EMPIRE MEDICARE SERVICES
AREA 01 NEW JERSEY
2005 FEE SCHEDULE

 

# PROCEDURE
CODE		 MOD PAR
FEE		 NONPAR
FEE		 LIMITING
CHARGE
ANES 19.01 18.06 20.77
G0008 21.37 21.37 N/A
G0009 21.37 21.37 N/A
G0010 21.37 21.37 N/A
G0030 TC 941.83 894.74 1,028.95
G0030 26 88.89 84.45 97.12
G0030 1,026.78 975.44 1,121.76
G0031 TC 1,573.51 1,494.83 1,719.05
G0031 26 110.49 104.97 120.72
G0031 1,682.10 1,598.00 1,837.70
G0032 TC 941.83 894.74 1,028.95
G0032 26 87.06 82.71 95.12
G0032 1,027.11 975.75 1,122.11
G0033 TC 1,573.51 1,494.83 1,719.05
G0033 26 111.41 105.84 121.72
G0033 1,682.10 1,598.00 1,837.70
G0034 TC 941.83 894.74 1,028.95
G0034 26 88.06 83.66 96.21
G0034 1,027.11 975.75 1,122.11
G0035 TC 1,573.51 1,494.83 1,719.05
G0035 26 110.58 105.05 120.81
G0035 1,682.10 1,598.00 1,837.70
G0036 TC 941.83 894.74 1,028.95
G0036 26 87.60 83.22 95.70
G0036 1,026.78 975.44 1,121.76
G0037 TC 1,573.51 1,494.83 1,719.05
G0037 26 109.67 104.19 119.82
G0037 1,682.10 1,598.00 1,837.70
G0038 TC 941.83 894.74 1,028.95
G0038 26 86.51 82.18 94.51
G0038 1,026.78 975.44 1,121.76
G0039 TC 1,573.51 1,494.83 1,719.05
G0039 26 110.04 104.54 120.22
G0039 1,682.42 1,598.30 1,838.05
G0040 TC 941.83 894.74 1,028.95
G0040 26 89.34 84.87 97.60
G0040 1,026.78 975.44 1,121.76
G0041 TC 1,573.51 1,494.83 1,719.05
G0041 26 110.58 105.05 120.81
G0041 1,681.77 1,597.68 1,837.33
G0042 TC 941.83 894.74 1,028.95
G0042 26 89.89 85.40 98.21
G0042 1,026.78 975.44 1,121.76
G0043 TC 1,573.51 1,494.83 1,719.05
G0043 26 111.87 106.28 122.22
G0043 1,682.10 1,598.00 1,837.70
G0044 TC 941.83 894.74 1,028.95
G0044 26 88.97 84.52 97.20
G0044 1,026.78 975.44 1,121.76
G0045 TC 1,573.51 1,494.83 1,719.05
G0045 26 110.13 104.62 120.31
G0045 1,682.10 1,598.00 1,837.70
G0046 TC 941.83 894.74 1,028.95
G0046 26 88.97 84.52 97.20
G0046 1,026.78 975.44 1,121.76
G0047 TC 1,573.51 1,494.83 1,719.05
G0047 26 110.58 105.05 120.81
G0047 1,682.10 1,598.00 1,837.70
# G0101 26.56 25.23 29.01
G0101 42.57 40.44 46.51
# G0102 9.93 9.43 10.84
G0102 25.02 23.77 27.34
# G0104 64.31 61.09 70.25
G0104 145.28 138.02 158.72
# G0105 53 64.31 61.09 70.25
G0105 53 145.28 138.02 158.72
# G0105 226.26 214.95 247.19
G0105 439.87 417.88 480.56
G0106 TC 106.80 101.46 116.68
G0106 26 55.81 53.02 60.97
G0106 162.61 154.48 177.65
G0108 38.33 36.41 41.87
G0109 22.33 21.21 24.39
# G0110 50.83 48.29 55.53
G0110 68.67 65.24 75.03
# G0111 17.14 16.28 18.72
G0111 24.46 23.24 26.73
# G0112 100.54 95.51 109.84
G0112 126.16 119.85 137.83
# G0113 72.32 68.70 79.01
G0113 90.62 86.09 99.00
# G0114 66.88 63.54 73.07
G0114 71.91 68.31 78.56
# G0115 66.15 62.84 72.27
G0115 86.73 82.39 94.75
# G0116 61.44 58.37 67.13
G0116 89.80 85.31 98.11
# G0117 27.10 25.75 29.61
G0117 51.35 48.78 56.10
# G0118 9.93 9.43 10.84
G0118 31.43 29.86 34.34
G0120 TC 106.80 101.46 116.68
G0120 26 55.81 53.02 60.97
G0120 162.61 154.48 177.65
# G0121 53 64.31 61.09 70.25
G0121 53 145.28 138.02 158.72
# G0121 226.26 214.95 247.19
G0121 439.87 417.88 480.56
G0124 24.44 23.22 26.70
G0125 TC 2,576.42 2,447.60 2,814.74


# These amounts apply when service is performed in a facility setting.

Limiting charge applies to unassigned claims by non-participating providers.

All Current Procedural Terminology (CPT) codes and descriptors are copyrighted
by the American Medical Association.