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August 28, 2019

White Rock Physician Fee Schedule

PRACTICECHARGE CODEDESCRIPTIONCPT CODECURRENT FEE
FWP72192CT PELVIS WO CONTRAST721921604
FWP93005EKG9300559
FWP93010RTN ECG 12 LEADS INTRP/RP93010105
FWP99281EVALUATION AND MANAGEMENT SERVICES LEVEL 199281185
FWP99281DEVALUATION AND MANAGEMENT SERVICES LEVEL 199281185
FWP99406SMOKING CESSATION 3-1099406228
FWP99282EVALUATION AND MANAGEMENT SERVICES LEVEL 299282250
FWP99282DEVALUATION AND MANAGEMENT SERVICES LEVEL 299282250
FWP99283EVALUATION AND MANAGEMENT SERVICES LEVEL 399283415
FWP99283DEVALUATION AND MANAGEMENT SERVICES LEVEL 399283415
FWP99292CRITICAL CARE ADD 30 MIN99292431
FWP99284EVALUATION AND MANAGEMENT SERVICES LEVEL 499284630
FWP99284DEVALUATION AND MANAGEMENT SERVICES LEVEL 499284630
FWP99285EVAULATION AND MANAGEMENT SERVICES LEVEL 599285964
FWP99285DEVAULATION AND MANAGEMENT SERVICES LEVEL 599285964
FWP99291CRITICAL CARE 30-74 MIN992911197
FWP99291DCRITICAL CARE 30-74 MIN992911197
FWP85025CBC8502543
FWP82784IGC IMMUNOGLOBULIN8278451
FWP81000U/A DIPSTICK8100052
FWP87275IAADI INF B VIRUS8727552
FWP87807INF AGT DET IMNAS OPT RSV8780759
FWP81003U/A W/O MICRO DIPSTICK8100365
FWP82607VITAMIN B-128260780
FWP86038ANTINUCLEAR AB8603880
FWP82055ALCOHOL-BLOOD8205590
FWPH0048ALCOHOL TEST-SPECIAL COLL NON-BLOODH0048117
FWP87400INFLUENZA A&B87400118
FWP83970PARATHORMONE(PARATHYRIOD)83970130
FWP80100DRUG ABUSE PANEL II80100146
FWP80101DRUG SCREEN-EMERGENCY80101146
FWP87804INFLUENZA IMMUNOASSAY OPT87804176
FWP80053METABOLIC COMPRE PANEL80053190
FWP87110CHLAMYDIA CULTURE87110642
FWP99217OBSERVATION CARE DISCHARGE SERVICE99217367
FWP99218INITIAL OBSERVATION CARE99218788
FWP99219INITIAL OBSERVATION CARE99219817
FWP99220INITIAL OBSERVATION CARE99220834
FWP99234OBSERVATION AND DISCHARGE ON SAME DAY992341137
FWP99235OBSERVATION ADMIT AND DISCHARGE ON SAME DAY992351167
FWP99236OBSERVATION ADMIT AND DISCHARGE ON SAME DAY992361184
FWPA0394ALS IV DRUG THERAPY SUPPLIESA03941
FWPA6455SELF ADHER BANDAGEA64556
FWPJ3490UNCLASSIFIED DRUGSJ34908
FWPA6449LIGHT COMP BANDAGEA644922
FWPJ1885TORADOL INJ 15 MGJ188522
FWPJ2405ONDANSETRON HCI, PER MGJ240522
FWPL1830KNEE IMMOBOLIZERL183024
FWPQ9965LOW OSMOLAR CON MAT PER MQ996525
FWPJ2150MANNITOL INJECTIONJ215026
FWPJ2930SOLU-MEDROL 125 MGJ293026
FWPA0396ALS ESPOHAGEAL INTUB SUPPLIESA039630
FWPJ1630HALOPERIDOL 5MGJ163035
FWPJ3260TOBRAMYCIN SULFATE INJECTIONJ326036
FWPA4649SURGICAL SUPPLY MISCA464941
FWPS0020INJ, BUPIVICAINE, 30MLS002046
FWPJ3301KENOLOG 10 MGJ330158
FWPA4570SPECIAL CASTING MATERIALA4570125
FWPJ0696ROCEPHIN 250 MGJ0696133
FWPG0168WND CLS TISSUE ADHESIVEG0168152
FWPL3650SO FIGURE EIGHT ABDUCTIONL3650251
FWPL3660SO FIG 8 ABDUCTION RESTRAL3660272
