October 2, 1989

SUBJECT: INSURANCE

Circular Letter No. 14 (1989)

WITHDRAWN

TO: AUTOMOBILE SELF-INSURERS AND INSURERS LICENSED TO WRITE AUTOMOBILE INSURANCE IN NEW YORK STATE

RE: NO-FAULT REIMBURSMENT SCHEDULES FOR HOSPITAL

(A) INPATIENT SERVICES RENDERED ON AND AFTER JANUARY 1, 1986; AND

(B) INPATIENT SERVICES RENDERED ON AND AFTER JANUARY 1, 1987

Pursuant to Regulation No. 83, 11 NYCRR 68.2; the no-fault rate schedules' for reimbursing hospital services provided under § 5102(a)(1) of the Insurance Law shall be those established, for workers' compensation by the Chair of the Workers' Compensation Board (WCB). These rates have now been established for hospital inpatient services in conformity with Chapter 767 of the Laws of 1977, as amended and § 2807-a of the Public Health Law; as amended.

Attached are two rate schedules duly established by. the WCB Chair:

(a) the first revised per diem schedule to. reimburse hospitals for inpatient services rendered during the period January 1, 1986' through December 31, 1986.

(b) the second per diem schedule to reimburse hospitals for inpatient services, rendered during the period January 1, 1987 through December 31, 1987.

Please note that the Health Department has determined that inpatient hospital admissions prior to January 1, 1988 shall be reimbursed on a per diem basis, rather than by the Diagnosis-Related Group (DRG) approach, effective January 1, 1988 for inpatient reimbursement as discussed in Circular Letter Nos..11 and 18 (1988).

Very truly yours,

[SIGNATURE]

James P. Corcoran

Superintendent of Insurance

TO: Medical Fee Schedule Users

Subject: Amendments to September 1986 Medical Fee Schedule

Attached are amendments to the September 1986 Workers' Compensation Board Schedule of Medical Fees. The amendments to the Medical Fee. Schedule, which include changes in Dollar Conversion Factors, apply to Medical, Physical Therapy and Occupational Therapy services rendered on or after September 1, 1989.

For services rendered prior to September 1, 1989, please refer to previously issued material.

NOTE: Effective 1-1-89, the fees listed in this schedule are applicable to services rendered under the Volunteer Ambulance Workers' Benefit Law.

Barbara Patton

Chairwoman

CONVERSION FACTORS

This schedule is divided into seven sections, each containing a coded listing of procedures pertinent to the section, with unit values assigned on a relativity basis to each section therein. The relativity within any one section is applicable to that particular section only. Familiarize yourself with the instructions preceding each section. In submitting reports and bills, list the 5 digit code(s) that identifies the service(s) performed (it is not necessary to describe the service if the 5 digit code is enumerated).

BILLING: The unit values reflect relativity, not fees. To determine the fee for a procedure, it is necessary to multiply the unit value of each procedure by the dollar conversion factor applicable to the particular section in effect on the date the service was rendered.

The Chairman has established four regions within New York State based on the difference in cost of maintaining a medical practice in different localities of the State. The Chairman has defined each such region by use of the U.S. Postal Service Zip Codes for the State of New York, based upon the relative cost factors which are compatible with that region.

The fees payable for medical care and treatment shall be determined by the Region in which the services were rendered.

REGIONAL CONVERSION FACTORS - effective September 1, 1986

REGIONAL CONVERSION FACTORS - effective September 1, 1987

REGIONAL CONVERSION FACTORS - effective September 1, 1988

REGIONAL CONVERSION FACTORS - effective September 1, 1989

POSTAL ZIP CODES INCLUDED IN EACH REGION

NUMERICAL LIST OF POSTAL ZIP CODES

MEDICINE

The relative values listed in this section have been determined on an entirely different basis than those in other sections. A conversion factor applicable to this section is not applicable to any other section.

The unit values listed in this section reflect the relativity of charges for procedures within this section only.

The fee for a particular procedure or service in this section is determined by multiplying the listed "unit value" by the current dollar "conversion factor" applicable to this section, subject to the Ground Rules, Instructions and Definitions of the Schedule.

MEDICINE GROUND RULES

General information and Instructions

1. GENERAL: Visits, examinations, consultations and similar services as listed in this section reflect the wide variations in time and skills required in the diagnosis and treatment of illness or injury. The listed relativities apply only when these services are performed by or under the responsible and direct supervision of a physician unless otherwise stated.

