medicare_pfs_common.csv

cpt_code,description,medicare_national_facility,medicare_national_nonfacility,category,notes
99281,Emergency department visit level 1,29.05,29.05,em_ed,CY2025 PFS national, no GPCI
99282,Emergency department visit level 2,56.15,56.15,em_ed,CY2025 PFS national
99283,Emergency department visit level 3,84.21,84.21,em_ed,CY2025 PFS national
99284,Emergency department visit level 4,159.41,159.41,em_ed,CY2025 PFS national
99285,Emergency department visit level 5,233.07,233.07,em_ed,CY2025 PFS national
99291,Critical care first 30-74 min,277.91,277.91,em_critical,CY2025 PFS national
99292,Critical care each additional 30 min,135.34,135.34,em_critical,CY2025 PFS national
99202,Office or other outpatient new patient level 2,73.45,109.65,em_office,
99203,Office or other outpatient new patient level 3,114.39,170.45,em_office,
99204,Office or other outpatient new patient level 4,172.94,257.79,em_office,
99205,Office or other outpatient new patient level 5,229.05,341.45,em_office,
99212,Office or other outpatient established level 2,55.48,73.39,em_office,
99213,Office or other outpatient established level 3,89.99,118.71,em_office,
99214,Office or other outpatient established level 4,128.55,170.04,em_office,
99215,Office or other outpatient established level 5,180.21,237.79,em_office,
71046,Chest X-ray 2 views,28.78,53.32,radiology,Most common ED imaging code
71045,Chest X-ray single view,21.24,40.91,radiology,
72100,X-ray spine lumbosacral 2-3 views,30.16,55.06,radiology,
73030,X-ray shoulder complete min 2 views,26.50,46.79,radiology,
73070,X-ray elbow 2 views,23.75,42.61,radiology,
73080,X-ray elbow complete min 3 views,27.18,48.18,radiology,
73110,X-ray wrist complete min 3 views,28.43,49.92,radiology,
73130,X-ray hand min 3 views,25.46,47.14,radiology,
73510,X-ray hip 1 view,22.71,40.91,radiology,
73560,X-ray knee 1-2 views,26.16,46.10,radiology,
73610,X-ray ankle complete min 3 views,26.85,46.79,radiology,
70450,CT head/brain without contrast,116.51,257.79,radiology,
70486,CT maxillofacial area without contrast,128.20,290.92,radiology,
70551,MRI brain without contrast,217.97,478.18,radiology,
74176,CT abdomen and pelvis without contrast,166.41,372.97,radiology,
76700,US abdomen complete,108.41,202.99,radiology,
76705,US abdomen limited,77.91,143.32,radiology,
76770,US retroperitoneal complete,109.43,202.99,radiology,
76856,US pelvic non-obstetric complete,86.55,160.21,radiology,
76942,US guidance for needle placement,33.96,237.27,radiology,
93000,Electrocardiogram complete,15.74,15.74,cardiology,EKG with interp+report
93005,Electrocardiogram tracing only,7.96,7.96,cardiology,
93010,Electrocardiogram interpretation only,7.78,7.78,cardiology,
93306,Echocardiogram complete,159.41,253.04,cardiology,
85025,Complete CBC with differential,9.07,9.07,lab,
85027,Complete CBC without differential,6.86,6.86,lab,
85610,Prothrombin time,4.95,4.95,lab,
80048,Basic metabolic panel,9.07,9.07,lab,
80053,Comprehensive metabolic panel,12.46,12.46,lab,
80061,Lipid panel,15.06,15.06,lab,
80076,Hepatic function panel,9.59,9.59,lab,
83036,Hemoglobin A1c,11.62,11.62,lab,
84443,Thyroid stimulating hormone (TSH),17.13,17.13,lab,
81001,Urinalysis with microscopy automated,3.41,3.41,lab,
81003,Urinalysis automated without microscopy,2.55,2.55,lab,
87086,Urine culture quantitative colony count,9.93,9.93,lab,
36415,Routine venipuncture,3.00,3.00,lab,
J3490,Unclassified drugs,0.00,0.00,drug,Variable; lookup by NDC
J1100,Dexamethasone sodium phosphate 1 mg,0.46,0.46,drug,Per HCPCS unit
