OWCP MEDICAL FEE SCHEDULE - EFFECTIVE Table Of RVU & Conversion . - DOL

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OWCP MEDICAL FEE SCHEDULE - EFFECTIVETable of RVU & Conversion Factor values by CPT/HCPCS CodesEffective Date: June 30, 2020Last Update: June 30, 2020Pay Status: B Bundled (Non-ASC providers); C Covered; D Not Payable by DOL; R Suspend for Review; S Suspend for ReviewTable of RVU & Conversion Factor values by CPT/HCPCS .00END DATESHORT DESCRIPTION(ADA, HCPCS & OWCP codes only; Refer to AMA CPT)Anesth Salivary GlandAnesth Repair Of Cleft LipAnesth BlepharoplastyAnesth ElectroshockAnesth Ear SurgeryAnesth Ear ExamAnesth TympanotomyAnesth Procedures On EyeAnesth Lens SurgeryAnesth Corneal TransplantAnesth Vitreoretinal SurgAnesth IridectomyAnesth Eye ExamAnesth Nose/Sinus SurgeryAnesth Nose/Sinus SurgeryAnesth Biopsy Of NoseAnesth Procedure On MouthAnesth Cleft Palate RepairAnesth Pharyngeal SurgeryAnesth Pharyngeal SurgeryAnesth Face/Skull Bone SurgAnesth Facial Bone SurgeryAnesth Cranial Surg NosAnesth Cran Surg HemotomaAnesth Skull DrainageAnesth Skull DrainageAnesth Skull Repair/FractAnesth Head Vessel SurgeryAnesth Special Head SurgeryAnesth Intrcrn NerveAnesth Head Nerve SurgeryAnesth Head/Neck/PtrunkAnesth Neck Organ 1Yr/ Anesth Biopsy Of ThyroidAnesth Larynx/Trach 1 YrAnesth Neck Vessel SurgeryAnesth Neck Vessel SurgeryAnesth Skin Ext/Per/AtrunkAnesth Surgery Of BreastAnesth Surgery Of BreastAnesth Surgery Of BreastAnesth Correct Heart RhythmAnesth Surgery Of ShoulderAnesth Collar Bone BiopsyAnesth Removal Of RibAnesth Chest Wall RepairAnesth Surgery Of RibAnesth Esophageal SurgeryAnesth Chest ProcedureAnesth Chest Lining BiopsyAnesth Chest DrainageAnes Mediascpy & Dx ThorscpyAnes Medscpy&Thorscpy 1 LungAnesth Pacemaker InsertionAnesth Vascular AccessAnesth Cardioverter/DefibAnesth Cardiac ElectrophysAnesth Trach-Bronch ReconstAnesth Chest SurgeryAnesth One Lung VentilationAnesthesia Removal PleuraAnesth Lung Chest Wall SurgAnesth Trachea Bronchi SurgAnesth Sternal DebridementAnesth Heart Surg W/O PumpAnesth Heart Surg 1 YrAnesth Hrt Surg W/Pmp Age 1 Anesth Heart Surg W/ArrestAnesth Cabg W/O PumpAnesth Cabg W/PumpAnesth Heart/Lung TransplntAnesth Spine Cord SurgeryAnesth Sitting ProcedureAnesth Spine Cord SurgeryAnes Spine Tranthor W/O VentAnes Spine Transthor W/VentAnesth Spine Cord SurgeryAnesth Removal Of NervesAnesth Lumbar PunctureAnesth Spine ManipulationAnesth Spine Cord Surgery