2. Specialists rendering services outside their field of specialization as designated by Workers' Compensation Board Coding may charge only general practitioner fees. A specialist shall be paid a specialist's fee only if the injuries sustained or the services rendered are within the scope of his specialty and the services of specialists are indicated or required. (See page 6 for specialist codings and scope restrictions.)

3. Fees indicated for examinations or visits by specialists are payable only to specialists with "C" ratings. Physicians with specialty ratings such as "IM,S" etc., (without the "C" prefix) shall be paid three-quarters of the fee indicated as payable to a specialist with a "C" rating for an office, home or hospital call, but in no event shall the fee for a physician with such a specialty rating be less than the fee payable to a general practitioner for the same service. (See also comprehensive level of service, page 4.)

4. If a patient is referred by a physician to a specialist for an opinion on diagnosis, prognosis, necessity and type of treatment, and such written opinion is sent to the referring physician, the insurance carrier, and the Workers' Compensation Board, a fee shall be payable for such opinion and examination in accordance with the level of service (see definitions), regardless of whether or not the specialist subsequently operates upon or treats the patient. See Ground Rule 20 below.

5. If a patient consults a specialist directly (non-referred case) and a complete examination is necessary for diagnosis, prognosis, necessity and type of treatment, and the specialist submits a report thereon to the Workers' Compensation Board and to the insurance carrier, in addition to or on the regular C-4/C-48 form, a specialist's fee is payable in accordance with the level of service (see definitions), regardless of whether or not the specialist subsequently operates upon or treats the patient.

6. A fee is payable to a specialist, in accordance with the level of service, for the examination of a patient who seeks the care of a physician either directly or by referral from another physician, in instances of elective surgery or when it is incumbent upon the specialist to examine the patient in order to make a proper diagnosis, prognosis and to decide on the necessity and type of treatment to be rendered. This fee is in addition to the unit fee prescribed for the operation or treatment subsequently rendered by the specialist except that where the therapeutic procedure or treatment is of a minor character and the fee for the procedure or treatment is in excess of the fee for the office visit, the greater fee (not both fees) is payable. Similarly, if the fee for the minor procedure or treatment is less than the fee for the office visit, the fee for the office visit alone is payable.

7. Where a physician renders treatment in the EMERGENCY ROOM of a hospital as an individual or as a member of a group under contract with the hospital, including those physicians who are hospital salaried or employed, all such services shall be paid at the general practice rates.

Where a physician enters into an agreement to cover the emergency room of a hospital on a fee-for-service basis, and is not under contract or salaried by the hospital, such physician shall be paid the fees of a general practitioner for the services rendered under the appropriate office visit category.

The above applies to all physicians regardless of specialty coding except for those physicians coded C-EM (Board Certified in Emergency Medicine) or EM (Board-eligible). C-EM's or EM's practicing under a fee-for-service agreement with a hospital shall be paid fees as set forth in the Specialist Fees section, office visits (see page 17). However, C-EM or EM remuneration shall not be at a level of reimbursement above the intermediate level with the exception of treatment of a substantiated life or limb threatening situation when the comprehensive level of service may be applicable. Consultation fees do not apply to C-EMs.

SUBSEQUENT CONSULTATIONS

IMMUNIZATION AND THERAPEUTIC

INJECTIONS

(For allergy testing, see 95000 et seq) (For skin testing of bacterial, viral, fungal extracts see 86400-86585)

These injections are usually given in conjunction with a medical service. The unit value for the appropriate medical service will be added to the unit values for the type of injection administered. The cost of the medication or material injected is also additional in accordance with Ground Rule 13; specify material.

PSYCHIATRIC SERVICES

Medical services may be described as coded and listed in other segments in the Medicine Section as appropriate. For initial office or hospital visit see 90010-90020; for subsequent office or hospital visit see 90040-90060; for consultations see 90600-90642. For diagnostic services performed in hospital emergency rooms, Hospital care by the attending physician in treating a psychiatric inpatient may be initial or subsequent in nature, and may include exchanges with nursing and ancillary personnel. Hospital care services involve a variety of responsibilities unique to the medical management of inpatients, such as physician hospital orders, interpretation of laboratory or other medical diagnostic studies and observations, review of activity therapy reports, supervision of nursing and ancillary personnel, and the programming of all hospital resources for diagnosis and treatment. Some patients receive hospital care services only and others receive hospital care services and other procedures. If other procedures such as electroconvulsive therapy or medical psychotherapy are rendered, these should be listed separately.

