1. (b) The above cost centers use as the basis for the Standard Unit of Measure the Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies (RVS). Relative Value Units for unlisted BR (By Report), and RNE (Relativity Not Established) procedures are to be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. Use the “Total Unit Value”, not the “PC Unit Value”, in recording the relative value unit counts. Because the California Medical Association is no longer publishing their Relative Value Studies booklet, the Radiology/Nuclear Medicine chapter is set forth as subdivisions (c)-(g) of this section with the approval of CMA.

   1. (1) GENERAL: Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician.

      1. (i) The total unit value includes the professional component (see PC unit value below) plus the technical component. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). 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.
      2. (ii) 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 supevision of the procedure, interpretation and written report of the examination and consultation with the referring physician. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). 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 Appendix 1^‡ for use of modifiers.)
      3. (iii) When this section of the RVS is used in connection with a “conversion factor” to establish fees, it must be emphasized that the SAME 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.
      4. (iv) The technical component includes the charges for personnel, materials, including usual contrast media and drugs, film or xerograph, space, equipment and other facility 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 Appendix 1^‡ for use of modifiers.)
   2. (2) UNUSUAL SERVICE OR PROCEDURE: A service may necessitate skills and time of the physician over and above listed services and values. If substantiated “by report,” additional values may be warranted. (See unit value modifier −22 and rule 4, below.)
   3. (3) UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is provided, the values used should be substantiated “by report.” (See rule 4 below.) Identify by unlisted procedure number in appropriate section. For a comprehensive listing, see pages 15-16.

   4. (4) PROCEDURES LISTED WITHOUT SPECIFIC UNIT VALUES:

      1. (i) BY REPORT “BR” ITEMS: BR in the value column indicates that the value of this service is to be determined “by report,” because the service is too unusual or variable to be assigned a unit value. Pertinent information concerning the nature, extent and need for the procedure or service, the time, the skill and equipment necessary, etc., is to furnished. A detailed clinical record is not necessary.
      2. (ii) RELATIVITY NOT ESTABLISHED “RNE” ITEMS: RNE in the value column indicates new or infrequently performed services for which sufficient data have not been collected to allow establishment of a relative value. A report may be necessary.
   5. (5) MATERIALS SUPPLIED BY PHYSICIAN: Identify as 99070. (Radionuclides are identified as 99069.) 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.)

   6. (6) 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. The injection procedure is included in the unit value for radiographic procedures marked with a small star (*).

   7. (7) MISCELLANEOUS:

      1. (i) A physician may elect to reduce the listed value of a service for a variety of reasons. To identify such charges, see modifier −52.
      2. (ii) Examination outside of regular hours, at bedside or in operating room, may warrant an additional charge for technologist's time (see 99065, 99066).
      3. (iii) 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.”

   8. (8) SPECIAL SERVICES AND BILLING PROCEDURES:

      1. (i) The following services are generally not part of the basic services as listed in the RVS, but do involve additional expense to the physician for materials, for his time or that of his employees. Those services that are generally provided as an adjunct to common medical services should be charged for only when circumstances clearly warrant an additional charge over and above the usual charges for the basic services.

         			Unit Value
         (ii)	99065	Examination outside of regular hours may warrant an additional charge for technologist's time	1.3(R)
         (iii)	99066	Examination at bedside or in operating room, unless otherwise indicated, may warrant an additional charge for technologist's time	1.3(R)
         (iv)	99069	Radiopharmaceutical or other radionuclide material cost. Listed values in this section do not include these costs. List the name of radiopharmiceutical, dosage and cost	BR†
         (v)	99070	Supplies and material 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, supplies or materials provided	BR†
         (vi)	99080	Special Reports ( e.g. . insurance forms, narrative reports, review of medical records): When information more than that necessary to establish or to clarify a patient's status is requested ( e.g. , more than the standard reporting form) or a request is made for review of medical records and report, a charge adequate to cover the value of the additional service is justifiable	BR†

   9. (9) UNIT VALUE MODIFIERS.

      1. (i) Listed values for most procedures may be modified under certain circumstances as listed below. When applicable, the modifying circumstances should be identified by the addition of the appropriate “modifier code number” (including the hyphen) after the usual procedure number. The values should be listed as a single modified total for the procedure. When multiple modifiers are applicable to a single procedure, see modifier −99.

         			Unit Value
         (ii)	-22	Unusual services: When the services provided are greater than those usually required for the listed procedure, identify by adding this modifier (-22) to the usual procedure number. List modified value. May require report.
         (iii)	-26	Professional component: Under certain circumstances the physician may wish to submit a charge for the professional component of a procedure and not for the technical component. (See definition of professional component under ground rule 1.) Under these circumstances the professional component charge is identified by adding this modifier (-26) to the usual procedure number and valued according to the "PC unit value" for that procedure.
         (iv)	-27	Technical component: Under certain circumstances, a charge may be made for the technical component alone (see definition of technical component under Ground Rule 1). Under those circumstances the technical component charge is identified by adding this modifier (-27) to the usual procedure number.
         (v)	-52	Reduced values: Under certain circumstances, the listed value is reduced or eliminated because of ground rules, common practice. or at the physician's election (e.g., a physician may elect to reduce the listed values in a patient with multiple injuries requiring extensive radiographic examination). Under these or similar circumstances, the services provided can be identified by their usual procedure numbers and the use of a reduced value indicated by adding this modifier (-52) to the procedure number. (Use of this modifier provides a means of reporting services at reduced charge without disturbing usual relative values.)
         (vi)	-90	Reference (outside) laboratory: When laboratory procedures are performed by other than the billing physician, the procedure (s) shall be identified by adding this modifier (-90) to the usual single or panel procedure number and shall be billed as charged to the physician. (For collection and handling charges, see 99007et seq.)
         (vii)	-99	Multiple modifiers: Under certain circumstances, multiple modifiers may be applicable (e.g., a physician may perform services greater than those usually required [modifier -22]) and bill the professional component [modifier -26]). Under these circumstances, identify by adding this modifier (-99) to the usual procedure number and briefly indicate the circumstances. Value in accordance with appropriate modifiers.	BR†

         (d) DIAGNOSTIC RADIOLOGY.

