ACS-Bundled-Rates

FHCP Ambulatory Surgery Facility

Surgery Procedures	Billing Code	Bundled Facility Fee
Excision Lesion Trunk Arms or Legs 1.1 to 2.0	11402	$ 199.62
Excision Lesion Trunk Arms or Legs 2.1 to 3.0	11403	$ 217.00
Excision Lesion Trunk Arms or Legs 3.1 to 4.0	11404	$ 977.74
Excision Lesion Trunk Arms or Legs Over 4.0	11406	$ 977.74
Excision Lesin Scalp Neck Hand, FT	11423	$ 218.23
Excision Lesin Scalp Neck Hands 3.1 to 4.0	11424	$ 977.74
Excision Lesin Scalp Neck Hands Over 4.0	11426	$ 1,927.52
Excision malg Lesion Trunk Arm Legs 0.6 to 1.0 cm	11601	$ 266.58
Excision malg Lesion Trunk Arm Legs 1.1 to 2 cm	11602	$ 286.54
Excision malg Lesion Trunk Arm Leg 2.1 to 3.0	11603	$ 310.36
Excision malg Lesion Trunk Arm Leg 3.1 to 4.0 cm	11604	$ 533.28
Removal of Nail Plate	11730	$ 312.04
Excision Pilonidial Cyst Extensive	11771	$ 1,927.52
Excision Excess Skin Abdomen	15830	$ 3,741.88
Biop Breast w/ Place of Local Device	19083	$ 977.74
Excn Brst Lesion ID Pre Op Open Single Lesion	19125	$ 1,889.54
Biopsy Bone Excisional	20240	$ 1,927.52
Arthrocent Aspiration and / or Injection	20600	$ 41.20
Removal Support Implant Superficial	20670	$ 977.74
Removal Support Implant Deep	20680	$ 1,927.52
Excision Tumor Soft Tissue Neck/ Ant Thrx, Subq	21552	$ 1,927.52
Excision Tumor Soft Tissue Neck/ Ant Thrx, Less 3 cm	21555	$ 977.74
Excision Tumor Soft Tissue Back or Flank 5 cm or greater	21931	$ 977.74
Excision Tumor Soft Tissue Abdominal Wall	22901	$ 1,927.52
Excision Tumor Soft Tissue Abdominal Wall 3 cm or greater	22903	$ 1,927.52
Excision Tumor Soft Tissue Shoulder 3 cm or greater	23071	$ 977.74
Excision Tumor Soft Tissue Upper Arm / Elbow	24071	$ 1,927.52
Repair Ruptured Tendon	24342	$ 4,903.82
Open Tenotomy Elbow W Tendon Repair	24359	$ 2,245.76
Incision of Tendon Sheath	25000	$ 1,259.88
Treatment Forearm Bone	25035	$ 4,903.82
Excision Tumor Soft Tissue Forearm / Wrist	25071	$ 977.74
Removal of Forearm Lesion	25075	$ 977.74
Removal Wrist Tendon Lesion	25111	$ 1,259.88
Exploration Removal Deep Foreign Body	25248	$ 1,259.88
Transplantation Forearm Tendon	25310	$ 2,245.76
Revise Wrist Joint	25332	$ 2,245.76
Reconstruct Wrist Joint	25441	$ 15,139.84
Repair Wrist Joint(s)	25447	$ 2,245.76
Remove Wrist Joint Implant	25449	$ 4,903.82
Treat FX Distal Radial	25607	$ 6,940.24
Treat FX Radial	25609	$ 6,997.02
Treat Wrist Fracture	25680	$ 207.20
Treat Wrist Fracture	25685	$ 2,245.76
Release Palm Contracture	26040	$ 1,259.88
Incise Finger Tendon Sheath	26055	$ 1,259.88
Incision of Finger Tendon	26060	$ 1,259.88
Remove Lesion Hand/Finger Subcu	26111	$ 977.74
Remove Lesion Hand/Finger Subfascial	26113	$ 977.74
Removal Hand Lesion Subcut	26115	$ 977.74
Remove Tumor Hand/Finger 3cm Greater	26118	$ 1,927.52
Excision Lesion of Tendon Sheath	26160	$ 1,259.88
Remove Hand Bone Lesion	26200	$ 1,259.88
Remove/Graft Bone Lesion	26205	$ 4,903.82
Partial Removal Hand Bone	26230	$ 2,245.76
Repair Finger/Hand Tendon	26350	$ 2,245.76
Repair/Graft Hand Tendon	26352	$ 2,245.76
Repair Finger/Hand Tendon	26356	$ 2,245.76
Repair/Graft Hand Tendon	26358	$ 2,245.76
Repair Hand Tendon	26410	$ 1,259.88
Repair/Graft Hand Tendon	26412	$ 2,245.76
Repair /Finger Tendon	26418	$ 1,259.88
Repair/Graft Finger Tendon	26420	$ 2,245.76
Repair Finger/Hand Tendon	26426	$ 2,245.76
Repair/ Graft Finger Tendon	26428	$ 2,245.76
