hcpcs/cpt code practitioner services mue values · practitioner services mue hcpcs/cpt code...

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Practitioner Services MUE HCPCS/CPT Code Practitioner Services MUE Values 0001M 1 0002M 1 0003M 1 0019T 1 0042T 1 0051T 1 0052T 1 0053T 1 0054T 2 0055T 2 0058T 1 0059T 1 0071T 1 0072T 1 0073T 2 0075T 1 0076T 2 0092T 1 0095T 1 0098T 1 0099T 2 0100T 2 0101T 1 0102T 2 0103T 1 0106T 4 0107T 4 0108T 4 0109T 4 0110T 4 0111T 1 0123T 2 0126T 1 0159T 2 0163T 2 0164T 4 0165T 4 0169T 1 0171T 1 Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2013 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Page 1 of 206

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Practitioner Services MUE

HCPCS/CPT Code Practitioner Services MUE Values0001M 10002M 10003M 10019T 10042T 10051T 10052T 10053T 10054T 20055T 20058T 10059T 10071T 10072T 10073T 20075T 10076T 20092T 10095T 10098T 10099T 20100T 20101T 10102T 20103T 10106T 40107T 40108T 40109T 40110T 40111T 10123T 20126T 10159T 20163T 20164T 40165T 40169T 10171T 1

Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2013 American Medical Association. All rights reserved.

CPT® is a registered trademark of the American Medical Association.

Applicable FARS\DFARS Restrictions Apply to Government Use.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not

directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein.

Page 1 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

0172T 30174T 10175T 10178T 10179T 10180T 10181T 10182T 30184T 10190T 20191T 20195T 10196T 10197T 20198T 201996 10199T 10200T 10201T 10202T 10206T 10207T 20208T 10209T 10210T 10211T 10212T 10213T 10214T 10215T 10216T 10217T 10218T 10219T 10220T 10221T 10222T 10223T 10224T 10225T 10226T 10227T 10228T 10230T 10232T 10233T 10234T 20235T 20236T 1

Page 2 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

0237T 20239T 10240T 10241T 10243T 10244T 10245T 10246T 10247T 10248T 10249T 10253T 10254T 20255T 20262T 10263T 10264T 10265T 10266T 10267T 10268T 10269T 10270T 10271T 10272T 10273T 10274T 10275T 10278T 10281T 10282T 10283T 10284T 10285T 10286T 10287T 20288T 10289T 20290T 10291T 10292T 10293T 10294T 10295T 10296T 10297T 10298T 10299T 10300T 1

Page 3 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

0301T 10302T 10303T 10304T 10305T 10306T 10307T 10308T 10309T 10310T 10311T 10312T 10313T 10314T 10315T 10316T 10317T 10319T 10320T 10321T 10322T 10323T 10324T 10325T 10326T 10327T 10328T 10329T 10330T 10331T 10332T 10333T 10334T 20335T 20336T 10337T 10338T 10339T 110040 110060 110061 110080 110081 110180 311000 111004 111005 111006 111008 1

Page 4 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

11010 111011 111012 211042 111043 111044 111055 111056 111057 111100 111200 111201 011446 311450 111451 111462 111463 111470 311471 211646 311719 111720 111721 111730 111732 911770 111771 111772 111900 111901 111920 111921 111922 111950 111951 111952 111954 111960 311970 211971 211976 111980 111981 111982 111983 112001 112002 112004 112005 1

Page 5 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

12006 112007 112011 112013 112014 112015 112016 112017 112018 112020 312021 312031 112032 112034 112035 112036 112037 112041 112042 112044 112045 112046 112047 112051 112052 112053 112054 112055 112056 112057 113100 113101 113120 113121 113131 113132 113151 113152 113160 314301 215002 115004 115040 115050 115100 115110 115115 115116 215120 1

Page 6 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

15130 115135 115150 115151 115152 215155 115156 115200 115220 115240 115260 115271 115272 315273 115275 115276 315277 115570 315572 215574 215576 215600 215610 215620 215630 215650 115731 115740 315750 215756 215757 315758 315760 215770 215775 115776 115777 115780 115781 215782 215783 215786 115787 315788 115789 115792 115793 115819 115820 1

Page 7 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

15821 115822 115823 115824 115825 115826 115828 115829 115830 115832 115833 115834 115835 115836 115837 215838 115839 215840 115841 215842 215845 215847 115851 115852 215860 115876 115877 115878 115879 115920 115922 115931 115933 115934 115935 115936 115937 115940 215941 215944 215945 215946 215950 215951 215952 215953 215956 215958 216000 1

