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August 28, 2019

Richmond Physician Fee Schedule

PRACTICE CHARGE CODE DESCRIPTION CPT CODE CURRENT FEE
FLP 72192 CT PELVIS WO CONTRAST 72192 1604
FLP 93005 EKG 93005 59
FLP 93010 RTN ECG 12 LEADS INTRP/RP 93010 105
FLP 99281 EVALUATION AND MANAGEMENT SERVICES LEVEL 1 99281 185
FLP 99281D EVALUATION AND MANAGEMENT SERVICES LEVEL 1 99281 185
FLP 99406 SMOKING CESSATION 3-10 99406 228
FLP 99282 EVALUATION AND MANAGEMENT SERVICES LEVEL 2 99282 250
FLP 99282D EVALUATION AND MANAGEMENT SERVICES LEVEL 2 99282 250
FLP 99283 EVALUATION AND MANAGEMENT SERVICES LEVEL 3 99283 415
FLP 99283D EVALUATION AND MANAGEMENT SERVICES LEVEL 3 99283 415
FLP 99292 CRITICAL CARE ADD 30 MIN 99292 431
FLP 99284 EVALUATION AND MANAGEMENT SERVICES LEVEL 4 99284 630
FLP 99284D EVALUATION AND MANAGEMENT SERVICES LEVEL 4 99284 630
FLP 99285 EVAULATION AND MANAGEMENT SERVICES LEVEL 5 99285 964
FLP 99285D EVAULATION AND MANAGEMENT SERVICES LEVEL 5 99285 964
FLP 99291 CRITICAL CARE 30-74 MIN 99291 1197
FLP 99291D CRITICAL CARE 30-74 MIN 99291 1197
FLP 85025 CBC 85025 43
FLP 82784 IGC IMMUNOGLOBULIN 82784 51
FLP 81000 U/A DIPSTICK 81000 52
FLP 87275 IAADI INF B VIRUS 87275 52
FLP 87807 INF AGT DET IMNAS OPT RSV 87807 59
FLP 81003 U/A W/O MICRO DIPSTICK 81003 65
FLP 82607 VITAMIN B-12 82607 80
FLP 86038 ANTINUCLEAR AB 86038 80
FLP 82055 ALCOHOL-BLOOD 82055 90
FLP H0048 ALCOHOL TEST-SPECIAL COLL NON-BLOOD H0048 117
FLP 87400 INFLUENZA A&B 87400 118
FLP 83970 PARATHORMONE(PARATHYRIOD) 83970 130
FLP 80100 DRUG ABUSE PANEL II 80100 146
FLP 80101 DRUG SCREEN-EMERGENCY 80101 146
FLP 87804 INFLUENZA IMMUNOASSAY OPT 87804 176
FLP 80053 METABOLIC COMPRE PANEL 80053 190
FLP 87110 CHLAMYDIA CULTURE 87110 642
FLP 99217 OBSERVATION CARE DISCHARGE SERVICE 99217 367
FLP 99218 INITIAL OBSERVATION CARE 99218 788
FLP 99219 INITIAL OBSERVATION CARE 99219 817
FLP 99220 INITIAL OBSERVATION CARE 99220 834
FLP 99234 OBSERVATION AND DISCHARGE ON SAME DAY 99234 1137
FLP 99235 OBSERVATION ADMIT AND DISCHARGE ON SAME DAY 99235 1167
FLP 99236 OBSERVATION ADMIT AND DISCHARGE ON SAME DAY 99236 1184
FLP A0394 ALS IV DRUG THERAPY SUPPLIES A0394 1
FLP A6455 SELF ADHER BANDAGE A6455 6
FLP J3490 UNCLASSIFIED DRUGS J3490 8
FLP A6449 LIGHT COMP BANDAGE A6449 22
FLP J1885 TORADOL INJ 15 MG J1885 22
FLP J2405 ONDANSETRON HCI, PER MG J2405 22