   10. (1) Definitions.

       1. (i) Limited examination: An examination which usually includes AP and lateral views but is less than the “complete examination” defined below. This may be due to limitation of routine views by the physician; limitation for a specific purpose (e.g., AP and lateral views on post-reduction fracture of ankle); or necessary limitation due to the condition of the patient (e.g., single views for fractures in critically injured patient).

       2. (ii) Complete examination: An examination which includes all of the necessary views for optimal examination of the part for the suspected condition. All listed values are for complete examinations unless otherwise indicated. Necessary additional methods of examination (e.g., fluoroscopy, tomography, cineradiography) may be charged for separately.

          	(2) Head and Neck.
          70002	Pneumoencephalography	25.0
          	(For injection procedure for pneumoencephalography, see 61053, 62286)
          70010	Cisternography, positive contrast (posterior, fossa myelography	RNE°
          	(For injection procedure, see 61052, 61053)
          70020	Ventriculography, air or positive contrast	15.5
          	(For injection procedures for ventriculography, see 61025, 61080, 61120)
          70022	Stereotactic localization	BR†
          ‡70024	Computer assisted tomography, cerebral ( e.g., EMI scan), with or without intravenous contrast, limited (2 or 3 scans)	RNE°
          ‡70025	complete (4 scans)	RNE°
          ‡70028	each additional scan above 4	RNE°
          70030	Eye, for detection of foreign body	5.2
          70040	for localization of foreign body (70030 not included)	8.4
          70050	combined 70030 and 70040	10.5
          70100	Mandible, limited or unilateral	3.8
          70110	complete	5.9
          70120	Mastoid(s), limited or unilateral	3.8
          70130	complete and bilateral	7.6
          70134	Internal auditory meatuses	7.1
          ‡70136	Middle and inner ear, polytomography	RNE°
          70140	Facial bones, limited	4.4
          70150	complete, and/or orbits	6.4
          70154	with nasal bones	7.3
          70160	Nasal bones	3.9
          70170	Nasolacrimal duct (dacryocystography)	5.9
          	(For injection procedure for dacryocystography, see 68850)
          70190	Optic foramina	3.8
          70210	Paranasal sinuses, limited	3.1
          70220	complete	6.4
          70240	Sella Turcica	3.3
          70250	Skull, limited	3.8
          70260	complete	7.1
          70300	Teeth, single view	1.3
          70310	partial examination. less then full mouth	2.5
          70320	complete examination, full mouth	4.7
          70330	Temporomandibular joints	5.6
          70350	Cephalogram (orthodontic)	RNE°
          70360	Neck for soft tissues	2.7
          †70368	Soft palate, cineradiography or videotape	RNE°
          †70373	Laryngography, contrast	8.2
          	(For injection procedure for laryngography, see 31708)
          70380	Salivary gland for calculus	3.8
          70390	Sialography	5.1
          	(For injection procedure for sialography, see 42550)
          ‡70400	Orbitography, air or positive contrast	BR†
          	(For injection procedure for orbitography, see 67510)
          †70999	Unlisted procedure, head and neck	BR†
          	(3) Chest.
          71000	Chest, "minifilm"	1.2
          71010	Chest, single view	2.5
          71020	two views	3.8
          †71021	three views	4.4
          71030	complete, minimum of four views	4.9
          71034	including fluoroscopy	6.4
          	(For independent chest fluoroscopy, see 76000)
          71036	Fluoroscopic localization for needle biopsy of intrathoracic lesion, including follow-up films	BR†
          	(For biopsy procedure, see 32420)
          †71038	Fluoroscopic localization for bronchial brush biopsy or fiber-optic bronchoscopy, including films	BR†
          	(For biopsy procedure, see 31717)
          71040	Bronchography, unilateral	9.1
          71060	bilateral	13.0
          	(For injection procedure for bronchography, see 31710, 31715)
          †71090	Fluoroscopy and radiography for pacemaker insertion	BR†
          	(For extended room time, see 76001)
          71100	Ribs, unilateral	4.4
          71110	bilateral	5.4
          71120	Sternum	3.8
          71130	Sternoclavicular joint(s)	3.8
          †71199	Unlisted procedure, chest	BR†
          	(4) Spine and Pelvis.
          72010	Spine, entire, survey study (AP and lateral)	9.3
          †72020	Spine, any level, single view	RNE°
          72040	cervical, AP and lateral	3.8
          72050	complete	6.0
          72052	including flexion and extension views	7.7
          72070	thoracic	4.4
          72080	thoraco-lumbar junction	4.4
          72090	scoliosis study	3.8
          72190	lumbar, limited	4.4
          72110	lumbosacral, complete	7.4
          72114	including bending views	9.3
          72120	bending views only	4.7
          72170	Pelvis, limited	3.1
          72180	stereo	3.8
          72190	complete	4.9
          	(For pelvimetry, see 74710)
          72202	Sacroiliac joints	5.1
          72220	Sacrum and coccyx	4.1
          72250	Myelography, lumbar or any other single levels	11.5
          72270	all levels	18.0
          †72275	gas	BR†
          	(For injection procedures for myelography, see 62284)
          72290	Discography, lumbar or cervical	12.2
          	(For injection procedures for discography, see 62290, 62291)
          †72299	Unlisted procedures, spine or pelvis	BR†
          	(5) Upper Extremities.
          73000	Clavicle	3.1
          73010	Scapula	3.8
