 1,148.82 1,321.14 27425 414.82 394.08 453.19 27301 618.74 587.80 675.97 27427 680.53 646.50 743.48 # 27301 465.57 442.29 508.63 27428 1,046.96 994.61 1,143.80 27303 603.74 573.55 659.58 27429 1,172.31 1,113.69 1,280.74 27305 440.48 418.46 481.23 27430 702.28 667.17 767.25 27306 357.41 339.54 390.47 27435 753.45 715.78 823.15 27307 439.35 417.38 479.99 27437 624.66 593.43 682.44 27310 688.01 653.61 751.65 27438 799.40 759.43 873.34 27323 250.10 237.60 273.24 27440 729.39 692.92 796.86 # 27323 167.93 159.53 183.46 27441 752.85 715.21 822.49 27324 358.81 340.87 392.00 27442 827.87 786.48 904.45 27325 496.56 471.73 542.49 27443 775.81 737.02 847.57 27326 458.85 435.91 501.30 27445 1,206.53 1,146.20 1,318.13 27327 421.93 400.83 460.95 27446 1,070.46 1,016.94 1,169.48 # 27327 327.79 311.40 358.11 27447 1,481.61 1,407.53 1,618.66 27328 395.19 375.43 431.74 27448 781.02 741.97 853.27 27329 981.35 932.28 1,072.12 27450 973.04 924.39 1,063.05 27330 376.75 357.91 411.60 27454 1,225.57 1,164.29 1,338.93 27331 445.32 423.05 486.51 27455 899.48 854.51 982.69 27332 603.58 573.40 659.41 27457 925.73 879.44 1,011.36 27333 547.10 519.75 597.71 27465 1,162.49 1,104.37 1,270.03 27334 641.87 609.78 701.25 27466 1,130.75 1,074.21 1,235.34 27335 725.80 689.51 792.94 27468 1,279.75 1,215.76 1,398.12 27340 341.80 324.71 373.42 27470 1,127.89 1,071.50 1,232.23 27345 450.97 428.42 492.68 27472 1,218.84 1,157.90 1,331.59 27347 482.98 458.83 527.65 27475 621.08 590.03 678.53 27350 613.88 583.19 670.67 27477 696.24 661.43 760.64 27355 569.05 540.60 621.69 27479 897.12 852.26 980.10 27356 697.17 662.31 761.66 27485 635.82 604.03 694.63 27357 773.36 734.69 844.89 27486 1,351.67 1,284.09 1,476.70 27358 279.75 265.76 305.62 27487 1,704.11 1,618.90 1,861.74 27360 805.21 764.95 879.69 27488 1,144.12 1,086.91 1,249.95 27365 1,169.14 1,110.68 1,277.28 27495 1,084.24 1,030.03 1,184.53 27370 162.32 154.20 177.33 27496 473.80 450.11 517.63 # 27370 51.43 48.86 56.19 27497 513.19 487.53 560.66 27372 558.93 530.98 610.63 27498 558.94 530.99 610.64 # 27372 379.83 360.84 414.97 27499 620.77 589.73 678.19 27380 558.44 530.52 610.10 27500 479.02 455.07 523.33 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 99 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 444.72 422.48 485.85 27613 234.64 222.91 256.35 27501 470.06 446.56 513.54 # 27613 157.65 149.77 172.24 # 27501 463.28 440.12 506.14 27614 526.45 500.13 575.15 27502 747.15 709.79 816.26 # 27614 390.03 370.53 426.11 27503 761.56 723.48 832.00 27615 836.63 794.80 914.02 27506 1,271.35 1,207.78 1,388.95 27618 459.02 436.07 501.48 27507 942.21 895.10 1,029.37 # 27618 362.09 343.99 395.59 27508 483.69 459.51 528.44 27619 731.39 694.82 799.04 # 27508 455.77 432.98 497.93 # 27619 559.86 531.87 611.65 27509 608.23 577.82 664.49 27620 439.56 417.58 480.22 27510 660.99 627.94 722.13 27625 567.03 538.68 619.48 27511 975.46 926.69 1,065.69 27626 612.65 582.02 669.32 27513 1,226.27 1,164.96 1,339.70 27630 505.28 480.02 552.02 27514 989.06 939.61 1,080.55 # 27630 353.70 336.02 386.42 27516 453.21 430.55 495.13 27635 565.11 536.85 617.38 # 27516 426.89 405.55 466.38 27637 716.27 680.46 782.53 27517 635.00 603.25 693.74 27638 745.74 708.45 814.72 27519 894.12 849.41 976.82 27640 825.81 784.52 902.20 27520 287.30 272.94 313.88 27641 661.67 628.59 722.88 # 27520 259.38 246.41 283.37 27645 1,001.58 951.50 1,094.23 27524 716.87 681.03 783.18 27646 885.17 840.91 967.05 27530 359.95 341.95 393.24 27647 778.87 739.93 850.92 # 27530 334.42 317.70 365.36 27648 156.34 148.52 170.80 27532 573.03 544.38 626.04 # 27648 51.03 48.48 55.75 # 27532 541.51 514.43 591.59 27650 645.92 613.62 705.66 27535 870.82 827.28 951.37 27652 708.67 673.24 774.23 27536 1,133.43 1,076.76 1,238.27 27654 691.99 657.39 756.00 27538 430.30 408.79 470.11 27656 509.12 483.66 556.21 # 27538 402.77 382.63 440.02 # 27656 334.00 317.30 364.90 27540 793.65 753.97 867.07 27658 366.41 348.09 400.30 27550 452.84 430.20 494.73 27659 480.16 456.15 524.57 # 27550 420.93 399.88 459.86 27664 349.82 332.33 382.18 27552 585.57 556.29 639.73 27665 400.33 380.31 437.36 27556 879.28 835.32 960.62 27675 489.00 464.55 534.23 27557 1,051.01 998.46 1,148.23 27676 594.18 564.47 649.14 27558 1,177.18 1,118.32 1,286.07 27680 415.02 394.27 453.41 27560 332.64 316.01 363.41 27681 494.36 469.64 540.09 # 27560 300.73 285.69 328.54 27685 596.83 566.99 652.04 27562 432.20 410.59 472.18 # 27685 457.21 434.35 499.50 27566 852.62 809.99 931.49 27686 539.42 512.45 589.32 27570 139.20 132.24 152.08 27687 443.85 421.66 484.91 27580 1,380.74 1,311.70 1,508.46 27690 610.18 579.67 666.62 27590 785.18 745.92 857.81 27691 716.92 681.07 783.23 27591 873.39 829.72 954.18 27692 108.25 102.84 118.27 27592 667.73 634.34 729.49 27695 472.94 449.29 516.68 27594 485.17 460.91 530.05 27696 562.72 534.58 614.77 27596 700.32 665.30 765.10 27698 632.09 600.49 690.56 27598 712.75 677.11 778.68 27700 595.71 565.92 650.81 27600 402.98 382.83 440.25 27702 955.59 907.81 1,043.98 27601 418.48 397.56 457.19 27703 1,104.97 1,049.72 1,207.18 27602 492.63 468.00 538.20 27704 542.46 515.34 592.64 27603 490.76 466.22 536.15 27705 733.93 697.23 801.81 # 27603 365.90 347.61 399.75 27707 375.24 356.48 409.95 27604 430.53 409.00 470.35 27709 1,064.72 1,011.48 1,163.20 # 27604 322.43 306.31 352.26 27712 1,045.13 992.87 1,141.80 27605 345.63 328.35 377.60 27715 1,020.46 969.44 1,114.86 # 27605 192.45 182.83 210.25 27720 840.17 798.16 917.88 27606 283.42 269.25 309.64 27722 837.73 795.84 915.22 27607 583.71 554.52 637.70 27724 1,230.31 1,168.79 1,344.11 27610 623.50 592.33 681.18 27725 1,146.58 1,089.25 1,252.64 27612 543.44 516.27 593.71 27726 869.07 825.62 949.46 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 20 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 928.26 881.85 1,014.13 27870 1,004.25 954.04 1,097.15 27730 561.47 533.40 613.41 27871 661.58 628.50 722.78 27732 380.20 361.19 415.37 27880 880.43 836.41 961.87 27734 568.11 539.70 620.66 27881 854.53 811.80 933.57 27740 631.44 599.87 689.85 27882 600.96 570.91 656.55 27742 663.14 629.98 724.48 27884 560.03 532.03 611.83 27745 721.11 685.05 787.81 27886 638.74 606.80 697.82 27750 310.27 294.76 338.97 27888 676.42 642.60 738.99 # 27750 283.94 269.74 310.20 27889 657.74 624.85 718.58 27752 497.31 472.44 543.31 27892 518.96 493.01 566.96 # 27752 463.01 439.86 505.84 27893 525.88 499.59 574.53 27756 537.40 510.53 587.11 27894 805.69 765.41 880.22 27758 846.43 804.11 924.73 28001 254.97 242.22 278.55 27759 958.55 910.62 1,047.21 # 28001 175.99 167.19 192.27 27760 298.97 284.02 326.62 28002 472.85 449.21 516.59 # 27760 270.65 257.12 295.69 # 28002 371.13 352.57 405.46 27762 445.57 423.29 486.78 28003 648.31 615.89 708.27 # 27762 410.87 390.33 448.88 # 28003 545.39 518.12 595.84 27766 579.31 550.34 632.89 28005 595.91 566.11 651.03 27767 237.08 225.23 259.01 28008 402.13 382.02 439.32 # 27767 238.28 226.37 260.33 # 28008 298.41 283.49 326.01 27768 379.28 360.32 414.37 28010 222.19 211.08 242.74 27769 656.05 623.25 716.74 # 28010 207.43 197.06 226.62 27780 267.65 254.27 292.41 28011 314.43 298.71 343.52 # 27780 241.72 229.63 264.07 # 28011 292.09 277.49 319.11 27781 386.30 366.99 422.04 28020 478.45 454.53 522.71 # 27781 359.57 341.59 392.83 # 28020 351.21 333.65 383.70 27784 654.13 621.42 714.63 28022 441.41 419.34 482.24 27786 283.51 269.33 309.73 # 28022 324.93 308.68 354.98 # 27786 254.39 241.67 277.92 28024 419.80 398.81 458.63 27788 389.59 370.11 425.63 # 28024 308.11 292.70 336.61 # 27788 358.47 340.55 391.63 28035 481.21 457.15 525.72 27792 661.65 628.57 722.86 # 28035 354.36 336.64 387.14 27808 297.07 282.22 324.55 28043 320.21 304.20 349.83 # 27808 265.96 252.66 290.56 # 28043 254.79 242.05 278.36 27810 436.03 414.23 476.36 28045 449.88 427.39 491.50 # 27810 400.53 380.50 437.58 # 28045 323.04 306.89 352.92 27814 739.90 702.91 808.35 28046 812.36 771.74 887.50 27816 280.51 266.48 306.45 # 28046 657.59 624.71 718.42 # 27816 251.79 239.20 275.08 28050 423.61 402.43 462.79 27818 448.67 426.24 490.18 # 28050 305.94 290.64 334.24 # 27818 408.38 387.96 446.15 28052 390.51 370.98 426.63 27822 811.71 771.12 886.79 # 28052 278.03 264.13 303.75 27823 923.42 877.25 1,008.84 28054 367.60 349.22 401.60 27824 281.00 266.95 306.99 # 28054 253.91 241.21 277.39 # 27824 270.23 256.72 295.23 28055 386.38 367.06 422.12 27825 510.34 484.82 557.54 28060 473.49 449.82 517.29 # 27825 468.06 444.66 511.36 # 28060 355.42 337.65 388.30 27826 776.97 738.12 848.84 28062 555.84 528.05 607.26 27827 1,036.82 984.98 1,132.73 # 28062 415.43 394.66 453.86 27828 1,236.93 1,175.08 1,351.34 28070 470.03 446.53 513.51 27829 620.80 589.76 678.22 # 28070 347.97 330.57 380.16 27830 326.23 309.92 356.41 28072 464.93 441.68 507.93 # 27830 305.09 289.84 333.32 # 28072 338.08 321.18 369.36 27831 355.05 337.30 387.90 28080 455.48 432.71 497.62 27832 665.58 632.30 727.15 # 28080 341.39 324.32 372.97 27840 325.56 309.28 355.67 28086 499.52 474.54 545.72 27842 456.87 434.03 499.13 # 28086 353.13 335.47 385.79 27846 705.32 670.05 770.56 28088 424.52 403.29 463.78 27848 798.28 758.37 872.13 # 28088 294.48 279.76 321.72 27860 170.65 162.12 186.44 28090 426.75 405.41 466.22 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 99 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 306.69 291.36 335.06 # 28202 440.21 418.20 480.93 28092 386.46 367.14 422.21 28208 420.64 399.61 459.55 # 28092 269.98 256.48 294.95 # 28208 304.16 288.95 332.29 28100 550.65 523.12 601.59 28210 538.74 511.80 588.57 # 28100 398.67 378.74 435.55 # 28210 411.49 390.92 449.56 28102 544.07 516.87 594.40 28220 414.60 393.87 452.95 28103 438.44 416.52 479.00 # 28220 306.50 291.18 334.86 28104 471.53 447.95 515.14 28222 477.84 453.95 522.04 # 28104 348.27 330.86 380.49 # 28222 364.16 345.95 397.84 28106 462.04 438.94 504.78 28225 361.26 343.20 394.68 28107 523.68 497.50 572.13 # 28225 254.36 241.64 277.89 # 28107 380.07 361.07 415.23 28226 433.63 411.95 473.74 28108 397.27 377.41 434.02 # 28226 317.55 301.67 346.92 # 28108 287.58 273.20 314.18 28230 398.77 378.83 435.65 28110 418.18 397.27 456.86 # 28230 291.87 277.28 318.87 # 28110 287.34 272.97 313.92 28232 354.89 337.15 387.72 28111 474.68 450.95 518.59 # 28232 248.79 236.35 271.80 # 28111 335.07 318.32 366.07 28234 368.46 350.04 402.55 28112 450.15 427.64 491.79 # 28234 261.15 248.09 285.30 # 28112 314.13 298.42 343.18 28238 633.03 601.38 691.59 28113 536.47 509.65 586.10 # 28238 494.22 469.51 539.94 # 28113 410.42 389.90 448.39 28240 410.34 389.82 448.29 28114 972.18 923.57 1,062.11 # 28240 299.44 284.47 327.14 # 28114 793.07 753.42 866.43 28250 520.64 494.61 568.80 28116 692.53 657.90 756.59 # 28250 396.98 377.13 433.70 # 28116 560.10 532.10 611.92 28260 633.62 601.94 692.23 28118 540.16 513.15 590.12 # 28260 511.16 485.60 558.44 # 28118 407.33 386.96 445.00 28261 914.23 868.52 998.80 28119 480.90 456.86 525.39 # 28261 775.81 737.02 847.57 # 28119 359.63 341.65 392.90 28262 1,282.59 1,218.46 1,401.23 28120 535.20 508.44 584.71 # 28262 1,091.92 1,037.32 1,192.92 # 28120 388.01 368.61 423.90 28264 821.78 780.69 897.79 28122 618.70 587.77 675.94 # 28264 686.95 652.60 750.49 # 28122 496.64 471.81 542.58 28270 443.45 421.28 484.47 28124 440.69 418.66 481.46 # 28270 331.76 315.17 362.45 # 28124 332.19 315.58 362.92 28272 362.76 344.62 396.31 28126 357.50 339.63 390.57 # 28272 258.25 245.34 282.14 # 28126 250.20 237.69 273.34 28280 486.86 462.52 531.90 28130 617.81 586.92 674.96 # 28280 360.81 342.77 394.19 28140 582.64 553.51 636.54 28285 429.66 408.18 469.41 # 28140 451.40 428.83 493.15 # 28285 318.37 302.45 347.82 28150 397.92 378.02 434.72 28286 419.68 398.70 458.51 # 28150 285.43 271.16 311.83 # 28286 305.20 289.94 333.43 28153 371.48 352.91 405.85 28288 538.07 511.17 587.85 # 28153 259.78 246.79 283.81 # 28288 415.61 394.83 454.05 28160 381.31 362.24 416.58 28289 677.67 643.79 740.36 # 28160 271.22 257.66 296.31 # 28289 538.46 511.54 588.27 28171 602.61 572.48 658.35 28290 530.71 504.17 579.80 28173 691.83 657.24 755.83 # 28290 394.69 374.96 431.20 # 28173 549.42 521.95 600.24 28292 719.53 683.55 786.08 28175 509.07 483.62 556.16 # 28292 579.52 550.54 633.12 # 28175 388.21 368.80 424.12 28293 962.02 913.92 1,051.01 28190 228.76 217.32 249.92 # 28293 699.15 664.19 763.82 # 28190 132.22 125.61 144.45 28294 694.90 660.16 759.18 28192 436.46 414.64 476.84 # 28294 532.94 506.29 582.23 # 28192 317.19 301.33 346.53 28296 682.98 648.83 746.15 28193 499.26 474.30 545.45 # 28296 531.79 505.20 580.98 # 28193 376.40 357.58 411.22 28297 771.01 732.46 842.33 28200 436.60 414.77 476.99 # 28297 596.69 566.86 651.89 # 28200 316.53 300.70 345.81 28298 665.69 632.41 727.27 28202 577.83 548.94 631.28 # 28298 507.73 482.34 554.69 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 99 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 851.12 808.56 929.84 # 28490 109.95 104.45 120.12 # 28299 684.78 650.54 748.12 28495 158.49 150.57 173.16 28300 645.96 613.66 705.71 # 28495 140.14 133.13 153.10 28302 639.42 607.45 698.57 28496 390.31 370.79 426.41 28304 738.19 701.28 806.47 # 28496 215.19 204.43 235.09 # 28304 585.81 556.52 640.00 28505 610.12 579.61 666.55 28305 673.57 639.89 735.87 # 28505 463.33 440.16 506.18 28306 556.91 529.06 608.42 28510 108.76 103.32 118.82 # 28306 398.15 378.24 434.98 # 28510 106.76 101.42 116.63 28307 658.57 625.64 719.49 28515 143.21 136.05 156.46 # 28307 449.94 427.44 491.56 # 28515 131.64 125.06 143.82 28308 504.36 479.14 551.01 28525 516.16 490.35 563.90 # 28308 365.14 346.88 398.91 # 28525 369.77 351.28 403.97 28309 867.86 824.47 948.14 28530 104.91 99.66 114.61 28310 495.95 471.15 541.82 # 28530 96.93 92.08 105.89 # 28310 355.14 337.38 387.99 28531 343.46 326.29 375.23 28312 455.68 432.90 497.84 # 28531 184.30 175.09 201.35 # 28312 317.66 301.78 347.05 28540 185.55 176.27 202.71 28313 477.93 454.03 522.13 # 28540 173.19 164.53 189.21 # 28313 364.64 346.41 398.37 28545 228.60 217.17 249.75 28315 437.82 415.93 478.32 # 28545 210.25 199.74 229.70 # 28315 323.73 307.54 353.67 28546 436.22 414.41 476.57 28320 610.30 579.79 666.76 # 28546 284.24 270.03 310.53 28322 719.79 683.80 786.37 28555 798.55 758.62 872.41 # 28322 563.82 535.63 615.97 # 28555 624.23 593.02 681.97 28340 572.02 543.42 624.93 28570 160.62 152.59 175.48 # 28340 437.59 415.71 478.07 # 28570 144.27 137.06 157.62 28341 657.30 624.44 718.11 28575 307.32 291.95 335.74 # 28341 516.89 491.05 564.71 # 28575 286.98 272.63 313.52 28344 443.03 420.88 484.01 28576 334.90 318.16 365.88 # 28344 309.40 293.93 338.02 28585 849.09 806.64 927.64 28345 532.02 505.42 581.23 # 28585 701.10 666.05 765.96 # 28345 403.18 383.02 440.47 28600 194.38 184.66 212.36 28360 937.76 890.87 1,024.50 # 28600 174.43 165.71 190.57 28400 225.50 214.23 246.36 28605 250.41 237.89 273.57 # 28400 206.75 196.41 225.87 # 28605 233.65 221.97 255.27 28405 364.98 346.73 398.74 28606 370.64 352.11 404.93 # 28405 341.45 324.38 373.04 28615 740.42 703.40 808.91 28406 501.03 475.98 547.38 28630 137.39 130.52 150.10 28415 1,095.60 1,040.82 1,196.94 # 28630 105.08 99.83 114.80 28420 1,151.75 1,094.16 1,258.28 28635 164.62 156.39 179.85 28430 210.72 200.18 230.21 # 28635 132.31 125.69 144.54 # 28430 187.19 177.83 204.50 28636 272.81 259.17 298.05 28435 296.42 281.60 323.84 # 28636 196.62 186.79 214.81 # 28435 274.09 260.39 299.45 28645 576.09 547.29 629.38 28436 402.95 382.80 440.22 # 28645 451.63 429.05 493.41 28445 1,031.51 979.93 1,126.92 28660 100.04 95.04 109.30 28446 1,127.92 1,071.52 1,232.25 # 28660 80.49 76.47 87.94 28450 195.02 185.27 213.06 28665 145.83 138.54 159.32 # 28450 174.27 165.56 190.39 # 28665 131.47 124.90 143.64 28455 269.33 255.86 294.24 28666 188.24 178.83 205.65 # 28455 250.98 238.43 274.19 28675 528.62 502.19 577.52 28456 259.59 246.61 283.60 # 28675 379.44 360.47 414.54 28465 587.04 557.69 641.34 28705 1,268.23 1,204.82 1,385.54 28470 194.63 184.90 212.64 28715 940.60 893.57 1,027.61 # 28470 175.08 166.33 191.28 28725 773.87 735.18 845.46 28475 245.64 233.36 268.36 28730 810.49 769.97 885.47 # 28475 226.50 215.18 247.46 28735 773.88 735.19 845.47 28476 321.24 305.18 350.96 28737 685.54 651.26 748.95 28485 507.07 481.72 553.98 28740 792.17 752.56 865.44 28490 125.91 119.61 137.55 # 28740 607.88 577.49 664.11 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 23 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 773.12 734.46 844.63 29240 55.36 52.59 60.48 # 28750 579.65 550.67 633.27 # 29240 42.60 40.47 46.54 28755 466.32 443.00 509.45 29260 48.08 45.68 52.53 # 28755 329.50 313.03 359.98 # 29260 35.31 33.54 38.57 28760 727.39 691.02 794.67 29280 46.47 44.15 50.77 # 28760 568.63 540.20 621.23 # 29280 33.31 31.64 36.39 28800 554.07 526.37 605.33 29305 217.00 206.15 237.07 28805 724.47 688.25 791.49 # 29305 149.99 142.49 163.86 28810 427.24 405.88 466.76 29325 241.28 229.22 263.60 28820 493.98 469.28 539.67 # 29325 169.48 161.01 185.16 # 28820 338.01 321.11 369.28 29345 124.87 118.63 136.42 28825 533.00 506.35 582.30 # 29345 96.95 92.10 105.92 # 28825 383.81 364.62 419.31 29355 128.95 122.50 140.88 28890 324.40 308.18 354.41 # 29355 103.02 97.87 112.55 # 28890 219.49 208.52 239.80 29358 141.00 133.95 154.04 29000 251.78 239.19 275.07 # 29358 98.71 93.77 107.84 # 29000 163.22 155.06 178.32 29365 112.19 106.58 122.57 29010 229.62 218.14 250.86 # 29365 84.27 80.06 92.07 # 29010 150.64 143.11 164.58 29405 82.56 78.43 90.19 29015 221.30 210.24 241.78 # 29405 61.82 58.73 67.54 # 29015 153.08 145.43 167.24 29425 89.08 84.63 97.32 29020 212.39 201.77 232.04 # 29425 67.94 64.54 74.22 # 29020 137.80 130.91 150.55 29435 109.40 103.93 119.52 29025 241.30 229.24 263.63 # 29435 82.27 78.16 89.88 # 29025 168.70 160.27 184.31 29440 48.83 46.39 53.35 29035 224.78 213.54 245.57 # 29440 33.28 31.62 36.36 # 29035 133.83 127.14 146.21 29445 136.31 129.49 148.91 29040 215.40 204.63 235.32 # 29445 108.39 102.97 