BIOFEEDBACK

Administration of biofeedback treatment is limited to qualified physicians. Those wishing to administer such treatments to patients covered by the provisions of the Workers' Compensation Law for the conditions listed below should submit evidence of their training and experience to the insurance carrier to expedite processing. Biofeedback treatments may be administered only for the following conditions:

(a) Idiopathic Raynaud's disease

(b) Temporomandibular Joint Dysfunction

(c) Myofascial Pain Dysfunction Syndrome (MPD)

(d) Tension headaches

(e) Migraine headaches

(f) Tinnitus

(g) Torticollis

(h) Neuromuscular re-education as result of neurological damage in CVA or spinal cord injury

(i) Inflammatory and/or musculoskeletal disorders usually related to the accepted condition.

Up to twelve Biofeedback treatments in a ninety day period may be allowed for the above conditions when the following is presented and authorization granted:

(a) An evaluation report documenting:

(i) The basis for the claimant's condition;

(ii) The condition's relationship to the industrial injury or illness;

(iii) An evaluation of the claimant's current functional measurable modalities (i.e., range of motion, up time, walking tolerance, medication intake, etc.);

(iv) An outline of the proposed treatment program;

(v) An outline of the expected restoration goals.

(b) No further Biofeedback treatments will be authorized or paid for without substantiation of evidence of improvement in measurable, functional modalities (i.e., range of motion, up time, walking tolerance, medication intake, etc.). The need for additional treatments will be determined on a case by case review in accordance with Workers' Compensation Board practices. The fees include interpretations and reports of the treatments.

When more than one of the treatments are performed on the same day, the maximum payment will be limited to 8.0 units.

MONITORING SERVICES

(For fetal monitoring during labor, see 59050)

The following values are for physician's services only and do not include charges for use of equipment or supplies where such charges are justified. The values apply only when the physician is engaged solely and is continuously present in the monitoring process.

DIALYSIS

The following descriptors apply only when these services are under the direct supervision of a physician and reflect only the professional component. Supplies, materials, and services of other personnel should be identified separately. If hemodialysis for acute renal failure exceeds six weeks, a further report is required. Detention time may be allowed in addition for highly complicated or unusual or extended hemodialysis if substantiated by report. If other significant, identifiable services are provided in addition to the appropriate hemodialysis procedure, list the appropriate visit for that service.

Peritoneal Dialysis

PHYSICAL THERAPY

The procedure codes listed in this section apply only to services rendered by a self-employed duly licensed and registered physical therapist (PT) unless otherwise stated. Physicians rendering physical therapy should utilize the appropriate codes in the Medicine Section.

The relative values listed in this section have been determined on an entirely different basis than those in other sections. A conversion factor applicable to this Section is not applicable to any other section.

The unit values listed in this section reflect the relativity for procedures within this section only.

The fee for a particular procedure or service in this section is determined by multiplying the listed "unit value" by the current dollar "conversion factor" applicable to this section, subject to the Ground Rules, Instructions and Definitions of the Schedule.

Physical Therapists are advised to familiarize themselves with the appropriate Ground Rules listed in the Medicine and Surgery Sections of this Schedule.

PHYSICAL THERAPY

The fees for physical therapy services listed below are payable only when the services are rendered by a self-employed duly licensed and registered physical therapist (PT) unless otherwise stated.

Referral of patients by a physician for the treatment by a PT must be made by means of a referral which may be directive, indicating treatment plan and duration of such treatment. The Physical Therapist shall be responsible for obtaining initial authorization and reauthorization from the carrier after the twelfth physical therapy treatment or after 45 days, whichever comes first, unless previous authorization was for a longer period of time or number of treatments.

The physical therapist shall submit PT-4 reports as required by regulation.

PT's employed by physicians (i.e. not self-employed) may not bill separately from the physician-employer although the latter's billing must indicate the manner of service as delineated above.

When physical therapy is rendered in a hospital department, the hospital shall be entitled to the listed values whether or not the head of the department is C-PMR or PMR coded.

When physical therapists who are self-employed render physical therapy during the after care periods for fractures, dislocations or other post-operative procedures, fees for such treatments shall be in addition to those payable to the referring physician or physician for the after care period, notwithstanding that one or more physicians are also treating the same patient during said after-care period. The referring physician or the physical therapist must inform the employer or carrier of the need for such additional therapy and obtain authorization for such from the employer or carrier. If such authorization is refused, a determination by the Workers' Compensation Board shall be requested. The refusal of such requested authorization shall be appealable in accordance with the Workers' Compensation Law.