          73020	Shoulder, limited	2.7
          73030	complete	3.8
          73040	arthrography	6.4
          	(For injection procedure for arthrography, see 23350)
          73050	Acromio-clavicular joints, bilateral, with or without weighted distraction	4.4
          73060	Humerus, including one joint	3.1
          73070	Elbow, limited	2.8
          73080	complete	3.8
          †73085	arthrography	BR†
          	(For injection procedure, see 24220)
          73090	Forearm, including one joint	3.0
          73100	Wrist, limited	2.5
          73110	complete	3.8
          †73115	arthrography	BR†
          	(For injection procedure, see 25246)
          73120	Hand, limited	2.5
          73130	complete	3.5
          73140	Finger(s)	2.3
          †73499	Unlisted procedure, upper extremities	BR†
          	(6) Lower Extremities.
          73500	Hip, unilateral, limited	3.1
          73510	complete (including AP pelvis)	4.4
          ‡ 73515	bilateral, limited ( e.g., infant AP and frog lateral	3.9
          73520	bilateral, complete (including AP of pelvis)	5.8
          ‡ 73525	arthrography	RNE°
          	(For injection procedures, see 27093-27094)
          73530	during operative procedures up to four studies	9.4
          73532	each additional study	1.8
          73550	Femur (thigh), including one joint	3.8
          73560	Knee, limited	2.7
          73570	complete	4.0
          73580	arthorgraphy	9.1
          	(For injection procedure, see 27370)
          73590	Tibia and fibula (leg), including one joint	3.1
          73600	Ankle, limited	2.7
          73610	complete	3.6
          ‡ 73615	arthrography	RNE°
          	(For injection procedures, see 27646
          73620	Foot, limited	2.5
          73630	complete	3.4
          73640	Foot and ankle	5.9
          73650	Os calcis (heel)	2.7
          73660	Toe(s)	2.3
          ‡ 73999	Unlisted procedure, lower extremities	BR†
          	(7) Abdomen.
          74000	Abdomen, single view (KUB)	2.6
          74010	with additional oblique or cone view	3.9
          74020	complete, includes decubitus and/or erect view	5.1
          	(8) Gastrointestinal Tract.
          74210	Pharynx and/or cerical esophagus	5.4
          74220	Esophagus	5.4
          74230	Pharynx and/or esophagus, by cineradiography	7.4
          ‡ 74242	Upper gastronintestinal tract, with or without KUB and with or without delayed films	9.1
          ‡ 74243	limited upper gastrointestinal tract ( e.g., recheck or follow-up study)	6.4
          74245	with small bowel, includes multiple serial films, with or without fluorscopy	11.0
          74250	Small bowel, includes multiple serial films with or without fluoroscopy or KUB, independent study	8.5
          ‡ 74260	Duodenography, hypotonic	RNE°
          74270	Colon, barium enema	7.5
          74275	combined with air contrast	11.0
          74280	air contrast (independent procedure)	8.9
          74290	Cholecystography, oral	6.0
          74291	repeat examination, same study	3.0
          74300	Cholangiography, operative	7.6
          *74305	post-operative (t-tube)	*7.2
          	(For biliary duct stone extraction, see 47630
          *74310	intravenous	*10.5
          74320	percutaneous, transhepatic or transjugular	9.5
          	(For injection procedures for transhepatic cholangiography or percutaneous, see 47500; for transjugular, see 91120
          ‡74325	Pneumoperitoneum, diagnostic.	RNE°
          	(For injection procedure, see 49400)
          ‡74340	Localization and/or manipulation of gastrointestinal tube ( e.g. duodenal aspiration, Miller-Abbot tube, small bowel biopsy, colonoscopy	RNE°
          ‡74399	Unlisted procedure, abdomen and gastrointestinal tract	BR†
          	(9) Urinary Tract.
          *74400	Urography, excretory (routine IVP)	*9.4
          *‡74406	extended ( e.g., hypertensive, drip infusion, and/or limited tomography)	*10.5
          *74415	Nephrotomography (independent procedure)	*16.0
          74420	Pyelography, retrograde, or unreterography, with or without KUB	7.5
          ‡74425	antegrade (nephrostogram, pyelostogram, loopogram, etc.)	RNE°
          	(For injection procedure, see 50394. 50684, 50690)
          74430	Cystography, contrast or chain	5.5
          	(For injection procedure for cystography, see 51600, 51605)
          74440	Vasography, vesiculography, or epididymography	5.5
          	(For injection procedure, see 52010, 52110. 55300)
          74450	Urethrocystography, retrograde	6.0
          	(For injection procedure for retrograde urethrocystography, see 51610)
          74455	voiding	8.9
          	(For injection procedure for voiding urethrocystography, see 51600)
          74460	Retroperitoneal pneumography	7.3
          	(For injection procedure for retroperitoneal pneumography, see 49430)
          74470	Translumbar renal cyst study (contrast visualization)	6.4
          	(For injection procedure for translumbar renal cyst study, see 50890)
          	(For performance of study with ultrasound guidance, see 76960)
          	(10) Female Genital Tract.
          	(For abdomen and pelvis, see 74000-74020, 72170-72190)
          74710	Pelvimetry	6.2
          74720	Abdomen for fetal age, fetal position and/or placental localization, single view	2.8
          74725	multiple views	4.1
          	(For amniocentesis and injection for amniography, see 59000)
          74740	Hysterosalpingography	6.6
          	(For injection procedure for hysterosalpinogography, see 58340)
          74760	Pelvic pneumography	6.4
          	(For injection procedure for pelvic pneumography, see 49440)