000.000.000.000.000.000.00Anesth Abdominal Wall SurgAnesth For Liver BiopsyAnesth Abdominal Wall SurgAnes Upr Gi Ndsc Px NosAnes Upr Gi Ndsc Px ErcpAnesth Repair Of HerniaAnesth Repair Of HerniaAnesth Repair Of HerniaAnesth Repair Of HerniaAnesth Blood Vessel RepairAnesth Surg Upper AbdomenAnesth Hemorr/Excise LiverAnesth Pancreas RemovalAnesth For Liver TransplantAnesth Surgery For ObesityAnesth Abdominal Wall SurgAnesth Fat Layer RemovalAnes Lwr Intst Ndsc NosAnes Lwr Intst Scr ColscAnes Upr Lwr Gi Ndsc PxAnesth Abdominal Wall SurgAnesth Repair Of HerniaAnesth Repair Of HerniaAnesth Hernia Repair 1 YrAnesth Hernia Repair PreemieAnesth Surg Lower AbdomenAnesth AmniocentesisAnesth Pelvis SurgeryAnesth HysterectomyAnesth Pelvic Organ SurgAnesth Tubal LigationAnesth Surgery Of AbdomenAnesth Kidney/Ureter SurgAnesth Removal Of BladderAnesth Removal Of ProstateAnesth Removal Of AdrenalAnesth Kidney TransplantAnesth Bladder Stone SurgAnesth Kidney Stone DestructAnesth Kidney Stone DestructAnesth Abdomen Vessel SurgAnesth Major Vein LigationAnesth Anorectal SurgeryAnesth Perineal SurgeryAnesth Removal Of VulvaAnesth Removal Of ProstateAnesth Bladder SurgeryAnesth Bladder Tumor SurgAnesth Removal Of ProstateAnesth Bleeding ControlAnesth Stone RemovalAnesth Genitalia SurgeryAnesth VasectomyAnesth Sperm Duct SurgeryAnesth Testis ExplorationAnesth Removal Of TestisAnesth Removal Of TestisAnesth Testis SuspensionAnesth Amputation Of PenisAnesth Penis Nodes RemovalAnesth Penis Nodes RemovalAnesth Insert Penis DeviceAnesth Vaginal ProceduresAnesth Surg On Vag/UrethralAnesth Vaginal HysterectomyAnesth Repair Of CervixAnesth Vaginal EndoscopyAnesth Hysteroscope/GraphAnesth Bone Aspirate/BxAnesth Pelvis SurgeryAnesth Body Cast ProcedureAnesth Amputation At PelvisAnesth Pelvic Tumor SurgeryAnesth Pelvis ProcedureAnesth Pelvis SurgeryAnesth Fx Repair PelvisAnesth Hip Joint ProcedureAnesth Arthroscopy Of HipAnesth Hip Joint SurgeryAnesth Hip DisarticulationAnesth Hip ArthroplastyAnesth Revise Hip RepairAnesth Procedure On FemurAnesth Surgery Of FemurAnesth Amputation Of FemurAnesth Radical Femur SurgAnesth Upper Leg SurgeryAnesth Upper Leg Veins SurgAnesth Thigh Arteries SurgAnesth Femoral Artery SurgAnesth Femoral EmbolectomyAnesth Knee Area SurgeryAnesth Knee Area ProcedureAnesth Knee Area Surgery