When it is necessary to render physical therapy in a patient's home, add 50% to the listed unit value. An explanation justifying the need for home therapy rather than in an office or out-patient hospital setting shall be submitted along with the bill.

When multiple services or procedures (different code numbers) are rendered or performed on one day, the payments will be limited to the greatest allowable fee plus one-half of the lesser fee(s) up to a maximum of twice the highest fee.

ELECTROMYOGRAPHY:

MODALITIES

Codes 97000 through 97201 apply whether treatment is rendered

to one or more areas on any one day. List Modalities used.

PHYSICAL THERAPY

(T97100-T97799)

PROCEDURES

Physical therapist is required to be in constant attendance

OCCUPATIONAL THERAPY

The procedure codes listed in this section apply only to services rendered by a self-employed duly licensed and registered Occupational Therapist (OT). Physicians rendering occupational therapy should utilize the appropriate codes in the Medicine Section.

The relative values listed in this section have been determined on an entirely different basis than those in other sections. A conversion factor applicable to this Section is not applicable to any other section.

The fee for a particular procedure or service in this section is determined by multiplying the listed "unit value" by the current dollar "conversion factor" applicable to this section, subject to the Ground Rules, Instructions and Definitions of the Schedule.

Occupational Therapists are advised to familiarize themselves with the appropriate Ground Rules listed in the Medicine and Surgery Sections of this Schedule.

AUDITORY SYSTEM

EXTERNAL EAR

(For diagnostic services, such as

audiometric, vestibular and

speech tests, see 92551 et seq)

An error occurred in the processing of a table at this point in the document. Please refer to the table in the online document.

RADIOLOGY

Including Nuclear. Medicine and Diagnostic Ultrasound

GROUND RULES

1. GENERAL: Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician, with CR ratings. The listed values for Nuclear Medicine also apply to those physicians with C-NUM ratings.

Fees for physicians with R ratings shall be three-fourths of fees indicated. Fees payable to qualified specialists (C-rated but other than C-R) for items listed in this section, and within the scope of their specialty, shall be two-thirds of the indicated fees, except that full fees are payable to those physicians who are certified by the American. Board of Neurological Surgery or the American Board of Psychiatry and Neurology as Neurologists, who perform and interpret CT scans for neurological diagnoses. Fees for all other physicians, including those for items outside the scope of their coding, shall be one-half of the indicated values.

Consultations and referrals for diagnostic and therapeutic radiology are to be done only by specialists, with CR & R ratings.

Physicians qualified as general practitioners with the GP ratings, treating patients under their general medical care are permitted to take x-rays, but radiology requiring the use of ingestion or injection of foreign substance, shall be limited to qualified specialists within their specialty and physicians with the R ratings.

2. DUPLICATION OF X-RAYS: Every attempt should be made to minimize the number of x-rays taken. The attending doctor or any other person or institution having possession of x-rays which pertain to the patient that are deemed to be needed for diagnostic or treatment purposes should make these x-rays available upon request.

No payments shall be made for additional x-rays when recent x-rays are available except when supported by adequate information regarding the need to re-x-ray.

The use of photographic media and/or imaging is not reported separately but is considered to be a component of the basic procedure, and shall not merit any additional payment.

3. MULTIPLE DIAGNOSTIC X-RAY PROCEDURES: The following adjustments apply:

a. For two contiguous parts, the charge shall be the greater fee plus 50% of the lesser fee.

b. For two remote parts, the charge shall be the greater fee plus 75% of the lesser fee.

c. For three or more parts, whether contiguous or remote, the charge shall be the greatest fee plus 75% of the total of the lesser fees.

d. Where more than one part is included in a single line item, it shall be charged for as a single line item. Any additional item examined shall be considered under paragraph a, b, or c above, whichever pertains.

e. No charge shall be made for comparative x-rays except when such x-rays are specifically authorized by the carrier or the chairman. Comparative x-rays specifically authorized shall be subject to fees for contiguous and remote parts as provided in this formula (3a-3d).

f. X-Rays of different areas taken on different but proximate dates and related to the injury or problem necessitating the first x-ray studies, and which could have reasonably been performed at one time, shall be subject to rules a through e above.