          ‡74799	Unlisted procedure, genitourinary tract	BR†
          	(11) Vascular System.
          	(i) The following nomenclature and relative values for vascular procedures permit accurate identification and description of complex as well as simple vascular studies.
          	(ii) Serialographic procedure. A basic code number and relative value are assigned for the initial projection of each serialographic procedure and the value includes personnel, room setup, contrast material, transportation, trays, etc. The value does not include the charge for the catheterization or the injection procedure performed by the physician. Each additional serialographic projection value reflects the additional costs for subsequent projections or serialographic runs performed at the time of the initial examination whether or not they involve the same anatomical area as the initial projection. Unless otherwise indicated, bilateral procedures should be identified by the code number and description for additional serialographic projection of the part involved.
          	(iii) This method is to be used in lieu of modifier -50 or -51 for description of multiple vascular radiologic procedures.
          	(iv) Example I: Unilateral carotid. AP and lateral would be 75635, initial projection, plus 75638, one additional serialographic projection.
          	(v) Example II: Bilateral carotid. AP and lateral would be 75635, initial projection, plus 75638, additional serialographic projections, times 3.
          	(vi) Example III: If an aortoilac femoral study is performed at the conclusion of Example I or II, use number 75778, one or more additional serialographic projections.
          	(vii) Cineradiographic Procedure. Value for cineradiographic procedures includes all projections. Injection procedures are listed in the appropriate section of Medicine or Surgery.
          	(viii) Cardiopulmonary.
          75500	Angiocardiography, bycineradiography	RNE°
          	(For injection procedure, see 93501 et seq.)
          75505	by serialography (initial projection)	26.0
          ‡75508	each additional serialographic projection	7.7
          75510	CO: angiocardiography for pericardial effusion (For injection procedure, see 36000)	RNE°
          ‡75550	Coronary arterigraphy, by by cineradiography (includes all projections) (For injection procedure, see 36230)	RNE°
          ‡75555	by serialography (initial projection)	26.0
          ‡75558	each additional serialographic projection)	7.7
          	(For ventriculography and heart cateterization, see 93541 et seq.)
          ‡75580	Pulmonary arteriography, by cineradiography, (includes one or more projections)	RNE°
          	(For injection procedure, see 36013; see also 93541)
          ‡75580	by serialography (initial projection)	26.0
          ‡75588	each additional serialography projection	7.7
          	Unlisted cardiopulmonary vascular procedure	BR†
          	(ix) Arteriography.
          75605	Thoracic aortic arch, by serialography, Initial projection	26.0
          	(For injection procedure, see 36290)
          ‡75608	each additional serialographic projection	7.7
          ‡75615	Cervico-thoracic selective ( e.g. , extracranial carotid, vertebral, thyrocervical, internal mammary, bronchial arteries, etc.) by serialography, initial projection	26.0
          	(For injection procedure, see 36210, 36220)
          ‡75618	each additional serialographic projection	7.7
          ‡75635	Cerebral (carotid, vertebral), by serialography, initial projection	26.0
          	(For injection procedure, see 80210, 36200.)
          ‡75638	each additional serialographic projection	7.7
          ‡75760	Abdominal aorta, without serialography	RNE°
          	(For injection procedure, see 36200)
          ‡75761	with serialography	26.0
          	each additional serialographic projection	7.7
          ‡75765	Abdominal selective (celiac, superior mesenteric, renal, adrenal, lumbar, etc.), by serialography, initial projection	26.0
          	(For injection procedure, see 36240, 36250.)
          ‡75768	each additional serialographic projection	7.7
          ‡75770	Aorto-iliac-femoral, without serialography	RNE°
          	(For injection procedure, see 36200)
          ‡75775	with serialography, initial projection	26.0
          ‡75778	each additional serialographic projection	7.7
          ‡75780	Extremity, without serialography	RNE°
          	(For injection procedure, see 36140, 36200)
          †75785	with serialography	26.0
          ‡75788	each additional serialographic projection	7.7
          ‡75790	Arteriovenous shunt examination ( e.g. , dialysis patient)	RNE°
          	(For injection procedure, see 36145)
          ‡75797	Operative angiogram, single projection	RNE°
          ‡75799	Unlisted arteriographic procedure	BR†
          	(x) Venography.
          ‡75900	Superior vena cava, without serialography	RNE°
          	(For injection procedure, see 36011)
          ‡75905	with serialography, initial projection	26.0
          ‡75908	each additional serialographic projection	7.7
          ‡75920	Cervico-cephalic, selective ( e.g. , jugular parathyroid), without serialography	RNE°
          	(For injection procedure, see, 36020, 36021)
          ‡75925	with serialography	26.0
          ‡75928	each additional serialographic projection	7.7
          ‡75930	Orbital, without serialography	RNE°
          	(For injection procedure, see 36060, 36020)
          ‡75935	with serialography, initial projection	26.0
          ‡75938	each additional serialographic projection	7.7
          ‡75940	Inferior vena cava, without serialography	RNE°