118.42 # 29040 148.79 141.35 162.55 29450 143.22 136.06 156.47 29044 243.01 230.86 265.49 # 29450 120.08 114.08 131.19 # 29044 155.65 147.87 170.05 29505 70.35 66.83 76.85 29046 265.04 251.79 289.56 # 29505 45.21 42.95 49.39 # 29046 178.48 169.56 194.99 29515 65.69 62.41 71.77 29049 79.78 75.79 87.16 # 29515 47.34 44.97 51.72 # 29049 57.85 54.96 63.20 29520 46.77 44.43 51.09 29055 192.18 182.57 209.96 # 29520 35.20 33.44 38.46 # 29055 128.36 121.94 140.23 29530 48.81 46.37 53.33 29058 102.52 97.39 112.00 # 29530 36.04 34.24 39.38 # 29058 78.59 74.66 85.86 29540 40.12 38.11 43.83 29065 87.19 82.83 95.25 # 29540 32.14 30.53 35.11 # 29065 64.45 61.23 70.41 29550 39.07 37.12 42.69 29075 81.01 76.96 88.50 # 29550 30.29 28.78 33.10 # 29075 58.27 55.36 63.66 29580 49.43 46.96 54.00 29085 86.12 81.81 94.08 # 29580 35.47 33.70 38.76 # 29085 62.58 59.45 68.37 29590 52.42 49.80 57.27 29086 65.93 62.63 72.02 # 29590 40.85 38.81 44.63 # 29086 45.99 43.69 50.24 29700 60.00 57.00 65.55 29105 79.58 75.60 86.94 # 29700 33.68 32.00 36.80 # 29105 56.05 53.25 61.24 29705 62.70 59.57 68.51 29125 62.05 58.95 67.79 # 29705 46.34 44.02 50.62 # 29125 40.11 38.10 43.82 29710 109.63 104.15 119.77 29126 70.98 67.43 77.54 # 29710 79.31 75.34 86.64 # 29126 49.04 46.59 53.58 29715 83.69 79.51 91.44 29130 37.36 35.49 40.81 # 29715 54.17 51.46 59.18 # 29130 27.39 26.02 29.92 29720 74.28 70.57 81.16 29131 46.33 44.01 50.61 # 29720 42.76 40.62 46.71 # 29131 30.77 29.23 33.61 29730 60.86 57.82 66.49 29200 49.44 46.97 54.02 # 29730 44.51 42.28 48.62 # 29200 38.27 36.36 41.81 29740 87.12 82.76 95.17 29220 51.07 48.52 55.80 # 29740 64.78 61.54 70.77 # 29220 39.90 37.91 43.60 29750 95.03 90.28 103.82 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 99 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 74.29 70.58 81.17 # 29893 414.09 393.39 452.40 29800 490.70 466.17 536.10 29894 494.81 470.07 540.58 29804 608.06 577.66 664.31 29895 478.54 454.61 522.80 29805 444.89 422.65 486.05 29897 501.85 476.76 548.27 29806 1,014.34 963.62 1,108.16 29898 559.81 531.82 611.59 29807 988.29 938.88 1,079.71 29899 1,006.55 956.22 1,099.65 29819 557.03 529.18 608.56 29900 432.62 410.99 472.64 29820 514.00 488.30 561.55 29901 473.68 450.00 517.50 29821 561.34 533.27 613.26 29902 506.01 480.71 552.82 29822 545.44 518.17 595.90 29904 585.68 556.40 639.86 29823 596.61 566.78 651.80 29905 630.90 599.36 689.26 29824 635.50 603.73 694.29 29906 664.66 631.43 726.14 29825 556.24 528.43 607.69 29907 813.28 772.62 888.51 29826 637.46 605.59 696.43 30000 217.12 206.26 237.20 29827 1,039.62 987.64 1,135.79 # 30000 111.02 105.47 121.29 29828 869.41 825.94 949.83 30020 209.94 199.44 229.36 29830 429.00 407.55 468.68 # 30020 111.81 106.22 122.15 29834 467.48 444.11 510.73 30100 131.80 125.21 143.99 29835 479.72 455.73 524.09 # 30100 67.18 63.82 73.39 29836 550.94 523.39 601.90 30110 211.77 201.18 231.36 29837 502.71 477.57 549.21 # 30110 123.62 117.44 135.06 29838 561.75 533.66 613.71 30115 406.92 386.57 444.56 29840 420.83 399.79 459.76 30117 787.95 748.55 860.83 29843 452.07 429.47 493.89 # 30117 316.05 300.25 345.29 29844 469.25 445.79 512.66 30118 728.01 691.61 795.35 29845 534.74 508.00 584.20 30120 489.20 464.74 534.45 29846 493.45 468.78 539.10 # 30120 425.38 404.11 464.73 29847 512.10 486.50 559.48 30124 256.16 243.35 279.85 29848 467.33 443.96 510.55 30125 582.78 553.64 636.69 29850 540.56 513.53 590.56 30130 356.57 338.74 389.55 29851 892.83 848.19 975.42 30140 408.88 388.44 446.71 29855 748.69 711.26 817.95 30150 747.83 710.44 817.01 29856 956.31 908.49 1,044.76 30160 750.07 712.57 819.46 29860 615.79 585.00 672.75 30200 105.37 100.10 115.12 29861 682.82 648.68 745.98 # 30200 57.51 54.63 62.82 29862 762.97 724.82 833.54 30210 138.17 131.26 150.95 29863 754.27 716.56 824.04 # 30210 93.89 89.20 102.58 29866 994.92 945.17 1,086.95 30220 274.17 260.46 299.53 29867 1,203.47 1,143.30 1,314.80 # 30220 118.60 112.67 129.57 29868 1,608.50 1,528.08 1,757.29 30300 213.42 202.75 233.16 29870 386.12 366.81 421.83 # 30300 115.30 109.54 125.97 29871 484.93 460.68 529.78 30310 194.00 184.30 211.95 29873 485.99 461.69 530.94 30320 427.27 405.91 466.80 29874 507.84 482.45 554.82 30400 984.13 934.92 1,075.16 29875 469.25 445.79 512.66 30410 1,162.50 1,104.38 1,270.04 29876 615.33 584.56 672.24 30420 1,302.03 1,236.93 1,422.47 29877 582.58 553.45 636.47 30430 865.18 821.92 945.21 29879 623.03 591.88 680.66 30435 1,135.19 1,078.43 1,240.19 29880 650.32 617.80 710.47 30450 1,497.70 1,422.82 1,636.24 29881 606.30 575.99 662.39 30460 721.80 685.71 788.57 29882 656.20 623.39 716.90 30462 1,454.12 1,381.41 1,588.62 29883 801.14 761.08 875.24 30465 927.44 881.07 1,013.23 29884 580.78 551.74 634.50 30520 569.41 540.94 622.08 29885 704.20 668.99 769.34 30540 635.19 603.43 693.94 29886 594.02 564.32 648.97 30545 918.73 872.79 1,003.71 29887 700.11 665.10 764.87 30560 252.68 240.05 276.06 29888 948.42 901.00 1,036.15 # 30560 131.02 124.47 143.14 29889 1,158.88 1,100.94 1,266.08 30580 594.74 565.00 649.75 29891 659.87 626.88 720.91 # 30580 473.48 449.81 517.28 29892 673.04 639.39 735.30 30600 547.69 520.31 598.36 29893 556.50 528.68 607.98 # 30600 419.65 398.67 458.47 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 99 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 584.51 555.28 638.57 31290 1,114.16 1,058.45 1,217.22 30630 589.92 560.42 644.48 31291 1,174.61 1,115.88 1,283.26 30801 212.33 201.71 231.97 31292 965.03 916.78 1,054.30 # 30801 125.76 119.47 137.39 31293 1,050.70 998.17 1,147.90 30802 272.33 258.71 297.52 31294 1,205.42 1,145.15 1,316.92 # 30802 177.79 168.90 194.24 31300 1,196.77 1,136.93 1,307.47 30901 98.43 93.51 107.54 31320 618.08 587.18 675.26 # 30901 59.74 56.75 65.26 31360 1,893.82 1,799.13 2,069.00 30903 182.77 173.63 199.67 31365 2,365.23 2,246.97 2,584.02 # 30903 77.86 73.97 85.07 31367 2,053.54 1,950.86 2,243.49 30905 227.41 216.04 248.45 31368 2,294.32 2,179.60 2,506.54 # 30905 100.17 95.16 109.43 31370 1,936.30 1,839.49 2,115.41 30906 260.83 247.79 284.96 31375 1,831.45 1,739.88 2,000.86 # 30906 131.19 124.63 143.32 31380 1,805.52 1,715.24 1,972.53 30915 545.37 518.10 595.82 31382 1,975.08 1,876.33 2,157.78 30920 783.64 744.46 856.13 31390 2,638.01 2,506.11 2,882.03 30930 115.21 109.45 125.87 31395 2,803.84 2,663.65 3,063.20 31000 168.23 159.82 183.79 31400 955.19 907.43 1,043.54 # 31000 99.22 94.26 108.40 31420 795.00 755.25 868.54 31002 190.71 181.17 208.35 31500 107.66 102.28 117.62 31020 456.44 433.62 498.66 31502 34.56 32.83 37.75 # 31020 333.58 316.90 364.44 31505 80.18 76.17 87.60 31030 659.45 626.48 720.45 # 31505 47.47 45.10 51.87 # 31030 494.71 469.97 540.47 31510 203.38 193.21 222.19 31032 539.94 512.94 589.88 # 31510 118.02 112.12 128.94 31040 707.89 672.50 773.38 31511 202.95 192.80 221.72 31050 467.63 444.25 510.89 # 31511 126.37 120.05 138.06 31051 610.21 579.70 666.66 31512 200.61 190.58 219.17 31070 411.89 391.30 450.00 # 31512 127.21 120.85 138.98 31075 742.61 705.48 811.30 31513 129.62 123.14 141.61 31080 958.04 910.14 1,046.66 31515 201.27 191.21 219.89 31081 1,176.50 1,117.68 1,285.33 # 31515 107.53 102.15 117.47 31084 1,118.18 1,062.27 1,221.61 31520 150.34 142.82 164.24 31085 1,183.65 1,124.47 1,293.14 31525 240.52 228.49 262.76 31086 1,057.54 1,004.66 1,155.36 # 31525 156.35 148.53 170.81 31087 1,046.97 994.62 1,143.81 31526 155.37 147.60 169.74 31090 948.00 900.60 1,035.69 31527 189.35 179.88 206.86 31200 507.40 482.03 554.33 31528 141.57 134.49 154.66 31201 693.14 658.48 757.25 31529 159.64 151.66 174.41 31205 810.78 770.24 885.78 31530 194.97 185.22 213.00 31225 1,732.87 1,646.23 1,893.16 31531 210.21 199.70 229.66 31230 1,939.20 1,842.24 2,118.58 31535 186.95 177.60 204.24 31231 182.04 172.94 198.88 31536 208.72 198.28 228.02 # 31231 74.74 71.00 81.65 31540 239.70 227.72 261.88 31233 254.22 241.51 277.74 31541 262.11 249.00 286.35 # 31233 134.15 127.44 146.56 31545 353.89 336.20 386.63 31235 291.72 277.13 318.70 31546 538.82 511.88 588.66 # 31235 160.09 152.09 174.90 31560 309.91 294.41 338.57 31237 313.80 298.11 342.83 31561 339.55 322.57 370.96 # 31237 178.17 169.26 194.65 31570 334.22 317.51 365.14 31238 322.50 306.38 352.34 # 31570 224.52 213.29 245.28 # 31238 193.25 183.59 211.13 31571 247.33 234.96 270.20 31239 631.54 599.96 689.95 31575 111.84 106.25 122.19 31240 158.45 150.53 173.11 # 31575 74.74 71.00 81.65 31254 270.67 257.14 295.71 31576 217.81 206.92 237.96 31255 399.38 379.41 436.32 # 31576 120.88 114.84 132.07 31256 196.40 186.58 214.57 31577 233.91 222.21 255.54 31267 315.61 299.83 344.80 # 31577 146.55 139.22 160.10 31276 503.18 478.02 549.72 31578 271.83 258.24 296.98 31287 230.54 219.01 251.86 # 31578 166.53 158.20 181.93 31288 267.21 253.85 291.93 31579 210.70 200.17 230.20 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 99 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 137.70 130.82 150.44 31750 1,281.08 1,217.03 1,399.58 31580 1,144.29 1,087.08 1,250.14 31755 1,631.58 1,550.00 1,782.50 31582 1,820.11 1,729.10 1,988.47 31760 1,358.91 1,290.96 1,484.60 31584 1,449.05 1,376.60 1,583.09 31766 1,770.40 1,681.88 1,934.16 31587 939.67 892.69 1,026.59 31770 1,310.78 1,245.24 1,432.03 31588 1,075.97 1,022.17 1,175.50 31775 1,354.34 1,286.62 1,479.61 31590 855.92 813.12 935.09 31780 1,148.28 1,090.87 1,254.50 31595 731.84 695.25 799.54 31781 1,388.84 1,319.40 1,517.31 31600 386.96 367.61 422.75 31785 1,050.34 997.82 1,147.49 31601 256.84 244.00 280.60 31786 1,462.81 1,389.67 1,598.12 31603 217.93 207.03 238.08 31800 670.57 637.04 732.60 31605 178.98 170.03 195.53 31805 808.56 768.13 883.35 31610 675.90 642.11 738.43 31820 408.97 388.52 446.80 31611 510.50 484.98 557.73 # 31820 312.84 297.20 341.78 31612 77.94 74.04 85.15 31825 570.08 541.58 622.82 # 31612 46.82 44.48 51.15 # 31825 460.38 437.36 502.96 31613 423.46 402.29 462.63 31830 412.36 391.74 450.50 31614 699.36 664.39 764.05 # 31830 325.00 308.75 355.06 31615 177.25 168.39 193.65 32035 688.81 654.37 752.53 # 31615 124.59 118.36 136.11 32036 746.93 709.58 816.02 31620 284.84 270.60 311.19 32095 612.80 582.16 669.48 # 31620 69.83 66.34 76.29 32100 945.30 898.04 1,032.75 31622 315.35 299.58 344.52 32110 1,420.59 1,349.56 1,551.99 # 31622 144.22 137.01 157.56 32120 847.60 805.22 926.00 31623 345.92 328.62 377.91 32124 900.72 855.68 984.03 # 31623 145.68 138.40 159.16 32140 962.95 914.80 1,052.02 31624 320.79 304.75 350.46 32141 1,444.91 1,372.66 1,578.56 # 31624 146.08 138.78 159.60 32150 970.26 921.75 1,060.01 31625 344.79 327.55 376.68 32151 993.40 943.73 1,085.29 # 31625 170.07 161.57 185.81 32160 743.92 706.72 812.73 31628 415.02 394.27 453.41 32200 1,089.95 1,035.45 1,190.77 # 31628 189.64 180.16 207.18 32201 950.92 903.37 1,038.88 31629 642.00 609.90 701.39 # 32201 211.36 200.79 230.91 # 31629 202.82 192.68 221.58 32215 783.43 744.26 855.90 31630 203.84 193.65 222.70 32220 1,563.76 1,485.57 1,708.41 31631 229.55 218.07 250.78 32225 971.77 923.18 1,061.66 31632 75.48 71.71 82.47 32310 897.30 852.44 980.31 # 31632 52.74 50.10 57.62 32320 1,564.52 1,486.29 1,709.23 31633 90.64 86.11 99.03 32400 153.24 145.58 167.42 # 31633 65.91 62.61 72.00 # 32400 90.61 86.08 98.99 31635 353.31 335.64 385.99 32402 552.61 524.98 603.73 # 31635 188.97 179.52 206.45 32405 102.65 97.52 112.15 31636 224.15 212.94 244.88 # 32405 102.25 97.14 111.71 31637 79.32 75.35 86.65 32420 112.80 107.16 123.23 31638 251.11 238.55 274.33 32421 160.65 152.62 175.51 31640 260.74 247.70 284.86 # 32421 78.08 74.18 85.31 31641 256.99 244.14 280.76 32422 201.72 191.63 220.37 31643 176.14 167.33 192.43 # 32422 126.33 120.01 138.01 31645 308.25 292.84 336.77 32440 1,563.95 1,485.75 1,708.61 # 31645 159.86 151.87 174.65 32442 2,878.98 2,735.03 3,145.28 31646 280.55 266.52 306.50 32445 3,272.82 3,109.18 3,575.56 # 31646 138.55 131.62 151.36 32480 1,475.77 1,401.98 1,612.28 31656 324.28 308.07 354.28 32482 1,574.58 1,495.85 1,720.23 # 31656 112.46 106.84 122.87 32484 1,421.08 1,350.03 1,552.53 31715 55.41 52.64 60.54 32486 2,255.78 2,142.99 2,464.44 31717 304.24 289.03 332.38 32488 2,287.99 2,173.59 2,499.63 # 31717 110.37 104.85 120.58 32491 1,466.73 1,393.39 1,602.40 31720 52.00 49.40 56.81 32500 1,428.08 1,356.68 1,560.18 31725 93.39 88.72 102.03 32501 247.72 235.33 270.63 31730 877.57 833.69 958.74 32503 1,800.47 1,710.45 1,967.02 # 31730 143.60 136.42 156.88 32504 2,067.76 1,964.37 2,259.03 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 27 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 1,628.37 1,546.95 1,778.99 33206 478.07 454.17 522.30 32550 806.84 766.50 881.48 33207 511.04 485.49 558.31 # 32550 228.44 217.02 249.57 33208 550.33 522.81 601.23 32551 176.41 167.59 192.73 33210 187.84 178.45 205.22 32560 299.68 284.70 327.41 33211 188.34 178.92 205.76 # 32560 111.80 106.21 122.14 33212 357.17 339.31 390.21 32601 309.73 294.24 338.38 33213 407.34 386.97 445.02 32602 335.81 319.02 366.87 33214 505.57 480.29 552.33 32603 434.77 413.03 474.98 33215 323.42 307.25 353.34 32604 488.19 463.78 533.35 33216 399.24 379.28 436.17 32605 385.39 366.12 421.04 33217 395.79 376.00 432.40 32606 466.38 443.06 509.52 33218 412.91 392.26 451.10 32650 666.45 633.13 728.10 33220 416.61 395.78 455.15 32651 1,044.63 992.40 1,141.26 33222 364.66 346.43 398.39 32652 1,583.62 1,504.44 1,730.11 33223 439.58 417.60 480.24 32653 1,012.65 962.02 1,106.32 33224 531.88 505.29 581.08 32654 1,116.76 1,060.92 1,220.06 33225 478.88 454.94 523.18 32655 926.33 880.01 1,012.01 33226 514.20 488.49 561.76 32656 796.70 756.87 870.40 33233 255.85 243.06 279.52 32657 786.68 747.35 859.45 33234 513.55 487.87 561.05 32658 719.27 683.31 785.81 33235 664.78 631.54 726.27 32659 730.68 694.15 798.27 33236 781.28 742.22 853.55 32660 1,027.17 975.81 1,122.18 33237 863.91 820.71 943.82 32661 802.40 762.28 876.62 33238 930.41 883.89 1,016.47 32662 897.97 853.07 981.03 33240 490.33 465.81 535.68 32663 1,375.29 1,306.53 1,502.51 33241 241.43 229.36 263.76 32664 853.11 810.45 932.02 33243 1,364.00 1,295.80 1,490.17 32665 1,189.59 1,130.11 1,299.63 33244 902.11 857.00 985.55 32800 915.43 869.66 1,000.11 33249 952.86 905.22 1,041.00 32810 886.85 842.51 968.89 33250 1,458.60 1,385.67 1,593.52 32815 2,597.57 2,467.69 2,837.84 33251 1,615.49 1,534.72 1,764.93 32820 1,319.90 1,253.91 1,442.00 33254 1,362.77 1,294.63 1,488.82 32851 2,562.91 2,434.76 2,799.97 33255 1,666.74 1,583.40 1,820.91 32852 2,839.82 2,697.83 3,102.50 33256 1,986.79 1,887.45 2,170.57 32853 3,057.88 2,904.99 3,340.74 33257 575.72 546.93 628.97 32854 3,332.56 3,165.93 3,640.82 33258 649.74 617.25 709.84 32855 257.29 244.43 281.09 33259 849.01 806.56 927.54 32856 310.42 294.90 339.14 33261 1,606.84 1,526.50 1,755.48 32900 1,343.10 1,275.95 1,467.34 33265 1,359.58 1,291.60 1,485.34 32905 1,325.89 1,259.60 1,448.54 33266 1,863.64 1,770.46 2,036.03 32906 1,644.94 1,562.69 1,797.09 33282 342.58 325.45 374.27 32940 1,214.92 1,154.17 1,327.30 33284 248.30 235.89 271.27 32960 139.05 132.10 151.92 33300 2,285.65 2,171.37 2,497.08 # 32960 99.96 94.96 109.20 33305 3,804.80 3,614.56 4,156.74 32997 354.84 337.10 387.67 33310 1,164.75 1,106.51 1,272.49 32998 2,937.09 2,790.24 3,208.78 33315 1,479.67 1,405.69 1,616.54 # 32998 309.95 294.45 338.62 33320 1,055.26 1,002.50 1,152.88 33010 125.10 118.85 136.68 33321 1,190.96 1,131.41 1,301.12 33011 122.19 116.08 133.49 33322 1,381.40 1,312.33 1,509.18 33015 535.46 508.69 584.99 33330 1,391.55 1,321.97 1,520.27 33020 860.51 817.48 940.10 33332 1,393.09 1,323.44 1,521.96 33025 794.94 755.19 868.47 33335 1,878.48 1,784.56 2,052.24 33030 1,270.42 1,206.90 1,387.94 33400 2,259.59 2,146.61 2,468.60 33031 1,416.66 1,345.83 1,547.70 33401 1,506.68 1,431.35 1,646.05 33050 983.56 934.38 1,074.54 33403 1,510.60 1,435.07 1,650.33 33120 1,550.89 1,473.35 1,694.35 33404 1,785.21 1,695.95 1,950.34 33130 1,365.68 1,297.40 1,492.01 33405 2,311.00 2,195.45 2,524.77 33140 1,554.34 1,476.62 1,698.11 33406 2,843.77 2,701.58 3,106.82 33141 152.35 144.73 166.44 33410 2,509.74 2,384.25 2,741.89 33202 776.42 737.60 848.24 33411 3,270.60 3,107.07 3,573.13 33203 817.90 777.01 893.56 33412 2,497.74 2,372.85 2,728.78 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 28 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 3,230.40 3,068.88 3,529.21 33615 2,015.75 1,914.96 2,202.20 33414 2,162.02 2,053.92 2,362.01 33617 2,160.52 2,052.49 2,360.36 33415 2,000.50 1,900.48 2,185.55 33619 2,642.78 2,510.64 2,887.24 33416 2,013.87 1,913.18 2,200.16 33641 1,605.18 1,524.92 1,753.66 33417 1,684.59 1,600.36 1,840.41 33645 1,586.55 1,507.22 1,733.30 33420 1,357.42 1,289.55 1,482.98 33647 1,689.10 1,604.65 1,845.35 33422 1,689.77 1,605.28 1,846.07 33660 1,765.50 1,677.23 1,928.81 33425 2,616.81 2,485.97 2,858.87 33665 1,907.95 1,812.55 2,084.43 33426 2,384.29 2,265.08 2,604.84 33670 1,982.43 1,883.31 2,165.81 33427 2,490.14 2,365.63 2,720.47 33675 1,981.66 1,882.58 2,164.97 33430 2,753.99 2,616.29 3,008.73 33676 2,064.99 1,961.74 2,256.00 33460 2,327.13 2,210.77 2,542.39 33677 2,146.03 2,038.73 2,344.54 33463 2,937.70 2,790.82 3,209.44 33681 1,837.53 1,745.65 2,007.50 33464 2,373.21 2,254.55 2,592.73 33684 1,867.73 1,774.34 2,040.49 33465 2,652.83 2,520.19 2,898.22 33688 1,875.37 1,781.60 2,048.84 33468 1,883.34 1,789.17 2,057.55 33690 1,157.31 1,099.44 1,264.36 33470 1,185.64 1,126.36 1,295.31 33692 1,771.69 1,683.11 1,935.58 33471 1,328.25 1,261.84 1,451.12 33694 1,994.90 1,895.16 2,179.43 33472 1,341.99 1,274.89 1,466.12 33697 2,151.23 2,043.67 2,350.22 33474 2,040.72 1,938.68 2,229.48 33702 1,537.16 1,460.30 1,679.35 33475 2,307.69 2,192.31 2,521.16 33710 1,873.21 1,779.55 2,046.48 33476 1,461.46 1,388.39 1,596.65 33720 1,559.45 1,481.48 1,703.70 33478 1,577.09 1,498.24 1,722.98 33722 1,540.45 1,463.43 1,682.94 33496 1,685.08 1,600.83 1,840.95 33724 1,582.70 1,503.57 1,729.11 33500 1,581.35 1,502.28 1,727.62 33726 2,062.26 1,959.15 2,253.02 33501 1,096.17 