J2270,Morphine sulfate up to 10 mg,0.55,0.55,drug,Per HCPCS unit
J7613,Albuterol inhalation solution 1 mg,0.06,0.06,drug,
A0428,Ambulance BLS non-emergency,228.40,228.40,ambulance,Medicare base rate
A0429,Ambulance BLS emergency,365.43,365.43,ambulance,Medicare base rate
A0427,Ambulance ALS emergency level 1,432.93,432.93,ambulance,Medicare base rate
A0433,Ambulance ALS level 2,626.49,626.49,ambulance,Medicare base rate
A0425,Ambulance mileage per loaded mile,7.43,7.43,ambulance,Per mile loaded
12001,Simple repair scalp/neck/etc 2.5 cm or less,124.30,148.39,procedure_minor,
12011,Simple repair face/ears/etc 2.5 cm or less,108.41,135.87,procedure_minor,
29125,Application of short arm splint static,40.91,73.45,procedure_minor,
29515,Application of short leg splint,47.14,84.55,procedure_minor,
29580,Strapping unna boot,29.05,49.92,procedure_minor,
20610,Arthrocentesis large joint,46.79,108.41,procedure_minor,Knee/shoulder/hip
20605,Arthrocentesis intermediate joint,40.91,84.55,procedure_minor,
51702,Insertion of temporary indwelling bladder catheter,21.24,42.61,procedure_minor,
96360,IV infusion hydration initial 31 min to 1 hr,55.06,73.45,infusion,
96361,IV infusion hydration each additional hour,15.74,21.24,infusion,
96365,IV infusion therapeutic initial up to 1 hr,73.45,108.41,infusion,
96374,IV push single or initial drug,73.45,84.55,infusion,
99221,Initial hospital inpatient or observation level 1,108.41,108.41,em_inpatient,
99222,Initial hospital inpatient or observation level 2,148.39,148.39,em_inpatient,
99223,Initial hospital inpatient or observation level 3,217.97,217.97,em_inpatient,
99231,Subsequent hospital inpatient level 1,46.79,46.79,em_inpatient,
99232,Subsequent hospital inpatient level 2,84.55,84.55,em_inpatient,
99233,Subsequent hospital inpatient level 3,128.55,128.55,em_inpatient,
99234,Hospital observation/inpatient same day level 1,148.39,148.39,em_inpatient,
99235,Hospital observation/inpatient same day level 2,205.45,205.45,em_inpatient,
99236,Hospital observation/inpatient same day level 3,266.41,266.41,em_inpatient,
99238,Hospital discharge day 30 min or less,84.55,84.55,em_inpatient,
99239,Hospital discharge day more than 30 min,128.55,128.55,em_inpatient,
99406,Smoking cessation counseling 3-10 min,13.91,13.91,em_preventive,
99407,Smoking cessation counseling more than 10 min,27.18,27.18,em_preventive,
99497,Advance care planning first 30 min,75.20,84.55,em_preventive,
G0438,Annual wellness visit initial,156.41,156.41,em_preventive,
G0439,Annual wellness visit subsequent,108.41,108.41,em_preventive,
G0447,Behavioral counseling obesity 15 min,25.46,25.46,em_preventive,
G2211,E/M add-on complexity for primary or continuing care,16.21,16.21,em_office,
99417,Prolonged outpatient E/M 15 min increment,33.05,40.91,em_office,
17000,Destruction premalignant lesion first,73.45,108.41,procedure_minor,Cryosurgery
17003,Destruction premalignant lesion 2-14 each,11.79,17.13,procedure_minor,
17110,Destruction benign lesion up to 14,109.65,148.39,procedure_minor,
11042,Debridement subcutaneous tissue first 20 sq cm,73.45,108.41,procedure_minor,
11102,Tangential biopsy single lesion,40.91,73.45,procedure_minor,
11104,Punch biopsy single lesion,67.20,108.41,procedure_minor,
99173,Visual acuity screening,1.74,1.74,em_office,
92012,Eye exam established patient intermediate,73.45,108.41,em_office,Ophthalmology
92014,Eye exam established patient comprehensive,109.65,148.39,em_office,Ophthalmology
69210,Removal impacted cerumen one or both ears,55.06,73.45,procedure_minor,