FLP L1830 KNEE IMMOBOLIZER L1830 24
FLP Q9965 LOW OSMOLAR CON MAT PER M Q9965 25
FLP J2150 MANNITOL INJECTION J2150 26
FLP J2930 SOLU-MEDROL 125 MG J2930 26
FLP A0396 ALS ESPOHAGEAL INTUB SUPPLIES A0396 30
FLP J1630 HALOPERIDOL 5MG J1630 35
FLP J3260 TOBRAMYCIN SULFATE INJECTION J3260 36
FLP A4649 SURGICAL SUPPLY MISC A4649 41
FLP S0020 INJ, BUPIVICAINE, 30ML S0020 46
FLP J3301 KENOLOG 10 MG J3301 58
FLP A4570 SPECIAL CASTING MATERIAL A4570 125
FLP J0696 ROCEPHIN 250 MG J0696 133
FLP G0168 WND CLS TISSUE ADHESIVE G0168 152
FLP L3650 SO FIGURE EIGHT ABDUCTION L3650 251
FLP L3660 SO FIG 8 ABDUCTION RESTRA L3660 272
FLP 94760 EAR OR PULSE OXIMETRY 94760 46
FLP 99080 MEDICAL RECORDS 99080 46
FLP 96372 THERAPEUTIC PROPHYLACTIC/ 96372 50
FLP 10120 I & RMVL SUB-CUT SIMPLE 10120 59
FLP 11042 DBRD SKN SUBQ TISSUE 11042 59
FLP 11400 EXC BGN LSN ARM/LEG <0.5 11400 59
FLP 36415 VENIPUNCTURE 36415 59
FLP 95992 CANALITH REPOSITIONING PROCEDURE(EG, EPLEY MANEUVER, SEMONT) PER DAY 95992 70
FLP 29130 APPLICATION FINGER SPLINT 29130 77
FLP 36410 VENIPUNCTURE, 3 YRS OR OLDER 36410 90
FLP 99153 MODERATE SEDATION ADD 15 MINUTES 99153 95
FLP 11201 REMOVAL SK TGS MLT FIBRO TAGS ANY 11201 102
FLP 28400 CLSD TX CLAVICLE FX WO MA 28400 106
FLP 28430 CLTX TALUS FX W/O MNPJ 28430 106
FLP 28470 CLTX METAR FX WO MNP 28470 106
FLP 28475 CL TX METAR FX W/MNPJ 28475 106
FLP 28600 CLOSED TX TARSOMETATARSAL DISLOC 28600 106
FLP 28660 CLSD TX PIP JNT DISLOCATI 28660 106
FLP 29700 RMVL/BIVALV GAUNTLET BOOT 29700 106
FLP 28515 FX CARE PHALANX NOT GREAT 28515 111
FLP 69210 RMVL IMPACTED CERUMEN 69210 116
FLP 99053 SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HR FACILITY 99053 117
FLP 29125 SHORT ARM SPLINT 29125 122
FLP 11040 DBRDMT, SKIN, PARTIAL THICK 11040 128
FLP 36000 INTRODUCTION OF NEEDLE/IN 36000 128
FLP 29515 SHORT LEG SPLINT 29515 142
FLP 11011 DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC 11011 146
FLP 99051 SCV PRV OV REG SCHED EVN 99051 146
FLP 11000 DBRDMT X10SV ECZMT/INFCT 11000 150
FLP 51702 INSERTION BLADDER CATH 51702 152
FLP 69200 RMVL FOREIGN BODY EAR 69200 161
FLP 30901 NASAL PACKING 30901 163
FLP 30903 CTRL NSL HEMRRG ANT CPLX 30903 163
FLP 31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE 31500 163
FLP 20552 TRIGGER POINT INJ 1-2 MUS 20552 166
FLP 20605 ARTHROCENTESIS, MED JOINT 20605 166
