http://www.medicarenhic.com/ne_prov/fees/2008revfee_areama99.txt
http://www.eatonhand.com/coding/cptall.htm
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 1
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 - Revised 12/21/06 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
G0101 37.24 35.38 40.69 G0271 14.98 14.23 16.36
G0102 21.53 20.45 23.52 G0275 13.31 12.64 14.54
# G0102 8.54 8.11 9.33 G0278 13.31 12.64 14.54
G0104 132.85 126.21 145.14 G0281 11.44 10.87 12.50
# G0104 57.47 54.60 62.79 G0283 11.44 10.87 12.50
G0105 395.55 375.77 432.14 G0288 349.33 331.86 381.64
# G0105 201.66 191.58 220.32 G0289 90.15 85.64 98.49
G0105 53 132.85 126.21 145.14 G0308 776.88 738.04 848.75
# G0105 53 57.47 54.60 62.79 G0309 649.00 616.55 709.03
G0106 167.74 159.35 183.25 G0310 509.12 483.66 556.21
G0106 TC 119.57 113.59 130.63 G0311 530.71 504.17 579.80
G0106 26 48.17 45.76 52.62 G0312 438.70 416.77 479.29
G0108 32.55 30.92 35.56 G0313 348.14 330.73 380.34
G0109 18.73 17.79 20.46 G0314 467.65 444.27 510.91
G0117 46.56 44.23 50.86 G0315 386.85 367.51 422.64
G0118 31.16 29.60 34.04 G0316 304.64 289.41 332.82
G0120 167.74 159.35 183.25 G0317 293.91 279.21 321.09
G0120 TC 119.57 113.59 130.63 G0318 242.66 230.53 265.11
G0120 26 48.17 45.76 52.62 G0319 191.80 182.21 209.54
G0121 395.55 375.77 432.14 G0320 626.80 595.46 684.78
# G0121 201.66 191.58 220.32 G0321 431.58 410.00 471.50
G0121 53 132.85 126.21 145.14 G0322 377.64 358.76 412.57
# G0121 53 57.47 54.60 62.79 G0323 236.80 224.96 258.70
G0124 23.91 22.71 26.12 G0324 21.35 20.28 23.32
G0127 17.76 16.87 19.40 G0325 12.93 12.28 14.12
# G0127 8.96 8.51 9.79 G0326 14.49 13.77 15.84
G0128 4.23 4.02 4.62 G0327 8.62 8.19 9.42
G0130 42.56 40.43 46.49 G0329 8.08 7.68 8.83
G0130 TC 31.69 30.11 34.63 G0332 82.50 78.38 90.14
G0130 26 10.87 10.33 11.88 G0341 357.41 339.54 390.47
G0141 23.91 22.71 26.12 G0342 673.36 639.69 735.64
G0166 162.15 154.04 177.15 G0343 1,109.91 1,054.41 1,212.57
G0168 93.24 88.58 101.87 G0344 96.57 91.74 105.50
# G0168 25.40 24.13 27.75 # G0344 68.93 65.48 75.30
G0179 53.15 50.49 58.06 G0364 12.85 12.21 14.04
G0180 69.46 65.99 75.89 # G0364 9.08 8.63 9.92
G0181 116.96 111.11 127.78 G0365 195.30 185.54 213.37
G0182 122.82 116.68 134.18 G0365 TC 182.94 173.79 199.86
G0202 141.85 134.76 154.97 G0365 26 12.36 11.74 13.50
G0202 TC 107.68 102.30 117.65 G0366 26.33 25.01 28.76
G0202 26 34.18 32.47 37.34 G0367 17.78 16.89 19.42
G0204 153.33 145.66 167.51 G0368 8.54 8.11 9.33
G0204 TC 111.03 105.48 121.30 G0372 18.59 17.66 20.31
G0204 26 42.30 40.19 46.22 # G0372 8.54 8.11 9.33
G0206 123.54 117.36 134.96 G0375 12.47 11.85 13.63
G0206 TC 89.36 84.89 97.62 G0376 23.84 22.65 26.05
G0206 26 34.18 32.47 37.34 # G0376 23.42 22.25 25.59
G0237 17.78 16.89 19.42 G0389 97.34 92.47 106.34
G0238 18.62 17.69 20.34 G0389 TC 68.62 65.19 74.97
G0239 14.43 13.71 15.77 G0389 26 28.72 27.28 31.37
G0245 64.88 61.64 70.89 G0392 2,603.81 2,473.62 2,844.66
# G0245 44.36 42.14 48.46 # G0392 490.29 465.78 535.65
G0246 38.49 36.57 42.06 G0393 1,994.95 1,895.20 2,179.48
# G0246 22.58 21.45 24.67 # G0393 311.92 296.32 340.77
G0247 41.24 39.18 45.06 G9041 25.62 24.34 27.99
# G0247 26.16 24.85 28.58 G9042 12.95 12.30 14.15
G0248 243.19 231.03 265.68 G9043 12.95 12.30 14.15
G0249 149.81 142.32 163.67 G9044 11.28 10.72 12.33
G0250 9.34 8.87 10.20 M0064 33.00 31.35 36.05
G0268 47.99 45.59 52.43 # M0064 17.51 16.63 19.12
# G0268 31.24 29.68 34.13 P3001 23.91 22.71 26.12
G0270 28.81 27.37 31.48 Q0035 24.23 23.02 26.47
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 2
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
Q0035 TC 15.69 14.91 17.15 11005 737.35 700.48 805.55
Q0035 26 8.54 8.11 9.33 11006 681.06 647.01 744.06
Q0091 42.10 40.00 46.00 11008 268.35 254.93 293.17
# Q0091 18.65 17.72 20.38 11010 450.15 427.64 491.79
Q0092 14.96 14.21 16.34 # 11010 270.92 257.37 295.98
R0070 156.98 149.13 171.50 11011 522.15 496.04 570.45
R0075 156.98 149.13 171.50 # 11011 287.22 272.86 313.79
0024T 412.83 392.19 451.02 11012 745.50 708.23 814.46
0067T 637.99 606.09 697.00 # 11012 425.14 403.88 464.46
0067T TC 508.36 482.94 555.38 11040 42.47 40.35 46.40
0067T 26 129.63 123.15 141.62 # 11040 27.39 26.02 29.92
0073T 707.52 672.14 772.96 11041 52.15 49.54 56.97
0145T 633.75 602.06 692.37 # 11041 36.24 34.43 39.59
0145T TC 531.33 504.76 580.47 11042 72.09 68.49 78.76
0145T 26 102.41 97.29 111.88 # 11042 47.80 45.41 52.22
0146T 633.75 602.06 692.37 11043 258.48 245.56 282.39
0146T TC 531.33 504.76 580.47 # 11043 223.72 212.53 244.41
0146T 26 102.41 97.29 111.88 11044 346.20 328.89 378.22
0147T 633.75 602.06 692.37 # 11044 310.60 295.07 339.33
0147T TC 531.33 504.76 580.47 11055 42.80 40.66 46.76
0147T 26 102.41 97.29 111.88 # 11055 23.12 21.96 25.25
0148T 633.75 602.06 692.37 11056 52.45 49.83 57.30
0148T TC 531.33 504.76 580.47 # 11056 32.35 30.73 35.34
0148T 26 102.41 97.29 111.88 11057 64.09 60.89 70.02
0149T 633.75 602.06 692.37 # 11057 41.89 39.80 45.77
0149T TC 531.33 504.76 580.47 11100 87.83 83.44 95.96
0149T 26 102.41 97.29 111.88 # 11100 44.69 42.46 48.83
0150T 633.75 602.06 692.37 11101 29.39 27.92 32.11
0150T TC 531.33 504.76 580.47 # 11101 23.11 21.95 25.24
0150T 26 102.41 97.29 111.88 11200 73.97 70.27 80.81
0151T 204.04 193.84 222.92 # 11200 61.82 58.73 67.54
0151T TC 136.66 129.83 149.30 11201 17.24 16.38 18.84
0151T 26 67.38 64.01 73.61 # 11201 15.56 14.78 17.00
10021 136.19 129.38 148.79 11300 62.03 58.93 67.77
# 10021 67.51 64.13 73.75 # 11300 27.27 25.91 29.80
10022 146.88 139.54 160.47 11301 80.90 76.86 88.39
# 10022 62.71 59.57 68.51 # 11301 46.14 43.83 50.40
10040 88.01 83.61 96.15 11302 96.87 92.03 105.83
# 10040 77.55 73.67 84.72 # 11302 57.09 54.24 62.38
10060 98.54 93.61 107.65 11303 115.66 109.88 126.36
# 10060 85.14 80.88 93.01 # 11303 67.09 63.74 73.30
10061 170.32 161.80 186.07 11305 63.15 59.99 68.99
# 10061 154.41 146.69 168.69 # 11305 35.93 34.13 39.25
10080 169.42 160.95 185.09 11306 85.53 81.25 93.44
# 10080 90.69 86.16 99.08 # 11306 53.28 50.62 58.21
10081 256.25 243.44 279.96 11307 100.08 95.08 109.34