30901,Anterior epistaxis control simple,73.45,108.41,procedure_minor,Nosebleed
31231,Nasal endoscopy diagnostic,108.41,148.39,procedure_minor,
45378,Colonoscopy diagnostic,217.97,395.45,procedure_gi,Screening if average risk
45380,Colonoscopy with biopsy,266.41,478.18,procedure_gi,
45385,Colonoscopy with polyp removal snare,290.92,540.20,procedure_gi,
43235,Upper GI endoscopy diagnostic,205.45,372.97,procedure_gi,
43239,Upper GI endoscopy with biopsy,253.04,440.59,procedure_gi,
77067,Screening mammography bilateral,75.20,128.55,radiology,
77063,Screening tomosynthesis bilateral,40.91,55.06,radiology,Add-on
77066,Diagnostic mammography bilateral,108.41,159.41,radiology,
76641,US breast unilateral complete,75.20,143.32,radiology,
76642,US breast unilateral limited,55.06,108.41,radiology,
72148,MRI lumbar spine without contrast,205.45,478.18,radiology,
73721,MRI joint of lower extremity without contrast,205.45,478.18,radiology,
73221,MRI joint of upper extremity without contrast,205.45,478.18,radiology,
74270,Barium enema diagnostic,108.41,257.79,radiology,
71250,CT chest without contrast,116.51,257.79,radiology,
71260,CT chest with contrast,128.55,290.92,radiology,
71275,CT angiography chest,205.45,478.18,radiology,
93306,Echocardiogram complete with Doppler,159.41,253.04,cardiology,
93350,Stress echocardiogram,159.41,290.92,cardiology,
93880,Duplex scan extracranial arteries complete,131.41,253.04,cardiology,
93922,Limited lower extremity arterial study,55.06,108.41,cardiology,
93970,Duplex scan extremity veins complete bilateral,143.32,253.04,cardiology,
94010,Spirometry,33.05,55.06,pulmonology,
94060,Bronchodilation responsiveness spirometry,55.06,108.41,pulmonology,
94375,Respiratory flow volume loop,33.05,55.06,pulmonology,
36558,Insertion tunneled centrally inserted CVC,159.41,253.04,procedure_vascular,
36569,Insertion PICC line age 5 or older,84.55,148.39,procedure_vascular,
90791,Psychiatric diagnostic evaluation,135.34,159.41,mental_health,
90792,Psychiatric diagnostic evaluation with medical services,159.41,180.21,mental_health,
90832,Psychotherapy 30 min,55.06,73.45,mental_health,
90834,Psychotherapy 45 min,73.45,108.41,mental_health,
90837,Psychotherapy 60 min,108.41,135.34,mental_health,
90839,Psychotherapy crisis first 60 min,135.34,159.41,mental_health,
90847,Family psychotherapy with patient present 50 min,108.41,135.34,mental_health,
H0001,Alcohol and drug assessment,0.00,0.00,mental_health,State Medicaid; lookup locally
H0004,Behavioral health counseling per 15 min,0.00,0.00,mental_health,State Medicaid
90471,Immunization administration single,15.74,21.24,immunization,
90472,Immunization administration each additional,11.79,15.74,immunization,
90686,Influenza vaccine quadrivalent IIV4 preservative-free 0.5 mL IM,17.13,17.13,immunization,
90707,MMR vaccine SQ,69.32,69.32,immunization,
90715,Tdap vaccine for use age 7+ IM,40.91,40.91,immunization,
90651,HPV vaccine 9-valent IM,217.97,217.97,immunization,
91300,Pfizer COVID-19 vaccine,0.00,0.00,immunization,Variable; government-purchased
59025,Fetal non-stress test,40.91,55.06,obstetrics,
59400,Routine obstetric care including vaginal delivery,2032.41,2032.41,obstetrics,Global; bundles antepartum + delivery + postpartum
59410,Vaginal delivery only including postpartum care,1132.07,1132.07,obstetrics,
59510,Routine OB care including cesarean delivery,2387.81,2387.81,obstetrics,Global
59514,Cesarean delivery only,1303.07,1303.07,obstetrics,
58300,Insertion of intrauterine device,73.45,128.55,gynecology,