          	(For injection procedure, see 36011)
          ‡75945	with serialography, initial projection	26.0
          ‡75948	each additional serialographic projection	7.7
          ‡75950	Abdominal, selective ( e.g. , renal, adrenal, hepatic), without serialography	RNE°
          	(For injection procedure, see 36020, 36021)
          ‡75955	with serialography, initial projection	26.0
          ‡75958	each additional serialographic projection	7.7
          ‡75960	Splenoportography, without serialography	RNE°
          	(For injection procedure, see 38200)
          ‡75965	with serialography, initial projection	26.0
          ‡75968	each additional serialographic projection	7.7
          ‡75970	Extremity, unilateral	11.0
          	(For injection procedure, see 36000, 36001)
          ‡75971	bilateral	16.5
          ‡75979	Unlisted venous procedure	BR†
          	(xi) Lymphangiography.
          ‡75980	Extremity, unilateral	RNE°
          	(For injection procedure, see 38790, 38791)
          ‡75982	bilateral	RNE°
          ‡75985	Complete (extremity-pelvic-abdominal, etc.)	23.0
          ‡75999	Unlisted lymphatic procedure	BR†
          	(12) Miscellaneous Studies.
          76000	Fluoroscopy (independent procedure)	2.6
          76001	extended physician and/or room time with periodic fluoroscopy per 30 minutes	REN°
          76020	Bone age studies	3.7
          76040	Bone length studies (ortho-roentgenogram	6.2
          76060	Bone survey (for metastases, metabolic survey, or long bones).	9.3
          †76065	infant ( e.g. , "battered child")	5.4
          ‡76082	Fistula or sinus tract study	5.4
          	(For injection procedure, see 20501)
          76090	Mammography, unilateral	5.4
          76091	bilateral	8.2
          ‡76092	by xeroradiography, unilateral	RNE°
          ‡76093	bilateral	RNE°
          ‡76095	Surgical specimen radiography	BR†
          76100	Laminography (tomography, planigraphy, body section radiography) (independent procedure)	8.2
          76105	to complement routine examination	4.2
          76120	Cineradiography (independent procedure)	7.7
          76125	to complement routine examination	4.4
          76140	Written consultation on X-ray examination made elsewhere (independent procedure)	BR†
          ‡76150	Xeroradiography, to complement routine exam other than mammography	RNE°
          76160	Polaroid X-ray film (in addition to value of procedure), per film	0.5
          ‡76170	Subtraction studies, per serialographic projection	1.8
          ‡76175	Duplication of radiographs, per film	0.45
          76180	Transportation of portable X-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen	RNE°
          ‡76181	more than one patient seen, per patient	BR†
          ‡76300	Thermography	RNE°
          ‡76499	Unlisted miscellaneous radiology procedure	BR†
          	(e) DIAGNOSTIC ULTRASOUND
          	(1) Head, Neck.
          ‡76500	Midline determination (A-mode).	7.0
          ‡76510	Echography, ophthalmic (A-mode)	7.0
          ‡76511	with amplitude quantitation	BR†
          ‡76512	contact scan (B-mode)	BR†
          ‡76513	immersion scan (B-mode)	BR†
          ‡76514	immersion (M-mode)	BR†
          ‡76515	tomography, serial scan (B-mode, with or without A-mode and/or M-mode)	BR†
          ‡76516	Echographic biometry ophthalmic (A-mode)	BR†
          ‡76517	scan (B-mode)	BR†
          ‡76529	Ophthalmic echographic foreign body localization	BR†
          ‡76535	Thyroid sonogram (B-scan)	13.0
          	(2) Chest.
          ‡76600	Pericardial effusion (M-mode)	7.0
          ‡76610	Complete echocardiogram (M-mode) includes: pericardial, mitral and aortic valves, left atrial and ventricular measurements	13.0
          ‡76620	Limited echocardiogram (M-mode) (Follow-up study or any of the individual studies listed above in 76610)	7.0
          ‡76630	Pleural effusion localization (A-mode)	7.0
          	(3) Abdomen.
          ‡76700	Abdomen, general survey study, includes delineation of any or all organs, and fluid collection (B-scan)	13.0
          ‡76705	Abdomen, limited survey study (includes tumor follow-up for radiation or chemotherapy within 30 days of initial study) (B-scan)	7.0
          ‡76710	Liver sonogram (B-scan)	13.0
          ‡76720	Gallbladder sonogram (B-scan)	13.0
          ‡76730	Kidneys sonogram (B-scan)	13.0
          ‡76740	Pancreas sonogram (B-scan)	13.0
          ‡76750	Spleen sonogram (B-scan)	13.0
          ‡76765	Aorta sonogram (B-scan)	13.0
          ‡76770	Retroperitoneal space sonogram (B-scan)	13.0
          ‡76780	Urinary bladder (B-scan)	13.0
          	(4) Obstetrics andGynecology.
          ‡76810	Pregnancy and fetal age determination (B-scan)	13.0
          ‡76815	Repeat fetal age measurement (B-scan) within 30 days of initial	4.0
          ‡76820	Placental localization	13.0
          †76840	Intrauterine device localization (B-scan)	13.0
          ‡76850	Pelvic mass examination (B-scan)	13.0
          	(5) Doppler.
          	(excludes auscultation of fetal heart
          ‡76900	Peripheral arterial flow study	12.0
          ‡76910	Peripheral venous flow study	12.0
          	(6) Miscellaneous.
          ‡76950	Mapping study for radiation therapy (includes contour, port demarcation on patient) (B-scan)	16.0
          ‡76960	Ultrasonic guidance for biopsy or aspiration (independent procedure)	4.0
          	(For aspiration and biopsy see appropriate section. If aspiration and biopsy are performed as part of or immediately following diagnostic B-scan, no extra charge is allowed)
          ‡76999	Unlisted ultrasound procedure	BR†