FWP94760EAR OR PULSE OXIMETRY9476046
FWP99080MEDICAL RECORDS9908046
FWP96372THERAPEUTIC PROPHYLACTIC/9637250
FWP10120I & RMVL SUB-CUT SIMPLE1012059
FWP11042DBRD SKN SUBQ TISSUE1104259
FWP11400EXC BGN LSN ARM/LEG <0.51140059
FWP36415VENIPUNCTURE3641559
FWP95992CANALITH REPOSITIONING PROCEDURE(EG, EPLEY MANEUVER, SEMONT) PER DAY9599270
FWP29130APPLICATION FINGER SPLINT2913077
FWP36410VENIPUNCTURE, 3 YRS OR OLDER3641090
FWP99153MODERATE SEDATION ADD 15 MINUTES9915395
FWP11201REMOVAL SK TGS MLT FIBRO TAGS ANY11201102
FWP28400CLSD TX CLAVICLE FX WO MA28400106
FWP28430CLTX TALUS FX W/O MNPJ28430106
FWP28470CLTX METAR FX WO MNP28470106
FWP28475CL TX METAR FX W/MNPJ28475106
FWP28600CLOSED TX TARSOMETATARSAL DISLOC28600106
FWP28660CLSD TX PIP JNT DISLOCATI28660106
FWP29700RMVL/BIVALV GAUNTLET BOOT29700106
FWP28515FX CARE PHALANX NOT GREAT28515111
FWP69210RMVL IMPACTED CERUMEN69210116
FWP99053SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HR FACILITY99053117
FWP29125SHORT ARM SPLINT29125122
FWP11040DBRDMT, SKIN, PARTIAL THICK11040128
FWP36000INTRODUCTION OF NEEDLE/IN36000128
FWP29515SHORT LEG SPLINT29515142
FWP11011DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC11011146
FWP99051SCV PRV OV REG SCHED EVN99051146
FWP11000DBRDMT X10SV ECZMT/INFCT11000150
FWP51702INSERTION BLADDER CATH51702152
FWP69200RMVL FOREIGN BODY EAR69200161
FWP30901NASAL PACKING30901163
FWP30903CTRL NSL HEMRRG ANT CPLX30903163
FWP31500INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE31500163
FWP20552TRIGGER POINT INJ 1-2 MUS20552166
FWP20605ARTHROCENTESIS, MED JOINT20605166
FWP96366IV INFUS THER PROPH/DX EA96366176
FWP43753GASTRIC INTUBATION AND ASPIRATION THERAPUETIC NECESSATING PHYSICIANS SKILL43753185
FWP10060INCISION/DRAINAGE ABSCESS10060193
FWP56405INC/DRAIN VULVA/PERINEAL56405193
FWP11200RMVL SKIN TAGS11200194
FWP31525LARGSC +-TRACHEOSCOPY DX31525198
FWP56420I & D BARTHOLIN ABSCESS56420198
FWP69209REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL69209204
FWP24640RADIAL HEAD SUBLUX. CHILD24640210
FWP24670CLTX ULNR FX PROX END WO24670210
FWP64400INJ ANESTHETIC, TRIGEMINA64400210
FWP64450INJ ANESTHETIC AGENT64450210
FWP65220RMVL FB EYE W/O SLIT LAMP65220210
FWP65222RMVL FB EYE65222210
FWP11730AVULSION/1-NAIL PLATE11730217
FWP11740EVAC SUBUNGUAL HEMATOMA11740217
FWP11760REPAIR NAIL BED11760217
FWP69005DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED69005220
FWP11041DEBRIDE SKIN, FULL11041221
FWP31505LARYNGOSCOPY, INDRCT DX31505229
FWP99151MOD SED BY SAME PHYSICIAN99151230
FWP23650SHOULDER DISLOCATION TRMT23650233
FWP24530CLTX SPRCNDYLR/TRANSCNDYL24530233
FWP24650CLTX RDL HEAD FX WO MANP24650233
FWP29105LONG ARM SPLINT29105233
FWP29505LONG LEG SPLINT29505233
FWP10121I & RMVL FB, SUB-CUT,COMP10121240