Repair Finger Tendon	26433	$ 2,245.76
Repair / Graft Finger Tendon	26434	$ 2,245.76
Release Palm / Finger Tendon	26440	$ 1,259.88
Release Palm & Finger Tendon	26442	$ 2,245.76
Release Hand & Finger Tendon	26445	$ 2,245.76
Release Hand Forearm & Hand Tendon	26449	$ 2,245.76
Incision of Palm Tendon	26450	$ 2,245.76
Incision of Finger Tendon	26455	$ 1,259.88
Incise Hand / Finger Tendon	26460	$ 1,259.88
Open Treatment Metacarpal Fx Single	26615	$ 2,245.76
Amputate Metacarpal Bone	26910	$ 2,245.76
Amputation of Finger/Thumb	26952	$ 2,245.76
Excision Tumor Soft Tissue Thigh / Knee	27327	$ 976.74
Excision Tumor Soft Tissue Thigh Knee Subq	27337	$ 1,927.52
Repair Knee Ligament	27407	$ 4,903.82
Fixation of Knee Joint	27570	$ 1,259.88
Repair of Archilles Tendon	27654	$ 4,903.82
Lenghth /Shorten Leg/Ankle Tendon	27685	$ 2,245.76
Revise Lower Leg Tendons Multiple	27686	$ 2,245.76
ReviseLlower Leg Tendon	27690	$ 4,903.82
Incision and Drainage	28001	$ 323.26
Decompression of Tibia Nerve	28035	$ 1,396.84
Excision Tumor Soft Tissue Foot Toe Subfascial	28045	$ 1,927.52
Ostectomy Exc of Tarsal Coal	28116	$ 2,245.76
Ostectomy Calcaneus	28118	$ 2,245.76
Phalangectomy Toe each Toe	28150	$ 2,245.76
Partial Removal of Toe	28160	$ 2,245.76
Removal of Foot Foreign Body	28190	$ 332.26
Removal of Foot Foreign Body Deep	28192	$ 977.74
Removal Foot Foreign Body Compl	28193	$ 977.74
Incision of Foot Tendon(s)	28230	$ 505.48
Incision of Foot Tendon	28234	$ 1,259.98
Tenotomy Abductor Hallucis	28240	$ 2,245.76
Correct Hammer Toe	28285	$ 2,245.76
Correct Cock- Up 5th Toe W/PL	28286	$ 2,245.76
Partial Osteomy each Metat	28288	$ 2,245.76
Correct Hallux Valgus w/ Implant	28291	$ 7,150.70
Keller Mcbride or Mayo Proce	28292	$ 2,245.76
Correct Bunion w/ Metatars OS	28296	$ 2,245.76
Correct Bunon Lapidus Type	28297	$ 6,788.38
Correct Bunon by Phalanx OS	28298	$ 4,903.82
Correct Bunon Double Osteot	28299	$ 2,245.76
Osteotomy First Metatarsal	28306	$ 4,903.82
Osteotomy other than First Metatarsal	28308	$ 2,245.76
Incision of Metatarsals	28309	$ 4,903.82
Osteotomy Prox Phanlanx 1st Toe	28310	$ 2,245.76
Osteotomy other Phalanges any Toe	28312	$ 2,245.76
Sesamoidectomy First Toe	28315	$ 2,245.76
Open Treatment Metacarpal Fx w Internal Fixation	28485	$ 6,384.06
Amputation thru Metatarsal	28805	$ 4,885.42
Amputation Toe & Metatarsal	28810	$ 2,245.76
Toe Amputation Interphalange	28825	$ 2,245.76
Shoulder Arthroscopy Surgery Debridement Extensive	29823	$ 2,245.76
Shoulder Arthroscopy Surgery W Lysis / Resection of adhensions	29825	$ 2,245.76
Shoulder Arthroscopy Surgery Distal Clavicul	29827	$ 4,903.82
Shoulder Arthroscopy Surgery Biceps Tenodesis	29828	$ 4,903.82
Elbow Athroscopy Surgery	29838	$ 2,245.76
Wrist Arthroscopy	29840	$ 2,245.76
Wrist Arthroscopy / Surgery	29843	$ 2,245.76
Wrist Endoscopy/Surgery	29848	$ 1,259.88
Athroscopy Knee Surgery Synovectomy	29876	$ 2,245.76
Athroscopy Knee Surgery Debridement Shaving Medial and Lateral	29880	$ 2,245.76
Athroscopy Knee Surgery Debridement Shaving Medial or Lateral	29881	$ 2,245.76
Athroscopy Knee Surgery Repair Medial or Lateral	29882	$ 2,245.76
Athroscopy Knee Surgery Ant Cruciate Ligament	29888	$ 6,605.60
Arthoscopy Ankle Surgical	29891	$ 2,245.76
Endoscopic Plantar Fasciotom	29893	$ 2,245.76
Arthroscopy Ankle w Ankle Arthrodesis	29899	$ 4,948.82