   (c) RADIOLOGY AND NUCLEAR MEDICINE GROUND RULES

2. (f) RADIATION THERAPY AND ONCOLOGY.

   1. (1) Radiation therapy as listed in this section includes teletherapy (i.e., the use of X-ray and other high-energy modalities, radium, cobalt, etc.) and brachytherapy (i.e., the surface, intracavitary or interstitial application of contained radioactive sources). For treatment by injectable or ingestible radioactive isotopes, see section on Nuclear Medicine.
   2. (2) The listed treatment values include initial treatment planning, initial and serial beam verification and central axis based calculations. They include normal follow-up care during the course of radiation therapy and for three months following its completion. Preliminary consultation and/or initial evaluation of the patient prior to radiation therapy are not included in the listed values. (See Medicine, 90000-90630). Complications or other circumstances requiring additional or unusual services concurrent with therapy or during the follow-up period may warrant additional charges.

   3. (3) Definitions. For the purpose of this section, the following definitions apply:

      1. (i) Treatment Week: Four or more treatment days in a calendar week. If three treatments or less in a week are given, use “treatment day” charge.
      2. (ii) Simple Treatment: Treatment of benign or malignant diseases requiring simple field localization or simple beam shaping devices, single field treatment, or surface or intracavitary therapy applied without general anesthesia.
      3. (iii) Complex Treatment: Treatment of malignant disease requiring complex field localization or use of beam shaping devices (e.g., treatment of eyelid; mantle fields in Hodgkin's disease, etc.) or two or more fields per region or two or more regions per day, massive single dose treatment, intracavitary therapy applied with general anesthesia.

      4. (iv) Adjunctive Radiotherapy Physics Services: The adjunctive radiotherapy physics services listed are those necessary to the conduct of radiation therapy for optimal patient care, performed in consultation with a qualified radiological physicist (e.g., patient dosimetry, design and construction of beam shaping devices). The values for these services apply when these services are performed by a physician or by a qualified radiological physicist under the supervision of a physician.

         	(4) Teletherapy.
         	(i) Per treatment schedule:
         	Simple Treatment
         77000	Superficial or orthovoltage (under 600 KVP), dermatoses, 3 fields or less, per treatment	2.0
         77010	more 3 fields, fields, per treatment	2.4
         77020	other benign lesions, per treatment	2.5
         77030	malignant lesions, per treatment	3.6
         77040	Supervoltage (600 KVP-2MeV, including Colbalt-60 and Cesium), per treatment	5.0
         77050	Megavoltage (3 MeV-8MeV), per treatment	6.0
         ‡77060	Megavoltage (over 8MeV or electron beam), per treatment	RNE°
         	Complex Treatment
         ‡77070	Superficial or orthovoltage (less than 600 KVP), per treatment	BR†
         ‡77080	Supervoltage (600 KVP-2MeV, including Colbalt-60 and Cesium), per treatment	6.0
         ‡77090	Megavoltage (3MeV-8MeV), per treatment	7.2
         ‡77095	Megavoltage (greater than 8MeV or electron beam), per treatment	BR†
         	(ii) Per treatment week schedule:
         	Simple Treatment
         77110	Superficial or orthovoltage (less than 600 KVP) per treatment week	18.0
         ‡77120	Supervoltage (600 KVP-2MeV, including Colbalt-60 and Cesium), per treatment week	25.0
         77130	Megavoltage (3MeV-8MeV), per treatment week	30.0
         ‡77135	Megavoltage (greater than 8 MeV or electron beam), per treatment week	BR†
         	Complex Treatment
         77210	Superficial or orthovoltage (less than 600 KVP), per treatment week	24.0
         77220	Supervoltage (600 KVP-2MeV, including Colbalt-60 and Cesium), per treatment week	29.0
         77230	Megavoltage (3MeV-8MeV), per treatment week	36.0
         ‡77235	Megavoltage (greater than 8MeV or electron beam), per treatment week	BR†
         ‡7299	Unlisted teletherapy procedure	BR†
         	(5) Brachytherapy.
         	(Radium and other isotope applications)
         	(For systemic, intracavitary and interstitial injection of radioactive material, see section on Nuclear Medicine.)
         	(The cost of providing the radioactive material is not included in the listed values. For use or purchase of radioactive source, use 99069.)
         	Surface application of radioactive material or mold:
         77500	Per application	2.9
         	Intracavitary application of sealed radioactive source:
         77520	Simple treatment, per application	26.0
         77530	Complex treatment, per application, total care by single physician	31.0
         77531	field preparation and application only	20.0
         77532	radioactive material preparation and monitoring	15.5
         ‡77533	Heyman packing, total care by single physician	BR†
         77534	field preparation and application only	BR†
         ‡77535	radioactive material preparation and monitoring	BR†
         	Interstitial insertion of sealed radioactive source
         77540	Simple treatment, per insertion	BR†
         77550	Complex treatment, per insertion	BR†
         ‡77599	Unlisted brachytherapy services	BR†
         	(For hyperbaric pressurization, see 96200, 96201)
         	(For chemotherapy of malignant disease, see 96030-96050)
         	(6) Adjunctive Radiotherapy Physics Services.
         	Isodose distributions, computer generated or otherwise:
         ‡77901	Teletherapy, simple (one or two fields), per plane	BR†
         ‡77902	complex (three or more fields, fixed or moving beam, or tissue inhomogeneity), per plane	BR†
         ‡77905	Brachytherapy, intracavitary radioactive sources, first plane	BR†
         77906	each additional plane	BR†
         ‡77911	Brachytherapy, interstitial radioactive sources, first plane	BR†
         ‡77912	each additional plane	BR†
         	Miscellaneous radiological physics services:
         ‡77920	In vivo dosimetry	BR†
         ‡77295	Design and construction of beam shaping devices ( e.g. , bolus, template, blocks, compensators	BR†
         ‡77930	Continuing radiological physics service in support of the radio-therapist in individual patient management per treatment course	BR†
         ‡77940	Tumor localization, simple, limited simulation and limited number of localization films (does not include "port" films or simple beam verification, which are included in basic treatment charge)	BR†
         ‡77941	Tumor localization, complex, simulation requiring multiple films and/or extensive participation of the radiologist or radiotherapist in the localization procedures	BR†
         ‡77999	Unlisted adjunctive radio-therapyphysics procedure	BR†

3. (g) NUCLEAR MEDICINE

   1. (1) When the physician providing Nuclear Medicine services is also responsible for the preliminary diagnostic work-up and/or follow-up care of the patient, see appropriate sections for office or hospital visits, consultations and other medical, surgical, radiological and pathology services.
   2. (2) For complex instrumental or special data handling, see ground rule 3 in this section.
   3. (3) For all pharmaceutical or other radionuclide material costs, see 99069. The listed values in this section do not include these costs. List name of radiopharmaceutical, dosage and cost.
   4. (4) For other supplies and material provided by the physician, see 99070.