FLP 96366 IV INFUS THER PROPH/DX EA 96366 176
FLP 10060 INCISION/DRAINAGE ABSCESS 10060 193
FLP 56405 INC/DRAIN VULVA/PERINEAL 56405 193
FLP 11200 RMVL SKIN TAGS 11200 194
FLP 31525 LARGSC +-TRACHEOSCOPY DX 31525 198
FLP 56420 I & D BARTHOLIN ABSCESS 56420 198
FLP 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL 69209 204
FLP 24640 RADIAL HEAD SUBLUX. CHILD 24640 210
FLP 24670 CLTX ULNR FX PROX END WO 24670 210
FLP 64400 INJ ANESTHETIC, TRIGEMINA 64400 210
FLP 64450 INJ ANESTHETIC AGENT 64450 210
FLP 65220 RMVL FB EYE W/O SLIT LAMP 65220 210
FLP 65222 RMVL FB EYE 65222 210
FLP 11730 AVULSION/1-NAIL PLATE 11730 217
FLP 11740 EVAC SUBUNGUAL HEMATOMA 11740 217
FLP 11760 REPAIR NAIL BED 11760 217
FLP 69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED 69005 220
FLP 11041 DEBRIDE SKIN, FULL 11041 221
FLP 31505 LARYNGOSCOPY, INDRCT DX 31505 229
FLP 23650 SHOULDER DISLOCATION TRMT 23650 233
FLP 24530 CLTX SPRCNDYLR/TRANSCNDYL 24530 233
FLP 24650 CLTX RDL HEAD FX WO MANP 24650 233
FLP 29105 LONG ARM SPLINT 29105 233
FLP 29505 LONG LEG SPLINT 29505 233
FLP 10121 I & RMVL FB, SUB-CUT,COMP 10121 240
FLP 11765 WEDGE EXC SKIN/NAIL BED 11765 242
FLP 65205 REMOVAL FB EYE-SUPERFCL 65205 244
FLP 24500 CLTX HUMRL SHFT FX W/O MN 24500 252
FLP 25530 CLSD TX ULNAR SHFT FX NO 25530 252
FLP 28450 TX TARSAL B1 FX XCP TALUS 28450 252
FLP 24576 CLTX HUMRL CNDLYR FX MEDI 24576 254
FLP 27508 CLTX FEM FX DSTAL END MED 27508 254
FLP 27560 CLTX PATELLAR DISLC W/O A 27560 254
FLP 11401 EXC BGN LSN TRUNK 0.6-1.0 11401 257
FLP 20610 ARTHROCENTESIS, LG JOINT 20610 262
FLP 16020 BURN, DRESSING/DBRDMNT-SM 16020 270
FLP 16000 BURN, INITIAL TREATMENT 16000 274
FLP 10080 I & D CYST SIMPLE 10080 275
FLP 30300 RMVL FOREIGN BODY NASAL 30300 279
FLP 10140 I & D HEMATOMA/SEROMA 10140 282
FLP 27220 CLTX ACETABULUM HIP/SOCKT FX W/O MNP 27220 293
FLP 40650 RPR LIP FULL THICKNESS 40650 293
FLP 42809 RMVL FB PHARYNX 42809 293
FLP 46083 INCISION THROM HEMORRHOID 46083 293
FLP 46255 HRHC SMPL 46255 293
FLP 99144 MOD SEDATION SERV UNDER 5 99144 293
FLP 12014 REPAIR LAC FACE 5.1-7.5CM 12014 320
FLP 12032 REPAIR-INT SCALP 2.6-7.5 12032 320
FLP 12034 INTERM RPR SCLP/TRNK/EXTR 12034 320
FLP 21310 CLTX NSL B1 FX W/O MNPJ 21310 320
FLP 21480 CLDS TX TEMP DISLOCATION 21480 320
FLP 21800 CLTX RIB FX UNCOMP EA 21800 320
FLP 27520 CLTX PATELLAR FX W/O MNPJ 27520 320
