Revisions to Medicare Payment Policies
Under the Physician Fee Schedule for Calendar Year 1996

Extension of Site-of-Service Payment Differential to Services
in Ambulatory Surgery Centers (ASCs)

The following procedure codes currently on the ASC list are furnished more than 50% of the time in a physician's office. Therefore, we are adding them to the list of services subject to the site-of-service payment differential.

Codes to Be Added to the Site-of-Service Differential List

HCPCS Description HCPCS Description

11042.......... Cleansing of skin/tissue.

11404.......... Removal of skin lesion.

11424.......... Removal of skin lesion.

11444.......... Removal of skin lesion.

11446.......... Removal of skin lesion.

11604.......... Removal of skin lesion.

11624.......... Removal of skin lesion.

11644.......... Removal of skin lesion.

12021.......... Closure of split wound.

13100.......... Repair of wound or lesion.

13101.......... Repair of wound or lesion.

13120.......... Repair of wound or lesion.

13121.......... Repair of wound or lesion.

13131.......... Repair of wound or lesion.

13132.......... Repair of wound or lesion.

13151.......... Repair of wound or lesion.

13152.......... Repair of wound or lesion.

14000.......... Skin tissue rearrangement.

14040.......... Skin tissue rearrangement.

14041.......... Skin tissue rearrangement.

14061.......... Skin tissue rearrangement.

19100.......... Biopsy of breast.

20670.......... Removal of support implant.

21025.......... Excision of bone, lower jaw.

21026.......... Excision of facial bone(s).

21040.......... Removal of jaw bone lesion.

21041.......... Removal of jaw bone lesion.

21210.......... Face bone graft.

21215.......... Lower jaw bone graft.

21248.......... Reconstruction of jaw.

21249.......... Reconstruction of jaw.

21485.......... Reset dislocated jaw.

21550.......... Biopsy of neck/chest.

21920.......... Biopsy soft tissue of back.

23330.......... Remove shoulder foreign body.

23620.......... Treat humerus fracture.

23931.......... Drainage of arm bursa.

24065.......... Biopsy arm/elbow soft tissue.

24362.......... Reconstruct elbow joint.

25065.......... Biopsy forearm soft tissues.

25624.......... Treat wrist bone fracture.

25635.......... Treat wrist bone fracture.

26070.......... Explore/treat hand joint.

26432.......... Repair finger tendon.

26605.......... Treat metacarpal fracture.

27086.......... Remove hip foreign body.

27323.......... Biopsy thigh soft tissues.

27520.......... Treat kneecap fracture.

27604.......... Drain lower leg bursa.

27613.......... Biopsy lower leg soft tissue.

27760.......... Treatment of ankle fracture.

27780.......... Treatment of fibula fracture.

27786.......... Treatment of ankle fracture.

27788.......... Treatment of ankle fracture.

28003.......... Treatment of foot infection.

28222.......... Release of foot tendons.

28313.......... Repair deformity of toe.

28400.......... Treatment of heel fracture.

28635.......... Treat toe dislocation.

28665.......... Treat toe dislocation.

29850.......... Knee arthroscopy/surgery.

30124.......... Removal of nose lesion.

30560.......... Release of nasal adhesions.

30580.......... Repair upper jaw fistula.

30801.......... Cauterization inner nose.

31233.......... Nasal/sinus endoscopy, dx.

31235.......... Nasal/sinus endoscopy, dx.

31237.......... Nasal/sinus endoscopy, surg.

31238.......... Nasal/sinus endoscopy, surg.

31525.......... Diagnostic laryngoscopy.

31570.......... Laryngoscopy with injection.

33011.......... Repeat drainage of heart sac.

38300.......... Drainage lymph node lesion.

38505.......... Needle biopsy, lymph node(s).

40801.......... Drainage of mouth lesion.

40814.......... Excise/repair mouth lesion.

40816.......... Excision of mouth lesion.

40819.......... Excise lip or cheek fold.

40820.......... Treatment of mouth lesion.

41000.......... Drainage of mouth lesion.

41008.......... Drainage of mouth lesion.

41105.......... Biopsy of tongue.

41110.......... Excision of tongue lesion.

41112.......... Excision of tongue lesion.

41113.......... Excision of tongue lesion.

41800.......... Drainage of gum lesion.

41806.......... Removal foreign body, jawbone.

41827.......... Excision of gum lesion.

42000.......... Drainage mouth roof lesion.

42104.......... Excision lesion, mouth roof.

42106.......... Excision lesion, mouth roof.

42107.......... Excision lesion, mouth roof.

42160.......... Treatment mouth roof lesion.

42300.......... Drainage of salivary gland.

42310.......... Drainage of salivary gland.

42335.......... Removal of salivary stone.

42340.......... Removal of salivary stone.

42405.......... Biopsy of salivary gland.

42700.......... Drainage of tonsil abscess.

45305.......... Proctosigmoidoscopy; biopsy.

45308.......... Proctosigmoidoscopy.

45309.......... Proctosigmoidoscopy.

46050.......... Incision of anal abscess.

46611.......... Anoscopy.

51710.......... Change of bladder tube.

52000.......... Cystoscopy.

52010.......... Cystoscopy & duct catheter.

52281.......... Cystoscopy and treatment.

52285.......... Cystoscopy and treatment.

53420.......... Reconstruct urethra, stage 1.

54065.......... Destruction, penis lesion(s).

55700.......... Biopsy of prostate.

56405.......... I & D of vulva/perineum.

56605.......... Biopsy of vulva/perineum.

57180.......... Treat vaginal bleeding.

57800.......... Dilation of cervical canal.

60000.......... Drain thyroid/tongue cyst.

61070.......... Brain canal shunt procedure.

65805.......... Drainage of eye.

66030.......... Injection treatment of eye.

66762.......... Revision of iris.

67031.......... Laser surgery, eye strands.

67101.......... Repair, detached retina.

67105.......... Repair, detached retina.

67141.......... Treatment of retina.

67208.......... Treatment of retinal lesion.

69424.......... Remove ventilating tube.

Source: 60 Fed Reg (July 26, 1995) 38,404-38,405 and 60 Fed Reg (Dec. 8, 1995) 63,133 .