   5. (5) The term imaging as used in this section includes scanning, scintiphotography, scintigraphy, etc.

      	(6) Diagnostic.
      	(i) Endrocrine System.
      78000	Thyroid uptake, single determination	4.0
      78001	multiple determinations (as in 6 and 24 hours, etc.)	5.3
      ‡78003	Thyroid stimulation, suppression or discharge (not including initial uptake studies)	5.7
      ‡78006	Thyroid, imaging, with uptake, single determination	10.0
      ‡78007	multiple determinations	10.5
      78010	Thyroid, imaging only	7.2
      ‡78015	Thyroid carcinoma metastases, imaging, neck and chest only	11.5
      ‡78016	with additional studies ( e.g. , imaging other body areas urinary recovery, etc.)	15.5
      	(Resin uptake T-3 or T-4[RT3U], see 84250)
      	(Triliodothyronine [True T-3], RIA, see 83539)
      	(T-4-thyroxin, CPB [Murphy-Pat-tee ], see 83536)
      	(T-4-thyroxin, RIA, see 83537)
      	(Calcitonin, RIA, see 82308)
      ‡78070	Parathyroid, imaging	RNE°
      	(Parathormone [parathyroid hormone], RIA, see 83970)
      ‡78075	Adrenal, imaging	RNE°
      	(Cortisol, RIA, plasma, see 82533)
      	(Cortisol, RIA, urine, see 82534)
      	(Aldosterone, double isotope technic, see 82087)
      	(Aldosterone, RIA, blood, see 82088
      	(Aldosterone, RIA, urine, see 82089)
      	(Pancreas, see 78240)
      	(Insulin, RIA, see 83525)
      	(Proinsulin, RIA, see 83526)
      	(Glucagon, RIA, see 82943)
      	(Adrenocorticotropic hormone
      	[ACTH], RIA, see 82024)
      	(Growth Hormone [HGH], [Somatotropin ], RIA, see 83003)
      	(Thyroid Stimulating Hormone [TSH], RIA, see 84443)
      	(Thyrotropin Releasing Factor, RIA, see 84444; plus long acting [LATS], see 84445)
      	(Follicle Stimulating Hormone, see Gonadotropin, pituitary [FSH], RIA, see 83001)
      	(Luteinizing Hormone, see Gonadotropin, pituitary [LH], [ICSH], RIA, see 83002)
      	(Prolactin level [Mammotropin], RLA, see 84146)
      	(Oxytocin level, see Oxytocinase, RIA, 83951)
      	(Vasopressin level, see Vasopressin [antidiuretic Hormone], RIA, see 84588)
      ‡78099	Unlisted endocrine procedure	BR†
      	(ii) Hematopoietic, Reticuloendothelial and Lymphatic System.
      ‡78102	Bone marrow, imaging, limited area	BR†
      ‡78103	multiple areas	BR†
      ‡78104	whole body	RNE°
      78110	Blood or plasma volume, single sampling	5.0
      78111	multiple sampling	7.0
      	(For dye method, see 84610)
      78120	Red cell mass determination, single sampling	9.4
      78121	multiple sampling	10.0
      	(see also 84610)
      78130	Red cell survival study ( e.g. , 51 Cr)	RNE°
      78135	plus splenic and/or hepatic sequestration	RNE°
      78140	Red cell splenic and/or hepatic sequestration	RNE°
      78160	Plasma radio-iron disappearance (turnover) rate	RNE°
      78170	Radio-iron, red cell utilization	RNE°
      78180	Radio-iron, body distribution and storage pools	RNE°
      	(Cyanocobalamine [Vitamin B-12], RIA, see 82611)
      	(Folic acid [folate] serum, RIA, see 82746)
      	(Human Hepatitis Antigen, Hepatitis Association Agent [Australian antigen] [HAA], RIA, see 86287)
      ‡78185	Spleen, imaging only, static	13.5
      	(If combined with liver study, use procedures 78215 and 78216)
      ‡78186	with vascular flow	RNE°
      ‡78195	Lymphatics and lymph glands imaging	BR†
      ‡78199	Unlisted procedure, hematopoietic, RE and lymphatic	BR†
      	(iii) Gastrointestinal System.
      ‡78201	Liver, imaging, static	13.5
      ‡78202	with vascular flow	RNE°
      	(For spleen imaging only, use 78185 and 78186)
      ‡78215	Liver and spleen, imaging, static	15.0
      ‡78216	with vascular flow of liver and/or spleen	RNE°
      ‡78220	Liver function ( e.g. , with radioiodinated rose bengal), with serial images	15.5
      ‡78221	with probe technique	BR†
      ‡78225	Liver-lung study, imaging ( e.g. , for subphrenic abscess)	27.0
      ‡78230	Salivary glands, imaging, static	RNE°
      ‡78231	with serial views	RNE°
      ‡78240	Pancreas, imaging	23.0
      ‡78270	Vitamin B-12 absorption studies
      	( e.g. , Schilling test) without intrinsic factor	5.3
      ‡78271	with intrinsic factor	5.3
      ‡78280	Gastrointestinal blood loss study	RNE°
      ‡78282	Gastrointestinal protein loss ( e.g. 51 Cr Albumin)	RNE°
      ‡78285	Gastrointestinal fat absorption study ( e.g. , radioiodinated triolein)	RNE°
      ‡78286	Gastrointestinal fatty acid absorption study ( e.g. , radioiodinated oleic acid)	RNE°
      	(Gastrin, RIA, see 82941) (Intrinsic factor level, see 84231)
      	(Carcinoembryonic antigen level, RIA, see 86151)
      ‡78299	Unlisted gastrointestinal procedure	BR†
      	(iv) Musculoskeletal System.