FLP 16030 BURN, DRESSNG/DBRDMNT-LG 16030 330
FLP 12002 REPAIR LAC SCALP 2.6-7.5 12002 332
FLP 99152 SEDATION
336
FLP 12011 REPAIR LAC FACE < 2.5 CM 12011 341
FLP 11421 EXC BGN LSN,SCALP 0.6-1.0 11421 344
FLP 26700 CLS TX MCP DISLOCATION 26700 381
FLP 27808 CLOSED TX BIMALLEOLAR ANK 27808 381
FLP 10061 INS/DRAIN ABSCESS COMPL 10061 385
FLP 12031 LYR CLSR S/A/T/E 2.5CM 12031 387
FLP 23500 CLTX CLAVICULAR FX WO MNP 23500 392
FLP 25565 CLOSED TX RADIAL&ULNAR SH 25565 392
FLP 25600 CLSD TX DISTAL RAD FX WO 25600 392
FLP 25650 CLTX UR SYLOID FX 25650 392
FLP 11422 EXC BGN LSN,SCALP 1.1-2.0 11422 398
FLP 12013 REPAIR LAC FACE 2.6-5.0CM 12013 403
FLP 12001 LACERATION REPAIR 12001 425
FLP 20600 ARTHROCENTESIS, SML JOINT 20600 427
FLP 64402 INJ ANESTHETIC FACIAL NRV 64402 427
FLP 23570 CLSD TX SCAPULAR FX WO MA 23570 438
FLP 10160 PUNCTURE ASP OF ABSCESS 10160 439
FLP 62270 SPINAL PUNCTURE,LUMBAR 62270 450
FLP 27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA 27550 455
FLP 12004 REPAIR LAC SCALP 7.6-12.5 12004 466
FLP 12041 LAYER CLSR NECK/HAND 2.6 12041 466
FLP 12042 REPAIR LAC HAND/FOOT 2.6- 12042 466
FLP 41800 DRNG ABSC DENTOALVEOLAR S 41800 466
FLP 41250 LACERATION REPAIR OF TONGUE 41250 472
FLP 11403 EXC BNGN LSN,TRUNK 2.1-3. 11403 474
FLP 28490 CLTX FX GRT TOE W/O MNLJ 28490 477
FLP 12021 TX SUPERFICIAL WOUND DEHISCENCE V 12021 483
FLP 10081 I&D PILONIDAL CST COMP 10081 491
FLP 46050 INC/DRAIN PERIANAL ABS SU 46050 505
FLP 12045 REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM 12045 506
FLP 27530 CLTX TIBL FX PROX W/O MNPJ 27530 507
FLP 12036 REPAIR INTERM S/A/T/E 20.1-30.0 CM 12036 508
FLP 46320 ENULEATION EXCC OF EXT HE 46320 513
FLP 26750 CLS TX FX FINGER/THUMB 26750 519
FLP 11750 EXC NAIL PART/COMP 11750 520
FLP 24560 CLTX HUMERAL EPICONYLAR 24560 520
FLP 28510 CLSD TX FX PLALANX/PHALAN 28510 523
FLP 26720 CLSD TX PHALANGEAL SHFTFX 26720 531
FLP 27760 CLTX MEDIAL MALLS FX W/O 27760 531
FLP 11423 EXC BGN LSN,SCALP 2.1-3.0 11423 536
FLP 12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE 12020 557
FLP 12005 REPAIR LAC,SCALP 12.6-20C 12005 559
FLP 26770 TREAT FINGER DISLOC FINGE 26770 560
FLP 26725 CLTX PHLNGL FX PROX/MIDDL 26725 567
FLP 42700 I&D ABSC PRITONSILLAR 42700 571
FLP 12051 LAYER CLSR OF WND NCK/HND 12051 583
FLP 12052 LYR CLSR WOUND 2.6-5.0FAC 12052 583
FLP 91105 GASTRIC INTUBATION/ASPER 91105 596