# 10081 154.48 146.76 168.77 # 11307 61.98 58.88 67.71
10120 134.82 128.08 147.29 11308 116.53 110.70 127.31
# 10120 86.66 82.33 94.68 # 11308 76.75 72.91 83.85
10121 250.23 237.72 273.38 11310 75.83 72.04 82.85
# 10121 176.53 167.70 192.86 # 11310 39.82 37.83 43.50
10140 138.03 131.13 150.80 11311 93.52 88.84 102.17
# 10140 112.90 107.26 123.35 # 11311 57.93 55.03 63.28
10160 115.79 110.00 126.50 11312 107.97 102.57 117.96
# 10160 91.50 86.93 99.97 # 11312 66.51 63.18 72.66
10180 216.74 205.90 236.79 11313 138.35 131.43 151.14
# 10180 169.84 161.35 185.55 # 11313 89.36 84.89 97.62
11000 48.72 46.28 53.22 11400 113.69 108.01 124.21
# 11000 31.55 29.97 34.47 # 11400 69.30 65.84 75.72
11001 21.16 20.10 23.12 11401 132.92 126.27 145.21
# 11001 15.72 14.93 17.17 # 11401 89.78 85.29 98.08
11004 547.33 519.96 597.95 11402 147.48 140.11 161.13
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 3
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
# 11402 99.32 94.35 108.50 # 11623 181.44 172.37 198.23
11403 169.18 160.72 184.83 11624 294.95 280.20 322.23
# 11403 125.21 118.95 136.79 # 11624 208.68 198.25 227.99
11404 192.55 182.92 210.36 11626 367.52 349.14 401.51
# 11404 138.95 132.00 151.80 # 11626 269.95 256.45 294.92
11406 261.64 248.56 285.84 11640 174.26 165.55 190.38
# 11406 202.59 192.46 221.33 # 11640 107.67 102.29 117.63
11420 111.65 106.07 121.98 11641 210.97 200.42 230.48
# 11420 76.05 72.25 83.09 # 11641 143.13 135.97 156.37
11421 141.54 134.46 154.63 11642 243.07 230.92 265.56
# 11421 100.92 95.87 110.25 # 11642 167.27 158.91 182.75
11422 157.29 149.43 171.84 11643 287.77 273.38 314.39
# 11422 119.18 113.22 130.20 # 11643 207.37 197.00 226.55
11423 184.86 175.62 201.96 11644 358.84 340.90 392.04
# 11423 138.79 131.85 151.63 # 11644 261.68 248.60 285.89
11424 210.56 200.03 230.03 11646 474.10 450.40 517.96
# 11424 160.73 152.69 175.59 # 11646 374.02 355.32 408.62
11426 299.02 284.07 326.68 11719 18.06 17.16 19.73
# 11426 242.49 230.37 264.93 # 11719 9.27 8.81 10.13
11440 127.60 121.22 139.40 11720 27.79 26.40 30.36
# 11440 92.42 87.80 100.97 # 11720 16.90 16.06 18.47
11441 153.92 146.22 168.15 11721 40.53 38.50 44.28
# 11441 118.74 112.80 129.72 # 11721 29.22 27.76 31.92
11442 171.65 163.07 187.53 11730 88.56 84.13 96.75
# 11442 131.03 124.48 143.15 # 11730 58.83 55.89 64.27
11443 207.57 197.19 226.77 11732 41.29 39.23 45.11
# 11443 162.35 154.23 177.36 # 11732 29.99 28.49 32.76
11444 260.81 247.77 284.94 11740 39.37 37.40 43.01
# 11444 208.05 197.65 227.30 # 11740 29.32 27.85 32.03
11446 345.76 328.47 377.74 11750 188.43 179.01 205.86
# 11446 291.32 276.75 318.26 # 11750 164.14 155.93 179.32
11450 329.95 313.45 360.47 11752 267.55 254.17 292.30
# 11450 206.83 196.49 225.96 # 11752 253.73 241.04 277.20
11451 436.85 415.01 477.26 11755 120.10 114.10 131.22
# 11451 274.37 260.65 299.75 # 11755 81.57 77.49 89.11
11462 326.28 309.97 356.47 11760 179.91 170.91 196.55
# 11462 199.39 189.42 217.83 # 11760 132.59 125.96 144.85
11463 449.30 426.84 490.87 11762 240.86 228.82 263.14
# 11463 281.37 267.30 307.40 # 11762 202.75 192.61 221.50
11470 355.17 337.41 388.02 11765 111.05 105.50 121.33
# 11470 237.08 225.23 259.01 # 11765 61.64 58.56 67.34
11471 461.11 438.05 503.76 11770 246.31 233.99 269.09
# 11471 301.14 286.08 328.99 # 11770 163.81 155.62 178.96
11600 168.65 160.22 184.25 11771 475.10 451.35 519.05
# 11600 99.98 94.98 109.23 # 11771 370.83 352.29 405.13
11601 194.16 184.45 212.12 11772 594.48 564.76 649.47
# 11601 127.58 121.20 139.38 # 11772 492.30 467.69 537.84
11602 208.99 198.54 228.32 11900 48.70 46.27 53.21
# 11602 137.80 130.91 150.55 # 11900 27.76 26.37 30.33
11603 238.97 227.02 261.07 11901 59.81 56.82 65.34
# 11603 161.50 153.43 176.44 # 11901 43.89 41.70 47.96
11604 264.97 251.72 289.48 11920 204.25 194.04 223.15
# 11604 177.45 168.58 193.87 # 11920 109.19 103.73 119.29
11606 366.73 348.39 400.65 11921 228.16 216.75 249.26
# 11606 262.04 248.94 286.28 # 11921 128.91 122.46 140.83
11620 168.73 160.29 184.33 11922 64.59 61.36 70.56
# 11620 99.63 94.65 108.85 # 11922 29.41 27.94 32.13
11621 194.96 185.21 212.99 11950 75.65 71.87 82.65
# 11621 128.80 122.36 140.71 # 11950 46.76 44.42 51.08
11622 219.21 208.25 239.49 11951 103.68 98.50 113.28
# 11622 147.60 140.22 161.25 # 11951 65.99 62.69 72.09
11623 258.91 245.96 282.85 11952 139.55 132.57 152.46
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 4
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
# 11952 93.07 88.42 101.68 # 12044 187.44 178.07 204.78
11954 166.08 157.78 181.45 12045 355.94 338.14 388.86
# 11954 107.46 102.09 117.40 # 12045 231.14 219.58 252.52
11960 856.89 814.05 936.16 12046 425.73 404.44 465.11
11970 561.26 533.20 613.18 # 12046 273.29 259.63 298.57
11971 484.44 460.22 529.25 12047 441.53 419.45 482.37
# 11971 282.18 268.07 308.28 # 12047 301.24 286.18 329.11
11976 139.53 132.55 152.43 12051 237.36 225.49 259.31
# 11976 93.89 89.20 102.58 # 12051 157.37 149.50 171.93
11980 100.81 95.77 110.14 12052 254.20 241.49 277.71
# 11980 77.78 73.89 84.97 # 12052 173.80 165.11 189.88
11981 128.14 121.73 139.99 12053 272.55 258.92 297.76
# 11981 82.08 77.98 89.68 # 12053 185.03 175.78 202.15
11982 148.78 141.34 162.54 12054 296.62 281.79 324.06
# 11982 100.20 95.19 109.47 # 12054 201.14 191.08 219.74
11983 220.07 209.07 240.43 12055 370.02 351.52 404.25
# 11983 180.71 171.67 197.42 # 12055 255.28 242.52 278.90
12001 144.16 136.95 157.49 12056 475.46 451.69 519.44
# 12001 95.58 90.80 104.42 # 12056 319.26 303.30 348.80
12002 152.63 145.00 166.75 12057 493.07 468.42 538.68
# 12002 106.98 101.63 116.87 # 12057 369.95 351.45 404.17
12004 178.56 169.63 195.07 13100 289.39 274.92 316.16
# 12004 125.37 119.10 136.97 # 13100 214.01 203.31 233.81
12005 222.29 211.18 242.86 13101 351.66 334.08 384.19
# 12005 156.13 148.32 170.57 # 13101 258.69 245.76 282.62
12006 275.26 261.50 300.73 13102 97.82 92.93 106.87
# 12006 198.20 188.29 216.53 # 13102 70.60 67.07 77.13
12007 310.76 295.22 339.50 13120 300.48 285.46 328.28
# 12007 227.84 216.45 248.92 # 13120 223.01 211.86 243.64
12011 152.66 145.03 166.78 13121 380.06 361.06 415.22