      78300	Bone imaging, limited area ( e.g. , skull, pelvis, etc.)	11.5
      78305	multiple areas	16.0
      ‡78307	whole body	20.0
      ‡78380	Joints, imaging	RNE°
      ‡78399	Unlisted musculoskeletal procedure	BR†
      	(v) Cardiovascular System.
      ‡78401	Cardiac blood pool, imaging, static
      	( e.g., as for pericardial effusion)	13.0
      ‡78402	with vascular flow	RNE°
      ‡78405	Myocardium, imaging	BR†
      ‡78435	Cardiac flow study, imaging ( i.e., angiocardiography)	RNE°
      ‡78445	Vascular flow study, imaging (i.e., angiography)	RNE°
      ‡78455	Venous thrombosis study	RNE°
      ‡78470	Cardiac output (see also 93561-93562)	RNE°
      ‡78490	Tissue clearance studies	RNE°
      	(Digoxin, RIA, see 82643)
      	(Digitoxin [digitalis], RIA, see 82640)
      ‡78499	Unlisted cardiovascular procedure	BR†
      	(vi) Respiratory System.
      ‡78580	Pulmonary perfusion imaging, particulate	17.5
      ‡78581	gaseous	BR†
      ‡78582	with ventilation, rebreathing and washout	BR†
      ‡78590	Pulmonary ventilation imaging, aerosol	BR†
      ‡78591	gaseous, single breath, single projection	RNE°
      ‡78592	multiple projections ( e.g., anterior, posterior, lateral views)	RNE°
      ‡78593	with rebreathing and washout with or without single breath, single projection	15.0
      ‡78594	multiple projections ( e.g., anterior, posterior, lateral views)	BR†
      ‡78599	Unlisted respiratory procedure	BR†
      	(vii) Nervous System.
      ‡78600	Brain, imaging, limited procedure, static	17.5
      ‡78601	with vascular flow	20.0
      ‡78605	complete, static	19.0
      ‡78606	with vascular flow	23.0
      ‡78610	vascular flow study only	5.7
      ‡78630	Cerebrospinal fluid flow, imaging, cisternography (not including introduction of material, e.g., for lumbar puncture, see 62288, etc.)	24.0
      ‡78635	ventriculography	24.0
      ‡78640	myelography	RNE°
      ‡78945	shunt evaluation	24.0
      ‡78650	CSF leakage	21.0
      ‡78699	Unlisted procedure, nervous system	BR†
      	(viii) Genitourinary System
      ‡78700	Kidney, imaging, static	12.0
      ‡78701	with vascular flow	17.0
      ‡78704	with function study ( i.e., imaging renogram)	19.0
      ‡78707	with vascular flow and function study	28.0
      78715	Kidney, vascular flow	RNE°
      ‡78720	Kidney, function study (i.e., renogram)	8.0
      ‡78721	with serial images	11.5
      ‡78725	Kidney function study, clearance	BR†
      	(Renin [Angiotensin I], RIA, see 84244; Angiotensin II, RIA, see 82163)
      ‡78730	Urinary bladder residual study	RNE°
      ‡78740	Ureteral reflux study	RNE°
      	(Estradiol, RIA, see 82670; see also 82677 and 82679)
      	(Progesterone, RIA, see 84144)
      	(Testosterone, blood, RIA, see 84403)
      	(Testosterone, urine, RIA, see 84405)
      ‡78770	Placenta, imaging	8.7
      ‡78775	localization ( e.g., radioiodinated HSA)	7.2
      	(See also 74720, 74725 and 76820)
      	(Lactogen, placental [HPL] chorionic somatomammotropin, RIA, see 83632)
      	(Chorionic gonadotropin, RIA, see 82998)
      ‡78799	Unlisted genitourinary procedure	BR†
      	(ix) Miscellaneous Studies.
      ‡78800	Tumor localization ( e.g., gallium, selenomethionine, etc.), limited area	RNE°
      	(For specific organ, see appropriate heading)
      ‡78801	multiple areas	RNE°
      ‡78802	whole body	RNE°
      ‡78899	Miscellaneous unlisted procedure	BR†
      	(7) Therapeutic.
      	(Preliminary and follow-up diagnostic tests not included. For these services, see appropriate sections.)
      	(For radiopharmaceutical or other radionuclide material costs, see 99069)
      	(For procedures involving radioactive sealed sources and surface application of radioactive material, see Radiation Therapy)
      79000	Hyperthyroidism, initial evaluation of patient and administration of radionuclide	28.0
      79001	subsequent, each	13.5
      79020	Thyroid suppression, evaluation of patient and administration of radionuclide	28.0
      ‡79030	Thyroid carcinoma, ablation of gland	BR†
      ‡79035	therapy, for metastases	BR†
      79100	Polycythemia vera, chronic leukemia, etc., per treatment	11.5
      79200	Intracavitary radioactive colloid therapy	BR†
      79300	Interstitial radioactive colloid therapy	BR†
      79400	Therapy, e.g., for metastases to bone (non-thyroid)	BR†
      ‡79499	Unlisted therapeutic procedure	BR†
      	(For chemotherapy procedure, see 96030-96055)

      BR† By report; see ground rule 4(a) for detailed information.

      RNE° Relativity not established; see ground rule 4(b) for detailed information.

      ‡ Code number new to 1974 revision of CRVS.

      □ Relativity for professional component of service only.

(a)