4. XERORADIOGRAPHY: Imaging performed by this process shall have the identical values listed for conventional x-ray procedures of the same area and views.

5. MULTIPLE SERVICES OTHER THAN DIAGNOSTIC RADIOLOGY: When multiple or bilateral procedures or services are provided at the same session, the highest fee procedure will be reported as listed. The other procedure (s) will be billed for in accordance with Surgery ground rule 5.

6. UNIT VALUES: The total unit value includes professional services plus expenses of personnel, materials, including usual contrast media and drugs, space, equipment and other facilities. Values for injection procedures include all usual pre and post-injection car specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter, and injection of contrast media. Supplies and materials provided by the physician (e.g. sterile trays, radioisotopes, etc.) over and above those usually included with or necessitated by the services rendered may be charged for separately; in these instances, list items individually on bill. See Medicine ground rule 13.

The total unit value includes the professional component (see PC unit value below) plus the technical component (TC). This value is applicable in any situation in which a single charge is made to include both professional, services and the technical cost of providing that service. Identification of a procedure by its 5-digit code without modifier -26 or -27 indicates that the charge includes both the "professional" and "technical" components.

The PC unit value (professional component unit value) represents the value of the professional radiological services of the physician. This includes examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and written report of the examination including images, and consultation with the referring physician. This component is applicable in any situation in which the physician submits a charge for these professional services only. It does not include the cost of personnel, materials, space, equipment or other facilities. To identify a charge for professional component, use the 5-digit procedure code followed by modifier -26. (See modifier -26 and rule 15 for use of modifiers.)

When this section of the Schedule is used in connection with a "conversion factor" to establish fees, it must be emphasized that the conversion factor cannot be applied to both the TOTAL UNIT VALUE and the PROFESSIONAL COMPONENT UNIT VALUE. Physicians who determine their fees by application of conversion factors to the unit values in this section must determine a separate factor for TOTAL UNIT VALUE and for PC UNIT VALUE.

The technical component includes the charges for personnel, materials, including usual contrast media and drugs, film or xerograph, space, equipment and other facilities but excludes the cost of radioisotopes. No unit values are listed for the technical component of radiology procedures, since these are institutional charges not billed separately by physicians. To identify a charge for the technical component, use the 5-digit procedure code followed by modifier -27. (See modifier -27 and Rule 15 for use of modifiers). The total cost of a procedure(s) (PC plus TC) cannot exceed the total unit value cost of the procedure(s).

Fees are for a competent diagnosis by image, expert interpretation and opinion. Size and number of films are not relevant except as indicated by minimum number listed for respective procedures.

7. NECESSITY OF SERVICES OR PROCEDURES: When a patient is referred to radiologists or other specialists for services covered in the Radiology Section, they shall evaluate the patient's problem and determine the service(s) or procedure(s) medically necessary. Such evaluations and necessary consultation with the referring physician(s) is an integral part of the professional component unit value and does not merit any additional charges.

8. REPORTS AND CUSTODY OF X-RAYS AND OTHER RECORDED IMAGES: C48 and C4 reports are not acceptable. A written report of the findings must be submitted in quadruplicate; mail one to the district office of the Workers' Compensation Board, one to the attending physician and retain one for your records; the fourth to accompany bill to insurance carrier, if known, or to the employer.

Films or other recorded images shall be preserved for at least six years (but in no case shall they be destroyed without a report of the findings of such images being filed, as a permanent record). They (or satisfactory reproductions) shall be made available to the attending physician, insurance carrier or self-insured employer. When requested, carriers and self-insured employers shall return original films to the physician within 20 days of their receipt.

When a carrier or self-insured employer requests x-rays and satisfactory reproductions are furnished in lieu of the original films, a fee of four dollars ($ 4.00) may be charged for the first sheet of duplicating film and two dollars ($ 2.00) for each additional sheet of film. These reproductions are not returnable to the physician. Copies of images produced by copiers (e.g. Xerox) shall not merit any additional payment and shall not be returnable to the physician; such copies should accompany the bill submitted for the particular, imaging procedure. (The use of photographic media and/or imaging is not reported separately but is considered to be a component of the basic procedure.)

In cases where the patient transfers from one physician to another the former treating physician will promptly forward all images or copies of such to the new attending physician.