# 12011 98.64 93.71 107.77 # 13121 283.74 269.55 309.98
12013 167.57 159.19 183.07 13122 116.19 110.38 126.94
# 12013 113.13 107.47 123.59 # 13122 80.60 76.57 88.06
12014 196.86 187.02 215.07 13131 328.20 311.79 358.56
# 12014 135.72 128.93 148.27 # 13131 253.24 240.58 276.67
12015 246.50 234.18 269.31 13132 501.16 476.10 547.52
# 12015 170.28 161.77 186.04 # 13132 415.73 394.94 454.18
12016 290.93 276.38 317.84 13133 152.73 145.09 166.85
# 12016 208.01 197.61 227.25 # 13133 123.42 117.25 134.84
12017 251.58 239.00 274.85 13150 343.98 326.78 375.80
12018 301.41 286.34 329.29 # 13150 257.30 244.44 281.11
12020 258.79 245.85 282.73 13151 371.51 352.93 405.87
# 12020 178.80 169.86 195.34 # 13151 295.30 280.54 322.62
12021 147.73 140.34 161.39 13152 498.66 473.73 544.79
# 12021 129.31 122.84 141.27 # 13152 398.57 378.64 435.44
12031 192.28 182.67 210.07 13153 171.11 162.55 186.93
# 12031 128.63 122.20 140.53 # 13153 135.52 128.74 148.05
12032 265.86 252.57 290.46 13160 753.13 715.47 822.79
# 12032 170.80 162.26 186.60 14000 593.31 563.64 648.19
12034 256.67 243.84 280.42 # 14000 488.20 463.79 533.36
# 12034 175.01 166.26 191.20 14001 767.42 729.05 838.41
12035 348.07 330.67 380.27 # 14001 656.87 624.03 717.63
# 12035 219.51 208.53 239.81 14020 658.64 625.71 719.57
12036 386.92 367.57 422.71 # 14020 560.65 532.62 612.51
# 12036 259.61 246.63 283.62 14021 853.93 811.23 932.91
12037 434.28 412.57 474.46 # 14021 760.97 722.92 831.36
# 12037 301.53 286.45 329.42 14040 692.70 658.07 756.78
12041 208.07 197.67 227.32 # 14040 608.94 578.49 665.26
# 12041 141.90 134.81 155.03 14041 933.60 886.92 1,019.96
12042 249.36 236.89 272.42 # 14041 829.33 787.86 906.04
# 12042 168.12 159.71 183.67 14060 710.01 674.51 775.69
12044 273.29 259.63 298.57 # 14060 641.75 609.66 701.11
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 5
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
14061 1,013.72 963.03 1,107.48 # 15200 600.21 570.20 655.73
# 14061 899.39 854.42 982.58 15201 153.84 146.15 168.07
14300 983.78 934.59 1,074.78 # 15201 76.79 72.95 83.89
# 14300 879.51 835.53 960.86 15220 696.48 661.66 760.91
14350 710.62 675.09 776.35 # 15220 578.80 549.86 632.34
15002 312.75 297.11 341.68 15221 139.97 132.97 152.92
# 15002 209.31 198.84 228.67 # 15221 68.78 65.34 75.14
15003 69.38 65.91 75.80 15240 823.07 781.92 899.21
# 15003 42.58 40.45 46.52 # 15240 720.06 684.06 786.67
15004 376.01 357.21 410.79 15241 174.23 165.52 190.35
# 15004 258.76 245.82 282.69 # 15241 108.06 102.66 118.06
15005 115.31 109.54 125.97 15260 869.68 826.20 950.13
# 15005 85.16 80.90 93.04 # 15260 780.06 741.06 852.22
15040 259.90 246.91 283.95 15261 198.73 188.79 217.11
# 15040 122.54 116.41 133.87 # 15261 139.27 132.31 152.16
15050 499.57 474.59 545.78 15300 310.66 295.13 339.40
# 15050 415.81 395.02 454.27 # 15300 267.11 253.75 291.81
15100 872.35 828.73 953.04 15301 58.33 55.41 63.72
# 15100 690.61 656.08 754.49 # 15301 54.98 52.23 60.06
15101 210.16 199.65 229.60 15320 355.02 337.27 387.86
# 15101 112.58 106.95 122.99 # 15320 306.02 290.72 334.33
15110 843.48 801.31 921.51 15321 86.86 82.52 94.90
# 15110 702.78 667.64 767.79 # 15321 81.84 77.75 89.41
15111 121.16 115.10 132.37 15330 285.21 270.95 311.59
# 15111 103.16 98.00 112.70 # 15330 242.08 229.98 264.48
15115 806.16 765.85 880.73 15331 57.91 55.01 63.26
# 15115 721.57 685.49 788.31 # 15331 54.98 52.23 60.06
15116 158.81 150.87 173.50 15335 316.34 300.52 345.60
# 15116 140.80 133.76 153.82 # 15335 269.85 256.36 294.81
15120 867.09 823.74 947.30 15336 84.68 80.45 92.52
# 15120 734.76 698.02 802.72 # 15336 78.40 74.48 85.65
15121 280.20 266.19 306.12 15340 306.99 291.64 335.39
# 15121 174.67 165.94 190.83 # 15340 256.74 243.90 280.49
15130 678.42 644.50 741.18 15341 45.82 43.53 50.06
# 15130 542.74 515.60 592.94 # 15341 26.97 25.62 29.46
15131 99.01 94.06 108.17 15360 335.10 318.35 366.10
# 15131 83.51 79.33 91.23 # 15360 278.99 265.04 304.80
15135 822.11 781.00 898.15 15361 67.89 64.50 74.18
# 15135 742.12 705.01 810.76 # 15361 62.03 58.93 67.77
15136 92.84 88.20 101.43 15365 347.20 329.84 379.32
# 15136 84.46 80.24 92.28 # 15365 292.76 278.12 319.84
15150 696.17 661.36 760.56 15366 84.14 79.93 91.92
# 15150 619.12 588.16 676.38 # 15366 78.28 74.37 85.53
15151 127.96 121.56 139.79 15400 342.77 325.63 374.47
# 15151 111.63 106.05 121.96 # 15400 330.20 313.69 360.74
15152 156.91 149.06 171.42 15401 108.58 103.15 118.62
# 15152 139.32 132.35 152.20 # 15401 56.23 53.42 61.43
15155 703.86 668.67 768.97 15420 387.40 368.03 423.23
# 15155 662.82 629.68 724.13 # 15420 344.27 327.06 376.12
15156 166.87 158.53 182.31 15421 111.99 106.39 122.35
# 15156 154.73 146.99 169.04 # 15421 83.09 78.94 90.78
15157 185.36 176.09 202.50 15430 514.71 488.97 562.32
# 15157 169.03 160.58 184.67 # 15430 499.64 474.66 545.86
15170 381.29 362.23 416.56 15570 848.63 806.20 927.13
# 15170 321.83 305.74 351.60 # 15570 665.21 631.95 726.74
15171 87.35 82.98 95.43 15572 779.61 740.63 851.72
# 15171 84.00 79.80 91.77 # 15572 651.47 618.90 711.74
15175 525.70 499.42 574.33 15574 843.42 801.25 921.44
# 15175 465.39 442.12 508.44 # 15574 716.12 680.31 782.36
15176 138.92 131.97 151.77 15576 751.72 714.13 821.25
# 15176 132.64 126.01 144.91 # 15576 629.02 597.57 687.21
15200 737.56 700.68 805.78 15600 369.47 351.00 403.65
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 6
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
# 15600 199.87 189.88 218.36 15832 835.34 793.57 912.61
15610 301.12 286.06 328.97 15833 780.13 741.12 852.29
# 15610 234.53 222.80 256.22 15834 784.14 744.93 856.67
15620 446.72 424.38 488.04 15835 807.93 767.53 882.66
# 15620 297.64 282.76 325.17 15836 686.03 651.73 749.49
15630 440.73 418.69 481.49 15837 718.49 682.57 784.96
# 15630 321.38 305.31 351.11 # 15837 650.23 617.72 710.38
15650 471.03 447.48 514.60 15838 537.33 510.46 587.03
# 15650 349.17 331.71 381.47 15839 767.24 728.88 838.21
15731 1,031.92 980.32 1,127.37 # 15839 657.94 625.04 718.80
# 15731 924.30 878.09 1,009.80 15840 952.27 904.66 1,040.36
15732 1,460.85 1,387.81 1,595.98 15841 1,570.78 1,492.24 1,716.08