1,041.36 1,197.56 33730 1,961.83 1,863.74 2,143.30 33502 1,270.52 1,206.99 1,388.04 33732 1,643.62 1,561.44 1,795.66 33503 1,364.40 1,296.18 1,490.61 33735 1,250.68 1,188.15 1,366.37 33504 1,448.25 1,375.84 1,582.22 33736 1,397.41 1,327.54 1,526.67 33505 1,974.54 1,875.81 2,157.18 33737 1,304.60 1,239.37 1,425.28 33506 2,057.33 1,954.46 2,247.63 33750 1,314.63 1,248.90 1,436.24 33507 1,743.11 1,655.95 1,904.34 33755 1,295.75 1,230.96 1,415.60 33508 16.35 15.53 17.86 33762 1,293.24 1,228.58 1,412.87 33510 1,965.96 1,867.66 2,147.81 33764 1,272.50 1,208.88 1,390.21 33511 2,144.39 2,037.17 2,342.75 33766 1,408.12 1,337.71 1,538.37 33512 2,411.69 2,291.11 2,634.78 33767 1,416.82 1,345.98 1,547.88 33513 2,461.58 2,338.50 2,689.28 33768 430.25 408.74 470.05 33514 2,608.43 2,478.01 2,849.71 33770 2,150.14 2,042.63 2,349.02 33516 2,713.27 2,577.61 2,964.25 33771 2,200.76 2,090.72 2,404.33 33517 185.74 176.45 202.92 33774 1,819.74 1,728.75 1,988.06 33518 401.47 381.40 438.61 33775 1,893.10 1,798.45 2,068.22 33519 536.09 509.29 585.68 33776 1,991.90 1,892.31 2,176.16 33521 649.38 616.91 709.45 33777 1,950.74 1,853.20 2,131.18 33522 739.71 702.72 808.13 33778 2,391.70 2,272.12 2,612.94 33523 844.54 802.31 922.66 33779 2,281.08 2,167.03 2,492.08 33530 510.23 484.72 557.43 33780 2,376.90 2,258.06 2,596.77 33533 1,916.25 1,820.44 2,093.51 33781 2,337.96 2,221.06 2,554.22 33534 2,224.52 2,113.29 2,430.28 33786 2,302.36 2,187.24 2,515.33 33535 2,467.53 2,344.15 2,695.77 33788 1,559.04 1,481.09 1,703.25 33536 2,641.60 2,509.52 2,885.95 33800 977.18 928.32 1,067.57 33542 2,537.86 2,410.97 2,772.62 33802 1,052.10 999.50 1,149.43 33545 2,993.44 2,843.77 3,270.34 33803 1,143.40 1,086.23 1,249.16 33548 2,946.25 2,798.94 3,218.78 33813 1,304.86 1,239.62 1,425.56 33572 236.61 224.78 258.50 33814 1,530.79 1,454.25 1,672.39 33600 1,715.43 1,629.66 1,874.11 33820 981.55 932.47 1,072.34 33602 1,631.76 1,550.17 1,782.70 33822 1,042.44 990.32 1,138.87 33606 1,779.81 1,690.82 1,944.44 33824 1,177.83 1,118.94 1,286.78 33608 1,829.94 1,738.44 1,999.21 33840 1,185.66 1,126.38 1,295.34 33610 1,784.01 1,694.81 1,949.03 33845 1,377.24 1,308.38 1,504.64 33611 1,955.07 1,857.32 2,135.92 33851 1,261.74 1,198.65 1,378.45 33612 2,020.21 1,919.20 2,207.08 33852 1,366.97 1,298.62 1,493.41 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 29 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 1,892.32 1,797.70 2,067.36 34803 1,308.54 1,243.11 1,429.58 33860 3,132.86 2,976.22 3,422.65 34804 1,280.32 1,216.30 1,398.75 33861 2,452.70 2,330.07 2,679.58 34805 1,200.93 1,140.88 1,312.01 33863 3,133.61 2,976.93 3,423.47 34806 108.61 103.18 118.66 33864 3,222.22 3,061.11 3,520.28 34808 213.36 202.69 233.09 33870 2,559.79 2,431.80 2,796.57 34812 353.49 335.82 386.19 33875 1,986.27 1,886.96 2,170.00 34813 245.08 232.83 267.75 33877 3,505.12 3,329.86 3,829.34 34820 507.17 481.81 554.08 33880 1,819.50 1,728.53 1,987.81 34825 719.83 683.84 786.42 33881 1,562.51 1,484.38 1,707.04 34826 211.62 201.04 231.20 33883 1,143.98 1,086.78 1,249.80 34830 1,873.66 1,779.98 2,046.98 33884 416.05 395.25 454.54 34831 1,982.51 1,883.38 2,165.89 33886 983.00 933.85 1,073.93 34832 2,012.52 1,911.89 2,198.67 33889 818.17 777.26 893.85 34833 631.53 599.95 689.94 33891 1,022.99 971.84 1,117.62 34834 286.69 272.36 313.21 33910 1,663.29 1,580.13 1,817.15 34900 933.83 887.14 1,020.21 33915 1,323.23 1,257.07 1,445.63 35001 1,165.90 1,107.61 1,273.75 33916 1,671.85 1,588.26 1,826.50 35002 1,229.89 1,168.40 1,343.66 33917 1,515.63 1,439.85 1,655.83 35005 1,069.67 1,016.19 1,168.62 33920 1,819.74 1,728.75 1,988.06 35011 1,021.79 970.70 1,116.31 33922 1,378.79 1,309.85 1,506.33 35013 1,267.04 1,203.69 1,384.24 33924 289.80 275.31 316.61 35021 1,245.16 1,182.90 1,360.34 33925 1,773.38 1,684.71 1,937.42 35022 1,404.77 1,334.53 1,534.71 33926 2,345.40 2,228.13 2,562.35 35045 993.91 944.21 1,085.84 33933 355.82 338.03 388.73 35081 1,775.61 1,686.83 1,939.85 33935 3,488.64 3,314.21 3,811.34 35082 2,230.41 2,118.89 2,436.72 33944 250.75 238.21 273.94 35091 1,879.06 1,785.11 2,052.88 33945 4,603.29 4,373.13 5,029.10 35092 2,660.76 2,527.72 2,906.88 33960 1,005.78 955.49 1,098.81 35102 1,925.84 1,829.55 2,103.98 33961 559.31 531.34 611.04 35103 2,304.27 2,189.06 2,517.42 33967 277.57 263.69 303.24 35111 1,422.24 1,351.13 1,553.80 33968 35.54 33.76 38.82 35112 1,740.97 1,653.92 1,902.01 33970 371.90 353.31 406.31 35121 1,687.28 1,602.92 1,843.36 33971 718.71 682.77 785.19 35122 2,018.86 1,917.92 2,205.61 33973 542.41 515.29 592.58 35131 1,441.28 1,369.22 1,574.60 33974 916.89 871.05 1,001.71 35132 1,738.65 1,651.72 1,899.48 33975 1,119.05 1,063.10 1,222.57 35141 1,143.19 1,086.03 1,248.93 33976 1,244.79 1,182.55 1,359.93 35142 1,367.04 1,298.69 1,493.49 33977 1,213.63 1,152.95 1,325.89 35151 1,288.63 1,224.20 1,407.83 33978 1,334.77 1,268.03 1,458.23 35152 1,495.84 1,421.05 1,634.21 33979 2,454.55 2,331.82 2,681.59 35180 858.71 815.77 938.14 33980 3,617.52 3,436.64 3,952.14 35182 1,762.13 1,674.02 1,925.12 34001 969.57 921.09 1,059.25 35184 1,037.61 985.73 1,133.59 34051 976.62 927.79 1,066.96 35188 872.98 829.33 953.73 34101 619.60 588.62 676.91 35189 1,622.64 1,541.51 1,772.74 34111 619.32 588.35 676.60 35190 761.50 723.43 831.94 34151 1,429.05 1,357.60 1,561.24 35201 954.92 907.17 1,043.25 34201 1,002.70 952.57 1,095.46 35206 780.24 741.23 852.41 34203 989.39 939.92 1,080.91 35207 712.48 676.86 778.39 34401 1,476.61 1,402.78 1,613.20 35211 1,386.06 1,316.76 1,514.27 34421 749.97 712.47 819.34 35216 1,917.34 1,821.47 2,094.69 34451 1,543.71 1,466.52 1,686.50 35221 1,421.76 1,350.67 1,553.27 34471 1,074.84 1,021.10 1,174.27 35226 861.34 818.27 941.01 34490 623.26 592.10 680.92 35231 1,197.47 1,137.60 1,308.24 34501 966.72 918.38 1,056.14 35236 996.95 947.10 1,089.17 34502 1,561.43 1,483.36 1,705.86 35241 1,448.23 1,375.82 1,582.19 34510 1,094.06 1,039.36 1,195.26 35246 1,572.72 1,494.08 1,718.19 34520 1,050.56 998.03 1,147.73 35251 1,689.48 1,605.01 1,845.76 34530 987.72 938.33 1,079.08 35256 1,047.81 995.42 1,144.73 34800 1,174.69 1,115.96 1,283.35 35261 1,060.38 1,007.36 1,158.46 34802 1,281.14 1,217.08 1,399.64 35266 878.40 834.48 959.65 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 99 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 1,383.77 1,314.58 1,511.77 35511 1,218.64 1,157.71 1,331.37 35276 1,452.72 1,380.08 1,587.09 35512 1,258.32 1,195.40 1,374.71 35281 1,616.46 1,535.64 1,765.99 35515 1,357.20 1,289.34 1,482.74 35286 962.79 914.65 1,051.85 35516 1,241.30 1,179.24 1,356.13 35301 1,078.34 1,024.42 1,178.08 35518 1,240.28 1,178.27 1,355.01 35302 1,145.02 1,087.77 1,250.94 35521 1,303.75 1,238.56 1,424.34 35303 1,259.58 1,196.60 1,376.09 35522 1,230.25 1,168.74 1,344.05 35304 1,309.61 1,244.13 1,430.75 35523 1,304.39 1,239.17 1,425.05 35305 1,257.98 1,195.08 1,374.34 35525 1,154.88 1,097.14 1,261.71 35306 469.01 445.56 512.39 35526 1,706.50 1,621.18 1,864.36 35311 1,543.31 1,466.14 1,686.06 35531 2,079.01 1,975.06 2,271.32 35321 917.32 871.45 1,002.17 35533 1,611.26 1,530.70 1,760.31 35331 1,513.18 1,437.52 1,653.15 35535 2,065.94 1,962.64 2,257.04 35341 1,423.86 1,352.67 1,555.57 35536 1,792.79 1,703.15 1,958.62 35351 1,322.28 1,256.17 1,444.60 35537 2,223.22 2,112.06 2,428.87 35355 1,074.38 1,020.66 1,173.76 35538 2,495.62 2,370.84 2,726.47 35361 1,627.96 1,546.56 1,778.54 35539 2,311.68 2,196.10 2,525.52 35363 1,774.97 1,686.22 1,939.15 35540 2,589.86 2,460.37 2,829.43 35371 848.25 805.84 926.72 35548 1,237.31 1,175.44 1,351.76 35372 1,017.22 966.36 1,111.31 35549 1,345.51 1,278.23 1,469.96 35390 165.63 157.35 180.95 35551 1,533.32 1,456.65 1,675.15 35400 156.71 148.87 171.20 35556 1,420.42 1,349.40 1,551.81 35450 530.69 504.16 579.78 35558 1,260.66 1,197.63 1,377.27 35452 368.65 350.22 402.75 35560 1,832.40 1,740.78 2,001.90 35454 323.55 307.37 353.48 35563 1,404.32 1,334.10 1,534.22 35456 391.37 371.80 427.57 35565 1,361.11 1,293.05 1,487.01 35458 501.88 476.79 548.31 35566 1,703.35 1,618.18 1,860.91 35459 461.29 438.23 503.96 35570 1,597.78 1,517.89 1,745.57 35460 320.46 304.44 350.11 35571 1,380.85 1,311.81 1,508.58 35470 3,000.30 2,850.29 3,277.83 35572 359.58 341.60 392.84 # 35470 472.89 449.25 516.64 35583 1,466.24 1,392.93 1,601.87 35471 3,295.01 3,130.26 3,599.80 35585 1,717.76 1,631.87 1,876.65 # 35471 566.16 537.85 618.53 35587 1,424.34 1,353.12 1,556.09 35472 2,285.80 2,171.51 2,497.24 35600 264.95 251.70 289.46 # 35472 377.88 358.99 412.84 35601 1,484.44 1,410.22 1,621.75 35473 2,184.86 2,075.62 2,386.96 35606 1,206.41 1,146.09 1,318.00 # 35473 334.78 318.04 365.75 35612 947.70 900.32 1,035.37 35474 2,916.96 2,771.11 3,186.78 35616 1,152.96 1,095.31 1,259.61 # 35474 404.31 384.09 441.70 35621 1,140.92 1,083.87 1,246.45 35475 2,344.30 2,227.09 2,561.15 35623 1,399.79 1,329.80 1,529.27 # 35475 504.99 479.74 551.70 35626 1,609.83 1,529.34 1,758.74 35476 1,774.89 1,686.15 1,939.07 35631 1,912.82 1,817.18 2,089.76 # 35476 322.51 306.38 352.34 35632 1,961.80 1,863.71 2,143.27 35480 574.98 546.23 628.16 35633 2,117.91 2,012.01 2,313.81 35481 416.06 395.26 454.55 35634 1,920.14 1,824.13 2,097.75 35482 363.81 345.62 397.46 35636 1,698.97 1,614.02 1,856.12 35483 438.80 416.86 479.39 35637 1,756.75 1,668.91 1,919.25 35484 545.08 517.83 595.50 35638 1,795.69 1,705.91 1,961.80 35485 508.35 482.93 555.37 35642 1,068.15 1,014.74 1,166.95 35490 632.27 600.66 690.76 35645 1,010.62 960.09 1,104.10 35491 423.66 402.48 462.85 35646 1,774.19 1,685.48 1,938.30 35492 385.04 365.79 420.66 35647 1,606.55 1,526.22 1,755.15 35493 469.21 445.75 512.61 35650 1,099.42 1,044.45 1,201.12 35494 594.15 564.44 649.11 35651 1,423.52 1,352.34 1,555.19 35495 543.22 516.06 593.47 35654 1,417.91 1,347.01 1,549.06 35500 331.32 314.75 361.96 35656 1,118.47 1,062.55 1,221.93 35501 1,607.04 1,526.69 1,755.69 35661 1,120.46 1,064.44 1,224.11 35506 1,364.39 1,296.17 1,490.60 35663 1,297.53 1,232.65 1,417.55 35508 1,409.86 1,339.37 1,540.28 35665 1,215.85 1,155.06 1,328.32 35509 1,544.23 1,467.02 1,687.07 35666 1,313.03 1,247.38 1,434.49 35510 1,291.24 1,226.68 1,410.68 35671 1,157.31 1,099.44 1,264.36 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 99 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 82.80 78.66 90.46 # 36215 252.04 239.44 275.36 35682 369.29 350.83 403.45 36216 1,317.65 1,251.77 1,439.54 35683 435.55 413.77 475.84 # 36216 284.11 269.90 310.39 35685 207.39 197.02 226.57 36217 2,155.27 2,047.51 2,354.64 35686 173.75 165.06 189.82 # 36217 340.30 323.29 371.78 35691 1,019.55 968.57 1,113.86 36218 201.36 191.29 219.98 35693 906.83 861.49 990.71 # 36218 54.17 51.46 59.18 35694 1,052.98 1,000.33 1,150.38 36245 1,332.16 1,265.55 1,455.38 35695 1,096.77 1,041.93 1,198.22 # 36245 260.32 247.30 284.40 35697 154.56 146.83 168.85 36246 1,306.42 1,241.10 1,427.27 35700 159.09 151.14 173.81 # 36246 283.25 269.09 309.45 35701 549.21 521.75 600.01 36247 2,058.37 1,955.45 2,248.77 35721 466.94 443.59 510.13 # 36247 337.13 320.27 368.31 35741 510.31 484.79 557.51 36248 172.64 164.01 188.61 35761 379.16 360.20 414.23 # 36248 54.17 51.46 59.18 35800 485.50 461.23 530.41 36260 582.87 553.73 636.79 35820 1,877.29 1,783.43 2,050.94 36261 356.88 339.04 389.90 35840 632.76 601.12 691.29 36262 272.47 258.85 297.68 35860 410.36 389.84 448.32 36400 25.80 24.51 28.19 35870 1,317.00 1,251.15 1,438.82 # 36400 17.82 16.93 19.47 35875 609.58 579.10 665.97 36405 23.65 22.47 25.84 35876 973.30 924.64 1,063.34 # 36405 15.68 14.90 17.14 35879 952.89 905.25 1,041.04 36406 17.18 16.32 18.77 35881 1,059.39 1,006.42 1,157.38 # 36406 9.21 8.75 10.06 35883 1,232.53 1,170.90 1,346.54 36410 19.18 18.22 20.95 35884 1,299.06 1,234.11 1,419.23 # 36410 8.81 8.37 9.63 35901 514.38 488.66 561.96 36420 48.58 46.15 53.07 35903 581.31 552.24 635.08 36425 38.43 36.51 41.99 35905 1,790.98 1,701.43 1,956.64 36430 39.15 37.19 42.77 35907 1,971.51 1,872.93 2,153.87 36440 51.33 48.76 56.07 36000 25.96 24.66 28.36 36450 118.69 112.76 129.67 # 36000 9.61 9.13 10.50 36455 129.49 123.02 141.47 36002 172.80 164.16 188.78 36460 337.34 320.47 368.54 # 36002 112.97 107.32 123.42 36470 139.83 132.84 152.77 36005 357.39 339.52 390.45 # 36470 69.62 66.14 76.06 # 36005 50.64 48.11 55.33 36471 171.45 162.88 187.31 36010 614.33 583.61 671.15 # 36471 97.65 92.77 106.69 # 36010 127.27 120.91 139.05 36475 1,850.24 1,757.73 2,021.39 36011 975.12 926.36 1,065.31 # 36475 342.02 324.92 373.66 # 36011 164.56 156.33 179.78 36476 389.79 370.30 425.85 36012 914.86 869.12 999.49 # 36476 166.81 158.47 182.24 # 36012 185.67 176.39 202.85 36478 1,520.36 1,444.34 1,660.99 36013 847.94 805.54 926.37 # 36478 345.61 328.33 377.58 # 36013 133.52 126.84 145.87 36479 410.54 390.01 448.51 36014 883.19 839.03 964.88 # 36479 168.01 159.61 183.55 # 36014 161.59 153.51 176.54 36481 421.44 400.37 460.43 36015 967.76 919.37 1,057.28 36500 185.65 176.37 202.83 # 36015 186.72 177.38 203.99 36510 111.35 105.78 121.65 36100 557.63 529.75 609.21 # 36510 57.50 54.63 62.82 # 36100 163.92 155.72 179.08 36511 90.13 85.62 98.46 36120 462.99 439.84 505.82 36512 91.73 87.14 100.21 # 36120 102.79 97.65 112.30 36513 95.00 90.25 103.79 36140 512.21 486.60 559.59 36514 540.49 513.47 590.49 # 36140 106.13 100.82 115.94 # 36514 89.33 84.86 97.59 36145 507.24 481.88 554.16 36515 2,033.95 1,932.25 2,222.09 # 36145 103.56 98.38 113.14 # 36515 87.34 82.97 95.42 36160 562.61 534.48 614.65 36516 2,305.47 2,190.20 2,518.73 # 36160 138.58 131.65 151.40 # 36516 62.87 59.73 68.69 36200 683.53 649.35 746.75 36522 1,434.44 1,362.72 1,567.13 # 36200 158.58 150.65 173.25 # 36522 102.93 97.78 112.45 36215 1,206.20 1,145.89 1,317.77 36555 279.47 265.50 305.33 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 99 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 127.09 120.74 138.85 36625 106.14 100.83 115.95 36556 237.64 225.76 259.62 36640 120.35 114.33 131.48 # 36556 120.76 114.72 131.93 36660 67.07 63.72 73.28 36557 870.25 826.74 950.75 36680 59.38 56.41 64.87 # 36557 303.41 288.24 331.48 36800 159.77 151.78 174.55 36558 842.60 800.47 920.54 36810 210.87 200.33 230.38 # 36558 290.52 275.99 317.39 36815 149.88 142.39 163.75 36560 1,197.62 1,137.74 1,308.40 36818 682.33 648.21 745.44 # 36560 357.95 340.05 391.06 36819 801.22 761.16 875.33 36561 1,185.75 1,126.46 1,295.43 36820 804.13 763.92 878.51 # 36561 346.47 329.15 378.52 36821 667.57 634.19 729.32 36563 1,198.46 1,138.54 1,309.32 36822 381.05 362.00 416.30 # 36563 359.98 341.98 393.28 36823 1,279.81 1,215.82 1,398.19 36565 999.47 949.50 1,091.93 36825 582.29 553.18 636.16 # 36565 340.89 323.85 372.43 36830 663.47 630.30 724.85 36566 3,788.76 3,599.32 4,139.22 36831 459.37 436.40 501.86 # 36566 364.63 346.40 398.36 36832 585.37 556.10 639.52 36568 321.68 305.60 351.44 36833 660.98 627.93 722.12 # 36568 98.29 93.38 107.39 36834 620.76 589.72 678.18 36569 279.16 265.20 304.98 36835 462.40 439.28 505.17 # 36569 98.86 93.92 108.01 36838 1,180.08 1,121.08 1,289.24 36570 1,221.69 1,160.61 1,334.70 36860 194.50 184.78 212.50 # 36570 320.98 304.93 350.67 # 36860 103.16 98.00 112.70 36571 1,268.03 1,204.63 1,385.32 36861 152.02 144.42 166.08 # 36571 311.48 295.91 340.30 36870 1,935.75 1,838.96 2,114.80 36575 167.86 159.47 183.39 # 36870 313.04 297.39 342.00 # 36575 39.82 37.83 43.50 37140 1,346.15 1,278.84 1,470.67 36576 367.14 348.78 401.10 37145 1,458.09 1,385.19 1,592.97 # 36576 188.83 179.39 206.30 37160 1,266.00 1,202.70 1,383.11 36578 517.25 491.39 565.10 37180 1,417.49 1,346.62 1,548.61 # 36578 216.88 206.04 236.95 37181 1,532.00 1,455.40 1,673.71 36580 240.69 228.66 262.96 37182 915.54 869.76 1,000.22 # 36580 71.16 67.60 77.74 37183 435.57 413.79 475.86 36581 787.92 748.52 860.80 37184 2,539.17 2,412.21 2,774.04 # 36581 204.73 194.49 223.66 # 37184 468.49 445.07 511.83 36582 1,097.56 1,042.68 1,199.08 37185 837.74 795.85 915.23 # 36582 299.77 284.78 327.50 # 37185 171.98 163.38 187.89 36583 1,097.78 1,042.89 1,199.32 37186 1,715.28 1,629.52 1,873.95 # 36583 299.99 284.99 327.74 # 37186 264.89 251.65 289.40 36584 237.50 225.63 259.47 37187 2,434.21 2,312.50 2,659.38 # 36584 73.95 70.25 80.79 # 37187 435.34 413.57 475.61 36585 1,129.30 1,072.84 1,233.77 37188 2,073.24 1,969.58 2,265.02 # 36585 282.05 267.95 308.14 # 37188 315.71 299.92 344.91 36589 168.44 160.02 184.02 37195 365.50 347.23 399.31 # 36589 141.31 134.24 154.38 37200 242.90 230.76 265.37 36590 275.51 261.73 300.99 37201 289.25 274.79 316.01 # 36590 199.72 189.73 218.19 37202 349.41 331.94 381.73 36591 24.21 23.00 26.45 37203 1,406.95 1,336.60 1,537.09 36592 26.60 25.27 29.06 # 37203 276.87 263.03 302.48 36593 38.52 36.59 42.08 37204 964.98 916.73 1,054.24 36595 632.80 601.16 691.33 37205 3,506.47 3,331.15 3,830.82 # 36595 196.41 186.59 214.58 # 37205 454.91 432.16 496.98 36596 142.30 135.19 155.47 37206 2,098.41 1,993.49 2,292.51 # 36596 46.97 44.62 51.31 # 37206 221.20 210.14 241.66 36597 131.64 125.06 143.82 37207 440.30 418.29 481.03 # 36597 65.42 62.15 71.47 37208 212.56 201.93 232.22 36598 119.60 113.62 130.66 37209 118.89 112.95 129.89 # 36598 63.36 60.19 69.22 37210 3,713.55 3,527.87 4,057.05 36600 31.32 29.75 34.21 # 37210 575.83 547.04 629.10 # 36600 15.36 14.59 16.78 37215 1,134.87 1,078.13 1,239.85 36620 50.48 47.96 55.15 37250 113.17 107.51 123.64 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 33 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 84.09 79.89 91.87 38550 446.85 424.51 488.19 37500 695.31 660.54 759.62 38555 925.66 879.38 1,011.29 37565 688.39 653.97 752.07 38562 665.82 632.53 727.41 37600 703.63 668.45 768.72 38564 658.63 625.70 719.56 37605 805.12 764.86 879.59 38570 536.91 510.06 586.57 37606 527.31 500.94 576.08 38571 843.61 801.43 921.64 37607 376.68 357.85 411.53 38572 923.85 877.66 1,009.31 37609 289.93 275.43 316.74 38700 744.83 707.59 813.73 # 37609 194.99 185.24 213.03 38720 1,233.98 1,172.28 1,348.12 37615 466.26 