FWP11765WEDGE EXC SKIN/NAIL BED11765242
FWP65205REMOVAL FB EYE-SUPERFCL65205244
FWP24500CLTX HUMRL SHFT FX W/O MN24500252
FWP25530CLSD TX ULNAR SHFT FX NO25530252
FWP28450TX TARSAL B1 FX XCP TALUS28450252
FWP24576CLTX HUMRL CNDLYR FX MEDI24576254
FWP27508CLTX FEM FX DSTAL END MED27508254
FWP27560CLTX PATELLAR DISLC W/O A27560254
FWP11401EXC BGN LSN TRUNK 0.6-1.011401257
FWP20610ARTHROCENTESIS, LG JOINT20610262
FWP16020BURN, DRESSING/DBRDMNT-SM16020270
FWP16000BURN, INITIAL TREATMENT16000274
FWP10080I & D CYST SIMPLE10080275
FWP30300RMVL FOREIGN BODY NASAL30300279
FWP10140I & D HEMATOMA/SEROMA10140282
FWP27220CLTX ACETABULUM HIP/SOCKT FX W/O MNP27220293
FWP40650RPR LIP FULL THICKNESS40650293
FWP42809RMVL FB PHARYNX42809293
FWP46083INCISION THROM HEMORRHOID46083293
FWP46255HRHC SMPL46255293
FWP99144MOD SEDATION SERV UNDER 599144293
FWP12014REPAIR LAC FACE 5.1-7.5CM12014320
FWP12032REPAIR-INT SCALP 2.6-7.512032320
FWP12034INTERM RPR SCLP/TRNK/EXTR12034320
FWP21310CLTX NSL B1 FX W/O MNPJ21310320
FWP21480CLDS TX TEMP DISLOCATION21480320
FWP21800CLTX RIB FX UNCOMP EA21800320
FWP27520CLTX PATELLAR FX W/O MNPJ27520320
FWP16030BURN, DRESSNG/DBRDMNT-LG16030330
FWP12002REPAIR LAC SCALP 2.6-7.512002332
FWP99152SEDATION336
FWP12011REPAIR LAC FACE < 2.5 CM12011341
FWP11421EXC BGN LSN,SCALP 0.6-1.011421344
FWP26700CLS TX MCP DISLOCATION26700381
FWP27808CLOSED TX BIMALLEOLAR ANK27808381
FWP10061INS/DRAIN ABSCESS COMPL10061385
FWP12031LYR CLSR S/A/T/E 2.5CM12031387
FWP23500CLTX CLAVICULAR FX WO MNP23500392
FWP25565CLOSED TX RADIAL&ULNAR SH25565392
FWP25600CLSD TX DISTAL RAD FX WO25600392
FWP25650CLTX UR SYLOID FX25650392
FWP11422EXC BGN LSN,SCALP 1.1-2.011422398
FWP12013REPAIR LAC FACE 2.6-5.0CM12013403
FWP12001LACERATION REPAIR12001425
FWP20600ARTHROCENTESIS, SML JOINT20600427
FWP64402INJ ANESTHETIC FACIAL NRV64402427
FWP23570CLSD TX SCAPULAR FX WO MA23570438
FWP10160PUNCTURE ASP OF ABSCESS10160439
FWP62270SPINAL PUNCTURE,LUMBAR62270450
FWP27550CLOSED TX KNEE DISLOCATION W/O ANESTHESIA27550455
FWP12004REPAIR LAC SCALP 7.6-12.512004466
FWP12041LAYER CLSR NECK/HAND 2.612041466
FWP12042REPAIR LAC HAND/FOOT 2.6-12042466
FWP41800DRNG ABSC DENTOALVEOLAR S41800466
FWP41250LACERATION REPAIR OF TONGUE41250472
FWP11403EXC BNGN LSN,TRUNK 2.1-3.11403474
FWP28490CLTX FX GRT TOE W/O MNLJ28490477
FWP12021TX SUPERFICIAL WOUND DEHISCENCE V12021483
FWP10081I&D PILONIDAL CST COMP10081491
FWP46050INC/DRAIN PERIANAL ABS SU46050505
FWP12045REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM12045506
FWP27530CLTX TIBL FX PROX W/O MNPJ27530507
FWP12036REPAIR INTERM S/A/T/E 20.1-30.0 CM12036508
FWP46320ENULEATION EXCC OF EXT HE46320513
FWP26750CLS TX FX FINGER/THUMB26750519
FWP11750EXC NAIL PART/COMP11750520