# 15732 1,240.58 1,178.55 1,355.33 15842 2,494.01 2,369.31 2,724.71
15734 1,490.19 1,415.68 1,628.03 15845 892.13 847.52 974.65
# 15734 1,269.92 1,206.42 1,387.38 15851 97.81 92.92 106.86
15736 1,375.38 1,306.61 1,502.60 # 15851 43.37 41.20 47.38
# 15736 1,115.32 1,059.55 1,218.48 15852 45.13 42.87 49.30
15738 1,444.76 1,372.52 1,578.40 15860 106.90 101.56 116.79
# 15738 1,210.67 1,150.14 1,322.66 15920 547.42 520.05 598.06
15740 877.68 833.80 958.87 15922 695.78 660.99 760.14
# 15740 775.92 737.12 847.69 15931 616.91 586.06 673.97
15750 859.12 816.16 938.58 15933 768.82 730.38 839.94
15756 2,246.53 2,134.20 2,454.33 15934 853.11 810.45 932.02
15757 2,244.67 2,132.44 2,452.31 15935 1,031.71 980.12 1,127.14
15758 2,244.61 2,132.38 2,452.24 15936 839.93 797.93 917.62
15760 781.45 742.38 853.74 15937 982.47 933.35 1,073.35
# 15760 660.42 627.40 721.51 15940 642.98 610.83 702.45
15770 611.55 580.97 668.12 15941 858.49 815.57 937.91
15775 321.04 304.99 350.74 15944 830.43 788.91 907.25
# 15775 210.49 199.97 229.97 15945 923.14 876.98 1,008.53
15776 420.74 399.70 459.66 15946 1,514.89 1,439.15 1,655.02
# 15776 316.46 300.64 345.74 15950 530.23 503.72 579.28
15780 797.90 758.01 871.71 15951 768.95 730.50 840.08
# 15780 643.79 611.60 703.34 15952 792.07 752.47 865.34
15781 486.91 462.56 531.94 15953 894.14 849.43 976.84
# 15781 406.93 386.58 444.57 15956 1,078.50 1,024.58 1,178.27
15782 570.43 541.91 623.20 15958 1,094.08 1,039.38 1,195.29
# 15782 424.28 403.07 463.53 16000 67.74 64.35 74.00
15783 458.14 435.23 500.51 # 16000 43.87 41.68 47.93
# 15783 342.14 325.03 373.78 16020 82.28 78.17 89.90
15786 218.91 207.96 239.15 # 16020 54.22 51.51 59.24
# 15786 128.45 122.03 140.33 16025 141.21 134.15 154.27
15787 55.81 53.02 60.97 # 16025 108.55 103.12 118.59
# 15787 18.96 18.01 20.71 16030 167.51 159.13 183.00
15788 375.38 356.61 410.10 # 16030 123.96 117.76 135.42
# 15788 210.80 200.26 230.30 16035 205.58 195.30 224.60
15789 525.75 499.46 574.38 16036 81.53 77.45 89.07
# 15789 385.88 366.59 421.58 17000 67.52 64.14 73.76
15792 362.12 344.01 395.61 # 17000 47.00 44.65 51.35
# 15792 244.02 231.82 266.59 17003 7.20 6.84 7.87
15793 392.56 372.93 428.87 # 17003 5.11 4.85 5.58
# 15793 309.23 293.77 337.84 17004 163.54 155.36 178.66
15819 685.41 651.14 748.81 # 17004 130.45 123.93 142.52
15820 508.69 483.26 555.75 17106 363.39 345.22 397.00
# 15820 451.73 429.14 493.51 # 17106 308.95 293.50 337.53
15821 544.34 517.12 594.69 17107 638.13 606.22 697.15
# 15821 479.01 455.06 523.32 # 17107 561.50 533.43 613.44
15822 405.83 385.54 443.37 17108 861.46 818.39 941.15
# 15822 351.81 334.22 384.35 # 17108 783.99 744.79 856.51
15823 620.58 589.55 677.98 17110 93.95 89.25 102.64
# 15823 562.37 534.25 614.39 # 17110 55.42 52.65 60.55
15830 1,095.07 1,040.32 1,196.37 17111 110.61 105.08 120.84
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 7
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
# 17111 71.24 67.68 77.83 19101 308.23 292.82 336.74
17250 71.36 67.79 77.96 # 19101 200.19 190.18 218.71
# 17250 33.67 31.99 36.79 19102 227.10 215.75 248.11
17260 88.56 84.13 96.75 # 19102 99.79 94.80 109.02
# 17260 62.18 59.07 67.93 19103 596.97 567.12 652.19
17261 119.42 113.45 130.47 # 19103 185.32 176.05 202.46
# 17261 80.06 76.06 87.47 19105 2,059.31 1,956.34 2,249.79
17262 145.99 138.69 159.49 # 19105 177.79 168.90 194.24
# 17262 102.44 97.32 111.92 19110 415.04 394.29 453.43
17263 161.09 153.04 176.00 # 19110 290.67 276.14 317.56
# 17263 113.35 107.68 123.83 19112 398.03 378.13 434.85
17264 173.90 165.21 189.99 # 19112 259.83 246.84 283.87
# 17264 120.29 114.28 131.42 19120 418.33 397.41 457.02
17266 199.67 189.69 218.14 # 19120 354.26 336.55 387.03
# 17266 139.36 132.39 152.25 19125 458.99 436.04 501.45
17270 126.86 120.52 138.60 # 19125 391.99 372.39 428.25
# 17270 86.66 82.33 94.68 19126 151.78 144.19 165.82
17271 137.50 130.63 150.22 19260 1,127.52 1,071.14 1,231.81
# 17271 97.71 92.82 106.74 19271 1,560.92 1,482.87 1,705.30
17272 157.39 149.52 171.95 19272 1,716.51 1,630.68 1,875.28
# 17272 113.01 107.36 123.46 19290 163.33 155.16 178.43
17273 176.46 167.64 192.79 # 19290 62.82 59.68 68.63
# 17273 127.46 121.09 139.25 19291 71.98 68.38 78.64
17274 211.68 201.10 231.27 # 19291 31.36 29.79 34.26
# 17274 156.82 148.98 171.33 19295 107.93 102.53 117.91
17276 249.17 236.71 272.22 # 19295 84.90 80.66 92.76
# 17276 189.71 180.22 207.25 19296 4,947.94 4,700.54 5,405.62
17280 117.75 111.86 128.64 # 19296 196.18 186.37 214.33
# 17280 78.80 74.86 86.09 19297 89.50 85.03 97.78
17281 150.46 142.94 164.38 19298 1,785.05 1,695.80 1,950.17
# 17281 110.26 104.75 120.46 # 19298 318.11 302.20 347.53
17282 173.98 165.28 190.07 19300 507.16 481.80 554.07
# 17282 127.92 121.52 139.75 # 19300 346.35 329.03 378.38
17283 212.26 201.65 231.90 19301 376.41 357.59 411.23
# 17283 160.33 152.31 175.16 19302 794.93 755.18 868.46
17284 249.05 236.60 272.09 19303 805.10 764.85 879.58
# 17284 192.10 182.50 209.88 19304 500.84 475.80 547.17
17286 321.77 305.68 351.53 19305 986.20 936.89 1,077.42
# 17286 262.73 249.59 287.03 19306 1,025.20 973.94 1,120.03
17311 672.17 638.56 734.34 19307 1,030.58 979.05 1,125.91
# 17311 352.65 335.02 385.27 19316 739.37 702.40 807.76
17312 407.12 386.76 444.77 19318 1,094.18 1,039.47 1,195.39
# 17312 187.69 178.31 205.06 19324 456.68 433.85 498.93
17313 614.24 583.53 671.06 19325 607.45 577.08 663.64
# 17313 316.08 300.28 345.32 19328 457.32 434.45 499.62
17314 377.06 358.21 411.94 19330 582.67 553.54 636.57
# 17314 173.54 164.86 189.59 19340 377.86 358.97 412.82
17315 78.85 74.91 86.15 19342 858.89 815.95 938.34
# 17315 49.11 46.65 53.65 19350 892.23 847.62 974.76
17340 42.56 40.43 46.49 # 19350 648.09 615.69 708.04
17360 115.94 110.14 126.66 19355 719.72 683.73 786.29
# 17360 89.56 85.08 97.84 # 19355 515.78 489.99 563.49
19000 112.70 107.07 123.13 19357 1,453.31 1,380.64 1,587.74
# 19000 43.60 41.42 47.63 19361 1,456.87 1,384.03 1,591.63
19001 26.20 24.89 28.62 19364 2,632.89 2,501.25 2,876.44
# 19001 21.59 20.51 23.59 19366 1,316.23 1,250.42 1,437.98
19020 409.63 389.15 447.52 19367 1,726.16 1,639.85 1,885.83