442.95 509.39 38724 1,337.54 1,270.66 1,461.26 37616 1,080.96 1,026.91 1,180.95 38740 624.50 593.28 682.27 37617 1,281.50 1,217.43 1,400.04 38745 793.59 753.91 867.00 37618 373.78 355.09 408.35 38746 259.70 246.72 283.73 37620 672.94 639.29 735.18 38747 252.31 239.69 275.64 37650 509.19 483.73 556.29 38760 783.06 743.91 855.50 37660 1,199.60 1,139.62 1,310.56 38765 1,213.59 1,152.91 1,325.85 37700 251.69 239.11 274.98 38770 816.77 775.93 892.32 37718 409.89 389.40 447.81 38780 1,028.90 977.46 1,124.08 37722 475.12 451.36 519.06 38790 80.75 76.71 88.22 37735 632.04 600.44 690.51 38792 39.69 37.71 43.37 37760 622.19 591.08 679.74 38794 308.24 292.83 336.75 37765 447.11 424.75 488.46 39000 478.05 454.15 522.27 37766 542.26 515.15 592.42 39010 789.51 750.03 862.53 37780 259.67 246.69 283.69 39200 872.63 829.00 953.35 37785 353.29 335.63 385.97 39220 1,123.15 1,066.99 1,227.04 # 37785 260.34 247.32 284.42 39400 491.06 466.51 536.49 37788 1,380.33 1,311.31 1,508.01 39501 799.24 759.28 873.17 37790 500.55 475.52 546.85 39502 956.92 909.07 1,045.43 38100 1,036.47 984.65 1,132.35 39503 5,534.59 5,257.86 6,046.54 38101 1,042.45 990.33 1,138.88 39520 958.10 910.20 1,046.73 38102 247.57 235.19 270.47 39530 915.69 869.91 1,000.40 38115 1,152.11 1,094.50 1,258.68 39531 955.41 907.64 1,043.79 38120 965.94 917.64 1,055.29 39540 815.13 774.37 890.53 38200 138.83 131.89 151.67 39541 879.19 835.23 960.51 38205 80.34 76.32 87.77 39545 870.23 826.72 950.73 38206 80.34 76.32 87.77 39560 749.82 712.33 819.18 38220 158.28 150.37 172.93 39561 1,168.15 1,109.74 1,276.20 # 38220 60.55 57.52 66.15 40490 124.27 118.06 135.77 38221 174.95 166.20 191.13 # 40490 70.42 66.90 76.94 # 38221 76.82 72.98 83.93 40500 470.82 447.28 514.37 38230 313.21 297.55 342.18 # 40500 342.38 325.26 374.05 38240 124.67 118.44 136.21 40510 454.11 431.40 496.11 38241 125.47 119.20 137.08 # 40510 337.23 320.37 368.43 38242 95.03 90.28 103.82 40520 467.41 444.04 510.65 38300 259.23 246.27 283.21 # 40520 341.36 324.29 372.93 # 38300 171.87 163.28 187.77 40525 529.18 502.72 578.13 38305 432.87 411.23 472.91 40527 624.14 592.93 681.87 38308 413.45 392.78 451.70 40530 514.66 488.93 562.27 38380 533.91 507.21 583.29 # 40530 386.61 367.28 422.37 38381 792.43 752.81 865.73 40650 389.01 369.56 424.99 38382 641.25 609.19 700.57 # 40650 272.14 258.53 297.31 38500 299.25 284.29 326.93 40652 458.03 435.13 500.40 # 38500 233.03 221.38 254.59 # 40652 332.78 316.14 363.56 38505 127.65 121.27 139.46 40654 539.06 512.11 588.93 # 38505 74.60 70.87 81.50 # 40654 403.44 383.27 440.76 38510 481.41 457.34 525.94 40700 880.20 836.19 961.62 # 38510 393.65 373.97 430.07 40701 1,094.39 1,039.67 1,195.62 38520 432.33 410.71 472.32 40702 845.20 802.94 923.38 38525 391.49 371.92 427.71 40720 937.08 890.23 1,023.76 38530 503.18 478.02 549.72 40761 1,015.02 964.27 1,108.91 38542 480.74 456.70 525.21 40800 190.40 180.88 208.01 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 34 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 121.00 114.95 132.19 41019 478.13 454.22 522.35 40801 289.36 274.89 316.12 41100 158.73 150.79 173.41 # 40801 208.39 197.97 227.67 # 41100 104.48 99.26 114.15 40804 193.99 184.29 211.93 41105 158.80 150.86 173.49 # 40804 122.19 116.08 133.49 # 41105 105.74 100.45 115.52 40805 303.03 287.88 331.06 41108 136.95 130.10 149.62 # 40805 215.67 204.89 235.62 # 41108 85.50 81.23 93.41 40806 102.11 97.00 111.55 41110 197.17 187.31 215.41 # 40806 32.70 31.07 35.73 # 41110 124.97 118.72 136.53 40808 171.58 163.00 187.45 41112 309.76 294.27 338.41 # 40808 101.77 96.68 111.18 # 41112 237.96 226.06 259.97 40810 189.90 180.41 207.47 41113 338.89 321.95 370.24 # 40810 120.10 114.10 131.22 # 41113 263.90 250.71 288.32 40812 265.46 252.19 290.02 41114 605.67 575.39 661.70 # 40812 185.68 176.40 202.86 41115 229.64 218.16 250.88 40814 355.99 338.19 388.92 # 41115 141.08 134.03 154.13 # 40814 287.38 273.01 313.96 41116 304.27 289.06 332.42 40816 374.77 356.03 409.43 # 41116 208.14 197.73 227.39 # 40816 300.17 285.16 327.93 41120 1,002.79 952.65 1,095.55 40818 331.55 314.97 362.22 41130 1,229.56 1,168.08 1,343.29 # 40818 258.55 245.62 282.46 41135 2,034.99 1,933.24 2,223.23 40819 284.45 270.23 310.76 41140 2,100.56 1,995.53 2,294.86 # 40819 221.43 210.36 241.91 41145 2,624.21 2,493.00 2,866.95 40820 249.30 236.84 272.37 41150 2,076.04 1,972.24 2,268.08 # 40820 163.93 155.73 179.09 41153 2,246.17 2,133.86 2,453.94 40830 227.45 216.08 248.49 41155 2,782.36 2,643.24 3,039.73 # 40830 150.46 142.94 164.38 41250 213.47 202.80 233.22 40831 301.30 286.24 329.18 # 41250 133.69 127.01 146.06 # 40831 211.55 200.97 231.12 41251 219.67 208.69 239.99 40840 761.80 723.71 832.27 # 41251 155.45 147.68 169.83 # 40840 602.24 572.13 657.95 41252 288.11 273.70 314.76 40842 749.44 711.97 818.77 # 41252 201.15 191.09 219.75 # 40842 588.68 559.25 643.14 41500 428.11 406.70 467.71 40843 974.53 925.80 1,064.67 41510 392.89 373.25 429.24 # 40843 761.12 723.06 831.52 41512 595.02 565.27 650.06 40844 1,293.56 1,228.88 1,413.21 41520 324.64 308.41 354.67 # 40844 1,068.98 1,015.53 1,167.86 # 41520 241.28 229.22 263.60 40845 1,402.76 1,332.62 1,532.51 41530 3,084.35 2,930.13 3,369.65 # 40845 1,194.94 1,135.19 1,305.47 # 41530 389.80 370.31 425.86 41000 150.17 142.66 164.06 41800 214.79 204.05 234.66 # 41000 105.50 100.23 115.26 # 41800 122.64 116.51 133.99 41005 212.94 202.29 232.63 41805 221.60 210.52 242.10 # 41005 121.20 115.14 132.41 # 41805 156.97 149.12 171.49 41006 337.39 320.52 368.60 41806 320.76 304.72 350.43 # 41006 245.65 233.37 268.38 # 41806 241.78 229.69 264.14 41007 338.79 321.85 370.13 41822 269.01 255.56 293.89 # 41007 238.66 226.73 260.74 # 41822 166.09 157.79 181.46 41008 348.07 330.67 380.27 41823 400.08 380.08 437.09 # 41008 254.73 241.99 278.29 # 41823 302.35 287.23 330.31 41009 369.77 351.28 403.97 41825 193.58 183.90 211.49 # 41009 276.82 262.98 302.43 # 41825 120.18 114.17 131.30 41010 191.54 181.96 209.25 41826 270.33 256.81 295.33 # 41010 104.18 98.97 113.82 # 41826 192.94 183.29 210.78 41015 397.29 377.43 434.04 41827 400.04 380.04 437.05 # 41015 318.31 302.39 347.75 # 41827 285.16 270.90 311.54 41016 408.00 387.60 445.74 41828 284.64 270.41 310.97 # 41016 330.61 314.08 361.19 # 41828 205.25 194.99 224.24 41017 411.19 390.63 449.22 41830 361.46 343.39 394.90 # 41017 332.21 315.60 362.94 # 41830 264.52 251.29 288.98 41018 469.49 446.02 512.92 41872 340.17 323.16 371.63 # 41018 387.31 367.94 423.13 # 41872 246.82 234.48 269.65 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 99 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 344.67 327.44 376.56 42425 809.92 769.42 884.83 # 41874 241.36 229.29 263.68 42426 1,312.48 1,246.86 1,433.89 42000 148.43 141.01 162.16 42440 448.62 426.19 490.12 # 42000 97.77 92.88 106.81 42450 428.93 407.48 468.60 42100 140.44 133.42 153.43 # 42450 344.37 327.15 376.22 # 42100 103.74 98.55 113.33 42500 409.46 388.99 447.34 42104 196.33 186.51 214.49 # 42500 328.08 311.68 358.43 # 42104 130.52 123.99 142.59 42505 529.03 502.58 577.97 42106 249.03 236.58 272.07 # 42505 437.28 415.42 477.73 # 42106 171.24 162.68 187.08 42507 494.91 470.16 540.68 42107 429.33 407.86 469.04 42508 702.58 667.45 767.57 # 42107 328.01 311.61 358.35 42509 799.77 759.78 873.75 42120 925.92 879.62 1,011.56 42510 606.98 576.63 663.12 42140 235.83 224.04 257.65 42550 147.85 140.46 161.53 # 42140 147.68 140.30 161.35 # 42550 66.08 62.78 72.20 42145 668.83 635.39 730.70 42600 460.41 437.39 503.00 42160 227.15 215.79 248.16 # 42600 340.34 323.32 371.82 # 42160 145.78 138.49 159.26 42650 78.96 75.01 86.26 42180 228.15 216.74 249.25 # 42650 57.02 54.17 62.30 # 42180 175.49 166.72 191.73 42660 100.96 95.91 110.30 42182 310.84 295.30 339.60 # 42660 75.43 71.66 82.41 # 42182 255.40 242.63 279.02 42665 293.14 278.48 320.25 42200 847.51 805.13 925.90 # 42665 199.00 189.05 217.41 42205 902.17 857.06 985.62 42700 178.03 169.13 194.50 42210 1,020.15 969.14 1,114.51 # 42700 130.16 123.65 142.20 42215 672.94 639.29 735.18 42720 434.76 413.02 474.97 42220 521.81 495.72 570.08 # 42720 379.71 360.72 414.83 42225 907.07 861.72 990.98 42725 777.03 738.18 848.91 42226 898.36 853.44 981.46 42800 149.18 141.72 162.98 42227 873.94 830.24 954.78 # 42800 107.29 101.93 117.22 42235 713.96 678.26 780.00 42802 229.89 218.40 251.16 42260 791.26 751.70 864.46 # 42802 130.97 124.42 143.08 # 42260 652.45 619.83 712.80 42804 192.12 182.51 209.89 42280 148.05 140.65 161.75 # 42804 111.14 105.58 121.42 # 42280 98.99 94.04 108.15 42806 216.07 205.27 236.06 42281 191.59 182.01 209.31 # 42806 129.90 123.41 141.92 # 42281 145.31 138.04 158.75 42808 216.74 205.90 236.79 42300 196.10 186.30 214.25 # 42808 158.11 150.20 172.73 # 42300 145.44 138.17 158.90 42809 161.02 152.97 175.92 42305 412.25 391.64 450.39 # 42809 123.93 117.73 135.39 42310 152.31 144.69 166.39 42810 367.18 348.82 401.14 # 42310 118.81 112.87 129.80 # 42810 273.84 260.15 299.17 42320 235.86 224.07 257.68 42815 533.09 506.44 582.41 # 42320 170.05 161.55 185.78 42820 280.06 266.06 305.97 42330 219.46 208.49 239.76 42821 292.63 278.00 319.70 # 42330 157.63 149.75 172.21 42825 251.86 239.27 275.16 42335 350.65 333.12 383.09 42826 243.01 230.86 265.49 # 42335 247.73 235.34 270.64 42830 198.87 188.93 217.27 42340 438.98 417.03 479.58 42831 214.84 204.10 234.72 # 42340 324.89 308.65 354.95 42835 179.36 170.39 195.95 42400 104.97 99.72 114.68 42836 233.45 221.78 255.05 # 42400 56.71 53.87 61.95 42842 929.21 882.75 1,015.16 42405 287.49 273.12 314.09 42844 1,303.54 1,238.36 1,424.11 # 42405 218.88 207.94 239.13 42845 2,117.30 2,011.44 2,313.16 42408 429.65 408.17 469.40 42860 180.42 171.40 197.11 # 42408 314.76 299.02 343.87 42870 555.54 527.76 606.92 42409 312.79 297.15 341.72 42890 1,321.61 1,255.53 1,443.86 # 42409 214.66 203.93 234.52 42892 1,729.52 1,643.04 1,889.50 42410 596.02 566.22 651.15 42894 2,213.61 2,102.93 2,418.37 42415 1,071.74 1,018.15 1,170.87 42900 332.46 315.84 363.22 42420 1,227.47 1,166.10 1,341.02 42950 766.16 727.85 837.03 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 36 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 945.49 898.22 1,032.95 43245 185.68 176.40 202.86 42955 720.55 684.52 787.20 43246 248.44 236.02 271.42 42960 162.79 154.65 177.85 43247 198.81 188.87 217.20 42961 404.54 384.31 441.96 43248 188.16 178.75 205.56 42962 500.07 475.07 546.33 43249 173.22 164.56 189.24 42970 372.72 354.08 407.19 43250 185.61 176.33 202.78 42971 440.26 418.25 480.99 43251 216.20 205.39 236.20 42972 494.00 469.30 539.70 43255 281.27 267.21 307.29 43020 506.29 480.98 553.13 43256 252.60 239.97 275.97 43030 502.03 476.93 548.47 43257 309.40 293.93 338.02 43045 1,267.96 1,204.56 1,385.24 43258 264.93 251.68 289.43 43100 599.84 569.85 655.33 43259 301.85 286.76 329.77 43101 990.53 941.00 1,082.15 43260 345.62 328.34 377.59 43107 2,441.00 2,318.95 2,666.79 43261 363.29 345.13 396.90 43108 4,069.92 3,866.42 4,446.38 43262 426.52 405.19 465.97 43112 2,608.07 2,477.67 2,849.32 43263 422.09 400.99 461.14 43113 4,078.82 3,874.88 4,456.11 43264 511.91 486.31 559.26 43116 4,629.55 4,398.07 5,057.78 43265 574.38 545.66 627.51 43117 2,384.19 2,264.98 2,604.73 43267 424.52 403.29 463.78 43118 3,356.09 3,188.29 3,666.53 43268 432.10 410.50 472.08 43121 2,674.85 2,541.11 2,922.28 43269 472.71 449.07 516.43 43122 2,411.26 2,290.70 2,634.31 43271 426.12 404.81 465.53 43123 4,092.37 3,887.75 4,470.91 43272 425.32 404.05 464.66 43124 3,506.80 3,331.46 3,831.18 43273 128.84 122.40 140.76 43130 758.32 720.40 828.46 43279 1,193.12 1,133.46 1,303.48 43135 1,405.75 1,335.46 1,535.78 43280 997.39 947.52 1,089.65 43200 211.71 201.12 231.29 43300 597.12 567.26 652.35 # 43200 102.02 96.92 111.46 43305 1,062.44 1,009.32 1,160.72 43201 291.46 276.89 318.42 43310 1,478.32 1,404.40 1,615.06 # 43201 127.91 121.51 139.74 43312 1,630.83 1,549.29 1,781.68 43202 279.01 265.06 304.82 43313 2,587.11 2,457.75 2,826.41 # 43202 112.67 107.04 123.10 43314 2,976.01 2,827.21 3,251.29 43204 221.81 210.72 242.33 43320 1,297.52 1,232.64 1,417.54 43205 222.39 211.27 242.96 43324 1,256.54 1,193.71 1,372.77 43215 151.95 144.35 166.00 43325 1,236.77 1,174.93 1,351.17 43216 193.60 183.92 211.51 43326 1,264.34 1,201.12 1,381.29 # 43216 141.74 134.65 154.85 43330 1,213.13 1,152.47 1,325.34 43217 372.17 353.56 406.59 43331 1,319.88 1,253.89 1,441.97 # 43217 166.74 158.40 182.16 43340 1,259.44 1,196.47 1,375.94 43219 169.34 160.87 185.00 43341 1,392.14 1,322.53 1,520.91 43220 125.23 118.97 136.82 43350 1,075.12 1,021.36 1,174.56 43226 139.69 132.71 152.62 43351 1,266.84 1,203.50 1,384.03 43227 207.51 197.13 226.70 43352 1,037.15 985.29 1,133.08 43228 221.72 210.63 242.22 43360 2,211.55 2,100.97 2,416.12 43231 188.81 179.37 206.28 43361 2,465.01 2,341.76 2,693.02 43232 259.87 246.88 283.91 43400 1,529.93 1,453.43 1,671.44 43234 276.34 262.52 301.90 43401 1,437.12 1,365.26 1,570.05 # 43234 117.58 111.70 128.46 43405 1,397.11 1,327.25 1,526.34 43235 297.87 282.98 325.43 43410 958.58 910.65 1,047.25 # 43235 143.89 136.70 157.21 43415 1,628.27 1,546.86 1,778.89 43236 371.12 352.56 405.44 43420 957.25 909.39 1,045.80 # 43236 174.86 166.12 191.04 43425 1,432.17 1,360.56 1,564.64 43237 238.17 226.26 260.20 43450 157.66 149.78 172.25 43238 294.69 279.96 321.95 # 43450 88.25 83.84 96.42 43239 344.45 327.23 376.31 43453 300.40 285.38 328.19 # 43239 170.13 161.62 185.86 # 43453 95.77 90.98 104.63 43240 395.05 375.30 431.60 43456 609.84 579.35 666.25 43241 154.50 146.78 168.80 # 43456 153.90 146.21 168.14 43242 421.34 400.27 460.31 43458 386.21 366.90 421.94 43243 265.66 252.38 290.24 # 43458 179.58 170.60 196.19 43244 294.56 279.83 321.80 43460 217.59 206.71 237.72 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 99 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 2,111.43 2,005.86 2,306.74 44021 895.08 850.33 977.88 43500 713.78 678.09 779.80 44025 900.38 855.36 983.66 43501 1,224.98 1,163.73 1,338.29 44050 852.95 810.30 931.85 43502 1,386.70 1,317.37 1,514.98 44055 1,362.43 1,294.31 1,488.46 43510 885.50 841.23 967.41 44100 113.59 107.91 124.10 43520 647.25 614.89 707.12 44110 771.91 733.31 843.31 43600 105.14 99.88 114.86 44111 897.92 853.02 980.97 43605 757.13 719.27 827.16 44120 1,110.44 1,054.92 1,213.16 43610 893.71 849.02 976.37 44121 228.30 216.89 249.42 43611 1,112.03 1,056.43 1,214.89 44125 1,079.18 1,025.22 1,179.00 43620 1,808.20 1,717.79 1,975.46 44126 2,224.59 2,113.36 2,430.36 43621 2,054.48 1,951.76 2,244.52 44127 2,589.70 2,460.22 2,829.25 43622 2,085.38 1,981.11 2,278.28 44128 229.52 218.04 250.75 43631 1,328.45 1,262.03 1,451.33 44130 1,161.24 1,103.18 1,268.66 43632 1,800.28 1,710.27 1,966.81 44137 1,032.54 980.91 1,128.05 43633 1,714.82 1,629.08 1,873.44 44139 114.24 108.53 124.81 43634 1,893.65 1,798.97 2,068.82 44140 1,229.46 1,167.99 1,343.19 43635 105.79 100.50 115.58 44141 1,617.71 1,536.82 1,767.34 43640 1,068.72 1,015.28 1,167.57 44143 1,515.16 1,439.40 1,655.31 43641 1,077.53 1,023.65 1,177.20 44144 1,587.71 1,508.32 1,734.57 43644 1,579.45 1,500.48 1,725.55 44145 1,530.01 1,453.51 1,671.54 43645 1,689.62 1,605.14 1,845.91 44146 1,914.71 1,818.97 2,091.82 43651 596.83 566.99 652.04 44147 1,716.63 1,630.80 1,875.42 43652 697.47 662.60 761.99 44150 1,682.77 1,598.63 1,838.42 43653 510.49 484.97 557.72 44151 1,921.97 1,825.87 2,099.75 43752 41.14 39.08 44.94 44155 1,882.06 1,787.96 2,056.15 43760 341.12 324.06 372.67 44156 2,070.51 1,966.98 2,262.03 # 43760 49.93 47.43 54.54 44157 1,966.08 1,867.78 2,147.95 43761 121.66 115.58 132.92 44158 2,014.76 1,914.02 2,201.12 # 43761 106.50 101.18 116.36 44160 1,132.35 1,075.73 1,237.09 43770 1,016.59 965.76 1,110.62 44180 845.87 803.58 924.12 43771 1,158.15 1,100.24 1,265.28 44186 598.56 568.63 653.92 43772 875.78 831.99 956.79 44187 1,009.13 958.67 1,102.47 43773 1,159.23 1,101.27 1,266.46 44188 1,116.06 1,060.26 1,219.30 43774 876.62 832.79 957.71 44202 1,272.35 1,208.73 1,390.04 43800 848.58 806.15 927.07 44203 227.22 215.86 248.24 43810 918.91 872.96 1,003.90 44204 1,419.08 1,348.13 1,550.35 43820 1,186.88 1,127.54 1,296.67 44205 1,239.51 1,177.53 1,354.16 43825 1,182.27 1,123.16 1,291.63 44206 1,611.06 1,530.51 1,760.09 43830 632.70 601.07 691.23 44207 1,689.31 1,604.84 1,845.57 43831 531.78 505.19 580.97 44208 1,840.08 1,748.08 2,010.29 43832 970.63 922.10 1,060.42 44210 1,646.56 1,564.23 1,798.86 43840 1,203.91 1,143.71 1,315.27 44211 2,020.42 1,919.40 2,207.31 43843 1,152.51 1,094.88 1,259.11 44212 1,896.14 1,801.33 2,071.53 43845 1,782.27 1,693.16 1,947.13 44213 179.13 170.17 195.70 43846 1,486.14 1,411.83 1,623.60 44227 1,536.34 1,459.52 1,678.45 43847 1,622.11 1,541.00 1,772.15 44300 767.21 728.85 838.18 43848 1,760.92 1,672.87 1,923.80 44310 957.32 909.45 1,045.87 43850 1,473.87 1,400.18 1,610.21 44312 547.30 519.94 597.93 43855 1,540.96 1,463.91 1,683.50 44314 928.31 881.89 1,014.17 43860 1,497.12 1,422.26 1,635.60 44316 1,267.46 1,204.09 1,384.70 43865 1,557.13 1,479.27 1,701.16 44320 1,092.71 1,038.07 1,193.78 43870 643.84 611.65 703.40 44322 880.23 836.22 961.65 43880 1,463.05 1,389.90 1,598.39 44340 551.97 524.37 603.03 43886 307.40 292.03 335.83 44345 957.50 909.63 1,046.07 43887 288.91 274.46 315.63 44346 1,073.37 1,019.70 1,172.66 43888 406.32 386.00 443.90 44360 156.74 148.90 171.24 44005 1,000.03 950.03 1,092.53 44361 172.65 164.02 188.62 44010 787.57 748.19 860.42 44363 204.00 193.80 222.87 44015 135.91 129.11 148.48 44364 219.90 208.91 240.25 44020 884.36 840.14 966.16 44365 195.84 186.05 213.96 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 38 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 259.17 246.21 283.14 45005 236.69 224.86 258.59 44369 264.64 251.41 289.12 # 45005 142.55 135.42 155.73 44370 285.48 271.21 311.89 45020 493.65 468.97 539.32 44372 251.62 239.04 274.90 45100 265.25 251.99 289.79 44373 204.00 193.80 222.87 45108 321.77 305.68 351.53 44376 301.17 286.11 