Unlisted Procedure / Arthroscopy	29999
Insert Central Venous Device >5	36561	$ 2,333.86
Biopsy/Excision Lymph Node (s)	38500	$ 1,889.54
Biopsy/Excision Llymph Node (s) Open Int	38530	$ 1,889.54
Laparoscopy Surg w Retroperitonel Biop	38570	$ 3,805.32
Esophagoscopy Flex	43200	$ 701.00
EGD	43233	$ 1,148.50
EGD Flex Diagnostic	43235	$ 701.00
EGD W/ Biopsy	43239	$ 701.00
EGD W/ Injection	43243	$ 1,148.50
EGD Flex With Band/Ligation	43244	$ 1,148.50
EGD Flex W/ Dialation	43245	$ 1,148.50
EGD W / Place Gastrostomy Tube	43246	$ 1,148.50
EGD with Removal Foreign Body	43247	$ 701.00
EGD W/ Wire insertion/ Dilators	43248	$ 701.00
EGD W Ballon Dilation	43249	$ 1,148.50
EGD W/ Removal Polyps/Tumors	43250	$ 1,148.50
EGD W/ Snare	43251	$ 1,148.50
EGD W/ Control Hemorrhage	43255	$ 1,148.50
EGD W/ Delivery Thermal Treatment	43257	$ 2,204.02
EGD W/ Ablation of Tumor(s)	43270	$ 1,148.50
Laproscopy Esophagogastric Fundoplasty	43280	$ 7,013.91
Laparoscopy Esopaesopheal Hernia	43281	$ 7,013.91
Laparoscopy Repair Paraesophageal Hernia W Implant of Mesh	43282	$ 7,013.91
Laparoscopy, Gastrostomy	43653	$ 3,805.32
Replacement of Gastrostomy Tube	43762	$ 213.02
Small Bowel Endoscopy Biopsy	44361	$ 1,148.50
Illeoscopy Stoma / Diagnostic	44380	$ 701.00
Sigmoidoscopy Flex Diagnostic	45330	$ 252.42
Sigmoidoscopy With Biopsy	45331	$ 685.66
Sigmoidoscopy & Polypectomy	45333	$ 685.66
Sigmoidoscopy for Bleeding	45334	$ 901.90
Sigmoidoscopy w/Removal Tumor Lesion by Snare	45338	$ 901.90
Sigmoidoscopy Flex W/ Band Ligations	45350	$ 901.90
Colonoscopy Flex Diagnostic	45378	$ 685.66
Colonoscopy W/ Foreign Body Removal	45379	$ 901.90
Colonoscopy and Biopsy	45380	$ 901.90
Colonoscopy, Submucous inj	45381	$ 901.90
Colonoscopy/Control Bleeding	45382	$ 901.90
Colonoscopy W Removal Polyp / Tumor	45384	$ 901.90
Colonoscopy Lesion Removal	45385	$ 901.90
Colonoscopy W Dilation by Ballon	45386	$ 901.90
Colonoscopy W/ albation tumor/ polyp	45388	$ 901.90
Colonoscopy Flex w Mucosal Resection	45390	$ 901.90
Colonoscopy Flex W/ Endoscope US	45391	$ 901.90
Hemorrhiodectomy Internal Band Ligation	46221	$ 325.18
Needle Biopsy of Liver	47000	$ 977.74
Cholecystectomy Laparoscopy Surg	47562	$ 3,805.32
Cholecystectomy W Cholangiography	47563	$ 3,805.32
Repair Inguinal Hernia >5 Reducible	49505	$ 2,400.50
Repair Recurrent Inguinal Hernia Any Age Reducible	49520	$ 2,400.50
Repair Initial Femoral Hernia Reducible	49550	$ 2,400.50
Repair Femoral Hernia Reducible	49553	$ 2,400.50
Repair Femoral Hernia Recurrent Reducible	49555	$ 2,400.50
Repair Recurrent Femoral Hernia Inc	49557	$ 2,400.50
Repair Incisional Hernia Incar/Strang Initial	49561	$ 2,400.50
Repair Recurrent Incisional Hernia Incar/Strang	49566	$ 3,805.32
Repair Umbiical l Hernia Reduced 5 yrs or over	49585	$ 2,400.50
Laparoscopy Surg Repair init Inguinl Hernia	49650	$ 3,805.32
Laparoscopy Surg Repair Recur Inguinl Hernia	49651	$ 3,805.32
Laparoscopy Surg Repair Hernia Incl Mesh / Perf Reduc	49652	$ 3,805.32
Laparoscopy Surg Repair Hernia Incl Mesh / Perf Strang	49653	$ 3,805.32
Laparoscopy Surg Repair Hernia Incl Mesh	49655	$ 6,125.74
Removal of Thyroid	60240	$ 3,805.32
Parathyroidectomy with neuro monitoring	60500	$ 3,888.48
Carpal Tunnel Surgery	64721	$ 1,396.84
Screen Colonoscopy High Risk	G0105	$ 685.66
Colonoscopy Screening Low Risk	G0121	$ 685.66