# 19020 257.62 244.74 281.45 19368 2,114.77 2,009.03 2,310.38
19030 171.01 162.46 186.83 19369 1,952.78 1,855.14 2,133.41
# 19030 75.53 71.75 82.51 19370 638.54 606.61 697.60
19100 135.10 128.35 147.60 19371 736.05 699.25 804.14
# 19100 65.17 61.91 71.20 19380 718.66 682.73 785.14
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 8
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
19396 165.29 157.03 180.58 20663 427.61 406.23 467.16
# 19396 128.02 121.62 139.86 20664 699.18 664.22 763.85
20000 194.43 184.71 212.42 20665 134.54 127.81 146.98
# 20000 151.30 143.74 165.30 # 20665 104.81 99.57 114.51
20005 284.10 269.90 310.39 20670 501.06 476.01 547.41
# 20005 227.99 216.59 249.08 # 20670 152.65 145.02 166.77
20100 570.07 541.57 622.81 20680 581.23 552.17 635.00
20101 376.70 357.87 411.55 # 20680 379.80 360.81 414.93
# 20101 190.76 181.22 208.40 20690 247.07 234.72 269.93
20102 457.06 434.21 499.34 20692 404.90 384.66 442.36
# 20102 229.67 218.19 250.92 20693 453.61 430.93 495.57
20103 555.53 527.75 606.91 20694 446.21 423.90 487.49
# 20103 340.70 323.67 372.22 # 20694 330.21 313.70 360.76
20150 866.47 823.15 946.62 20802 2,486.49 2,362.17 2,716.50
20200 185.20 175.94 202.33 20805 3,255.31 3,092.54 3,556.42
# 20200 88.04 83.64 96.19 20808 4,107.94 3,902.54 4,487.92
20205 252.72 240.08 276.09 20816 2,673.35 2,539.68 2,920.63
# 20205 139.65 132.67 152.57 20822 2,357.84 2,239.95 2,575.94
20206 292.40 277.78 319.45 20824 2,650.57 2,518.04 2,895.75
# 20206 61.24 58.18 66.91 20827 2,445.49 2,323.22 2,671.70
20220 216.40 205.58 236.42 20838 2,336.56 2,219.73 2,552.69
# 20220 77.37 73.50 84.53 20900 589.15 559.69 643.64
20225 970.80 922.26 1,060.60 # 20900 457.24 434.38 499.54
# 20225 116.93 111.08 127.74 20902 591.56 561.98 646.28
20240 227.12 215.76 248.12 20910 419.54 398.56 458.34
20245 608.49 578.07 664.78 20912 472.96 449.31 516.71
20250 357.47 339.60 390.54 20920 384.93 365.68 420.53
20251 402.39 382.27 439.61 20922 572.36 543.74 625.30
20500 130.60 124.07 142.68 # 20922 461.80 438.71 504.52
# 20500 103.38 98.21 112.94 20924 495.67 470.89 541.52
20501 141.92 134.82 155.04 20926 418.05 397.15 456.72
# 20501 37.23 35.37 40.68 20931 111.84 106.25 122.19
20520 189.07 179.62 206.56 20937 169.74 161.25 185.44
# 20520 140.91 133.86 153.94 20938 185.01 175.76 202.12
20525 497.23 472.37 543.23 20950 307.64 292.26 336.10
# 20525 241.78 229.69 264.14 # 20950 89.47 85.00 97.75
20526 75.37 71.60 82.34 20955 2,479.94 2,355.94 2,709.33
# 20526 57.37 54.50 62.68 20956 2,616.82 2,485.98 2,858.88
20550 57.23 54.37 62.53 20957 2,470.57 2,347.04 2,699.10
# 20550 38.80 36.86 42.39 20962 2,605.49 2,475.22 2,846.50
20551 56.08 53.28 61.27 20969 2,749.65 2,612.17 3,004.00
# 20551 41.43 39.36 45.26 20970 2,734.64 2,597.91 2,987.60
20552 52.95 50.30 57.85 20972 2,512.83 2,387.19 2,745.27
# 20552 32.85 31.21 35.89 20973 2,731.64 2,595.06 2,984.32
20553 59.46 56.49 64.96 20974 56.99 54.14 62.26
# 20553 36.43 34.61 39.80 # 20974 46.94 44.59 51.28
20600 52.61 49.98 57.48 20975 174.47 165.75 190.61
# 20600 39.21 37.25 42.84 20979 55.54 52.76 60.67
20605 57.56 54.68 62.88 # 20979 37.12 35.26 40.55
# 20605 40.39 38.37 44.13 20982 4,532.14 4,305.53 4,951.36
20610 71.51 67.93 78.12 # 20982 388.86 369.42 424.83
# 20610 48.06 45.66 52.51 21010 693.25 658.59 757.38
20612 56.84 54.00 62.10 21015 416.55 395.72 455.08
# 20612 41.77 39.68 45.63 21025 936.54 889.71 1,023.17
20615 223.75 212.56 244.44 # 21025 806.31 765.99 880.89
# 20615 157.58 149.70 172.16 21026 546.83 519.49 597.41
20650 187.11 177.75 204.41 # 21026 468.52 445.09 511.85
# 20650 151.10 143.55 165.08 21029 704.37 669.15 769.52
20660 235.85 224.06 257.67 # 21029 599.26 569.30 654.70
# 20660 170.94 162.39 186.75 21030 455.73 432.94 497.88
20661 428.65 407.22 468.30 # 21030 388.73 369.29 424.68
20662 456.51 433.68 498.73 21031 351.43 333.86 383.94
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 9
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
# 21031 277.31 263.44 302.96 21147 1,570.84 1,492.30 1,716.15
21032 358.17 340.26 391.30 21150 1,626.49 1,545.17 1,776.95
# 21032 272.74 259.10 297.97 21151 1,902.99 1,807.84 2,079.02
21034 1,281.49 1,217.42 1,400.03 21154 2,096.69 1,991.86 2,290.64
# 21034 1,140.78 1,083.74 1,246.30 21155 2,294.50 2,179.78 2,506.75
21040 458.24 435.33 500.63 21159 2,795.66 2,655.88 3,054.26
# 21040 379.10 360.15 414.17 21160 2,854.30 2,711.59 3,118.33
21044 841.11 799.05 918.91 21172 1,649.95 1,567.45 1,802.57
21045 1,163.66 1,105.48 1,271.30 21175 1,992.96 1,893.31 2,177.31
21046 1,033.08 981.43 1,128.64 21179 1,420.17 1,349.16 1,551.53
21047 1,272.18 1,208.57 1,389.86 21180 1,597.90 1,518.01 1,745.71
21048 1,052.10 999.50 1,149.43 21181 698.72 663.78 763.35
21049 1,209.55 1,149.07 1,321.43 21182 1,951.08 1,853.53 2,131.56
21050 824.43 783.21 900.69 21183 2,175.78 2,066.99 2,377.04
21060 766.83 728.49 837.76 21184 2,410.11 2,289.60 2,633.04
21070 618.66 587.73 675.89 21188 1,589.80 1,510.31 1,736.86
21076 992.79 943.15 1,084.62 21193 1,210.02 1,149.52 1,321.95
# 21076 886.84 842.50 968.88 21194 1,353.46 1,285.79 1,478.66
21077 2,477.20 2,353.34 2,706.34 21195 1,304.72 1,239.48 1,425.40
# 21077 2,244.78 2,132.54 2,452.42 21196 1,402.27 1,332.16 1,531.98
21079 1,683.71 1,599.52 1,839.45 21198 1,091.77 1,037.18 1,192.76
# 21079 1,490.24 1,415.73 1,628.09 21199 972.09 923.49 1,062.01
21080 1,912.92 1,817.27 2,089.86 21206 1,082.52 1,028.39 1,182.65
# 21080 1,681.76 1,597.67 1,837.32 21208 1,456.87 1,384.03 1,591.63
21081 1,738.74 1,651.80 1,899.57 # 21208 798.99 759.04 872.90
# 21081 1,522.66 1,446.53 1,663.51 21209 756.92 719.07 826.93
21082 1,575.61 1,496.83 1,721.35 # 21209 619.98 588.98 677.33
# 21082 1,394.71 1,324.97 1,523.72 21210 1,669.79 1,586.30 1,824.25
21083 1,495.06 1,420.31 1,633.36 # 21210 806.71 766.37 881.33
# 21083 1,287.77 1,223.38 1,406.89 21215 2,674.21 2,540.50 2,921.58
21084 1,714.94 1,629.19 1,873.57 # 21215 835.82 794.03 913.13
# 21084 1,488.80 1,414.36 1,626.51 21230 744.70 707.47 813.59
21085 680.22 646.21 743.14 21235 681.94 647.84 745.02