329.03 45110 1,695.10 1,610.35 1,851.90 44377 319.60 303.62 349.16 45111 995.99 946.19 1,088.12 44378 409.74 389.25 447.64 45112 1,740.43 1,653.41 1,901.42 44379 434.82 413.08 475.04 45113 1,788.21 1,698.80 1,953.62 44380 68.66 65.23 75.01 45114 1,631.46 1,549.89 1,782.37 44382 82.54 78.41 90.17 45116 1,465.65 1,392.37 1,601.23 44383 175.99 167.19 192.27 45119 1,789.68 1,700.20 1,955.23 44385 245.75 233.46 268.48 45120 1,432.18 1,360.57 1,564.66 # 44385 104.54 99.31 114.21 45121 1,566.29 1,487.98 1,711.18 44386 343.39 326.22 375.15 45123 1,015.23 964.47 1,109.14 # 44386 122.80 116.66 134.16 45126 2,646.07 2,513.77 2,890.84 44388 339.35 322.38 370.74 45130 992.42 942.80 1,084.22 # 44388 163.04 154.89 178.12 45135 1,216.94 1,156.09 1,329.50 44389 394.76 375.02 431.27 45136 1,684.79 1,600.55 1,840.63 # 44389 182.15 173.04 199.00 45150 365.98 347.68 399.83 44390 455.11 432.35 497.20 45160 905.62 860.34 989.39 # 44390 218.16 207.25 238.34 45170 708.66 673.23 774.21 44391 509.75 484.26 556.90 45190 619.07 588.12 676.34 # 44391 248.87 236.43 271.89 45300 103.55 98.37 113.13 44392 426.17 404.86 465.59 # 45300 46.91 44.56 51.24 # 44392 214.36 203.64 234.19 45303 822.54 781.41 898.62 44393 493.75 469.06 539.42 # 45303 79.39 75.42 86.73 # 44393 273.16 259.50 298.43 45305 168.90 160.46 184.53 44394 498.89 473.95 545.04 # 45305 71.96 68.36 78.61 # 44394 253.17 240.51 276.59 45307 186.84 177.50 204.13 44397 273.59 259.91 298.90 # 45307 90.30 85.79 98.66 44500 25.80 24.51 28.19 45308 171.80 163.21 187.69 44602 1,254.88 1,192.14 1,370.96 # 45308 76.86 73.02 83.97 44603 1,439.33 1,367.36 1,572.46 45309 193.77 184.08 211.69 44604 969.23 920.77 1,058.89 # 45309 90.06 85.56 98.39 44605 1,196.35 1,136.53 1,307.01 45315 207.92 197.52 227.15 44615 985.73 936.44 1,076.91 # 45315 101.82 96.73 111.24 44620 787.37 748.00 860.20 45317 200.03 190.03 218.53 44625 931.63 885.05 1,017.81 # 45317 106.69 101.36 116.56 44626 1,479.45 1,405.48 1,616.30 45320 202.29 192.18 221.01 44640 1,291.28 1,226.72 1,410.73 # 45320 102.17 97.06 111.62 44650 1,343.19 1,276.03 1,467.43 45321 98.65 93.72 107.78 44660 1,304.20 1,238.99 1,424.84 45327 115.34 109.57 126.01 44661 1,459.57 1,386.59 1,594.58 45330 134.00 127.30 146.40 44680 973.35 924.68 1,063.38 # 45330 61.00 57.95 66.64 44700 941.94 894.84 1,029.07 45331 170.70 162.17 186.50 44701 157.89 150.00 172.50 # 45331 74.16 70.45 81.02 44715 355.62 337.84 388.52 45332 280.84 266.80 306.82 44720 259.20 246.24 283.18 # 45332 108.11 102.70 118.11 44721 363.93 345.73 397.59 45333 282.55 268.42 308.68 44800 696.74 661.90 761.19 # 45333 107.44 102.07 117.38 44820 767.41 729.04 838.40 45334 162.90 154.76 177.97 44850 677.06 643.21 739.69 45335 241.94 229.84 264.32 44900 693.09 658.44 757.21 # 45335 89.96 85.46 98.28 44901 1,000.05 950.05 1,092.56 45337 139.37 132.40 152.26 # 44901 177.92 169.02 194.37 45338 314.00 298.30 343.05 44950 587.31 557.94 641.63 # 45338 139.69 132.71 152.62 44955 79.43 75.46 86.78 45339 323.05 306.90 352.94 44960 789.73 750.24 862.78 # 45339 184.63 175.40 201.71 44970 541.32 514.25 591.39 45340 434.18 412.47 474.34 45000 379.52 360.54 414.62 # 45340 113.06 107.41 123.52 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 39 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 155.51 147.73 169.89 46070 211.95 201.35 231.55 45342 237.53 225.65 259.50 46080 213.95 203.25 233.74 45345 172.62 163.99 188.59 # 46080 144.94 137.69 158.34 45355 198.03 188.13 216.35 46083 163.81 155.62 178.96 45378 391.20 371.64 427.39 # 46083 98.39 93.47 107.49 # 45378 213.29 202.63 233.02 46200 361.72 343.63 395.17 45378 53 134.00 127.30 146.40 # 46200 277.15 263.29 302.78 # 45378 53 61.00 57.95 66.64 46210 333.87 317.18 364.76 45379 496.65 471.82 542.59 # 46210 234.14 222.43 255.79 # 45379 266.88 253.54 291.57 46211 449.39 426.92 490.96 45380 469.71 446.22 513.15 # 46211 339.69 322.71 371.12 # 45380 257.10 244.25 280.89 46220 174.56 165.83 190.70 45381 457.62 434.74 499.95 # 46220 105.15 99.89 114.87 # 45381 243.41 231.24 265.93 46221 227.46 216.09 248.50 45382 619.68 588.70 677.01 # 46221 167.62 159.24 183.13 # 45382 328.48 312.06 358.87 46230 237.56 225.68 259.53 45383 556.74 528.90 608.24 # 46230 156.18 148.37 170.63 # 45383 329.77 313.28 360.27 46250 396.04 376.24 432.68 45384 460.03 437.03 502.58 # 46250 277.17 263.31 302.81 # 45384 266.57 253.24 291.23 46255 440.93 418.88 481.71 45385 528.37 501.95 577.24 # 46255 314.88 299.14 344.01 # 45385 304.98 289.73 333.19 46257 368.33 349.91 402.40 45386 659.79 626.80 720.82 46258 402.39 382.27 439.61 # 45386 262.09 248.99 286.34 46260 417.63 396.75 456.26 45387 341.99 324.89 373.62 46261 466.02 442.72 509.13 45391 295.36 280.59 322.68 46262 487.26 462.90 532.34 45392 373.16 354.50 407.68 46270 426.71 405.37 466.18 45395 1,833.43 1,741.76 2,003.02 # 46270 333.37 316.70 364.21 45397 1,982.39 1,883.27 2,165.76 46275 450.91 428.36 492.61 45400 1,056.43 1,003.61 1,154.15 # 46275 356.77 338.93 389.77 45402 1,410.76 1,340.22 1,541.25 46280 407.82 387.43 445.54 45500 468.47 445.05 511.81 46285 437.54 415.66 478.01 45505 514.58 488.85 562.18 # 46285 351.77 334.18 384.31 45520 121.88 115.79 133.16 46288 481.00 456.95 525.49 # 45520 36.51 34.68 39.88 46320 156.74 148.90 171.24 45540 973.90 925.21 1,063.99 # 46320 99.30 94.34 108.49 45541 840.20 798.19 917.92 46500 192.02 182.42 209.78 45550 1,339.96 1,272.96 1,463.90 # 46500 113.44 107.77 123.94 45560 666.09 632.79 727.71 46505 246.38 234.06 269.17 45562 1,019.82 968.83 1,114.15 # 46505 206.49 196.17 225.60 45563 1,475.57 1,401.79 1,612.06 46600 77.60 73.72 84.78 45800 1,144.37 1,087.15 1,250.22 # 46600 36.11 34.30 39.45 45805 1,291.09 1,226.54 1,410.52 46604 492.67 468.04 538.25 45820 1,135.25 1,078.49 1,240.26 # 46604 62.26 59.15 68.02 45825 1,368.35 1,299.93 1,494.92 46606 199.24 189.28 217.67 45900 181.19 172.13 197.95 # 46606 68.40 64.98 74.73 45905 154.73 146.99 169.04 46608 205.60 195.32 224.62 45910 182.89 173.75 199.81 # 46608 75.56 71.78 82.55 45915 290.57 276.04 317.45 46610 203.40 193.23 222.21 # 45915 204.81 194.57 223.76 # 46610 74.95 71.20 81.88 45990 100.77 95.73 110.09 46611 159.35 151.38 174.09 46020 233.39 221.72 254.98 # 46611 77.58 73.70 84.76 # 46020 203.08 192.93 221.87 46612 244.09 231.89 266.67 46030 118.30 112.39 129.25 # 46612 92.11 87.50 100.63 # 46030 80.41 76.39 87.85 46614 122.41 116.29 133.73 46040 457.43 434.56 499.74 # 46614 66.16 62.85 72.28 # 46040 364.09 345.89 397.77 46615 139.76 132.77 152.69 46045 373.16 354.50 407.68 # 46615 93.89 89.20 102.58 46050 166.67 158.34 182.09 46700 577.32 548.45 630.72 # 46050 85.30 81.04 93.20 46705 479.21 455.25 523.54 46060 411.43 390.86 449.49 46706 153.48 145.81 167.68 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 99 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 980.51 931.48 1,071.20 47142 4,172.65 3,964.02 4,558.62 46712 1,994.65 1,894.92 2,179.16 47143 301.07 286.02 328.92 46715 472.32 448.70 516.01 47144 451.59 429.01 493.36 46716 1,160.68 1,102.65 1,268.05 47145 451.59 429.01 493.36 46730 1,739.02 1,652.07 1,899.88 47146 310.19 294.68 338.88 46735 2,029.40 1,927.93 2,217.12 47147 361.94 343.84 395.42 46740 1,861.26 1,768.20 2,033.43 47300 1,018.09 967.19 1,112.27 46742 2,199.53 2,089.55 2,402.98 47350 1,248.45 1,186.03 1,363.93 46744 3,131.26 2,974.70 3,420.91 47360 1,695.46 1,610.69 1,852.29 46746 3,629.44 3,447.97 3,965.17 47361 2,782.23 2,643.12 3,039.59 46748 3,772.39 3,583.77 4,121.34 47362 1,294.35 1,229.63 1,414.07 46750 696.63 661.80 761.07 47370 1,140.77 1,083.73 1,246.29 46751 582.26 553.15 636.12 47371 1,163.69 1,105.51 1,271.34 46753 527.37 501.00 576.15 47380 1,332.54 1,265.91 1,455.80 46754 257.03 244.18 280.81 47381 1,359.28 1,291.32 1,485.02 # 46754 195.20 185.44 213.26 47382 843.01 800.86 920.99 46760 984.79 935.55 1,075.88 47400 1,930.84 1,834.30 2,109.45 46761 850.48 807.96 929.15 47420 1,222.40 1,161.28 1,335.47 46762 839.45 797.48 917.10 47425 1,234.29 1,172.58 1,348.47 46900 209.68 199.20 229.08 47460 1,167.56 1,109.18 1,275.56 # 46900 127.11 120.75 138.86 47480 779.30 740.34 851.39 46910 219.11 208.15 239.37 47490 527.20 500.84 575.97 # 46910 121.38 115.31 132.61 47500 104.41 99.19 114.07 46916 216.91 206.06 236.97 47505 40.27 38.26 44.00 # 46916 134.34 127.62 146.76 47510 498.10 473.20 544.18 46917 424.70 403.47 463.99 47511 622.55 591.42 680.13 # 46917 122.33 116.21 133.64 47525 617.10 586.25 674.19 46922 228.71 217.27 249.86 # 47525 131.64 125.06 143.82 # 46922 121.41 115.34 132.64 47530 1,481.19 1,407.13 1,618.20 46924 478.71 454.77 522.99 # 47530 374.25 355.54 408.87 # 46924 168.76 160.32 184.37 47550 156.61 148.78 171.10 46930 202.28 192.17 221.00 47552 337.08 320.23 368.26 # 46930 144.44 137.22 157.80 47553 335.79 319.00 366.85 46937 232.36 220.74 253.85 47554 493.16 468.50 538.78 # 46937 160.96 152.91 175.85 47555 403.09 382.94 440.38 46938 406.07 385.77 443.64 47556 455.94 433.14 498.11 # 46938 332.28 315.67 363.02 47560 252.99 240.34 276.39 46940 195.47 185.70 213.56 47561 274.96 261.21 300.39 # 46940 134.04 127.34 146.44 47562 674.83 641.09 737.25 46942 181.41 172.34 198.19 47563 690.27 655.76 754.12 # 46942 119.18 113.22 130.20 47564 796.34 756.52 870.00 46945 255.72 242.93 279.37 47570 711.45 675.88 777.26 # 46945 195.08 185.33 213.13 47600 964.55 916.32 1,053.77 46946 275.79 262.00 301.30 47605 893.68 849.00 976.35 # 46946 204.78 194.54 223.72 47610 1,143.82 1,086.63 1,249.62 46947 342.12 325.01 373.76 47612 1,155.27 1,097.51 1,262.14 47000 330.80 314.26 361.40 47620 1,253.93 1,191.23 1,369.91 # 47000 101.43 96.36 110.81 47630 565.73 537.44 618.06 47001 97.83 92.94 106.88 47700 956.27 908.46 1,044.73 47010 1,090.40 1,035.88 1,191.26 47701 1,643.46 1,561.29 1,795.48 47011 196.32 186.50 214.48 47711 1,420.48 1,349.46 1,551.88 47015 1,034.21 982.50 1,129.88 47712 1,816.50 1,725.68 1,984.53 47100 760.81 722.77 831.19 47715 1,194.80 1,135.06 1,305.32 47120 2,129.48 2,023.01 2,326.46 47720 1,033.44 981.77 1,129.04 47122 3,162.37 3,004.25 3,454.89 47721 1,217.87 1,156.98 1,330.53 47125 2,833.49 2,691.82 3,095.59 47740 1,176.86 1,118.02 1,285.72 47130 3,045.99 2,893.69 3,327.74 47741 1,332.69 1,266.06 1,455.97 47135 4,485.78 4,261.49 4,900.71 47760 1,997.61 1,897.73 2,182.39 47136 3,828.59 3,637.16 4,182.73 47765 2,628.09 2,496.69 2,871.19 47140 3,191.74 3,032.15 3,486.97 47780 2,182.19 2,073.08 2,384.04 47141 3,793.73 3,604.04 4,144.65 47785 2,839.69 2,697.71 3,102.37 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 99 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 1,434.30 1,362.59 1,566.98 49320 304.49 289.27 332.66 47801 1,017.49 966.62 1,111.61 49321 320.36 304.34 349.99 47802 1,377.62 1,308.74 1,505.05 49322 347.72 330.33 379.88 47900 1,241.91 1,179.81 1,356.78 49323 590.45 560.93 645.07 48000 1,717.47 1,631.60 1,876.34 49324 361.52 343.44 394.96 48001 2,109.71 2,004.22 2,304.85 49325 388.05 368.65 423.95 48020 1,062.03 1,008.93 1,160.27 49326 177.14 168.28 193.52 48100 806.25 765.94 880.83 49400 178.92 169.97 195.47 48102 547.86 520.47 598.54 # 49400 99.54 94.56 108.74 # 48102 259.86 246.87 283.90 49402 781.64 742.56 853.94 48105 2,598.82 2,468.88 2,839.21 49419 420.45 399.43 459.34 48120 1,005.61 955.33 1,098.63 49420 133.48 126.81 145.83 48140 1,422.81 1,351.67 1,554.42 49421 361.23 343.17 394.65 48145 1,477.38 1,403.51 1,614.04 49422 360.72 342.68 394.08 48146 1,688.72 1,604.28 1,844.92 49423 588.03 558.63 642.42 48148 1,121.11 1,065.05 1,224.81 # 49423 79.44 75.47 86.79 48150 2,845.92 2,703.62 3,109.16 49424 158.35 150.43 172.99 48152 2,632.23 2,500.62 2,875.71 # 49424 41.47 39.40 45.31 48153 2,841.72 2,699.63 3,104.57 49425 704.77 669.53 769.96 48154 2,638.50 2,506.58 2,882.57 49426 600.32 570.30 655.85 48155 1,639.02 1,557.07 1,790.63 49427 47.82 45.43 52.24 48400 103.28 98.12 112.84 49428 404.67 384.44 442.11 48500 1,028.29 976.88 1,123.41 49429 426.47 405.15 465.92 48510 976.78 927.94 1,067.13 49435 113.37 107.70 123.86 48511 966.47 918.15 1,055.87 49436 169.64 161.16 185.33 # 48511 212.56 201.93 232.22 49440 1,139.42 1,082.45 1,244.82 48520 994.27 944.56 1,086.24 # 49440 241.50 229.43 263.84 48540 1,187.36 1,127.99 1,297.19 49441 1,235.92 1,174.12 1,350.24 48545 1,202.11 1,142.00 1,313.30 # 49441 265.80 252.51 290.39 48547 1,619.71 1,538.72 1,769.53 49442 1,108.84 1,053.40 1,211.41 48548 1,518.72 1,442.78 1,659.20 # 49442 219.30 208.34 239.59 48551 204.63 194.40 223.56 49446 1,037.45 985.58 1,133.42 48552 216.17 205.36 236.16 # 49446 176.23 167.42 192.53 48554 2,273.70 2,160.02 2,484.02 49450 780.38 741.36 852.56 48556 1,129.86 1,073.37 1,234.38 # 49450 70.35 66.83 76.85 49000 709.50 674.03 775.13 49451 740.80 703.76 809.32 49002 924.86 878.62 1,010.41 # 49451 98.18 93.27 107.26 49010 876.48 832.66 957.56 49452 930.96 884.41 1,017.07 49020 1,450.40 1,377.88 1,584.56 # 49452 153.11 145.45 167.27 49021 925.30 879.04 1,010.90 49460 857.57 814.69 936.89 # 49021 179.36 170.39 195.95 # 49460 50.21 47.70 54.86 49040 909.70 864.22 993.85 49465 177.72 168.83 194.15 49041 942.54 895.41 1,029.72 # 49465 32.92 31.27 35.96 # 49041 212.16 201.55 231.78 49491 707.46 672.09 772.90 49060 1,017.99 967.09 1,112.15 49492 863.57 820.39 943.45 49061 927.10 880.75 1,012.86 49495 360.63 342.60 393.99 # 49061 196.32 186.50 214.48 49496 547.08 519.73 597.69 49062 693.89 659.20 758.08 49500 360.40 342.38 393.74 49080 172.90 164.26 188.90 49501 543.02 515.87 593.25 # 49080 71.58 68.00 78.20 49505 471.34 447.77 514.94 49081 161.53 153.45 176.47 49507 578.99 550.04 632.55 # 49081 67.39 64.02 73.62 49520 574.70 545.97 627.87 49180 172.09 163.49 188.01 49521 699.74 664.75 764.46 # 49180 91.91 87.31 100.41 49525 520.10 494.10 568.22 49203 1,109.24 1,053.78 1,211.85 49540 614.39 583.67 671.22 49204 1,414.63 1,343.90 1,545.49 49550 522.55 496.42 570.88 49205 1,618.85 1,537.91 1,768.60 49553 571.45 542.88 624.31 49215 2,029.77 1,928.28 2,217.52 49555 543.92 516.72 594.23 49220 885.96 841.66 967.91 49557 659.47 626.50 720.48 49250 531.20 504.64 580.34 49560 674.14 640.43 736.49 49255 719.89 683.90 786.49 49561 848.69 806.26 927.20 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 99 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 698.86 663.92 763.51 50360 2,305.94 2,190.64 2,519.24 49566 857.49 814.62 936.81 50365 2,597.27 2,467.41 2,837.52 49568 251.52 238.94 274.78 50370 1,078.95 1,025.00 1,178.75 49570 371.92 353.32 406.32 50380 1,833.29 1,741.63 2,002.87 49572 459.15 436.19 501.62 50382 1,368.72 1,300.28 1,495.32 49580 290.80 276.26 317.70 # 50382 296.48 281.66 323.91 49582 429.49 408.02 469.22 50384 1,176.21 1,117.40 1,285.01 49585 399.44 379.47 436.39 # 50384 269.92 256.42 294.88 49587 472.35 448.73 516.04 50385 1,343.05 1,275.90 1,467.29 49590 518.21 492.30 566.15 # 50385 254.46 241.74 278.00 49600 668.36 634.94 730.18 50386 868.91 825.46 949.28 49605 4,583.01 4,353.86 5,006.94 # 50386 192.38 182.76 210.17 49606 1,041.35 989.28 1,137.67 50387 635.60 603.82 694.39 49610 620.67 589.64 678.09 # 50387 107.46 102.09 117.40 49611 561.24 533.18 613.16 50389 368.98 350.53 403.11 49650 388.86 369.42 424.83 # 50389 59.03 56.08 64.49 49651 502.03 476.93 548.47 50390 104.41 99.19 114.07 49652 726.67 690.34 793.89 50391 136.47 129.65 149.10 49653 907.23 861.87 991.15 # 50391 106.56 101.23 116.41 49654 833.53 791.85 910.63 50392 192.53 182.90 210.34 49655 1,003.32 953.15 1,096.12 50393 234.60 222.87 256.30 49656 836.57 794.74 913.95 50394 112.35 106.73 122.74 49657 1,206.13 1,145.82 1,317.69 # 50394 53.71 51.02 58.67 49900 745.60 708.32 814.57 50395 194.00 184.30 211.95 49904 1,392.61 1,322.98 1,521.43 50396 125.76 119.47 137.39 49905 335.58 318.80 366.62 50398 571.68 543.10 624.57 50010 729.05 692.60 796.49 # 50398 79.44 75.47 86.79 50020 1,037.34 985.47 1,133.29 50400 1,227.52 1,166.14 1,341.06 50021 974.36 925.64 1,064.49 50405 1,488.99 1,414.54 1,626.72 # 50021 178.96 170.01 195.51 50500 1,186.29 1,126.98 1,296.03 50040 979.15 930.19 1,069.72 50520 1,101.86 1,046.77 1,203.79 50045 988.64 939.21 1,080.09 50525 1,373.56 1,304.88 1,500.61 50060 1,216.14 1,155.33 1,328.63 50526 1,434.51 1,362.78 1,567.20 50065 1,277.02 1,213.17 1,395.15 50540 1,201.24 1,141.18 1,312.36 50070 1,270.98 1,207.43 1,388.54 50541 980.50 931.48 1,071.20 50075 1,561.34 1,483.27 1,705.76 50542 1,244.33 1,182.11 1,359.43 50080 930.27 883.76 1,016.32 50543 1,587.10 1,507.75 1,733.91 50081 1,364.48 1,296.26 1,490.70 50544 1,336.24 1,269.43 1,459.84 50100 993.31 943.64 1,085.19 50545 1,434.42 1,362.70 1,567.11 50120 1,007.56 957.18 1,100.76 50546 1,273.80 1,210.11 1,391.63 50125 1,041.76 989.67 1,138.12 50547 1,529.16 1,452.70 1,670.61 50130 1,102.61 1,047.48 1,204.60 50548 1,445.76 1,373.47 1,579.49 50135 1,193.06 1,133.41 1,303.42 50551 397.14 377.28 433.87 50200 150.59 143.06 164.52 # 50551 318.56 302.63 348.02 50205 699.54 664.56 764.24 50553 413.82 393.13 452.10 50220 1,084.76 1,030.52 1,185.10 # 50553 336.04 319.24 367.13 50225 1,255.37 1,192.60 1,371.49 50555 451.44 428.87 493.20 50230 1,360.68 1,292.65 1,486.55 # 50555 368.07 349.67 402.12 50234 1,382.14 1,313.03 1,509.98 50557 460.84 437.80 503.47 50236 1,565.63 1,487.35 1,710.45 # 50557 373.89 355.20 408.48 50240 1,406.17 1,335.86 1,536.24 50561 522.34 496.22 570.65 50250 1,305.81 1,240.52 1,426.60 # 50561 427.00 405.65 466.50 50280 1,003.45 953.28 1,096.27 50562 629.80 598.31 688.06 50290 924.32 878.10 1,009.82 50570 532.79 506.15 582.07 50320 1,370.84 1,302.30 1,497.65 50572 580.10 551.10 633.77 50323 183.98 174.78 201.00 50574 612.20 581.59 668.83 50325 183.98 174.78 201.00 50575 774.03 735.33 845.63 50327 202.33 192.21 221.04 50576 611.38 580.81 667.93 50328 177.76 168.87 194.20 50580 654.33 621.61 714.85 50329 176.06 167.26 192.35 50590 1,005.46 955.19 1,098.47 50340 844.83 802.59 922.98 # 50590 601.38 571.31 657.01 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 99 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 3,920.40 3,724.38 