9. MATERIALS SUPPLIED BY PHYSICIAN: Supplies and materials provided by the physician (e.g., sterile trays, drugs, etc.) over and above those usually included with the office visit or other services rendered may be charged for separately. (List drugs, trays, materials or supplies provided.) Radiopharmaceutical or other radionuclide material cost: Listed values in this section do not include these costs. List the name and dosage of radiopharmaceutical material and cost (See Medicine ground rule 13.)

10. INJECTION PROCEDURES: Values for injection procedures include all usual pre-and post-injection care specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter and injection of contrast media.

Vascular injection procedures are listed in the cardiovascular section, under procedure codes 36000-36299. Other injection procedures are listed in appropriate sections.

11. "BR" (BY REPORT) ITEMS: "BR" in the value column (s) indicates that the value of that service is to be determined by report because the service is too unusual, variable or new to be assigned a unit value (s).

Submit a special report describing medical appropriateness of the service. Pertinent information-should include an adequate definition or description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service. Additional items which may be helpful might include:

Complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, and follow-up care.

12. UNLISTED SERVICE OR PROCEDURE: A service or procedure may be provided that is not listed in this Fee Schedule. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service, identifying it by report ("BR"). See 11. above.

13. SUBSECTION INFORMATION: Several of the subheadings or subsections have special needs or instructions unique to that section. Where these are indicated, e.g. "Therapeutic Radiology," special "NOTES" will be presented preceding those procedural terminology listings, referring to that subsection specifically. If there is an "Unlisted Procedure" code number (see item 12) for the individual subsection it will be shown. Those subsections with "NOTES" are as follows.

14. MISCELLANEOUS:

a.) Emergency services rendered between 10 p.m. and 8 a.m. in response to requests received during those hours or on Sundays or legal holidays, provided such services are not otherwise reimbursed, may warrant an additional payment of one-third of the applicable fee. Submit report (See 11 above and Medicine ground rules 7 & 8).

b.) Values for office, home and hospital visits, consultation and other medical services, anesthesia, surgical and laboratory procedures are listed in the sections entitled "Medicine," "Anesthesia," "Surgery," and "Pathology."

15. UNIT VALUE MODIFIERS:

-26 Professional Component: When the professional component unit value only is applicable, identify by adding this modifier (-26) to the usual procedure number(s). Charges shall be in accordance with the "PC Unit Value" for that procedure(s).

-27 Technical Component: When the professional component is charged for separately from the total unit value, the technical component will also be charged for separately. The technical component unit value will be the total value, less the professional component value. Identify by adding this modifier (-27) to the usual procedure(s) code number(s).

See item 6 above for correct conversion factor applicable to -26 and -27.

16. CT SCAN RECONSTRUCTION: (effective September 1, 1989)

An additional fee up to a maximum of $ 100 may be permitted for CT scan reconstruction. This additional fee shall be payable only when the reconstruction is requested by the primary care physician. The request must follow a review of the regular CT scan film and only if there is a specifically stated need for clarification via reconstruction.

The fee for reconstruction must be submitted on a separate bill with a separate report and a copy of the primary care physician's request.

17. MAGNETIC RESONANCE IMAGING: (effective September 1, 1989)

The fees for Magnetic Resonance Imaging shall be as follows: Professional component: 4 Radiology units for an MRI of any one part of the body Technical component: see chart below

The fees payable for an MRI study include both standard and axial views.

The provisions of Radiology Ground Rules 1 and 3 apply to Magnetic Resonance Imaging.

DIAGNOSTIC RADIOLOGY

HEAD AND NECK

VEINS AND LYMPHATICS

For injection procedure only for venous system, see 36400-36510) For injection procedure only for lymphatic system, see 38790-38794)

TRANSCATHETER THERAPY AND BIOPSY

MISCELLANEOUS

(For arthrography of shoulder, see 73040, 73041; elbow, see 73085, 73086; wrist, see 73115, 73116; hip, see 73525, 73526, knee, see 73580, 73581; ankle, see 73615, 73616)

DIAGNOSTIC ULTRASOUND

NOTES

A-mode implies a one-dimensional ultrasonic measurement procedure. M-mode implies a one-dimensional ultrasonic measurement procedure with movement of the trace to record amplitude and velocity of moving echo-producing structures. B-scan implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display. Real-time scan implies a two-dimensional ultrasonic scanning procedure with display of both two-dimensional structure and motion with time.

HEAD AND NECK

CHEST

ABDOMEN AND RETROPERITONEUM

PELVIS