000.000.000.000.000.000.00Anesth Knee Joint ProcedureAnesth Dx Knee ArthroscopyAnesth Knee Area ProcedureAnesth Knee Area SurgeryAnesth Knee Joint SurgeryAnesth Knee ArthroplastyAnesth Amputation At KneeAnesth Knee Joint CastingAnesth Knee Veins SurgeryAnesth Knee Vessel SurgAnesth Knee Arteries SurgAnesth Knee Artery SurgAnesth Knee Artery RepairAnesth Lower Leg ProcedureAnesth Ankle/Ft ArthroscopyAnesth Lower Leg SurgeryAnesth Achilles Tendon SurgAnesth Lower Leg SurgeryAnesth Lower Leg Bone SurgAnesth Radical Leg SurgeryAnesth Lower Leg RevisionAnesth Ankle ReplacementAnesth Lower Leg CastingAnesth Leg Arteries SurgAnesth Lwr Leg EmbolectomyAnesth Lower Leg Vein SurgAnesth Lower Leg Vein SurgAnesth Surgery Of ShoulderAnesth Shoulder ProcedureAnes Dx Shoulder ArthroscopyAnesth Surgery Of ShoulderAnesth Shoulder Joint AmputAnesth Forequarter AmputAnesth Shoulder ReplacementAnesth Shoulder Artery SurgAnesth Shoulder Vessel SurgAnesth Shoulder Vessel SurgAnesth Arm-Leg Vessel SurgAnesth Shoulder Vein SurgAnesth Shoulder CastingAnesth Elbow Area SurgeryAnesth Uppr Arm Tendon SurgAnesth Uppr Arm Tendon SurgAnesth Biceps Tendon RepairAnesth Uppr Arm ProcedureAnesth Dx Elbow ArthroscopyAnesth Upper Arm SurgeryAnesth Humerus SurgeryAnesth Humerus RepairAnesth Radical Humerus SurgAnesth Humeral Lesion SurgAnesth Elbow ReplacementAnesth Uppr Arm Artery SurgAnesth Uppr Arm EmbolectomyAnesth Upper Arm Vein SurgAnesth Uppr Arm Vein RepairAnesth Lower Arm SurgeryAnesth Lower Arm ProcedureAnesth Dx Wrist ArthroscopyAnesth Lower Arm SurgeryAnesth Wrist ReplacementAnesth Lwr Arm Artery SurgAnesth Lwr Arm EmbolectomyAnesth Vascular Shunt SurgAnesth Lower Arm Vein SurgAnesth Lwr Arm Vein RepairAnesth Lower Arm CastingAnesth Dx ArteriographyAnesth Catheterize HeartAnesth Cat Or MRI ScanAnes Ther Interven Rad ArtrlAnes Ther Interven Rad CardAnes Tx Interv Rad Hrt/CranAnes Ther Interven Rad VeinAnes Ther Interven Rad TipsAnes Tx Interv Rad Th VeinAnes Tx Interv Rad Cran VeinAnesth Perc Img Dx Sp ProcAnesth Perc Img Tx Sp ProcAnesth Burn Less 4 PercentAnesth Burn 4-9 PercentAnesth Burn Each 9 PercentAnesth Antepartum ManipulAnesth Vaginal DeliveryAnesth Cs DeliveryAnesth Emer HysterectomyAnesth Cs HysterectomyAnesth Inc/Missed Ab ProcAnesth Induced Ab ProcedureAnesth/Analg Vag DeliveryAnes/Analg Cs Deliver Add-OnAnesth/Analg Cs Hyst Add-OnSupport For Organ DonorAnesth Nerve Block/Inj

5.8055.8055.8055.8055.80Anesth N Block/Inj ProneHosp Manage Cont Drug AdminUnlisted Anesth ProcedureFna Bx W/O Img Gdn Ea AddlFna Bx W/Us Gdn 1St LesFna Bx W/Us Gdn Ea AddlFna Bx W/Fluor Gdn 1St LesFna Bx W/Fluor Gdn Ea AddlFna Bx W/Ct Gdn 1St LesFna Bx W/Ct Gdn Ea AddlFna Bx W/Mr Gdn 1St LesFna Bx W/Mr Gdn Ea AddlFna W/O ImageGuide Cathet Fluid DrainagePerq Dev Soft Tiss 1St ImagPerq