4,283.04 50980 386.10 366.80 421.82 # 50592 386.97 367.62 422.76 51020 495.75 470.96 541.60 50593 5,058.72 4,805.78 5,526.65 51030 490.37 465.85 535.73 # 50593 488.96 464.51 534.19 51040 311.04 295.49 339.81 50600 995.06 945.31 1,087.11 51045 493.51 468.83 539.15 50605 957.77 909.88 1,046.36 51050 502.37 477.25 548.84 50610 1,017.00 966.15 1,111.07 51060 618.26 587.35 675.45 50620 964.14 915.93 1,053.32 51065 613.75 583.06 670.52 50630 939.15 892.19 1,026.02 51080 431.02 409.47 470.89 50650 1,098.90 1,043.96 1,200.55 51100 65.21 61.95 71.24 50660 1,214.05 1,153.35 1,326.35 # 51100 40.88 38.84 44.67 50684 196.12 186.31 214.26 51101 135.94 129.14 148.51 # 50684 53.31 50.64 58.24 # 51101 54.96 52.21 60.04 50686 96.96 92.11 105.93 51102 254.17 241.46 277.68 50688 85.07 80.82 92.94 # 51102 160.82 152.78 175.70 50690 107.08 101.73 116.99 51500 659.54 626.56 720.54 # 50690 74.77 71.03 81.68 51520 622.05 590.95 679.59 50700 985.15 935.89 1,076.27 51525 912.88 867.24 997.33 50715 1,159.76 1,101.77 1,267.04 51530 813.74 773.05 889.01 50722 1,009.05 958.60 1,102.39 51535 826.80 785.46 903.28 50725 1,155.41 1,097.64 1,262.29 51550 1,002.60 952.47 1,095.34 50727 534.92 508.17 584.40 51555 1,332.03 1,265.43 1,455.24 50728 733.44 696.77 801.29 51565 1,361.93 1,293.83 1,487.90 50740 1,136.37 1,079.55 1,241.48 51570 1,553.05 1,475.40 1,696.71 50750 1,236.07 1,174.27 1,350.41 51575 1,942.45 1,845.33 2,122.13 50760 1,151.92 1,094.32 1,258.47 51580 2,025.55 1,924.27 2,212.91 50770 1,193.72 1,134.03 1,304.13 51585 2,255.06 2,142.31 2,463.66 50780 1,156.03 1,098.23 1,262.96 51590 2,053.09 1,950.44 2,243.01 50782 1,134.69 1,077.96 1,239.65 51595 2,333.36 2,216.69 2,549.19 50783 1,175.86 1,117.07 1,284.63 51596 2,509.10 2,383.65 2,741.20 50785 1,282.26 1,218.15 1,400.87 51597 2,419.06 2,298.11 2,642.83 50800 976.47 927.65 1,066.80 51600 210.72 200.18 230.21 50810 1,280.03 1,216.03 1,398.43 # 51600 47.18 44.82 51.54 50815 1,300.37 1,235.35 1,420.65 51605 41.10 39.05 44.91 50820 1,383.14 1,313.98 1,511.08 51610 120.24 114.23 131.36 50825 1,754.29 1,666.58 1,916.57 # 51610 67.99 64.59 74.28 50830 1,902.30 1,807.19 2,078.27 51700 94.25 89.54 102.97 50840 1,308.75 1,243.31 1,429.81 # 51700 47.18 44.82 51.54 50845 1,328.98 1,262.53 1,451.91 51701 65.93 62.63 72.02 50860 1,006.24 955.93 1,099.32 # 51701 28.84 27.40 31.51 50900 885.34 841.07 967.23 51702 85.48 81.21 93.39 50920 936.45 889.63 1,023.07 # 51702 32.03 30.43 34.99 50930 1,128.49 1,072.07 1,232.88 51703 151.88 144.29 165.93 50940 942.11 895.00 1,029.25 # 51703 87.26 82.90 95.34 50945 1,043.91 991.71 1,140.47 51705 122.71 116.57 134.06 50947 1,478.90 1,404.96 1,615.70 # 51705 71.65 68.07 78.28 50948 1,373.03 1,304.38 1,500.04 51710 172.79 164.15 188.77 50951 414.91 394.16 453.28 # 51710 101.79 96.70 111.21 # 50951 332.34 315.72 363.08 51715 316.18 300.37 345.43 50953 437.56 415.68 478.03 # 51715 212.07 201.47 231.69 # 50953 366.56 348.23 400.46 51720 125.35 119.08 136.94 50955 484.59 460.36 529.41 # 51720 89.05 84.60 97.29 # 50955 396.04 376.24 432.68 51725 240.35 228.33 262.58 50957 470.49 446.97 514.02 51725 TC 159.46 151.49 174.21 # 50957 383.13 363.97 418.57 51725 26 80.89 76.85 88.38 50961 424.93 403.68 464.23 51726 351.48 333.91 384.00 # 50961 343.15 325.99 374.89 51726 TC 259.46 246.49 283.46 50970 402.13 382.02 439.32 51726 26 92.01 87.41 100.52 50972 387.04 367.69 422.84 51736 57.71 54.82 63.04 50974 512.27 486.66 559.66 51736 TC 24.61 23.38 26.89 50976 504.51 479.28 551.17 51736 26 33.11 31.45 36.17 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 44 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 90.71 86.17 99.10 52270 448.96 426.51 490.49 51741 TC 28.87 27.43 31.54 # 52270 196.46 186.64 214.64 51741 26 61.83 58.74 67.55 52275 613.83 583.14 670.61 51772 269.42 255.95 294.34 # 52275 268.78 255.34 293.64 51772 TC 183.67 174.49 200.66 52276 287.01 272.66 313.56 51772 26 85.74 81.45 93.67 52277 350.33 332.81 382.73 51784 219.93 208.93 240.27 52281 336.57 319.74 367.70 51784 TC 138.32 131.40 151.11 # 52281 166.64 158.31 182.06 51784 26 81.61 77.53 89.16 52282 361.36 343.29 394.78 51785 239.20 227.24 261.33 52283 306.18 290.87 334.50 51785 TC 157.47 149.60 172.04 # 52283 216.03 205.23 236.01 51785 26 81.74 77.65 89.30 52285 309.04 293.59 337.63 51792 252.89 240.25 276.29 # 52285 209.32 198.85 228.68 51792 TC 194.25 184.54 212.22 52290 264.11 250.90 288.54 51792 26 58.63 55.70 64.06 52300 303.08 287.93 331.12 51795 331.68 315.10 362.37 52301 318.94 302.99 348.44 51795 TC 249.67 237.19 272.77 52305 301.09 286.04 328.95 51795 26 82.01 77.91 89.60 52310 275.50 261.73 300.99 51797 163.78 155.59 178.93 # 52310 163.41 155.24 178.53 51797 TC 116.66 110.83 127.45 52315 486.66 462.33 531.68 51797 26 47.12 44.76 51.47 # 52315 296.78 281.94 324.23 51798 22.95 21.80 25.07 52317 1,055.52 1,002.74 1,153.15 51800 1,108.71 1,053.27 1,211.26 # 52317 376.20 357.39 411.00 51820 1,128.54 1,072.11 1,232.93 52318 512.47 486.85 559.88 51840 675.43 641.66 737.91 52320 266.39 253.07 291.03 51841 800.55 760.52 874.60 52325 346.38 329.06 378.42 51845 616.47 585.65 673.50 52327 582.86 553.72 636.78 51860 752.85 715.21 822.49 # 52327 282.89 268.75 309.06 51865 931.63 885.05 1,017.81 52330 860.36 817.34 939.94 51880 489.78 465.29 535.08 # 52330 285.15 270.89 311.52 51900 864.40 821.18 944.36 52332 533.39 506.72 582.73 51920 799.72 759.73 873.69 # 52332 168.40 159.98 183.98 51925 1,042.56 990.43 1,138.99 52334 277.25 263.39 302.90 51940 1,699.57 1,614.59 1,856.78 52341 315.85 300.06 345.07 51960 1,472.34 1,398.72 1,608.53 52342 343.22 326.06 374.97 51980 756.33 718.51 826.29 52343 381.58 362.50 416.88 51990 775.58 736.80 847.32 52344 414.01 393.31 452.31 51992 844.54 802.31 922.66 52345 441.37 419.30 482.20 52000 228.05 216.65 249.15 52346 497.86 472.97 543.92 # 52000 133.91 127.21 146.29 52351 339.44 322.47 370.84 52001 414.55 393.82 452.89 52352 398.64 378.71 435.52 # 52001 309.64 294.16 338.28 52353 458.38 435.46 500.78 52005 317.33 301.46 346.68 52354 423.75 402.56 462.94 # 52005 143.02 135.87 156.25 52355 504.87 479.63 551.57 52007 599.21 569.25 654.64 52400 520.34 494.32 568.47 # 52007 178.77 169.83 195.30 52402 289.78 275.29 316.58 52010 443.36 421.19 484.37 52450 499.02 474.07 545.18 # 52010 172.91 164.26 188.90 52500 521.33 495.26 569.55 52204 490.47 465.95 535.84 52601 877.84 833.95 959.04 # 52204 151.41 143.84 165.42 52630 472.20 448.59 515.88 52214 643.36 611.19 702.87 52640 324.75 308.51 354.79 # 52214 235.68 223.90 257.49 52647 2,408.39 2,287.97 2,631.17 52224 926.67 880.34 1,012.39 # 52647 687.15 652.79 750.71 # 52224 182.73 173.59 199.63 52648 2,457.27 2,334.41 2,684.57 52234 266.24 252.93 290.87 # 52648 732.84 696.20 800.63 52235 312.04 296.44 340.91 52649 1,047.53 995.15 1,144.42 52240 544.79 517.55 595.18 52700 461.53 438.45 504.22 52250 261.64 248.56 285.84 53000 158.95 151.00 173.65 52260 225.51 214.23 246.36 53010 312.19 296.58 341.07 52265 467.46 444.09 510.70 53020 104.57 99.34 114.24 # 52265 169.88 161.39 185.60 53025 68.77 65.33 75.13 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 45 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 418.04 397.14 456.71 53852 2,668.12 2,534.71 2,914.92 53060 184.94 175.69 202.04 # 53852 660.08 627.08 721.14 # 53060 162.60 154.47 177.64 54000 170.58 162.05 186.36 53080 465.06 441.81 508.08 # 54000 114.74 109.00 125.35 53085 652.85 620.21 713.24 54001 208.46 198.04 227.75 53200 165.79 157.50 181.13 # 54001 147.03 139.68 160.63 # 53200 150.24 142.73 164.14 54015 330.50 313.98 361.08 53210 818.47 777.55 894.18 54050 128.14 121.73 139.99 53215 993.38 943.71 1,085.27 # 54050 101.02 95.97 110.37 53220 479.65 455.67 524.02 54055 122.27 116.16 133.58 53230 638.29 606.38 697.34 # 54055 92.75 88.11 101.33 53235 679.53 645.55 742.38 54056 133.98 127.28 146.37 53240 457.71 434.82 500.04 # 54056 104.46 99.24 114.13 53250 424.98 403.73 464.29 54057 147.97 140.57 161.66 53260 212.38 201.76 232.02 # 54057 97.71 92.82 106.74 # 53260 186.45 177.13 203.70 54060 198.86 188.92 217.26 53265 236.73 224.89 258.62 # 54060 135.44 128.67 147.97 # 53265 196.05 186.25 214.19 54065 216.66 205.83 236.70 53270 216.16 205.35 236.15 # 54065 165.20 156.94 180.48 # 53270 191.82 182.23 209.56 54100 200.21 190.20 218.73 53275 283.00 268.85 309.18 # 54100 122.42 116.30 133.75 53400 851.87 809.28 930.67 54105 298.71 283.77 326.34 53405 937.87 890.98 1,024.63 # 54105 230.10 218.60 251.39 53410 1,045.59 993.31 1,142.31 54110 664.22 631.01 725.66 53415 1,204.54 1,144.31 1,315.96 54111 856.99 814.14 936.26 53420 853.91 811.21 932.89 54112 1,005.63 955.35 1,098.65 53425 1,006.98 956.63 1,100.12 54115 482.13 458.02 526.72 53430 1,002.66 952.53 1,095.41 # 54115 448.62 426.19 490.12 53431 1,231.06 1,169.51 1,344.94 54120 671.97 638.37 734.13 53440 934.22 887.51 1,020.64 54125 864.59 821.36 944.56 53442 823.59 782.41 899.77 54130 1,278.51 1,214.58 1,396.77 53444 849.28 806.82 927.84 54135 1,620.85 1,539.81 1,770.78 53445 939.10 892.15 1,025.97 54150 182.31 173.19 199.17 53446 687.40 653.03 750.98 # 54150 103.33 98.16 112.88 53447 867.98 824.58 948.27 54160 253.20 240.54 276.62 53448 1,367.98 1,299.58 1,494.52 # 54160 154.67 146.94 168.98 53449 653.24 620.58 713.67 54161 210.39 199.87 229.85 53450 435.59 413.81 475.88 54162 292.09 277.49 319.11 53460 488.67 464.24 533.88 # 54162 209.12 198.66 228.46 53500 783.42 744.25 855.89 54163 233.05 221.40 254.61 53502 516.49 490.67 564.27 54164 205.69 195.41 224.72 53505 519.07 493.12 567.09 54200 120.01 114.01 131.11 53510 674.60 640.87 737.00 # 54200 90.89 86.35 99.30 53515 849.02 806.57 927.56 54205 572.64 544.01 625.61 53520 592.54 562.91 647.35 54220 230.99 219.44 252.36 53600 93.10 88.45 101.72 # 54220 144.03 136.83 157.35 # 53600 69.16 65.70 75.56 54230 105.40 100.13 115.15 53601 91.37 86.80 99.82 # 54230 85.85 81.56 93.79 # 53601 57.87 54.98 63.23 54231 152.30 144.69 166.39 53605 69.31 65.84 75.72 # 54231 126.37 120.05 138.06 53620 133.67 126.99 146.04 54235 97.68 92.80 106.72 # 53620 94.18 89.47 102.89 # 54235 78.93 74.98 86.23 53621 127.18 120.82 138.94 54240 110.10 104.60 120.29 # 53621 78.11 74.20 85.33 54240 TC 38.75 36.81 42.33 53660 79.82 75.83 87.20 54240 26 71.35 67.78 77.95 # 53660 44.32 42.10 48.42 54250 134.65 127.92 147.11 53661 79.38 75.41 86.72 54250 TC 13.71 13.02 14.97 # 53661 43.48 41.31 47.51 54250 26 120.94 114.89 132.12 53665 40.42 38.40 44.16 54300 693.05 658.40 757.16 53850 2,777.10 2,638.25 3,033.99 54304 810.99 770.44 886.01 # 53850 605.50 575.23 661.51 54308 772.35 733.73 843.79 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 99 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 893.18 848.52 975.80 55040 359.19 341.23 392.41 54316 1,077.96 1,024.06 1,177.67 55041 538.98 512.03 588.83 54318 780.28 741.27 852.46 55060 401.54 381.46 438.68 54322 843.90 801.71 921.97 55100 233.06 221.41 254.62 54324 1,047.90 995.51 1,144.84 # 55100 171.23 162.67 187.07 54326 982.35 933.23 1,073.21 55110 408.05 387.65 445.80 54328 997.98 948.08 1,090.29 55120 374.82 356.08 409.49 54332 1,091.58 1,037.00 1,192.55 55150 516.56 490.73 564.34 54336 1,235.68 1,173.90 1,349.99 55175 384.50 365.28 420.07 54340 601.84 571.75 657.51 55180 728.41 691.99 795.79 54344 1,035.94 984.14 1,131.76 55200 534.73 507.99 584.19 54348 1,098.29 1,043.38 1,199.89 # 55200 294.19 279.48 321.40 54352 1,547.38 1,470.01 1,690.51 55250 474.51 450.78 518.40 54360 778.16 739.25 850.14 # 55250 242.75 230.61 265.20 54380 862.28 819.17 942.05 55300 191.85 182.26 209.60 54385 1,044.63 992.40 1,141.26 55400 538.45 511.53 588.26 54390 1,256.59 1,193.76 1,372.82 55450 413.59 392.91 451.85 54400 570.76 542.22 623.55 # 55450 271.18 257.62 296.26 54401 701.89 666.80 766.82 55500 397.78 377.89 434.57 54405 865.13 821.87 945.15 55520 408.11 387.70 445.86 54406 780.72 741.68 852.93 55530 376.62 357.79 411.46 54408 840.58 798.55 918.33 55535 454.34 431.62 496.36 54410 922.93 876.78 1,008.30 55540 493.65 468.97 539.32 54411 1,090.06 1,035.56 1,190.89 55550 449.49 427.02 491.07 54415 562.74 534.60 614.79 55600 454.33 431.61 496.35 54416 753.49 715.82 823.19 55605 534.51 507.78 583.95 54417 956.31 908.49 1,044.76 55650 759.69 721.71 829.97 54420 757.19 719.33 827.23 55680 361.17 343.11 394.58 54430 686.86 652.52 750.40 55700 250.71 238.17 273.90 54435 446.22 423.91 487.50 # 55700 145.40 138.13 158.85 54450 78.78 74.84 86.07 55705 288.05 273.65 314.70 # 54450 62.83 59.69 68.64 55706 409.22 388.76 447.07 54500 81.05 77.00 88.55 55720 494.22 469.51 539.94 54505 228.40 216.98 249.53 55725 626.16 594.85 684.08 54512 571.09 542.54 623.92 55801 1,158.37 1,100.45 1,265.52 54520 347.66 330.28 379.82 55810 1,399.51 1,329.53 1,528.96 54522 619.34 588.37 676.63 55812 1,719.98 1,633.98 1,879.08 54530 541.64 514.56 591.74 55815 1,885.88 1,791.59 2,060.33 54535 782.13 743.02 854.47 55821 932.57 885.94 1,018.83 54550 521.11 495.05 569.31 55831 1,010.12 959.61 1,103.55 54560 707.65 672.27 773.11 55840 1,428.99 1,357.54 1,561.17 54600 482.56 458.43 527.19 55842 1,530.96 1,454.41 1,672.57 54620 323.65 307.47 353.59 55845 1,749.58 1,662.10 1,911.42 54640 496.65 471.82 542.59 55860 935.35 888.58 1,021.87 54650 757.73 719.84 827.82 55862 1,181.89 1,122.80 1,291.22 54660 379.71 360.72 414.83 55865 1,430.55 1,359.02 1,562.87 54670 431.87 410.28 471.82 55866 1,859.75 1,766.76 2,031.77 54680 834.74 793.00 911.95 55870 189.06 179.61 206.55 54690 672.39 638.77 734.59 # 55870 154.36 146.64 168.64 54692 825.20 783.94 901.53 55873 1,220.25 1,159.24 1,333.13 54700 225.20 213.94 246.03 55875 813.09 772.44 888.31 54800 141.62 134.54 154.72 55876 153.92 146.22 168.15 54830 393.48 373.81 429.88 # 55876 114.43 108.71 125.02 54840 345.38 328.11 377.33 55920 454.22 431.51 496.24 54860 445.48 423.21 486.69 56405 106.38 101.06 116.22 54861 601.08 571.03 656.68 # 56405 103.98 98.78 113.60 54865 380.10 361.10 415.27 56420 123.83 117.64 135.29 54900 800.78 760.74 874.85 # 56420 89.52 85.04 97.80 54901 1,146.05 1,088.75 1,252.06 56440 178.26 169.35 194.75 55000 131.56 124.98 143.73 56441 147.59 140.21 161.24 # 55000 90.07 85.57 98.41 # 56441 139.22 132.26 152.10 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 47 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 48.04 45.64 52.49 57200 289.17 274.71 315.92 56501 128.27 121.86 140.14 57210 357.58 339.70 390.66 # 56501 110.72 105.18 120.96 57220 311.35 295.78 340.15 56515 217.27 206.41 237.37 57230 388.38 368.96 424.30 # 56515 190.94 181.39 208.60 57240 641.27 609.21 700.59 56605 82.23 78.12 89.84 57250 626.14 594.83 684.05 # 56605 59.09 56.14 64.56 57260 780.03 741.03 852.18 56606 37.86 35.97 41.37 57265 872.47 828.85 953.18 # 56606 29.08 27.63 31.77 57267 263.08 249.93 287.42 56620 480.82 456.78 525.30 57268 468.19 444.78 511.50 56625 575.60 546.82 628.84 57270 772.91 734.26 844.40 56630 838.72 796.78 916.30 57280 939.51 892.53 1,026.41 56631 1,066.66 1,013.33 1,165.33 57282 497.14 472.28 543.12 56632 1,236.05 1,174.25 1,350.39 57283 666.88 633.54 728.57 56633 1,092.78 1,038.14 1,193.86 57284 814.88 774.14 890.26 56634 1,155.04 1,097.29 1,261.88 57285 649.56 617.08 709.64 56637 1,363.57 1,295.39 1,489.70 57287 688.88 654.44 752.61 56640 1,359.43 1,291.46 1,485.18 57288 722.38 686.26 789.20 56700 181.00 171.95 197.74 57289 758.70 720.77 828.89 56740 287.78 273.39 314.40 57291 528.06 501.66 576.91 56800 237.14 225.28 259.07 57292 805.23 764.97 879.72 56805 1,111.22 1,055.66 1,214.01 57295 480.90 456.86 525.39 56810 254.38 241.66 277.91 57296 918.54 872.61 1,003.50 56820 108.90 103.46 118.98 57300 515.49 489.72 563.18 # 56820 82.57 78.44 90.21 57305 857.66 814.78 937.00 56821 145.57 138.29 159.03 57307 959.82 911.83 1,048.60 # 56821 112.06 106.46 122.43 57308 614.28 583.57 671.11 57000 185.75 176.46 202.93 57310 482.95 458.80 527.62 57010 417.53 396.65 456.15 57311 550.49 522.97 601.42 57020 92.15 87.54 100.67 57320 548.51 521.08 599.24 # 57020 79.38 75.41 86.72 57330 776.20 737.39 848.00 57022 161.47 153.40 176.41 57335 1,128.79 1,072.35 1,233.20 57023 302.42 287.30 330.40 57400 132.29 125.68 144.53 57061 112.09 106.49 122.46 57410 104.02 98.82 113.64 # 57061 94.93 90.18 103.71 57415 155.86 148.07 170.28 57065 188.23 178.82 205.64 57420 114.40 108.68 124.98 # 57065 166.29 157.98 181.68 # 57420 87.68 83.30 95.80 57100 86.93 82.58 94.97 57421 153.96 146.26 168.20 # 57100 63.80 60.61 69.70 # 57421 119.65 113.67 130.72 57105 133.43 126.76 145.77 57423 898.22 853.31 981.31 # 57105 122.27 116.16 133.58 57425 946.99 899.64 1,034.59 57106 460.58 437.55 503.18 57452 107.70 102.32 117.67 57107 1,353.14 1,285.48 1,478.30 # 57452 89.75 85.26 98.05 57109 1,545.55 1,468.27 1,688.51 57454 151.38 143.81 165.38 57110 872.60 828.97 953.32 # 57454 133.43 126.76 145.77 57111 1,563.19 1,485.03 1,707.78 57455 141.51 134.43 154.59 57112 1,657.78 1,574.89 1,811.12 # 57455 108.41 102.99 118.44 57120 497.13 472.27 543.11 57456 133.88 127.19 146.27 57130 177.59 168.71 194.02 # 57456 101.18 96.12 110.54 # 57130 157.24 149.38 171.79 57460 298.44 283.52 326.05 57135 190.04 180.54 207.62 # 57460 160.02 152.02 174.82 # 57135 169.30 160.84 184.97 57461 333.72 317.03 364.58 57150 50.62 48.09 55.30 # 57461 184.14 174.93 201.17 # 57150 29.08 27.63 31.77 57500 132.25 125.64 144.49 57155 411.63 391.05 449.71 # 57500 72.82 69.18 79.56 57160 76.56 72.73 83.64 57505 100.24 95.23 109.51 # 57160 46.65 44.32 50.97 # 57505 89.07 84.62 97.31 57170 68.39 64.97 74.72 57510 130.39 123.87 142.45 # 57170 47.25 44.89 51.62 # 57510 113.24 107.58 123.72 57180 140.73 133.69 153.74 57511 142.69 135.56 155.89 # 57180 104.43 99.21 114.09 # 57511 128.33 121.91 140.20 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 99 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 140.69 133.66 153.71 58353 1,168.67 1,110.24 1,276.78 # 57513 129.12 122.66 141.06 # 58353 214.90 204.16 234.78 57520 302.17 287.06 330.12 58356 2,142.36 2,035.24 2,340.53 # 57520 266.27 252.96 290.90 # 58356 