FWP24560CLTX HUMERAL EPICONYLAR24560520
FWP28510CLSD TX FX PLALANX/PHALAN28510523
FWP26720CLSD TX PHALANGEAL SHFTFX26720531
FWP27760CLTX MEDIAL MALLS FX W/O27760531
FWP11423EXC BGN LSN,SCALP 2.1-3.011423536
FWP12020TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE12020557
FWP12005REPAIR LAC,SCALP 12.6-20C12005559
FWP26770TREAT FINGER DISLOC FINGE26770560
FWP26725CLTX PHLNGL FX PROX/MIDDL26725567
FWP42700I&D ABSC PRITONSILLAR42700571
FWP12051LAYER CLSR OF WND NCK/HND12051583
FWP12052LYR CLSR WOUND 2.6-5.0FAC12052583
FWP91105GASTRIC INTUBATION/ASPER91105596
FWP11404EXC BGN LSN TRUNK 3.1-4.011404601
FWP25535CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION25535605
FWP12015REPAIR LAC FACE 7.6-12.512015615
FWP25560CLTX RDL&UR SHFT FXS W/O25560635
FWP23600CLTX PROX HUMRL FX WO MAN23600642
FWP12053LYR CLSR F/E/E/N/L/M&/MUC12053645
FWP24600CLSD TX ELBOW DISLOCAT24600650
FWP25500CLTX RDL SHFT FX WO MANP25500650
FWP25622CLSD TX NAVICULAR FX WO M25622650
FWP67700I&D ABSCESS EYELID67700663
FWP31515LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION31515670
FWP12044LYR CLSR N/H/F/ETRNL GENT12044674
FWP12006REPAIR LAC SCALP 20.1-30.12006679
FWP11043DEBRIDEMENT SUBQ TISS&MUS11043712
FWP28190RMVL FB BODY FOOT SUBQ28190712
FWP10180INCISION & DRAINAGE COMPLEX PO WO10180727
FWP13151CMPX RPR EYE NOSE 1.1-2.513151759
FWP12016REPAIR LAC,FACE 12.6-20CM12016790
FWP12007REPAIR LAC SCALP >30.0CM12007791
FWP26755CLTX DSTL PHLNGL FX FNGR/26755792
FWP26600CLSD TX METACARPAL FX26600838
FWP11406EXC BGN LSN ARM/LEG >4.011406853
FWP12035REPAIR INTERM S/A/T/E 12.12035860
FWP12054REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM12054865
FWP32551TUBE THORACOSTOMY INCLUDES WATER SEAL32551894
FWP27780CLTX PROX FIVULA/SHFT FX27780956
FWP12017REPAIR LAC FACE 20-30 CM12017986
FWP27786CLSD TX DISTAL FIBULAR FX27786993
FWP26605CLSD TX MEDICARPAL FX266051053
FWP12018REPAIR LAC FACE >30.0 CM120181179
FWP36556INS NON TUN CTR CVC 5YR>365561297
FWP13132RPR CMPX FOREHEAD/CHECK/C131321345
FWP28192RMVL FB FOOT DEEP281921373
FWP27810CLTX BIMAL ANKLE FX W/POT278101704
FWP13152RPR CPLX E/N/E/L 2.6-7.5131521830
FWP25605CLSD TX DISTAL RAD FX256051876
FWP46040I&D ISCHIOR/PRIRC ABSC SP460401957
FWP27752CLTX TIBL SFT FX W/MANP277521968
FWP25505CLSD TX RAD SHAFT W/MANIP255052213
FWP59409VAG DLVR ONLY594092704
FWP90723DTAP-HEPB-IPV VACCINE INTRAMUSCLAR90723141
FWPXRAYCDRADIOLOGICAL CDXRAYCD28
FWP71101RIB UNILATERAL W CHEST71101187
FWP72170RAD EXAM PELVIS 1/2 VEIW72170251
FWP73560XRAY KNEE, SUNRISE VIEW73560312
FWP73510XRAY HIP MIN 2 VIEWS73510325
FWP71020XRAY CHEST PA & LATERAL71020327
FWP70150XRAY FACIAL BONES >3 VIEW70150409
FWP73630XRAY FOOT MIN 3 VIEWS73630537
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