Dev Soft Tiss Add ImagAcne SurgeryDrainage Of Skin AbscessDrainage Of Skin AbscessDrainage Of Pilonidal CystDrainage Of Pilonidal CystRemove Foreign BodyRemove Foreign BodyDrainage Of Hematoma/FluidPuncture Drainage Of LesionComplex Drainage WoundDebride Infected SkinDebride Infected Skin Add-OnDebride Genitalia & PerineumDebride Abdom WallDebride Genit/Per/Abdom WallRemove Mesh From Abd WallDebride Skin At Fx SiteDebride Skin Musc At Fx SiteDeb Skin Bone At Fx SiteDeb Subq Tissue 20 Sq Cm/ Deb Musc/Fascia 20 Sq Cm/ Deb Bone 20 Sq Cm/ Deb Subq Tissue Add-OnDeb Musc/Fascia Add-OnDeb Bone Add-OnTrim Skin LesionTrim Skin Lesions 2 To 4Trim Skin Lesions Over 4Tangntl Bx Skin Single LesTangntl Bx Skin Ea Sep/AddlPunch Bx Skin Single LesionPunch Bx Skin Ea Sep/AddlIncal Bx Skn Single LesIncal Bx Skn Ea Sep/AddlRemoval Of Skin Tags W/15Remove Skin Tags Add-OnShave Skin Lesion 0.5 Cm/ Shave Skin Lesion 0.6-1.0 CmShave Skin Lesion 1.1-2.0 CmShave Skin Lesion 2.0 CmShave Skin Lesion 0.5 Cm/ Shave Skin Lesion 0.6-1.0 CmShave Skin Lesion 1.1-2.0 CmShave Skin Lesion 2.0 CmShave Skin Lesion 0.5 Cm/ Shave Skin Lesion 0.6-1.0 CmShave Skin Lesion 1.1-2.0 CmShave Skin Lesion 2.0 CmExc Tr-Ext B9 Marg 0.5 Cm Exc Tr-Ext B9 Marg 0.6-1 CmExc Tr-Ext B9 Marg 1.1-2 CmExc Tr-Ext B9 Marg 2.1-3Cm/ Exc Tr-Ext B9 Marg 3.1-4 CmExc Tr-Ext B9 Marg 4.0 CmExc H-F-Nk-Sp B9 Marg 0.5/ Exc H-F-Nk-Sp B9 Marg 0.6-1Exc H-F-Nk-Sp B9 Marg 1.1-2Exc H-F-Nk-Sp B9 Marg 2.1-3Exc H-F-Nk-Sp B9 Marg 3.1-4Exc H-F-Nk-Sp B9 Marg 4 CmExc Face-Mm B9 Marg 0.5 Cm/ Exc Face-Mm B9 Marg 0.6-1 CmExc Face-Mm B9 Marg 1.1-2 CmExc Face-Mm B9 Marg 2.1-3 CmExc Face-Mm B9 Marg 3.1-4 CmExc Face-Mm B9 Marg 4 CmRemoval Sweat Gland LesionRemoval Sweat Gland LesionRemoval Sweat Gland LesionRemoval Sweat Gland LesionRemoval Sweat Gland LesionRemoval Sweat Gland LesionExc Tr-Ext Mal Marg 0.5 Cm/ Exc Tr-Ext Mal Marg 0.6-1 CmExc Tr-Ext Mal Marg 1.1-2 CmExc Tr-Ext Mal Marg 2.1-3 CmExc Tr-Ext Mal Marg 3.1-4 CmExc Tr-Ext Mal Marg 4 Cm

055.8055.8055.8055.8055.8055.80Exc H-F-Nk-Sp Mal Marg 0.5/ Exc S/N/H/F/G Mal Mrg 0.6-1Exc S/N/H/F/G Mal Mrg 1.1-2Exc S/N/H/F/G Mal Mrg 2.1-3Exc S/N/H/F/G Mal Mrg 3.1-4Exc S/N/H/F/G Mal Mrg 4 CmExc F/E/E/N/L Mal Mrg 0.5Cm Exc F/E/E/N/L Mal Mrg 0.6-1Exc F/E/E/N/L Mal Mrg 1.1-2Exc F/E/E/N/L Mal Mrg 2.1-3Exc F/E/E/N/L Mal Mrg 3.1-4Exc F/E/E/N/L Mal Mrg 4 CmTrim Nail(S) Any NumberDebride Nail 1-5Debride Nail 6 Or MoreRemoval Of Nail PlateRemove Nail Plate Add-OnDrain Blood From Under NailRemoval Of Nail BedBiopsy Nail UnitRepair Of Nail