2021 CPT Reimbursement Reference Guide - Clarius

2021 CPT Reimbursement

Reference Guide

Table of Contents

(Click on your specialty to jump to that page)

Anesthesiology ............................................................................................................................................................... 1

Ultrasound Guidance of Regional Anesthesia in the ASC ..................................................................................... 2

Echocardiograph .......................................................................................................................................................... 3

Emergency Medicine ................................................................................................................................................... 4

Endocrinology ................................................................................................................................................................. 5

Musculoskeletal Applications .................................................................................................................................. 6-7

Obstetrics and Gynecology..................................................................................................................................... 8-9

Pain Management ....................................................................................................................................................... 10

Pulmonary Medicine .................................................................................................................................................... 11

Surgery ......................................................................................................................................................................12-13

Vascular Access ............................................................................................................................................................ 14

Vascular Surgery ..................................................................................................................................................... 15-16

CPT Reimbursement Reference

Anesthesiology

2021 Medicare Physician Fee Schedule

¡ª National Average*

CPT

Code

CPT Code Descriptor

76942

Ultrasonic guidance for needle placement

(e.g., biopsy, aspiration injection, localization

device), imaging supervision and

interpretation

+76937

Ultrasonic guidance for vascular access requiring

ultrasound evaluation of potential access sites,

documentation of selected vessel patency,

concurrent realtime ultrasound visualization of

vascular needle entry, with permanent recording

and reporting

2021 Hospital

Outpatient Prospective

Payment System

(OPPS)?

APC Code

APC

Global

Professional

Technical

Payment

Payment

Payment

$58.97

$31.40

$27.57

Packaged

Service

No

Payment

$39.08

$13.96

$25.12

Packaged

Service

No

Payment

Payment

93308

Echocardiography, transthoracic, real time with

image documentation (2D) includes M-mode

recording; when performed, follow up or limited study

$102.93

$25.47

$77.46

5523

$230.13

+93321

Doppler Echocardiography, pulsed wave and/or

continuous wave with spectral display (List

separately in addition to codes for 2D

echocardiographic imaging); follow up or limited

study

$27.22

$7.33

$19.89

Packaged

Service

No

Payment

+93325

Doppler echocardiography color flow velocity

mapping (List separately in addition to codes for

echocardiography)

$25.47

$3.14

$22.33

Packaged

Service

No

Payment

CPT

Code

64405

CPT Code Descriptor

Injection, anesthetic agent; occipital nerve

Non-Facility

Payment

Facility

Payment

APC Code

APC

Payment

$76.42

$54.78

5441

$261.17

64415

Injection, anesthetic agent; brachial plexus, single

$116.89

$64.20

5443

$822.46

64417

Injection, anesthetic agent; axillary nerve

$144.46

$61.76

5443

$822.46

64418

Injection, anesthetic agent; suprascapular nerve

$91.42

$58.62

5442

$634.59

64420

Injection, anesthetic agent; intercostal nerve, single

$102.59

$60.37

5442

$634.59

64421

Injection, anesthetic agent; intercostal nerves,

multiple, regional block

$34.54

$25.47

5443

$822.46

64425

Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves

$117.94

$56.53

5442

$634.59

64445

Injection, anesthetic agent; sciatic nerve, single

$131.90

$54.78

5442

$634.59

64446

Nerve block injection, sciatic continuous infusion

N/A

$60.02

5442

$822.46

64447

Injection, anesthetic agent; femoral nerve, single

$92.12

$53.74

5442

$634.59

64448

Nerve block injection, femoral continuous infusion

N/A

$61.76

5443

$822.46

64450

Nerve block injection, other peripheral nerve or branch

$79.91

$43.27

5442

$634.59

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement

purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for

the medical services discussed, as obtained from the American Medical Association in July 2021. Payment will vary by region. Clarius

Mobile Health disclaims any responsibility to update the information provided. It is the provider¡¯s responsibility to determine and submit

appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current

requirements and policies with the applicable payer.

1

CPT Reimbursement Reference

Ultrasound Guidance of Regional Anesthesia in the ASC

2021 Medicare Physician Fee Schedule National Average*

CPT Code

76942

CPT Code Descriptor

Ultrasonic guidance for needle placement (e.g.,

biopsy, aspiration, injection localization device),

imaging supervision and interpretation

Professional Payment

$31.40

2021 Medicare Physician Fee Schedule National Average*

2021 Hospital Outpatient

Prospective Payment

System (0PPS)?