# 21085 598.98 569.03 654.38 # 21235 534.12 507.41 583.52
21086 1,849.36 1,756.89 2,020.42 21240 1,089.71 1,035.22 1,190.50
# 21086 1,670.97 1,587.42 1,825.53 21242 1,001.68 951.60 1,094.34
21087 1,828.93 1,737.48 1,998.10 21243 1,620.76 1,539.72 1,770.68
# 21087 1,657.24 1,574.38 1,810.54 21244 992.53 942.90 1,084.34
21100 673.19 639.53 735.46 21245 1,071.85 1,018.26 1,171.00
# 21100 369.17 350.71 403.32 # 21245 872.93 829.28 953.67
21110 660.60 627.57 721.71 21246 835.05 793.30 912.30
# 21110 587.73 558.34 642.09 21247 1,584.34 1,505.12 1,730.89
21116 190.51 180.98 208.13 21248 991.47 941.90 1,083.19
# 21116 42.26 40.15 46.17 # 21248 852.85 810.21 931.74
21120 627.80 596.41 685.87 21249 1,408.91 1,338.46 1,539.23
# 21120 497.98 473.08 544.04 # 21249 1,217.95 1,157.05 1,330.61
21121 709.19 673.73 774.79 21255 1,344.43 1,277.21 1,468.79
# 21121 617.06 586.21 674.14 21256 1,119.78 1,063.79 1,223.36
21122 679.61 645.63 742.47 21260 1,138.02 1,081.12 1,243.29
21123 873.61 829.93 954.42 21261 2,179.68 2,070.70 2,381.31
21125 2,842.88 2,700.74 3,105.85 21263 1,880.58 1,786.55 2,054.53
# 21125 727.27 690.91 794.55 21267 1,546.19 1,468.88 1,689.21
21127 2,724.41 2,588.19 2,976.42 21268 1,834.47 1,742.75 2,004.16
# 21127 847.49 805.12 925.89 21270 866.80 823.46 946.98
21137 698.11 663.20 762.68 # 21270 673.75 640.06 736.07
21138 882.65 838.52 964.30 21275 775.40 736.63 847.12
21139 983.96 934.76 1,074.97 21280 498.18 473.27 544.26
21141 1,284.90 1,220.66 1,403.76 21282 335.12 318.36 366.11
21142 1,273.40 1,209.73 1,391.19 21295 174.28 165.57 190.41
21143 1,304.54 1,239.31 1,425.21 21296 382.62 363.49 418.01
21145 1,468.77 1,395.33 1,604.63 21310 113.51 107.83 124.00
21146 1,514.89 1,439.15 1,655.02 # 21310 27.24 25.88 29.76
0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 10
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
21315 245.01 232.76 267.67 # 21461 871.65 828.07 952.28
# 21315 141.99 134.89 155.12 21462 1,719.52 1,633.54 1,878.57
21320 234.67 222.94 256.38 # 21462 946.90 899.56 1,034.49
# 21320 133.33 126.66 145.66 21465 884.12 839.91 965.90
21325 490.91 466.36 536.31 21470 1,137.31 1,080.44 1,242.51
21330 595.79 566.00 650.90 21480 94.02 89.32 102.72
21335 712.83 677.19 778.77 # 21480 30.79 29.25 33.64
21336 630.24 598.73 688.54 21485 558.57 530.64 610.24
21337 374.60 355.87 409.25 # 21485 509.58 484.10 556.72
# 21337 268.24 254.83 293.05 21490 884.45 840.23 966.26
21338 799.50 759.53 873.46 21495 604.48 574.26 660.40
21339 867.44 824.07 947.68 21497 558.71 530.77 610.39
21340 763.38 725.21 833.99 # 21497 504.27 479.06 550.92
21343 1,147.93 1,090.53 1,254.11 21501 414.44 393.72 452.78
21344 1,466.31 1,392.99 1,601.94 # 21501 302.21 287.10 330.17
21345 744.01 706.81 812.83 21502 511.68 486.10 559.02
# 21345 621.73 590.64 679.24 21510 459.94 436.94 502.48
21346 921.57 875.49 1,006.81 21550 233.31 221.64 254.89
21347 1,135.34 1,078.57 1,240.36 # 21550 148.30 140.89 162.02
21348 1,087.15 1,032.79 1,187.71 21555 401.57 381.49 438.71
21355 413.50 392.83 451.75 # 21555 304.41 289.19 332.57
# 21355 300.01 285.01 327.76 21556 383.91 364.71 419.42
21356 470.78 447.24 514.33 21557 553.66 525.98 604.88
# 21356 360.23 342.22 393.55 21600 516.19 490.38 563.94
21360 506.37 481.05 553.21 21610 999.64 949.66 1,092.11
21365 1,054.80 1,002.06 1,152.37 21615 665.45 632.18 727.01
21366 1,174.73 1,115.99 1,283.39 21616 814.52 773.79 889.86
21385 687.88 653.49 751.51 21620 514.55 488.82 562.14
21386 638.05 606.15 697.07 21627 534.97 508.22 584.45
21387 734.70 697.97 802.67 21630 1,216.60 1,155.77 1,329.14
21390 727.67 691.29 794.98 21632 1,200.75 1,140.71 1,311.82
21395 912.88 867.24 997.33 21685 940.53 893.50 1,027.53
21400 164.77 156.53 180.01 21700 405.28 385.02 442.77
# 21400 133.78 127.09 146.15 21705 605.71 575.42 661.73
21401 460.81 437.77 503.44 21720 347.21 329.85 379.33
# 21401 276.97 263.12 302.59 21725 500.02 475.02 546.27
21406 518.12 492.21 566.04 21740 1,032.43 980.81 1,127.93
21407 612.60 581.97 669.27 21750 688.43 654.01 752.11
21408 842.75 800.61 920.70 21800 92.46 87.84 101.02
21421 641.64 609.56 700.99 21805 245.19 232.93 267.87
# 21421 577.15 548.29 630.53 21810 476.87 453.03 520.98
21422 651.95 619.35 712.25 21820 126.16 119.85 137.83
21423 776.68 737.85 848.53 # 21820 124.07 117.87 135.55
21431 684.51 650.28 747.82 21825 554.59 526.86 605.89
21432 654.74 622.00 715.30 21920 225.16 213.90 245.99
21433 1,629.05 1,547.60 1,779.74 # 21920 141.83 134.74 154.95
21435 1,259.71 1,196.72 1,376.23 21925 393.56 373.88 429.96
21436 1,848.80 1,756.36 2,019.81 # 21925 311.90 296.31 340.76
21440 455.07 432.32 497.17 21930 436.37 414.55 476.73
# 21440 397.70 377.82 434.49 # 21930 340.05 323.05 371.51
21445 668.36 634.94 730.18 21935 1,099.34 1,044.37 1,201.03
# 21445 584.61 555.38 638.69 22010 846.43 804.11 924.73
21450 472.33 448.71 516.02 22015 839.49 797.52 917.15
# 21450 427.94 406.54 467.52 22100 757.45 719.58 827.52
21451 635.95 604.15 694.77 22101 759.72 721.73 829.99
# 21451 571.46 542.89 624.32 22102 762.15 724.04 832.65
21452 618.74 587.80 675.97 22103 140.97 133.92 154.01
# 21452 293.36 278.69 320.49 22110 942.22 895.11 1,029.38
21453 734.59 697.86 802.54 22112 939.24 892.28 1,026.12
# 21453 701.50 666.43 766.39 22114 943.03 895.88 1,030.26
21454 528.44 502.02 577.32 22116 141.17 134.11 154.23
21461 1,540.84 1,463.80 1,683.37 22210 1,669.54 1,586.06 1,823.97
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 11
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
22212 1,379.93 1,310.93 1,507.57 22846 765.54 727.26 836.35
22214 1,399.81 1,329.82 1,529.29 22847 842.15 800.04 920.05
22216 369.98 351.48 404.20 22848 365.79 347.50 399.63
22220 1,504.79 1,429.55 1,643.98 22849 1,251.57 1,188.99 1,367.34
22222 1,388.87 1,319.43 1,517.34 22850 685.35 651.08 748.74
22224 1,497.92 1,423.02 1,636.47 22851 409.03 388.58 446.87
22226 366.21 347.90 400.09 22852 656.26 623.45 716.97
22305 178.40 169.48 194.90 22855 1,050.80 998.26 1,148.00
# 22305 162.48 154.36 177.51 22857 1,402.10 1,332.00 1,531.80
22310 261.40 248.33 285.58 22862 1,699.44 1,614.47 1,856.64