BedReconstruction Of Nail BedExcision Of Nail Fold ToeRemove Pilonidal Cyst SimpleRemove Pilonidal Cyst ExtenRemove Pilonidal Cyst ComplInject Skin Lesions /W 7Inject Skin Lesions 7Correct Skin Color 6.0 Cm/ Correct Skn Color 6.1-20.0CmCorrect Skin Color Ea 20.0CmTx Contour Defects 1 Cc/ Tx Contour Defects 1.1-5.0CcTx Contour Defects 5.1-10CcTx Contour Defects 10.0 CcInsert Tissue Expander(S)Replace Tissue ExpanderRemove Tissue Expander(S)Remove Contraceptive CapsuleImplant Hormone Pellet(S)Insert Drug Implant DeviceRemove Drug Implant DeviceRemove/Insert Drug ImplantRpr S/N/Ax/Gen/Trnk 2.5Cm/ Rpr S/N/Ax/Gen/Trnk2.6-7.5CmRpr S/N/Ax/Gen/Trk7.6-12.5CmRpr S/N/A/Gen/Trk12.6-20.0CmRpr S/N/A/Gen/Trk20.1-30.0CmRpr S/N/Ax/Gen/Trnk 30.0 CmRpr F/E/E/N/L/M 2.5 Cm/ Rpr F/E/E/N/L/M 2.6-5.0 CmRpr F/E/E/N/L/M 5.1-7.5 CmRpr F/E/E/N/L/M 7.6-12.5 CmRpr Fe/E/En/L/M 12.6-20.0 CmRpr Fe/E/En/L/M 20.1-30.0 CmRpr F/E/E/N/L/M 30.0 CmClosure Of Split WoundClosure Of Split WoundIntmd Rpr S/A/T/Ext 2.5 Cm/ Intmd Rpr S/A/T/Ext 2.6-7.5Intmd Rpr S/Tr/Ext 7.6-12.5Intmd Rpr S/A/T/Ext 12.6-20Intmd Rpr S/A/T/Ext 20.1-30Intmd Rpr S/Tr/Ext 30.0 CmIntmd Rpr N-Hf/Genit 2.5Cm/ Intmd Rpr N-Hf/Genit2.6-7.5Intmd Rpr N-Hf/Genit7.6-12.5Intmd Rpr N-Hf/Genit12.6-20Intmd Rpr N-Hf/Genit20.1-30Intmd Rpr N-Hf/Genit 30.0CmIntmd Rpr Face/Mm 2.5 Cm/ Intmd Rpr Face/Mm 2.6-5.0 CmIntmd Rpr Face/Mm 5.1-7.5 CmIntmd Rpr Face/Mm 7.6-12.5CmIntmd Rpr Face/Mm 12.6-20 CmIntmd Rpr Face/Mm 20.1-30.0Intmd Rpr Face/Mm 30.0 CmCmplx Rpr Trunk 1.1-2.5 CmCmplx Rpr Trunk 2.6-7.5 CmCmplx Rpr Trunk Addl 5Cm/ Cmplx Rpr S/A/L 1.1-2.5 CmCmplx Rpr S/A/L 2.6-7.5 CmCmplx Rpr S/A/L Addl 5 Cm/ Cmplx Rpr F/C/C/M/N/Ax/G/H/FCmplx Rpr F/C/C/M/N/Ax/G/H/FCmplx Rpr F/C/C/M/N/Ax/G/H/FCmplx Rpr E/N/E/L 1.1-2.5 CmCmplx Rpr E/N/E/L 2.6-7.5 CmCmplx Rpr E/N/E/L Addl 5Cm/ Late Closure Of WoundTis Trnfr Trunk 10 Sq Cm/ Tis Trnfr Trunk 10.1-30SqcmTis Trnfr S/A/L 10 Sq Cm/ Tis Trnfr S/A/L 10.1-30 Sqcm

055.8055.8055.80Tis Trnfr F/C/C/M/N/A/G/H/FTis Trnfr F/C/C/M/N/A/G/H/FTis Trnfr E/N/E/L 10 Sq Cm/ Tis Trnfr E/N/E/L10.1-30SqcmTis Trnfr Any 30.1-60 Sq CmTis Trnfr Addl 30 Sq Cm/ Filleted Finger/Toe FlapWound Prep Trk/Arm/LegWound Prep Addl 100 CmWound Prep F/N/Hf/GWnd Prep F/N/Hf/G Addl CmHarvest Cultured Skin GraftSkin Pinch GraftSkin Splt Grft Trnk/Arm/LegSkin Splt Grft T/A/L Add-OnEpidrm Autogrft Trnk/Arm/LegEpidrm Autogrft T/A/L Add-OnEpidrm A-Grft Face/Nck/Hf/GEpidrm A-Grft F/N/Hf/G AddlSkn Splt A-Grft Fac/Nck/Hf/GSkn Splt A-Grft F/N/Hf/G AddDerm Autograft Trnk/Arm/LegDerm