APC

APC Code

Payment

Packaged

Service

No

Payment

2021 Hospital Outpatient

Prospective Payment

System (OPPS) for ASC?

CPT Code

CPT Code Descriptor

Physician at Facility Payment

64415

Injection, anesthetic agent; brachial plexus, single

$64.20

ASC Payment

$417.75

64417

Injection, anesthetic agent; axillary nerve

$61.76

$417.75

64418

Injection, anesthetic agent; suprascapular nerve

$58.62

$46.34

64420

Injection, anesthetic agent; intercostal nerve,

single

$60.37

$322.32

64421

Injection, anesthetic agent; intercostal nerves,

multiple, regional block

$25.47

$417.75

64425

Injection, anesthetic agent; ilioinguinal,

iliohypogastric nerves

$56.53

$76.48

64445

Injection, anesthetic agent; sciatic nerve, single

$54.78

$90.42

64446

Nerve block injection, sciatic continuous infusion

$60.02

$417.75

64447

Injection, anesthetic agent; femoral nerve, single

$53.74

$47.96

64448

Nerve block injection, femoral continuous infusion

$61.76

$417.75

64450

Nerve block injection, other peripheral nerve

$43.27

$48.61

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts

above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as

obtained from the American Medical Association in July 2021. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the

information provided. It is the provider¡¯s responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before

filing any claims, providers should verify current requirements and policies with the applicable payer.

2

CPT Reimbursement Reference

Echocardiograph

2021 Medicare Physician Fee Schedule

¡ª National Average*

CPT

CPT Code Descriptor

2021 Hospital

Outpatient Prospective

Payment System

(OPPS)?

APC Code

APC

Global

Professional

Technical

Payment

Payment

Payment

93306

Echocardiography, transthoracic, real time with

image documentation (2D) includes M-mode

recording when performed; complete, with spectral

Doppler and color flow Doppler.

$207.96

$70.82

$137.13

5524

$482.89

93307

Echocardiography, transthoracic, real time with

image documentation (2D) includes M-mode

recording when performed; complete, without

spectral Doppler or color flow Doppler.

$146.90

$45.36

$101.54

5523

$230.13

93308

Echocardiography, transthoracic, real time with

image documentation (2D) includes M-mode

recording when performed; follow up or limited

$102.93

$25.47

$77.46

5523

$230.13

93303

Transthoracic echocardiography for congenital

cardiac anomalies, complete

$237.97

$62.81

$175.16

5524

$482.89

93304

Transthoracic echocardiography for congenital

cardiac anomalies, follow-up or limited

$166.79

$36.99

$129.80

5524

$482.89

93350

Echocardiography, transthoracic, real-time with

image documentation (2D, with or without M-mode

recording), during rest and cardiovascular stress test

using treadmill, bicycle exercise and/or

pharmacologically induced stress, with interpretation

and report

$196.80

$70.83

$125.96

5524

$482.89

93015

Cardiovascular stress test using maximal or

submaximal treadmill or bicycle exercise,

continuous electrocardiographic monitoring,

and/or pharmacological stress; with physician

supervision, with interpretation and report.

Non-facility

Payment

$71.88

NA

NA

NA

NA

+93320

Doppler Echocardiography, pulsed wave and/or

continuous wave with spectral display (List

separately in addition to codes for 2D

echocardiographic imaging); complete.

$54.43

$18.14

$36.29

Packaged

Service

No

Payment

+93321

Doppler Echocardiography, pulsed wave and/or

continuous wave with spectral display (List

separately in addition to codes for 2D

echocardiographic imaging); follow up or limited.

$27.22

$7.33

$19.89

Packaged

Service

No

Payment

+93325

Doppler echocardiography color flow velocity

mapping (List separately in addition to codes for

echocardiography)

$25.47

$3.14

$22.33

Packaged

Service

No

Payment

Code

Payment

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement

purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for

the medical services discussed, as obtained from the American Medical Association in July 2021. Payment will vary by region. Clarius

Mobile Health disclaims any responsibility to update the information provided. It is the provider¡¯s responsibility to determine and submit

appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current

requirements and policies with the applicable payer.

3

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