Table 1.
Cost inputs used in diagnostic and therapeutic procedures
| Procedure code | Description | 2013 Medicare reimbursement |
|---|---|---|
| CPT 99203 |
E & M new patient – 30 minutes (nonfacility [NF]) |
$108.19 |
| CPT 73560 |
Xray knee one or two views |
$32.32 |
| CPT 73721 |
MRI knee - Global |
$405.21 |
| CPT 73721-25 |
MRI knee - Professional |
$66.69 |
| CPT 73221 |
MRI shoulder - Global |
$405.21 |
| CPT 73221-26 |
MRI shoulder – Professional |
$66.69 |
| CPT 29805 |
Diagnostic shoulder arthroscopy (NF) |
$479.38 |
| CPT 29827 |
Rotator cuff repair |
$1,086.35 |
| CPT 29870 |
Diagnostic knee arthroscopy (NF) |
$603.23 |
| CPT 29877 |
Chondroplasty (Facility) - if a TP or a FN crossover (FN CO) |
$632.49 |
| CPT 29881 |
Meniscectomy (Facility) – if a FP |
$551.51 |
| CPT 01440 |
General anesthesia (45 minutes) – for hospital outpatient procedure - knee |
$131.55 |
| CPT 01630 |
General anesthesia (90 minutes) for hospital outpatient procedure – rotator cuff repair |
$243.32 |
| APC 0041 |
Outpatient knee arthroscopy |
$2,111.62 |
| APC 0042 |
Outpatient shoulder arthroscopy |
$3,880.22 |
| CPT 99213 |
E & M existing patient – 30 minutes Non-facility (NF) |
$72.81 |
| CPT 97110 |
Therapeutic procedures, 15 minutes each, physical therapy |
$31.98 |
| CPT 20610 | Arthrocentesis – major joint | $65.56 |