58301,Removal of intrauterine device,55.06,108.41,gynecology,
97110,Therapeutic exercises each 15 min,28.43,28.43,physical_therapy,
97140,Manual therapy each 15 min,26.85,26.85,physical_therapy,
97530,Therapeutic activities each 15 min,33.05,33.05,physical_therapy,
97161,PT evaluation low complexity,82.41,82.41,physical_therapy,
97162,PT evaluation moderate complexity,82.41,82.41,physical_therapy,
97163,PT evaluation high complexity,108.41,108.41,physical_therapy,
20550,Injection single tendon sheath,46.79,68.65,procedure_minor,
20551,Injection single tendon origin/insertion,46.79,68.65,procedure_minor,
20552,Injection trigger points 1 or 2 muscles,46.79,68.65,procedure_minor,
20553,Injection trigger points 3 or more muscles,55.06,80.41,procedure_minor,
64483,Transforaminal epidural injection lumbar/sacral single level,143.32,290.92,procedure_pain,
64484,Transforaminal epidural injection lumbar/sacral each additional,73.45,128.55,procedure_pain,
27447,Total knee arthroplasty,1408.65,1408.65,orthopedic_surgery,Surgeon fee only; facility separate
27130,Total hip arthroplasty,1452.71,1452.71,orthopedic_surgery,Surgeon fee
29881,Knee arthroscopy with meniscectomy medial or lateral,548.06,548.06,orthopedic_surgery,
29827,Shoulder arthroscopy with rotator cuff repair,899.41,899.41,orthopedic_surgery,
47562,Laparoscopic cholecystectomy,548.06,548.06,general_surgery,
49505,Inguinal hernia repair age 5+,440.59,440.59,general_surgery,
55700,Prostate biopsy needle or punch,108.41,253.04,procedure_minor,
51798,Bladder ultrasound residual urine,15.74,26.85,radiology,
86618,Lyme disease antibody,28.78,28.78,lab,
86617,Lyme disease western blot,32.41,32.41,lab,
87635,SARS-CoV-2 amplified probe,75.20,75.20,lab,COVID-19 PCR
87880,Strep group A direct optical immunoassay,17.13,17.13,lab,Rapid strep
87804,Influenza A and B direct optical immunoassay,17.13,17.13,lab,Rapid flu
87807,RSV direct optical immunoassay,17.13,17.13,lab,
87650,Strep group A amplified probe,75.20,75.20,lab,
86701,HIV-1 antibody,16.21,16.21,lab,
86703,HIV-1 and HIV-2 single assay,21.24,21.24,lab,
83036,Hemoglobin A1c by HPLC,11.62,11.62,lab,
82043,Microalbumin random,7.96,7.96,lab,
82728,Ferritin,21.24,21.24,lab,
82570,Creatinine other source,7.78,7.78,lab,
84439,Free thyroxine,15.74,15.74,lab,
84479,Triiodothyronine uptake,9.07,9.07,lab,
84436,Thyroxine total,9.59,9.59,lab,
83970,Parathyroid hormone,53.18,53.18,lab,
85651,Sedimentation rate erythrocyte non-automated,3.41,3.41,lab,
85652,Sedimentation rate erythrocyte automated,3.07,3.07,lab,
86140,C-reactive protein,7.43,7.43,lab,
86141,C-reactive protein high sensitivity,15.06,15.06,lab,
J1885,Ketorolac tromethamine per 15 mg,0.41,0.41,drug,Toradol
J0696,Ceftriaxone sodium per 250 mg,1.64,1.64,drug,Rocephin
J2550,Promethazine HCl up to 50 mg,0.49,0.49,drug,Phenergan
J3010,Fentanyl citrate per 0.1 mg,0.45,0.45,drug,
J3420,Vitamin B-12 cyanocobalamin per 1000 mcg,1.40,1.40,drug,
J2405,Ondansetron HCl per 1 mg,0.18,0.18,drug,Zofran
J1170,Hydromorphone up to 4 mg,0.94,0.94,drug,Dilaudid
J0290,Ampicillin sodium per 500 mg,0.94,0.94,drug,
A4550,Surgical trays,0.00,0.00,supply,Bundled into surgical CPT; should not bill separately
A4649,Surgical supplies miscellaneous,0.00,0.00,supply,Often improperly billed alongside surgical CPT
99053,Service in office between 10pm and 8am,40.91,40.91,em_after_hours,
99058,Service requiring office disruption,21.24,21.24,em_after_hours,
99070,Supplies and materials provided,0.00,0.00,supply,Variable; demand itemization