# 22310 242.55 230.42 264.98 22865 1,655.39 1,572.62 1,808.51
22315 804.17 763.96 878.55 22900 372.18 353.57 406.61
# 22315 705.34 670.07 770.58 23000 521.25 495.19 569.47
22318 1,496.98 1,422.13 1,635.45 # 23000 349.56 332.08 381.89
22319 1,659.52 1,576.54 1,813.02 23020 670.11 636.60 732.09
22325 1,298.55 1,233.62 1,418.66 23030 433.16 411.50 473.23
22326 1,371.52 1,302.94 1,498.38 # 23030 251.84 239.25 275.14
22327 1,344.56 1,277.33 1,468.93 23031 423.26 402.10 462.42
22328 276.88 263.04 302.50 # 23031 217.64 206.76 237.77
22505 115.78 109.99 126.49 23035 688.73 654.29 752.43
22520 2,747.50 2,610.13 3,001.65 23040 697.87 662.98 762.43
# 22520 570.33 541.81 623.08 23044 555.37 527.60 606.74
22521 2,558.14 2,430.23 2,794.76 23065 193.25 183.59 211.13
# 22521 540.52 513.49 590.51 # 23065 153.47 145.80 167.67
22522 239.45 227.48 261.60 23066 484.75 460.51 529.59
22523 603.30 573.14 659.11 # 23066 326.46 310.14 356.66
22524 577.50 548.63 630.92 23075 246.94 234.59 269.78
22525 267.36 253.99 292.09 # 23075 167.37 159.00 182.85
22526 2,191.66 2,082.08 2,394.39 23076 531.77 505.18 580.96
# 22526 331.08 314.53 361.71 23077 1,116.15 1,060.34 1,219.39
22527 1,792.45 1,702.83 1,958.25 23100 472.64 449.01 516.36
# 22527 151.30 143.74 165.30 23101 437.82 415.93 478.32
22532 1,630.69 1,549.16 1,781.53 23105 618.69 587.76 675.92
22533 1,509.81 1,434.32 1,649.47 23106 464.24 441.03 507.18
22534 363.84 345.65 397.50 23107 644.24 612.03 703.83
22548 1,750.85 1,663.31 1,912.81 23120 546.29 518.98 596.83
22554 1,240.38 1,178.36 1,355.11 23125 680.85 646.81 743.83
22556 1,575.15 1,496.39 1,720.85 23130 589.81 560.32 644.37
22558 1,436.19 1,364.38 1,569.04 23140 487.99 463.59 533.13
22585 337.38 320.51 368.59 23145 659.21 626.25 720.19
22590 1,443.98 1,371.78 1,577.55 23146 600.70 570.67 656.27
22595 1,373.25 1,304.59 1,500.28 23150 623.38 592.21 681.04
22600 1,175.57 1,116.79 1,284.31 23155 762.23 724.12 832.74
22610 1,167.75 1,109.36 1,275.76 23156 654.20 621.49 714.71
22612 1,518.93 1,442.98 1,659.43 23170 520.71 494.67 568.87
22614 394.85 375.11 431.38 23172 528.30 501.89 577.17
22630 1,457.35 1,384.48 1,592.15 23174 729.50 693.03 796.98
22632 319.70 303.72 349.28 23180 705.69 670.41 770.97
22800 1,296.36 1,231.54 1,416.27 23182 673.73 640.04 736.05
22802 2,070.28 1,966.77 2,261.79 23184 756.55 718.72 826.53
22804 2,399.78 2,279.79 2,621.76 23190 539.39 512.42 589.28
22808 1,746.50 1,659.18 1,908.06 23195 718.05 682.15 784.47
22810 1,966.05 1,867.75 2,147.91 23200 847.59 805.21 925.99
22812 2,136.68 2,029.85 2,334.33 23210 883.10 838.95 964.79
22818 2,139.75 2,032.76 2,337.67 23220 1,038.98 987.03 1,135.08
22819 2,415.32 2,294.55 2,638.73 23221 1,163.10 1,104.95 1,270.69
22830 777.58 738.70 849.51 23222 1,633.04 1,551.39 1,784.10
22840 770.81 732.27 842.11 23330 222.24 211.13 242.80
22842 771.52 732.94 842.88 # 23330 146.86 139.52 160.45
22843 812.17 771.56 887.29 23331 571.71 543.12 624.59
22844 1,004.98 954.73 1,097.94 23332 859.41 816.44 938.91
22845 736.78 699.94 804.93 23350 171.45 162.88 187.31
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 12
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
# 23350 49.59 47.11 54.18 # 23665 370.55 352.02 404.82
23395 1,240.65 1,178.62 1,355.41 23670 593.29 563.63 648.17
23397 1,114.03 1,058.33 1,217.08 23675 520.18 494.17 568.30
23400 948.12 900.71 1,035.82 # 23675 478.72 454.78 523.00
23405 613.94 583.24 670.73 23680 735.73 698.94 803.78
23406 766.72 728.38 837.64 23700 188.88 179.44 206.36
23410 877.87 833.98 959.08 23800 980.18 931.17 1,070.85
23412 933.83 887.14 1,020.21 23802 1,142.29 1,085.18 1,247.96
23415 719.91 683.91 786.50 23900 1,284.26 1,220.05 1,403.06
23420 1,021.11 970.05 1,115.56 23920 1,038.20 986.29 1,134.23
23430 724.21 688.00 791.20 23921 427.31 405.94 466.83
23440 748.82 711.38 818.09 23930 365.14 346.88 398.91
23450 932.81 886.17 1,019.10 # 23930 208.10 197.70 227.36
23455 994.64 944.91 1,086.65 23931 301.54 286.46 329.43
23460 1,075.68 1,021.90 1,175.19 # 23931 157.49 149.62 172.06
23462 1,048.66 996.23 1,145.66 23935 487.00 462.65 532.05
23465 1,091.80 1,037.21 1,192.79 24000 455.75 432.96 497.90
23466 1,072.88 1,019.24 1,172.13 24006 689.81 655.32 753.62
23470 1,192.91 1,133.26 1,303.25 24065 221.82 210.73 242.34
23472 1,465.60 1,392.32 1,601.17 # 24065 152.31 144.69 166.39
23480 804.81 764.57 879.26 24066 571.91 543.31 624.81
23485 943.30 896.14 1,030.56 # 24066 375.92 357.12 410.69
23490 800.14 760.13 874.15 24075 458.75 435.81 501.18
23491 1,000.10 950.10 1,092.62 # 24075 294.17 279.46 321.38
23500 200.16 190.15 218.67 24076 448.46 426.04 489.95
# 23500 189.27 179.81 206.78 24077 779.94 740.94 852.08
23505 327.44 311.07 357.73 24100 383.83 364.64 419.34
# 23505 305.66 290.38 333.94 24101 483.72 459.53 528.46
23515 560.41 532.39 612.25 24102 597.37 567.50 652.63
23520 203.64 193.46 222.48 24105 324.73 308.49 354.76
# 23520 200.29 190.28 218.82 24110 564.21 536.00 616.40
23525 329.76 313.27 360.26 24115 692.82 658.18 756.91
# 23525 305.05 289.80 333.27 24116 844.41 802.19 922.52
23530 531.48 504.91 580.65 24120 504.68 479.45 551.37
23532 602.47 572.35 658.20 24125 564.40 536.18 616.61
23540 204.39 194.17 223.30 24126 613.19 582.53 669.91
# 23540 188.90 179.46 206.38 24130 491.57 466.99 537.04
23545 295.71 280.92 323.06 24134 753.65 715.97 823.37
# 23545 264.72 251.48 289.20 24136 613.49 582.82 670.24
23550 553.17 525.51 604.34 24138 641.89 609.80 701.27
23552 638.90 606.96 698.00 24140 731.79 695.20 799.48
23570 213.24 202.58 232.97 24145 622.36 591.24 679.93
# 23570 209.47 199.00 228.85 24147 646.54 614.21 706.34
23575 358.61 340.68 391.78 24149 1,098.12 1,043.21 1,199.69
# 23575 335.58 318.80 366.62 24150 945.38 898.11 1,032.83
23585 669.98 636.48 731.95 24151 1,096.06 1,041.26 1,197.45
23600 303.29 288.13 331.35 24152 706.38 671.06 771.72
# 23600 267.69 254.31 292.46 24153 651.47 618.90 711.74
23605 445.23 422.97 486.42 24155 814.07 773.37 889.38
# 23605 404.19 383.98 441.58 24160 588.50 559.08 642.94
23615 789.62 750.14 862.66 24164 481.98 457.88 526.56
23616 1,423.51 1,352.33 1,555.18 24200 203.30 193.14 222.11
23620 245.70 233.42 268.43 # 24200 132.95 126.30 145.25