339.75 322.76 371.17 57522 258.05 245.15 281.92 58400 435.44 413.67 475.72 # 57522 236.11 224.30 257.95 58410 775.27 736.51 846.99 57530 334.52 317.79 365.46 58520 757.02 719.17 827.05 57531 1,642.23 1,560.12 1,794.14 58540 878.74 834.80 960.02 57540 753.86 716.17 823.60 58541 829.56 788.08 906.29 57545 794.87 755.13 868.40 58542 920.12 874.11 1,005.23 57550 395.08 375.33 431.63 58543 935.28 888.52 1,021.80 57555 580.88 551.84 634.62 58544 1,010.12 959.61 1,103.55 57556 555.13 527.37 606.48 58545 865.07 821.82 945.09 57558 122.74 116.60 134.09 58546 1,095.36 1,040.59 1,196.68 # 57558 110.37 104.85 120.58 58548 1,705.94 1,620.64 1,863.74 57700 298.99 284.04 326.65 58550 855.44 812.67 934.57 57720 298.10 283.20 325.68 58552 942.71 895.57 1,029.91 57800 59.57 56.59 65.08 58553 1,100.92 1,045.87 1,202.75 # 57800 47.60 45.22 52.00 58554 1,260.83 1,197.79 1,377.46 58100 108.40 102.98 118.43 58555 236.87 225.03 258.78 # 58100 85.66 81.38 93.59 # 58555 185.82 176.53 203.01 58110 48.00 45.60 52.44 58558 319.10 303.15 348.62 # 58110 40.42 38.40 44.16 # 58558 261.65 248.57 285.86 58120 244.23 232.02 266.82 58559 336.26 319.45 367.37 # 58120 209.12 198.66 228.46 58560 379.93 360.93 415.07 58140 882.87 838.73 964.54 58561 537.38 510.51 587.09 58145 525.40 499.13 574.00 58562 336.66 319.83 367.80 58146 1,123.60 1,067.42 1,227.53 # 58562 285.20 270.94 311.58 58150 955.65 907.87 1,044.05 58563 1,901.13 1,806.07 2,076.98 58152 1,206.58 1,146.25 1,318.19 # 58563 336.26 319.45 367.37 58180 917.70 871.82 1,002.59 58565 2,020.02 1,919.02 2,206.87 58200 1,262.62 1,199.49 1,379.41 # 58565 432.41 410.79 472.41 58210 1,681.41 1,597.34 1,836.94 58570 890.23 845.72 972.58 58240 2,639.26 2,507.30 2,883.40 58571 976.84 928.00 1,067.20 58260 799.77 759.78 873.75 58572 1,105.30 1,050.04 1,207.55 58262 893.06 848.41 975.67 58573 1,249.26 1,186.80 1,364.82 58263 961.99 913.89 1,050.97 58600 352.28 334.67 384.87 58267 1,021.90 970.81 1,116.43 58605 320.62 304.59 350.28 58270 856.09 813.29 935.28 58611 75.97 72.17 83.00 58275 952.71 905.07 1,040.83 58615 242.72 230.58 265.17 58280 1,018.81 967.87 1,113.05 58660 650.76 618.22 710.95 58285 1,276.32 1,212.50 1,394.38 58661 624.44 593.22 682.20 58290 1,118.24 1,062.33 1,221.68 58662 684.37 650.15 747.67 58291 1,215.12 1,154.36 1,327.51 58670 354.95 337.20 387.78 58292 1,280.06 1,216.06 1,398.47 58671 354.83 337.09 387.65 58293 1,328.66 1,262.23 1,451.56 58672 719.70 683.72 786.28 58294 1,180.65 1,121.62 1,289.86 58673 782.72 743.58 855.12 58301 94.93 90.18 103.71 58700 737.71 700.82 805.94 # 58301 66.21 62.90 72.34 58720 693.24 658.58 757.37 58321 78.05 74.15 85.27 58740 845.03 802.78 923.20 # 58321 48.53 46.10 53.02 58750 878.97 835.02 960.27 58322 86.61 82.28 94.62 58752 885.85 841.56 967.79 # 58322 57.49 54.62 62.81 58760 796.74 756.90 870.44 58323 19.15 18.19 20.92 58770 814.83 774.09 890.20 # 58323 12.37 11.75 13.51 58800 312.36 296.74 341.25 58340 129.78 123.29 141.78 # 58800 289.62 275.14 316.41 # 58340 58.37 55.45 63.77 58805 392.88 373.24 429.23 58345 270.26 256.75 295.26 58820 304.58 289.35 332.75 58346 441.87 419.78 482.75 58822 682.24 648.13 745.35 58350 95.76 90.97 104.62 58823 936.38 889.56 1,022.99 # 58350 76.62 72.79 83.71 # 58823 178.87 169.93 195.42 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 99 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 673.92 640.22 736.25 59412 101.05 96.00 110.40 58900 400.65 380.62 437.71 59414 89.29 84.83 97.55 58920 678.34 644.42 741.08 59425 428.44 407.02 468.07 58925 707.26 671.90 772.69 # 59425 329.92 313.42 360.43 58940 485.53 461.25 530.44 59426 767.06 728.71 838.02 58943 1,078.70 1,024.77 1,178.49 # 59426 583.57 554.39 637.55 58950 1,029.69 978.21 1,124.94 59430 136.61 129.78 149.25 58951 1,325.61 1,259.33 1,448.23 # 59430 122.65 116.52 134.00 58952 1,495.58 1,420.80 1,633.92 59510 1,938.30 1,841.39 2,117.60 58953 1,854.15 1,761.44 2,025.66 59514 887.43 843.06 969.52 58954 2,012.36 1,911.74 2,198.50 59515 1,049.83 997.34 1,146.94 58956 1,305.69 1,240.41 1,426.47 59525 472.03 448.43 515.69 58957 1,427.46 1,356.09 1,559.50 59610 1,802.60 1,712.47 1,969.34 58958 1,586.07 1,506.77 1,732.79 59612 839.82 797.83 917.50 58960 890.33 845.81 972.68 59614 941.88 894.79 1,029.01 58970 219.47 208.50 239.78 59618 2,027.65 1,926.27 2,215.21 # 58970 194.34 184.62 212.31 59620 974.27 925.56 1,064.39 58976 251.81 239.22 275.10 59622 1,138.66 1,081.73 1,243.99 # 58976 218.70 207.77 238.94 59812 305.29 290.03 333.53 59000 128.75 122.31 140.66 # 59812 283.35 269.18 309.56 # 59000 79.29 75.33 86.63 59820 363.29 345.13 396.90 59001 181.18 172.12 197.94 # 59820 336.56 319.73 367.69 59012 198.99 189.04 217.40 59821 368.87 350.43 402.99 59015 153.27 145.61 167.45 # 59821 340.55 323.52 372.05 # 59015 129.73 123.24 141.73 59830 421.71 400.62 460.71 59020 70.63 67.10 77.17 59840 211.85 201.26 231.45 59020 TC 33.87 32.18 37.01 # 59840 204.67 194.44 223.61 59020 26 36.76 34.92 40.16 59841 366.90 348.56 400.84 59025 46.52 44.19 50.82 # 59841 344.97 327.72 376.88 59025 TC 16.91 16.06 18.47 59850 377.20 358.34 412.09 59025 26 29.61 28.13 32.35 59851 387.90 368.51 423.79 59030 110.36 104.84 120.57 59852 545.04 517.79 595.46 59050 49.28 46.82 53.84 59855 402.11 382.00 439.30 59051 40.74 38.70 44.51 59856 474.04 450.34 517.89 59070 389.50 370.03 425.53 59857 566.95 538.60 619.39 # 59070 282.19 268.08 308.29 59866 233.51 221.83 255.10 59072 462.95 439.80 505.77 59870 456.26 433.45 498.47 59074 367.96 349.56 401.99 59871 131.03 124.48 143.15 # 59074 279.40 265.43 305.24 60000 153.75 146.06 167.97 59076 451.78 429.19 493.57 # 60000 139.78 132.79 152.71 59100 797.43 757.56 871.19 60100 114.06 108.36 124.61 59120 762.35 724.23 832.86 # 60100 81.75 77.66 89.31 59121 765.72 727.43 836.54 60200 617.12 586.26 674.20 59130 892.76 848.12 975.34 60210 657.84 624.95 718.69 59135 905.49 860.22 989.25 60212 943.64 896.46 1,030.93 59136 844.56 802.33 922.68 60220 720.88 684.84 787.57 59140 380.81 361.77 416.04 60225 866.79 823.45 946.97 59150 741.39 704.32 809.97 60240 915.33 869.56 999.99 59151 723.91 687.71 790.87 60252 1,235.79 1,174.00 1,350.10 59160 210.13 199.62 229.56 60254 1,592.02 1,512.42 1,739.28 # 59160 175.03 166.28 191.22 60260 1,032.46 980.84 1,127.97 59200 73.82 70.13 80.65 60270 1,300.18 1,235.17 1,420.45 # 59200 43.90 41.71 47.97 60271 997.59 947.71 1,089.87 59300 189.40 179.93 206.92 60280 417.70 396.82 456.34 # 59300 142.73 135.59 155.93 60281 555.05 527.30 606.40 59320 149.81 142.32 163.67 60300 108.96 103.51 119.04 59325 235.53 223.75 257.31 # 60300 50.32 47.80 54.97 59350 269.89 256.40 294.86 60500 949.55 902.07 1,037.38 59400 1,711.68 1,626.10 1,870.02 60502 1,191.66 1,132.08 1,301.89 59409 749.43 711.96 818.75 60505 1,309.57 1,244.09 1,430.70 59410 871.31 827.74 951.90 60512 230.91 219.36 252.26 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 99 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 978.96 930.01 1,069.51 61519 2,735.19 2,598.43 2,988.19 60521 1,126.38 1,070.06 1,230.57 61520 3,488.40 3,313.98 3,811.08 60522 1,356.92 1,289.07 1,482.43 61521 2,937.68 2,790.80 3,209.42 60540 1,032.57 980.94 1,128.08 61522 2,018.10 1,917.20 2,204.78 60545 1,172.88 1,114.24 1,281.38 61524 1,904.81 1,809.57 2,081.01 60600 1,359.15 1,291.19 1,484.87 61526 3,156.03 2,998.23 3,447.96 60605 1,707.48 1,622.11 1,865.43 61530 2,682.25 2,548.14 2,930.36 60650 1,147.44 1,090.07 1,253.58 61531 1,107.77 1,052.38 1,210.24 61000 106.04 100.74 115.85 61533 1,395.53 1,325.75 1,524.61 61001 104.00 98.80 113.62 61534 1,503.83 1,428.64 1,642.94 61020 125.24 118.98 136.83 61535 902.62 857.49 986.11 61026 124.32 118.10 135.82 61536 2,393.27 2,273.61 2,614.65 61050 105.74 100.45 115.52 61537 2,195.94 2,086.14 2,399.06 61055 135.60 128.82 148.14 61538 2,352.36 2,234.74 2,569.95 61070 80.09 76.09 87.50 61539 2,166.03 2,057.73 2,366.39 61105 410.00 389.50 447.93 61540 2,035.39 1,933.62 2,223.66 61107 300.15 285.14 327.91 61541 1,949.86 1,852.37 2,130.23 61108 811.09 770.54 886.12 61542 2,117.76 2,011.87 2,313.65 61120 664.50 631.28 725.97 61543 1,976.98 1,878.13 2,159.85 61140 1,150.63 1,093.10 1,257.07 61544 1,624.86 1,543.62 1,775.16 61150 1,229.05 1,167.60 1,342.74 61545 2,910.94 2,765.39 3,180.20 61151 890.69 846.16 973.08 61546 2,110.43 2,004.91 2,305.65 61154 1,153.75 1,096.06 1,260.47 61548 1,427.91 1,356.51 1,559.99 61156 1,147.91 1,090.51 1,254.09 61550 934.41 887.69 1,020.84 61210 350.40 332.88 382.81 61552 1,227.32 1,165.95 1,340.84 61215 446.12 423.81 487.38 61556 1,503.59 1,428.41 1,642.67 61250 776.74 737.90 848.59 61557 1,554.24 1,476.53 1,698.01 61253 851.62 809.04 930.40 61558 1,587.24 1,507.88 1,734.06 61304 1,513.52 1,437.84 1,653.52 61559 2,221.11 2,110.05 2,426.56 61305 1,822.75 1,731.61 1,991.35 61563 1,779.62 1,690.64 1,944.24 61312 1,888.84 1,794.40 2,063.56 61564 2,233.77 2,122.08 2,440.39 61313 1,809.18 1,718.72 1,976.53 61566 2,059.14 1,956.18 2,249.61 61314 1,675.02 1,591.27 1,829.96 61567 2,313.60 2,197.92 2,527.61 61315 1,906.07 1,810.77 2,082.39 61570 1,684.96 1,600.71 1,840.82 61316 82.47 78.35 90.10 61571 1,832.06 1,740.46 2,001.53 61320 1,762.62 1,674.49 1,925.66 61575 2,169.91 2,061.41 2,370.62 61321 1,929.90 1,833.41 2,108.42 61576 3,480.04 3,306.04 3,801.95 61322 2,140.88 2,033.84 2,338.92 61580 2,294.62 2,179.89 2,506.87 61323 2,177.19 2,068.33 2,378.58 61581 2,574.78 2,446.04 2,812.95 61330 1,485.47 1,411.20 1,622.88 61582 2,662.79 2,529.65 2,909.10 61332 1,725.44 1,639.17 1,885.05 61583 2,682.34 2,548.22 2,930.45 61333 1,741.06 1,654.01 1,902.11 61584 2,610.94 2,480.39 2,852.45 61334 1,127.02 1,070.67 1,231.27 61585 2,755.80 2,618.01 3,010.71 61340 1,314.05 1,248.35 1,435.60 61586 1,997.95 1,898.05 2,182.76 61343 2,027.09 1,925.74 2,214.60 61590 2,909.26 2,763.80 3,178.37 61345 1,877.14 1,783.28 2,050.77 61591 2,931.27 2,784.71 3,202.42 61440 1,837.42 1,745.55 2,007.38 61592 2,937.03 2,790.18 3,208.71 61450 1,737.59 1,650.71 1,898.32 61595 2,208.47 2,098.05 2,412.76 61458 1,856.32 1,763.50 2,028.03 61596 2,417.71 2,296.82 2,641.34 61460 1,876.69 1,782.86 2,050.29 61597 2,655.88 2,523.09 2,901.55 61470 1,743.67 1,656.49 1,904.96 61598 2,353.42 2,235.75 2,571.11 61480 1,690.01 1,605.51 1,846.34 61600 1,990.37 1,890.85 2,174.48 61490 1,757.24 1,669.38 1,919.79 61601 2,181.62 2,072.54 2,383.42 61500 1,242.32 1,180.20 1,357.23 61605 2,078.87 1,974.93 2,271.17 61501 1,065.15 1,011.89 1,163.67 61606 2,790.37 2,650.85 3,048.48 61510 2,003.48 1,903.31 2,188.81 61607 2,579.36 2,450.39 2,817.95 61512 2,361.92 2,243.82 2,580.39 61608 3,009.58 2,859.10 3,287.97 61514 1,754.42 1,666.70 1,916.71 61609 576.96 548.11 630.33 61516 1,711.62 1,626.04 1,869.95 61610 1,770.82 1,682.28 1,934.62 61517 82.50 78.38 90.14 61611 447.25 424.89 488.62 61518 2,541.90 2,414.81 2,777.03 61612 1,566.28 1,487.97 1,711.17 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 51 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 2,921.30 2,775.24 3,191.53 62141 1,058.58 1,005.65 1,156.50 61615 2,309.14 2,193.68 2,522.73 62142 808.40 767.98 883.18 61616 3,033.39 2,881.72 3,313.98 62143 945.80 898.51 1,033.29 61618 1,198.15 1,138.24 1,308.98 62145 1,293.19 1,228.53 1,412.81 61619 1,378.92 1,309.97 1,506.47 62146 1,109.44 1,053.97 1,212.07 61623 549.87 522.38 600.74 62147 1,316.87 1,251.03 1,438.68 61624 1,093.09 1,038.44 1,194.21 62148 117.78 111.89 128.67 61626 889.57 845.09 971.85 62160 180.83 171.79 197.56 61630 1,248.54 1,186.11 1,364.03 62161 1,392.80 1,323.16 1,521.63 61635 1,366.75 1,298.41 1,493.17 62162 1,729.82 1,643.33 1,889.83 61680 2,091.08 1,986.53 2,284.51 62163 1,123.77 1,067.58 1,227.72 61682 3,920.61 3,724.58 4,283.27 62164 1,840.36 1,748.34 2,010.59 61684 2,612.30 2,481.69 2,853.94 62165 1,425.72 1,354.43 1,557.59 61686 4,199.06 3,989.11 4,587.48 62180 1,457.59 1,384.71 1,592.42 61690 1,987.82 1,888.43 2,171.69 62190 832.25 790.64 909.24 61692 3,391.22 3,221.66 3,704.91 62192 885.56 841.28 967.47 61697 3,826.92 3,635.57 4,180.91 62194 360.09 342.09 393.40 61698 4,112.06 3,906.46 4,492.43 62200 1,261.88 1,198.79 1,378.61 61700 3,209.88 3,049.39 3,506.80 62201 1,085.39 1,031.12 1,185.79 61702 3,580.71 3,401.67 3,911.92 62220 930.26 883.75 1,016.31 61703 1,234.21 1,172.50 1,348.38 62223 956.75 908.91 1,045.25 61705 2,359.81 2,241.82 2,578.09 62225 458.46 435.54 500.87 61708 2,022.23 1,921.12 2,209.29 62230 769.71 731.22 840.90 61710 1,850.10 1,757.60 2,021.24 62252 98.48 93.56 107.59 61711 2,407.21 2,286.85 2,629.88 62252 TC 54.00 51.30 59.00 61720 1,071.80 1,018.21 1,170.94 62252 26 44.48 42.26 48.60 61735 1,313.04 1,247.39 1,434.50 62256 536.70 509.87 586.35 61750 1,290.21 1,225.70 1,409.56 62258 1,034.04 982.34 1,129.69 61751 1,259.77 1,196.78 1,376.30 62263 632.63 601.00 691.15 61760 1,417.81 1,346.92 1,548.96 # 62263 362.18 344.07 395.68 61770 1,393.96 1,324.26 1,522.90 62264 385.37 366.10 421.02 61790 782.98 743.83 855.40 # 62264 219.43 208.46 239.73 61791 1,011.93 961.33 1,105.53 62267 250.12 237.61 273.25 61795 233.95 222.25 255.59 # 62267 161.17 153.11 176.08 61796 737.87 700.98 806.13 62268 458.88 435.94 501.33 61797 199.68 189.70 218.16 # 62268 261.02 247.97 285.17 61798 737.87 700.98 806.13 62269 498.11 473.20 544.18 61799 276.05 262.25 301.59 # 62269 264.75 251.51 289.24 61800 141.70 134.62 154.81 62270 152.88 145.24 167.03 61850 899.81 854.82 983.04 # 62270 75.50 71.73 82.49 61860 1,429.48 1,358.01 1,561.71 62272 181.24 172.18 198.01 61863 1,391.37 1,321.80 1,520.07 # 62272 80.32 76.30 87.75 61864 388.49 369.07 424.43 62273 159.85 151.86 174.64 61867 2,039.07 1,937.12 2,227.69 # 62273 106.80 101.46 116.68 61868 570.14 541.63 622.87 62280 300.84 285.80 328.67 61870 1,089.37 1,034.90 1,190.14 # 62280 147.66 140.28 161.32 61875 1,058.41 1,005.49 1,156.31 62281 277.76 263.87 303.45 61880 504.27 479.06 550.92 # 62281 141.73 134.64 154.84 61885 585.53 556.25 639.69 62282 289.55 275.07 316.33 61886 736.76 699.92 804.91 # 62282 131.19 124.63 143.32 61888 367.91 349.51 401.94 62284 221.86 210.77 242.39 62000 801.15 761.09 875.25 # 62284 89.03 84.58 97.27 62005 1,138.62 1,081.69 1,243.94 62287 525.98 499.68 574.63 62010 1,391.51 1,321.93 1,520.22 62290 320.73 304.69 350.39 62100 1,478.26 1,404.35 1,615.00 # 62290 165.16 156.90 180.44 62115 1,307.72 1,242.33 1,428.68 62291 299.94 284.94 327.68 62116 1,632.36 1,550.74 1,783.35 # 62291 159.52 151.54 174.27 62117 1,755.13 1,667.37 1,917.48 62292 469.03 445.58 512.42 62120 1,678.92 1,594.97 1,834.22 62294 760.84 722.80 831.22 62121 1,530.89 1,454.35 1,672.50 62310 211.89 201.30 231.50 62140 964.27 916.06 1,053.47 # 62310 97.01 92.16 105.98 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 52 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 187.65 178.27 205.01 63180 1,284.03 1,219.83 1,402.80 # 62311 80.75 76.71 88.22 63182 1,372.36 1,303.74 1,499.30 62318 226.58 215.25 247.54 63185 1,045.90 993.61 1,142.65 # 62318 96.94 92.09 105.90 63190 1,202.51 1,142.38 1,313.74 62319 204.98 194.73 223.94 63191 1,144.89 1,087.65 1,250.80 # 62319 90.89 86.35 99.30 63194 1,363.92 1,295.72 1,490.08 62350 369.28 350.82 403.44 63195 1,384.29 1,315.08 1,512.34 62351 782.69 743.56 855.09 63196 1,629.59 1,548.11 1,780.33 62355 277.85 263.96 303.55 63197 1,553.41 1,475.74 1,697.10 62360 266.53 253.20 291.18 63198 1,709.37 1,623.90 1,867.49 62361 369.03 350.58 403.17 63199 1,809.94 1,719.44 1,977.36 62362 389.07 369.62 425.06 63200 1,389.98 1,320.48 1,518.55 62365 308.04 292.64 336.54 63250 2,685.78 2,551.49 2,934.21 62367 37.41 35.54 40.87 63251 2,791.85 2,652.26 3,050.10 # 62367 23.05 21.90 25.19 63252 2,794.24 2,654.53 3,052.71 62368 53.23 50.57 58.16 63265 1,538.71 1,461.77 1,681.04 # 62368 36.07 34.27 39.41 63266 1,580.96 1,501.91 1,727.20 63001 1,135.53 1,078.75 1,240.56 63267 1,275.52 1,211.74 1,393.50 63003 1,142.34 1,085.22 1,248.00 63268 1,277.88 1,213.99 1,396.09 63005 1,086.47 1,032.15 1,186.97 63270 1,891.53 1,796.95 2,066.49 63011 1,025.26 974.00 1,120.10 63271 1,903.28 1,808.12 2,079.34 63012 1,104.71 1,049.47 1,206.89 63272 1,753.66 1,665.98 1,915.88 63015 1,365.63 1,297.35 1,491.95 63273 1,653.87 1,571.18 1,806.86 63016 1,401.74 1,331.65 1,531.40 63275 1,651.32 1,568.75 1,804.06 63017 1,145.90 1,088.61 1,251.90 63276 1,645.57 1,563.29 1,797.78 63020 1,085.12 1,030.86 1,185.49 63277 1,445.29 1,373.03 1,578.98 63030 902.82 857.68 986.33 63278 1,413.75 1,343.06 1,544.52 63035 190.42 180.90 208.04 63280 1,954.11 1,856.40 2,134.86 63040 1,315.42 1,249.65 1,437.10 63281 1,931.68 1,835.10 2,110.37 63042 1,232.87 1,171.23 1,346.91 63282 1,823.64 1,732.46 1,992.33 63043 389.76 370.27 425.81 63283 1,727.47 1,641.10 1,887.27 63044 354.43 336.71 387.22 63285 2,394.56 2,274.83 2,616.05 63045 1,177.19 1,118.33 1,286.08 63286 2,387.75 2,268.36 2,608.61 63046 1,124.76 1,068.52 1,228.80 63287 2,517.15 2,391.29 2,749.98 63047 1,028.19 976.78 1,123.30 63290 2,545.40 2,418.13 2,780.85 63048 204.50 194.28 223.42 63295 301.23 286.17 329.10 63050 1,412.79 1,342.15 1,543.47 63300 1,702.11 1,617.00 1,859.55 63051 1,592.56 1,512.93 1,739.87 63301 1,901.33 1,806.26 2,077.20 63055 1,512.93 1,437.28 1,652.87 63302 1,890.73 1,796.19 2,065.62 63056 1,396.66 1,326.83 1,525.85 63303 1,971.28 1,872.72 2,153.63 63057 313.64 297.96 342.65 63304 2,101.59 1,996.51 2,295.99 63064 1,652.59 1,569.96 1,805.45 63305 2,136.80 2,029.96 2,334.45 63066 193.26 183.60 211.14 63306 2,255.73 2,142.94 2,464.38 63075 1,293.84 1,229.15 1,413.52 63307 2,079.52 1,975.54 2,271.87 63076 242.19 230.08 264.59 63308 314.41 298.69 343.49 63077 1,412.49 1,341.87 1,543.15 63600 777.67 738.79 849.61 63078 192.36 182.74 210.15 63610 1,324.88 1,258.64 1,447.44 63081 1,657.66 1,574.78 1,811.00 # 63610 413.40 392.73 451.64 63082 261.45 248.38 285.64 63615 1,059.36 1,006.39 1,157.35 63085 1,764.93 1,676.68 1,928.18 63620 737.87 700.98 806.13 63086 185.17 175.91 202.30 63621 229.58 218.10 250.82 63087 2,254.19 2,141.48 2,462.70 63650 387.17 367.81 422.98 