Autograft T/A/L Add-OnDerm Autograft Face/Nck/Hf/GDerm Autograft F/N/Hf/G AddCult Skin Grft T/Arm/LegCult Skin Grft T/A/L AddlCult Skin Graft T/A/L %Cult Skin Graft F/N/Hf/GCult Skin Grft F/N/Hfg AddCult Epiderm Grft F/N/Hfg %Skin Full Graft TrunkSkin Full Graft Trunk Add-OnSkin Full Graft Sclp/Arm/LegSkin Full Graft Add-OnSkin Full Grft Face/Genit/HfSkin Full Graft Add-OnSkin Full Graft Een & LipsSkin Full Graft Add-OnSkin Sub Graft Trnk/Arm/LegSkin Sub Graft T/A/L Add-OnSkin Sub Grft T/Arm/Lg ChildSkn Sub Grft T/A/L Child AddSkin Sub Graft Face/Nk/Hf/GSkin Sub Graft F/N/Hf/G AddlSkn Sub Grft F/N/Hf/G ChildSkn Sub Grft F/N/Hf/G Ch AddSkin Pedicle Flap TrunkSkin Pedicle Flap Arms/LegsPedcle Fh/Ch/Ch/M/N/Ax/G/H/FPedicle E/N/E/L/NtroralDelay Flap TrunkDelay Flap Arms/LegsDelay Flap F/C/C/N/Ax/G/H/FDelay Flap Eye/Nos/Ear/LipTransfer Skin Pedicle FlapMdfc Flap W/Prsrv Vasc PedclForehead Flap W/Vasc PedicleMusc Myoq/Fscq Flp H&N PedclMuscle-Skin Graft TrunkMuscle-Skin Graft ArmMuscle-Skin Graft LegIsland Pedicle Flap GraftNeurovascular Pedicle FlapFree Myo/Skin Flap MicrovascFree Skin Flap MicrovascFree Fascial Flap MicrovascComposite Skin .80Grfg Autol Soft Tiss Dir ExcDerma-Fat-Fascia Graft6.738.675.881.1509055.80Grfg Autol Fat Lipo 50 Cc/ 2.502.291.140.43XXX55.80Grfg Autol Fat Lipo Ea Addl6.838.725.931.1509055.80Grfg Autol Fat Lipo 25 Cc/ .420.210.020.270.660.250.601.880.470.620.5

Table of RVU & Conversion Factor values by CPT/HCPCS Codes: CPT; NON-FACILITY FACILITY: ADA PAY: WORK PE: PE MPE: GLOBAL CONVERSION: SHORT DESCRIPTION HCPCS: MODIFIER STATUS: RVU RVU: RVU RVU: PERIOD FACTOR: END DATE (ADA, HCPCS & OWCP codes only; Refer to AMA CPT) 00100 C: 0.00 0.00: 0.00 0.00: XXX 0.00: Anesth Salivary Gland 00102:

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Table of RVU & Conversion Factor values by CPT/HCPCS Codes: CPT/HCPCS: NON-FACILITY; FACILITY ADA: PAY WORK: PE PE: MPE GLOBAL: CONVERSION TERM: SHORT DESCRIPTION HCPCS: MODIFIER STATUS: RVU RVU: RVU RVU: PERIOD FACTOR: DATE (ADA, HCPCS & OWCP codes only; Refer to AMA CPT) 00100 C: 0.00 0.00: 0.00 0.00: XXX 0.00: Anesth Salivary Gland 00102:

This is usually where I would tell you about everyone else who’s out there and could help, but doesn’t, can’t, or won’t, but I’ll pass on that here. You know though. The bottom line is this: I’m going to help you. My company is dedicated to you. You are everything to us. We love you, sincerely. Now buckle up and get ready to Break OWCP.

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