# 23620 223.09 211.94 243.73 24201 570.77 542.23 623.56
23625 359.42 341.45 392.67 # 24201 352.17 334.56 384.74
# 23625 333.03 316.38 363.84 24220 187.77 178.38 205.14
23630 563.45 535.28 615.57 # 24220 65.49 62.22 71.55
23650 279.98 265.98 305.88 24300 386.05 366.75 421.76
# 23650 243.13 230.97 265.62 24301 732.35 695.73 800.09
23655 354.95 337.20 387.78 24305 563.42 535.25 615.54
23660 558.36 530.44 610.01 24310 462.03 438.93 504.77
23665 395.68 375.90 432.29 24320 733.63 696.95 801.49
0 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
0 LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
0 ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 13
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
24330 698.56 663.63 763.17 24640 118.95 113.00 129.95
24331 767.64 729.26 838.65 # 24640 79.16 75.20 86.48
24332 577.97 549.07 631.43 24650 241.59 229.51 263.94
24340 597.24 567.38 652.49 # 24650 204.74 194.50 223.68
24341 686.78 652.44 750.31 24655 416.49 395.67 455.02
24342 768.30 729.89 839.37 # 24655 372.10 353.50 406.53
24343 682.62 648.49 745.76 24665 629.75 598.26 688.00
24344 1,054.19 1,001.48 1,151.70 24666 711.09 675.54 776.87
24345 678.32 644.40 741.06 24670 270.23 256.72 295.23
24346 1,047.40 995.03 1,144.28 # 24670 231.29 219.73 252.69
24350 435.68 413.90 475.99 24675 433.49 411.82 473.59
24351 474.94 451.19 518.87 # 24675 392.87 373.23 429.21
24352 505.80 480.51 552.59 24685 657.17 624.31 717.96
24354 505.57 480.29 552.33 24800 792.12 752.51 865.39
24356 519.53 493.55 567.58 24802 975.89 927.10 1,066.17
24360 874.83 831.09 955.75 24900 681.36 647.29 744.38
24361 981.90 932.81 1,072.73 24920 679.29 645.33 742.13
24362 1,014.36 963.64 1,108.19 24925 524.79 498.55 573.33
24363 1,423.87 1,352.68 1,555.58 24930 708.83 673.39 774.40
24365 623.76 592.57 681.46 24931 783.53 744.35 856.00
24366 667.36 633.99 729.09 24935 970.22 921.71 1,059.97
24400 801.21 761.15 875.32 25000 403.65 383.47 440.99
24410 1,014.99 964.24 1,108.88 25001 316.57 300.74 345.85
24420 957.10 909.25 1,045.64 25020 606.19 575.88 662.26
24430 988.94 939.49 1,080.41 25023 1,122.45 1,066.33 1,226.28
24435 1,021.60 970.52 1,116.10 25024 716.93 681.08 783.24
24470 657.57 624.69 718.39 25025 1,074.73 1,020.99 1,174.14
24495 665.53 632.25 727.09 25028 528.51 502.08 577.39
24498 853.33 810.66 932.26 25031 468.95 445.50 512.33
24500 327.22 310.86 357.49 25035 816.50 775.68 892.03
# 24500 283.67 269.49 309.91 25040 580.93 551.88 634.66
24505 476.30 452.49 520.36 25065 219.83 208.84 240.17
# 24505 428.14 406.73 467.74 # 25065 154.08 146.38 168.34
24515 853.15 810.49 932.06 25066 442.04 419.94 482.93
24516 844.02 801.82 922.09 25075 382.82 363.68 418.23
24530 352.73 335.09 385.35 25076 565.17 536.91 617.45
# 24530 308.76 293.32 337.32 25077 856.45 813.63 935.67
24535 592.97 563.32 647.82 25085 497.52 472.64 543.54
# 24535 544.81 517.57 595.21 25100 363.85 345.66 397.51
24538 730.08 693.58 797.62 25101 421.36 400.29 460.33
24545 771.50 732.93 842.87 25105 521.89 495.80 570.17
24546 1,088.51 1,034.08 1,189.19 25107 625.52 594.24 683.38
24560 294.97 280.22 322.25 25109 485.81 461.52 530.75
# 24560 247.65 235.27 270.56 25110 431.70 410.12 471.64
24565 490.88 466.34 536.29 25111 324.73 308.49 354.76
# 24565 447.75 425.36 489.16 25112 391.45 371.88 427.66
24566 673.63 639.95 735.94 25115 928.03 881.63 1,013.87
24575 776.05 737.25 847.84 25116 795.44 755.67 869.02
24576 310.85 295.31 339.61 25118 401.83 381.74 439.00
# 24576 270.65 257.12 295.69 25119 539.24 512.28 589.12
24577 511.24 485.68 558.53 25120 704.44 669.22 769.60
# 24577 467.27 443.91 510.50 25125 786.65 747.32 859.42
24579 833.09 791.44 910.16 25126 801.25 761.19 875.37
24582 757.36 719.49 827.41 25130 463.26 440.10 506.12
24586 1,069.73 1,016.24 1,168.68 25135 570.88 542.34 623.69
24587 1,059.73 1,006.74 1,157.75 25136 503.54 478.36 550.11
24600 355.33 337.56 388.19 25145 715.58 679.80 781.77
# 24600 306.75 291.41 335.12 25150 609.54 579.06 665.92
24605 436.50 414.68 476.88 25151 784.81 745.57 857.41
24615 697.57 662.69 762.09 25170 1,030.18 978.67 1,125.47
24620 529.33 502.86 578.29 25210 505.25 479.99 551.99
24635 1,084.47 1,030.25 1,184.79 25215 658.42 625.50 719.33
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 COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS07 MASSACHUSETTS - MEDICARE CARRIER 31143 PAGE 14
FSY07 LOCALITY FEE SCHEDULE FOR AREA 99 DATE 12/18/06
0 PAR NON-PAR LIMITING PAR NON-PAR LIMITING
NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE NOTE PROCEDURE MOD AMOUNT AMOUNT CHARGE
---- --------- --- ------------ ------------ ------------ ---- --------- --- ------------ ------------ ------------
25230 450.50 427.98 492.18 # 25500 212.57 201.94 232.23
25240 477.72 453.83 521.90 25505 476.42 452.60 520.49
25246 187.22 177.86 204.54 # 25505 432.45 410.83 472.45
# 25246 72.06 68.46 78.73 25515 675.80 642.01 738.31
25248 536.97 510.12 586.64 25520 529.54 503.06 578.52
25250 507.51 482.13 554.45 # 25520 498.13 473.22 544.20
25251 690.98 656.43 754.89 25525 906.61 861.28 990.47
25259 385.13 365.87 420.75 25526 1,059.96 1,006.96 1,158.00
25260 822.57 781.44 898.66 25530 238.62 226.69 260.69
25263 818.46 777.54 894.17 # 25530 205.11 194.85 224.08
25265 941.93 894.83 1,029.05 25535 454.63 431.90 496.69
25270 697.79 662.90 762.34 # 25535 424.48 403.26 463.75
25272 767.47 729.10 838.47 25545 669.44 635.97 731.37
25274 869.09 825.64 949.49 25560 247.79 235.40 270.71
25275 649.80 617.31 709.91 # 25560 208.42 198.00 227.70
25280 768.89 730.45 840.02 25565 497.74 472.85 543.78
25290 774.95 736.20 846.63 # 25565 447.49 425.12 488.89
25295 725.11 688.85 792.18 25574 589.25 559.79 643.76
25300 685.31 651.04 748.70 25575 861.63 818.55 941.33
25301 654.94 622.19 715.52 25600 272.33 258.71 297.52
25310 822.79 781.65 898.90 # 25600 231.71 220.12 253.14
25312 915.02 869.27 999.66 25605 570.92 542.37 623.73
25315 968.85 920.41 1,058.47 # 25605 531.56 504.98 580.73
25316 1,117.47 1,061.60 1,220.84 25606 669.07 635.62 730.96
25320 941.52 894.44 1,028.61 25607 666.72 633.38 728.39
25332 824.29 783.08 900.54 25608 759.32 721.35 829.55
25