FLP 11404 EXC BGN LSN TRUNK 3.1-4.0 11404 601
FLP 25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION 25535 605
FLP 12015 REPAIR LAC FACE 7.6-12.5 12015 615
FLP 25560 CLTX RDL&UR SHFT FXS W/O 25560 635
FLP 23600 CLTX PROX HUMRL FX WO MAN 23600 642
FLP 12053 LYR CLSR F/E/E/N/L/M&/MUC 12053 645
FLP 24600 CLSD TX ELBOW DISLOCAT 24600 650
FLP 25500 CLTX RDL SHFT FX WO MANP 25500 650
FLP 25622 CLSD TX NAVICULAR FX WO M 25622 650
FLP 67700 I&D ABSCESS EYELID 67700 663
FLP 31515 LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION 31515 670
FLP 12044 LYR CLSR N/H/F/ETRNL GENT 12044 674
FLP 12006 REPAIR LAC SCALP 20.1-30. 12006 679
FLP 11043 DEBRIDEMENT SUBQ TISS&MUS 11043 712
FLP 28190 RMVL FB BODY FOOT SUBQ 28190 712
FLP 10180 INCISION & DRAINAGE COMPLEX PO WO 10180 727
FLP 13151 CMPX RPR EYE NOSE 1.1-2.5 13151 759
FLP 12016 REPAIR LAC,FACE 12.6-20CM 12016 790
FLP 12007 REPAIR LAC SCALP >30.0CM 12007 791
FLP 26755 CLTX DSTL PHLNGL FX FNGR/ 26755 792
FLP 26600 CLSD TX METACARPAL FX 26600 838
FLP 11406 EXC BGN LSN ARM/LEG >4.0 11406 853
FLP 12035 REPAIR INTERM S/A/T/E 12. 12035 860
FLP 12054 REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM 12054 865
FLP 32551 TUBE THORACOSTOMY INCLUDES WATER SEAL 32551 894
FLP 27780 CLTX PROX FIVULA/SHFT FX 27780 956
FLP 12017 REPAIR LAC FACE 20-30 CM 12017 986
FLP 27786 CLSD TX DISTAL FIBULAR FX 27786 993
FLP 26605 CLSD TX MEDICARPAL FX 26605 1053
FLP 12018 REPAIR LAC FACE >30.0 CM 12018 1179
FLP 36556 INS NON TUN CTR CVC 5YR> 36556 1297
FLP 13132 RPR CMPX FOREHEAD/CHECK/C 13132 1345
FLP 28192 RMVL FB FOOT DEEP 28192 1373
FLP 27810 CLTX BIMAL ANKLE FX W/POT 27810 1704
FLP 13152 RPR CPLX E/N/E/L 2.6-7.5 13152 1830
FLP 25605 CLSD TX DISTAL RAD FX 25605 1876
FLP 46040 I&D ISCHIOR/PRIRC ABSC SP 46040 1957
FLP 27752 CLTX TIBL SFT FX W/MANP 27752 1968
FLP 25505 CLSD TX RAD SHAFT W/MANIP 25505 2213
FLP 59409 VAG DLVR ONLY 59409 2704
FLP 90723 DTAP-HEPB-IPV VACCINE INTRAMUSCLAR 90723 141
FLP XRAYCD RADIOLOGICAL CD XRAYCD 28
FLP 71101 RIB UNILATERAL W CHEST 71101 187
FLP 72170 RAD EXAM PELVIS 1/2 VEIW 72170 251
FLP 73560 XRAY KNEE, SUNRISE VIEW 73560 312
FLP 73510 XRAY HIP MIN 2 VIEWS 73510 325
FLP 71020 XRAY CHEST PA & LATERAL 71020 327
FLP 70150 XRAY FACIAL BONES >3 VIEW 70150 409
FLP 73630 XRAY FOOT MIN 3 VIEWS 73630 537
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