63088 253.69 241.01 277.16 63655 784.72 745.48 857.30 63090 1,843.70 1,751.52 2,014.25 63660 411.42 390.85 449.48 63091 173.93 165.23 190.01 63685 375.29 356.53 410.01 63101 2,117.27 2,011.41 2,313.12 63688 336.86 320.02 368.02 63102 2,107.69 2,002.31 2,302.66 63700 1,136.78 1,079.94 1,241.93 63103 277.84 263.95 303.54 63702 1,279.62 1,215.64 1,397.99 63170 1,421.57 1,350.49 1,553.06 63704 1,422.22 1,351.11 1,553.78 63172 1,280.93 1,216.88 1,399.41 63706 1,660.85 1,577.81 1,814.48 63173 1,579.35 1,500.38 1,725.44 63707 840.88 798.84 918.67 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 99 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 1,020.46 969.44 1,114.86 64484 132.68 126.05 144.96 63710 1,020.72 969.68 1,115.13 # 64484 64.87 61.63 70.87 63740 868.08 824.68 948.38 64505 97.62 92.74 106.65 63741 560.02 532.02 611.82 # 64505 80.87 76.83 88.35 63744 590.74 561.20 645.38 64508 139.14 132.18 152.01 63746 517.69 491.81 565.58 # 64508 66.94 63.59 73.13 64400 103.67 98.49 113.26 64510 137.98 131.08 150.74 # 64400 60.19 57.18 65.76 # 64510 64.59 61.36 70.56 64402 105.72 100.43 115.49 64517 163.11 154.95 178.19 # 64402 68.62 65.19 74.97 # 64517 113.25 107.59 123.73 64405 99.21 94.25 108.39 64520 181.67 172.59 198.48 # 64405 70.09 66.59 76.58 # 64520 73.17 69.51 79.94 64408 115.00 109.25 125.64 64530 186.99 177.64 204.29 # 64408 85.48 81.21 93.39 # 64530 86.47 82.15 94.47 64410 134.59 127.86 147.04 64550 15.19 14.43 16.59 # 64410 75.16 71.40 82.11 # 64550 8.81 8.37 9.63 64412 134.81 128.07 147.28 64553 195.69 185.91 213.80 # 64412 67.40 64.03 73.63 # 64553 151.81 144.22 165.85 64413 110.49 104.97 120.72 64555 208.47 198.05 227.76 # 64413 73.00 69.35 79.75 # 64555 149.44 141.97 163.27 64415 126.04 119.74 137.70 64560 206.19 195.88 225.26 # 64415 70.19 66.68 76.68 # 64560 153.93 146.23 168.16 64416 88.64 84.21 96.84 64561 1,150.00 1,092.50 1,256.38 64417 127.53 121.15 139.32 # 64561 416.03 395.23 454.51 # 64417 69.69 66.21 76.14 64565 164.76 156.52 180.00 64418 130.45 123.93 142.52 # 64565 114.10 108.40 124.66 # 64418 69.81 66.32 76.27 64573 551.90 524.31 602.96 64420 156.75 148.91 171.25 64575 270.46 256.94 295.48 # 64420 63.01 59.86 68.84 64577 338.39 321.47 369.69 64421 231.58 220.00 253.00 64580 281.15 267.09 307.15 # 64421 85.99 81.69 93.94 64581 805.72 765.43 880.24 64425 122.99 116.84 134.37 64585 332.36 315.74 363.10 # 64425 89.08 84.63 97.32 # 64585 156.05 148.25 170.49 64430 152.71 145.07 166.83 64590 310.13 294.62 338.81 # 64430 85.30 81.04 93.20 # 64590 174.10 165.40 190.21 64435 141.24 134.18 154.31 64595 323.29 307.13 353.20 # 64435 81.40 77.33 88.93 # 64595 138.20 131.29 150.98 64445 131.10 124.55 143.23 64600 391.92 372.32 428.17 # 64445 76.85 73.01 83.96 # 64600 203.24 193.08 222.04 64446 88.40 83.98 96.58 64605 548.99 521.54 599.77 64447 66.53 63.20 72.68 # 64605 323.21 307.05 353.11 64448 78.12 74.21 85.34 64610 666.94 633.59 728.63 64449 87.42 83.05 95.51 # 64610 457.52 434.64 499.84 64450 99.57 94.59 108.78 64612 147.94 140.54 161.62 # 64450 69.25 65.79 75.66 # 64612 129.19 122.73 141.14 64455 50.46 47.94 55.13 64613 145.55 138.27 159.01 # 64455 39.29 37.33 42.93 # 64613 121.61 115.53 132.86 64470 256.90 244.06 280.67 64614 163.23 155.07 178.33 # 64470 99.34 94.37 108.53 # 64614 135.31 128.54 147.82 64472 109.29 103.83 119.40 64620 261.76 248.67 285.97 # 64472 63.02 59.87 68.85 # 64620 158.05 150.15 172.67 64475 231.08 219.53 252.46 64622 314.89 299.15 344.02 # 64475 78.30 74.39 85.55 # 64622 167.70 159.32 183.22 64476 92.17 87.56 100.69 64623 117.39 111.52 128.25 # 64476 47.10 44.75 51.46 # 64623 46.78 44.44 51.11 64479 271.09 257.54 296.17 64626 365.24 346.98 399.03 # 64479 117.51 111.63 128.37 # 64626 222.03 210.93 242.57 64480 134.48 127.76 146.92 64627 160.94 152.89 175.82 # 64480 76.24 72.43 83.29 # 64627 54.83 52.09 59.90 64483 264.70 251.47 289.19 64630 224.64 213.41 245.42 # 64483 103.55 98.37 113.13 # 64630 185.15 175.89 202.27 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 54 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 82.86 78.72 90.53 64823 721.12 685.06 787.82 # 64632 70.09 66.59 76.58 64831 639.37 607.40 698.51 64640 221.85 210.76 242.37 64832 331.14 314.58 361.77 # 64640 169.59 161.11 185.28 64834 703.86 668.67 768.97 64650 64.97 61.72 70.98 64835 763.23 725.07 833.83 # 64650 37.85 35.96 41.35 64836 762.78 724.64 833.34 64653 75.25 71.49 82.21 64837 367.81 349.42 401.83 # 64653 47.33 44.96 51.70 64840 864.60 821.37 944.58 64680 298.69 283.76 326.32 64856 958.31 910.39 1,046.95 # 64680 153.90 146.21 168.14 64857 1,001.59 951.51 1,094.24 64681 384.34 365.12 419.89 64858 1,157.35 1,099.48 1,264.40 # 64681 206.03 195.73 225.09 64859 249.41 236.94 272.48 64702 434.21 412.50 474.38 64861 1,302.35 1,237.23 1,422.81 64704 319.07 303.12 348.59 64862 1,273.27 1,209.61 1,391.05 64708 451.81 429.22 493.60 64864 828.47 787.05 905.11 64712 515.85 490.06 563.57 64865 1,102.85 1,047.71 1,204.87 64713 721.35 685.28 788.07 64866 1,146.48 1,089.16 1,252.53 64714 612.61 581.98 669.28 64868 1,001.75 951.66 1,094.41 64716 493.48 468.81 539.13 64870 967.36 918.99 1,056.84 64718 533.86 507.17 583.25 64872 116.96 111.11 127.78 64719 370.34 351.82 404.59 64874 171.66 163.08 187.54 64721 392.16 372.55 428.43 64876 186.80 177.46 204.08 # 64721 390.56 371.03 426.68 64885 1,078.20 1,024.29 1,177.93 64722 314.62 298.89 343.72 64886 1,279.62 1,215.64 1,397.99 64726 277.08 263.23 302.71 64890 1,032.21 980.60 1,127.69 64727 179.27 170.31 195.86 64891 1,062.05 1,008.95 1,160.29 64732 362.45 344.33 395.98 64892 1,004.65 954.42 1,097.58 64734 390.40 370.88 426.51 64893 1,056.33 1,003.51 1,154.04 64736 368.58 350.15 402.67 64895 1,235.73 1,173.94 1,350.03 64738 435.02 413.27 475.26 64896 1,366.12 1,297.81 1,492.48 64740 434.35 412.63 474.52 64897 1,197.82 1,137.93 1,308.62 64742 442.38 420.26 483.30 64898 1,307.05 1,241.70 1,427.96 64744 389.98 370.48 426.05 64901 583.72 554.53 637.71 64746 418.77 397.83 457.50 64902 670.29 636.78 732.30 64752 472.81 449.17 516.55 64905 960.05 912.05 1,048.86 64755 834.93 793.18 912.16 64907 1,261.25 1,198.19 1,377.92 64760 445.13 422.87 486.30 64910 775.80 737.01 847.56 64761 421.83 400.74 460.85 64911 932.92 886.27 1,019.21 64763 515.04 489.29 562.68 65091 557.37 529.50 608.93 64766 590.21 560.70 644.81 65093 557.04 529.19 608.57 64771 557.33 529.46 608.88 65101 642.89 610.75 702.36 64772 535.89 509.10 585.47 65103 670.63 637.10 732.67 64774 386.17 366.86 421.89 65105 739.23 702.27 807.61 64776 371.01 352.46 405.33 65110 1,072.60 1,018.97 1,171.82 64778 177.88 168.99 194.34 65112 1,263.33 1,200.16 1,380.18 64782 435.95 414.15 476.27 65114 1,311.38 1,245.81 1,432.68 64783 212.62 201.99 232.29 65125 407.94 387.54 445.67 64784 678.69 644.76 741.47 # 65125 253.16 240.50 276.58 64786 1,017.59 966.71 1,111.72 65130 635.28 603.52 694.05 64787 243.99 231.79 266.56 65135 646.88 614.54 706.72 64788 363.56 345.38 397.19 65140 704.46 669.24 769.63 64790 776.89 738.05 848.76 65150 512.12 486.51 559.49 64792 1,006.57 956.24 1,099.68 65155 742.82 705.68 811.53 64795 183.48 174.31 200.46 65175 573.13 544.47 626.14 64802 565.42 537.15 617.72 65205 50.15 47.64 54.79 64804 860.93 817.88 940.56 # 65205 39.38 37.41 43.02 64809 808.90 768.46 883.73 65210 61.53 58.45 67.22 64818 628.37 596.95 686.49 # 65210 47.57 45.19 51.97 64820 712.30 676.69 778.19 65220 51.50 48.93 56.27 64821 644.38 612.16 703.98 # 65220 38.73 36.79 42.31 64822 636.06 604.26 694.90 65222 67.59 64.21 73.84 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 55 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 52.03 49.43 56.84 65875 543.29 516.13 593.55 65235 606.71 576.37 662.83 65880 572.07 543.47 624.99 65260 831.05 789.50 907.93 65900 838.31 796.39 915.85 65265 934.60 887.87 1,021.05 65920 678.98 645.03 741.78 65270 238.95 227.00 261.05 65930 557.98 530.08 609.59 # 65270 123.27 117.11 134.68 66020 165.19 156.93 180.47 65272 437.16 415.30 477.60 # 66020 114.53 108.80 125.12 # 65272 300.34 285.32 328.12 66030 146.70 139.37 160.28 65273 329.56 313.08 360.04 # 66030 96.04 91.24 104.93 65275 485.86 461.57 530.81 66130 619.07 588.12 676.34 # 65275 391.32 371.75 427.51 # 66130 501.00 475.95 547.34 65280 577.94 549.04 631.40 66150 748.99 711.54 818.27 65285 899.13 854.17 982.30 66155 746.45 709.13 815.50 65286 618.26 587.35 675.45 66160 847.56 805.18 925.96 # 65286 425.19 403.93 464.52 66165 731.62 695.04 799.30 65290 425.05 403.80 464.37 66170 1,026.37 975.05 1,121.31 65400 583.84 554.65 637.85 66172 1,289.90 1,225.41 1,409.22 # 65400 514.84 489.10 562.47 66180 1,014.65 963.92 1,108.51 65410 127.52 121.14 139.31 66185 643.79 611.60 703.34 # 65410 92.02 87.42 100.53 66220 629.56 598.08 687.79 65420 455.76 432.97 497.92 66225 806.64 766.31 881.26 # 65420 326.12 309.81 356.28 66250 657.69 624.81 718.53 65426 572.49 543.87 625.45 # 66250 477.79 453.90 521.99 # 65426 413.33 392.66 451.56 66500 308.29 292.88 336.81 65430 101.99 96.89 111.42 66505 337.41 320.54 368.62 # 65430 92.02 87.42 100.53 66600 709.71 674.22 775.35 65435 70.82 67.28 77.37 66605 917.85 871.96 1,002.75 # 65435 61.64 58.56 67.34 66625 373.17 354.51 407.69 65436 334.78 318.04 365.75 66630 489.79 465.30 535.10 # 65436 320.82 304.78 350.50 66635 494.65 469.92 540.41 65450 279.25 265.29 305.08 66680 443.49 421.32 484.52 # 65450 275.66 261.88 301.16 66682 541.07 514.02 591.12 65600 338.39 321.47 369.69 66700 390.63 371.10 426.77 # 65600 291.32 276.75 318.26 # 66700 341.97 324.87 373.60 65710 956.96 909.11 1,045.48 66710 383.58 364.40 419.06 65730 1,063.15 1,009.99 1,161.49 # 66710 340.90 323.86 372.44 65750 1,076.43 1,022.61 1,176.00 66711 548.00 520.60 598.69 65755 1,070.17 1,016.66 1,169.16 66720 404.26 384.05 441.66 65756 1,027.77 976.38 1,122.84 # 66720 362.78 344.64 396.34 65770 1,228.74 1,167.30 1,342.40 66740 380.78 361.74 416.00 65772 390.16 370.65 426.25 # 66740 342.49 325.37 374.18 # 65772 348.68 331.25 380.94 66761 392.20 372.59 428.48 65775 476.72 452.88 520.81 # 66761 355.11 337.35 387.95 65780 769.48 731.01 840.66 66762 410.42 389.90 448.39 65781 1,160.27 1,102.26 1,267.60 # 66762 366.14 347.83 400.00 65782 1,001.91 951.81 1,094.58 66770 455.31 432.54 497.42 65800 133.28 126.62 145.61 # 66770 415.02 394.27 453.41 # 65800 116.13 110.32 126.87 66820 347.42 330.05 379.56 65805 146.04 138.74 159.55 66821 281.57 267.49 307.61 # 65805 116.13 110.32 126.87 # 66821 264.82 251.58 289.32 65810 404.41 384.19 441.82 66825 662.04 628.94 723.28 65815 560.01 532.01 611.81 66830 615.45 584.68 672.38 # 65815 409.63 389.15 447.52 66840 600.16 570.15 655.67 65820 652.82 620.18 713.21 66850 684.79 650.55 748.13 65850 736.89 700.05 805.06 66852 732.28 695.67 800.02 65855 297.66 282.78 325.20 66920 653.60 620.92 714.06 # 65855 260.17 247.16 284.23 66930 742.34 705.22 811.00 65860 275.07 261.32 300.52 66940 674.91 641.16 737.33 # 65860 224.81 213.57 245.61 66982 925.35 879.08 1,010.94 65865 414.72 393.98 453.08 66983 637.98 606.08 696.99 65870 511.34 485.77 558.64 66984 664.64 631.41 726.12 0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. 0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. 0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2008 BY THE AMERICAN MEDICAL ASSOCIATION. 1HNPRDS09 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 56 FSY09 LOCALITY FEE SCHEDULE FOR AREA 99 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 659.68 626.70 720.71 67320 285.16 270.90 311.54 66986 806.05 765.75 880.61 67331 269.89 256.40 294.86 66990 81.50 77.43 89.04 67332 293.64 278.96 320.80 67005 407.95 387.55 445.68 67334 266.31 252.99 290.94 67010 471.24 447.68 514.83 67335 134.31 127.59 146.73 67015 504.54 479.31 551.21 67340 317.35 301.48 346.70 67025 630.53 599.00 688.85 67343 564.18 535.97 616.37 # 67025 542.77 515.63 592.97 67345 205.86 195.57 224.91 67027 741.15 704.09 809.70 # 67345 186.31 176.99 203.54 67028 188.57 179.14 206.01 67346 178.57 169.64 195.09 # 67028 149.08 141.63 162.87 67400 817.14 776.28 892.72 67030 452.22 429.61 494.05 67405 696.81 661.97 761.27 67031 334.51 317.78 365.45 67412 756.36 718.54 826.32 # 67031 305.39 290.12 333.64 67413 757.19 719.33 827.23 67036 836.44 794.62 913.81 67414 1,149.92 1,092.42 1,256.28 67039 1,072.77 1,019.13 1,172.00 67415 93.93 89.23 102.61 67040 1,236.41 1,174.59 1,350.78 67420 1,435.99 1,364.19 1,568.82 67041 1,152.15 1,094.54 1,258.72 67430 1,097.46 1,042.59 1,198.98 67042 1,318.35 1,252.43 1,440.29 67440 1,057.48 1,004.61 1,155.30 67043 1,384.37 1,315.15 1,512.42 67445 1,234.77 1,173.03 1,348.98 67101 674.76 641.02 737.17 67450 1,097.25 1,042.39 1,198.75 # 67101 580.23 551.22 633.90 67500 78.81 74.87 86.10 67105 623.00 591.85 680.63 # 67500 70.83 67.29 77.38 # 67105 555.99 528.19 607.42 67505 77.42 73.55 84.58 67107 1,052.32 999.70 1,149.66 # 67505 69.04 65.59 75.43 67108 1,398.19 1,328.28 1,527.52 67515 81.99 77.89 89.57 67110 754.20 716.49 823.96 # 67515 75.21 71.45 82.17 # 67110 667.63 634.25 729.39 67550 851.49 808.92 930.26 67112 1,154.08 1,096.38 1,260.84 67560 865.87 822.58 945.97 67113 1,516.32 1,440.50 1,656.58 67570 1,016.70 965.87 1,110.75 67115 426.10 404.80 465.52 67700 240.76 228.72 263.03 67120 570.46 541.94 623.23 # 67700 100.35 95.33 109.63 # 67120 479.11 455.15 523.42 67710 203.49 193.32 222.32 67121 785.11 745.85 857.73 # 67710 84.22 80.01 92.01 67141 450.46 427.94 492.13 67715 213.83 203.14 233.61 # 67141 418.14 397.23 456.81 # 67715 94.96 90.21 103.74 67145 453.71 431.02 495.67 67800 111.45 105.88 121.76 # 67145 427.39 406.02 466.92 # 67800 91.11 86.55 99.53 67208 518.43 492.51 566.39 67801 142.53 135.40 155.71 # 67208 499.28 474.32 545.47 # 67801 117.79 111.90 128.69 67210 603.41 573.24 659.23 67805 176.93 168.08 193.29 # 67210 582.27 553.16 636.13 # 67805 145.02 137.77 158.44 67218 1,219.25 1,158.29 1,332.03 67808 316.37 300.55 345.63 67220 926.99 880.64 1,012.74 67810 205.79 195.50 224.83 # 67220 881.51 837.43 963.04 # 67810 84.13 79.92 91.91 67221 264.44 251.22 288.90 67820 46.43 44.11 50.73 # 67221 193.84 184.15 211.77 # 67820 48.03 45.63 52.47 67225 26.80 25.46 29.28 67825 113.01 107.36 123.46 # 67225 25.20 23.94 27.53 # 67825 105.83 100.54 115.62 67227 528.83 502.39 577.75 67830 239.79 227.80 261.97 # 67227 493.33 468.66 538.96 # 67830 120.52 114.49 131.66 67228 1,046.37 994.05 1,143.16 67835 384.19 364.98 419.73 # 67228 916.73 870.89 1,001.52 67840 249.90 237.41 273.02 67229 999.57 949.59 1,092.03 # 67840 139.40 132.43 152.29 67250 686.02 651.72 749.48 67850 200.86 190.82 219.44 67255 734.03 697.33 801.93 # 67850 125.46 119.19 137.07 67311 518.01 492.11 565.93 67875 155.87 148.08 170.29 67312 617.83 586.94 674.98 # 67875 86.46 82.14 94.46 67314 580.41 551.39 634.10 67880 399.34 379.37 436.28 67316 693.20 658.54 757.32 # 67880 316.37 300.55 345.63 67318 607.71 577.32 663.92 67882 491.33 466.76 536.77 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 99 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 407.16 386.80 444.82 # 68130 358.97 341.02 392.17 67900 568.57 540.14 621.16 68135 137.05 130.20 149.73 # 67900 449.30 426.84 490.87 # 68135 132.26 125.65 144.50 67901 613.28 582.62 670.01 68200 37.49 35.62 40.96 # 67901 504.38 479.16 551.03 # 68200 30.71 29.17 33.55 67902 622.60 591.47 680.19 68320 632.65 601.02 691.17 67903 543.70 516.52 594.00 # 68320 461.13 438.07 503.78 # 67903 435.99 414.19 476.32 68325 571.99 543.39 624.90 67904 641.92 609.82 701.29 68326 556.70 528.87 608.20 # 67904 515.87 490.08 563.59 68328 621.68 590.60 679.19 67906 450.97 428.42 492.68 68330 530.61 504.08 579.69 67908 432.76 411.12 472.79 # 68330 396.18 376.37 432.83 # 67908 377.71 358.82 412.64 68335 558.43 530.51 610.09 67909 476.10 452.30 520.15 68340 478.75 454.81 523.03 # 67909 385.95 366.65 421.65 # 68340 342.33 325.21 373.99 67911 482.01 457.91 526.60 68360 465.55 442.27 508.61 67912 816.37 775.55 891.88 # 68360 353.85 336.16 386.58 # 67912 435.43 413.66 475.71 68362 565.87 537.58 618.22 67914 347.44 330.07 379.58 68371 365.75 347.46 399.58 # 67914 253.70 241.02 277.17 68400 253.39 240.72 276.83 67915 311.67 296.09 340.50 # 68400 119.76 113.77 130.84 # 67915 224.31 213.09 245.05 68420 287.54 273.16 314.13 67916 477.19 453.33 521.33 # 68420 153.11 145.45 167.27 # 67916 379.06 360.11 414.13 68440 94.88 90.14 103.66 67917 520.74 494.70 568.91 # 68440 84.91 80.66 92.76 # 67917 418.62 397.69 457.34 68500 843.34 801.17 921.35 67921 331.14 314.58 361.77 68505 849.21 806.75 927.76 # 67921 237.40 225.53 259.36 68510 405.56 385.28 443.07 67922 301.85 286.76 329.77 # 68510 259.57 246.59 283.58 # 67922 216.08 205.28 236.07 68520 598.25 568.34 653.59 67923 502.03 476.93 548.47 68525 237.99 226.09 260.00 # 67923 408.29 387.88 446.06 68530 389.56 370.08 425.59 67924 520.74 494.70 568.91 # 68530 230.40 218.88 251.71 # 67924 394.29 374.58 430.77 68540 806.62 766.29 881.23 67930 327.38 311.01 357.66 68550 990.96 941.41 1,082.62 # 67930 215.69 204.91 235.65 68700 520.74 494.70 568.91 67935 530.06 503.56 579.09 68705 211.93 201.33 231.53 # 67935 395.63 375.85 432.23 # 68705 145.31 138.04 158.75 67938 219.42 208.45 239.72 68720 660.91 627.86 722.04 # 67938 100.95 95.90 110.29 68745 664.20 630.99 725.64 67950 512.68 487.05 560.11 68750 683.05 648.90 746.24 # 67950 411.36 390.79 449.41 68760 179.72 170.73 196.34 67961 512.31 486.69 559.69 # 68760 127.47 121.10 139.27 # 67961 401.82 381.73 438.99 68761 130.36 123.84 142.42 67966 669.95 636.45 731.92 # 68761 103.63 98.45 113.22 # 67966 566.24 537.93 618.62 68770 512.89 487.25 560.34 67971 639.94 607.94 699.13 68801 108.84 103.40 118.91 67973 828.43 787.01 905.06 # 68801 93.69 89.01 102.36 67974 824.95 783.70 901.26 68810 209.90 199.41 229.32 67975 604.77 574.53 660.71 # 68810 166.42 158.10 181.82 68020 104.39 99.17 114.05 68811 180.14 171.13 196.80 # 68020 96.81 91.97 105.77 68815 398.00 378.10 434.82 68040 57.90 55.01 63.26 # 68815 226.07 214.77 246.99 # 68040 47.53 45.15 51.92 68816 618.37 587.45 675.57 68100 154.67