Page 8 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

16020 116025 116030 116035 117000 117003 1317004 117106 117107 117108 117110 117111 117264 317266 217276 317286 317340 117360 117380 119000 219001 519020 219030 119081 119083 119085 119101 319110 119112 219120 119125 119126 319260 219271 219272 219281 119283 119285 119287 119296 119297 219298 119300 119301 119302 119303 119304 119305 119306 1

Page 9 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

19307 119316 119318 119324 119325 119328 119330 119340 119342 119350 119355 119357 119361 119364 119366 119367 119368 119369 119370 119371 119380 119396 120100 220102 420103 420150 220200 320205 420206 320250 320251 320526 120527 120552 120553 120555 120612 220615 120660 120661 120662 120663 120664 120665 120670 220680 220692 320693 220696 2

Page 10 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

20697 420802 120805 120808 120816 320822 320824 120827 120838 120900 220910 220912 120920 220922 220924 420926 220931 120937 120938 120950 220955 120956 120957 120962 120969 220970 120972 220973 120974 120975 120979 120982 120985 221010 121012 321014 321015 121016 221025 221026 221029 121030 121031 221032 121034 121040 221044 121045 121046 2

Page 11 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

21047 221048 221049 221050 121060 121070 121073 121076 121077 121079 121080 121081 121082 121083 121084 121085 121086 121087 121088 121100 121110 221116 121120 121121 121122 121123 121125 221127 221137 121138 121139 121141 121142 121143 121145 121146 121147 121150 121151 121154 121155 121159 121160 121172 121175 121179 121180 121181 121182 1

Page 12 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

21183 121184 121188 121193 121194 121195 121196 121198 121199 121206 121208 121209 121210 221215 221230 221235 221240 121242 121243 121244 121245 221246 221247 121255 121256 121260 121261 121263 121267 121268 121270 121275 121280 121282 121295 121296 121310 121315 121320 121325 121330 121335 121336 121337 121338 121339 121340 121343 121344 1

Page 13 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

21345 121346 121347 121348 121355 121356 121360 121365 121366 121385 121386 121387 121390 121395 121400 121401 121406 121407 121408 121421 121422 121423 121431 121432 121433 121435 121436 121440 221445 221450 121451 121452 121453 121454 121461 121462 121465 121470 121480 121485 121490 121495 121497 121501 321502 121510 121550 321554 321556 3

Page 14 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

21557 121558 121610 221615 121616 121620 121627 121630 121632 121685 121700 121705 121720 121725 121740 121742 121743 121750 121805 321810 121820 121825 121920 321925 321931 321933 321935 121936 122010 222015 222100 122101 122102 122103 322110 122112 122114 122116 322206 122207 122210 122212 122214 122216 622220 122222 122224 122305 122310 1

Page 15 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

22315 122318 122319 122325 122326 122327 122328 822505 122520 122521 122522 522523 122524 122525 522532 122533 122534 322548 122551 122554 122556 122558 122585 722586 122590 122595 122600 122610 122612 122614 1522630 122632 422633 122634 422800 122802 122804 122808 122810 122812 122818 122819 122830 122840 122842 122843 122844 122845 122846 1

Page 16 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

22847 122848 122849 122850 122851 922852 122855 122856 122857 122861 122862 122864 122865 122900 322901 322903 322904 122905 123000 123020 123030 223031 223035 223040 123044 123065 223066 223071 323073 323075 423076 223077 123078 123100 123101 223105 123106 123107 123120 123125 123130 123140 123145 123146 123150 123155 123156 123170 123172 1

Page 17 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

23174 123180 123182 123184 123190 123195 123200 123210 123220 123330 223334 123335 123350 123395 123397 123400 123405 223406 123410 123412 123415 123420 123430 123440 123450 123455 123460 123462 123465 123466 123470 123472 123473 123474 123480 123485 123490 123491 123500 123505 123515 123520 123525 123530 123532 123540 123545 123550 123552 1

Page 18 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

23570 123575 123585 123600 123605 123615 123616 123620 123625 123630 123650 123655 123660 123665 123670 123675 123680 123700 123800 123802 123900 123920 123921 123930 223931 223935 224000 124006 124065 224066 224071 324073 324077 124079 124100 124101 124102 124105 124110 124115 124116 124120 124125 124126 124130 124134 124136 124138 124140 1

Page 19 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

24145 124147 124149 124150 124152 124155 124160 124164 124200 324201 324220 124300 124301 224305 424320 224330 124331 124332 124340 124342 224343 124344 124345 124346 124357 224358 224359 224360 124361 124362 124363 124365 124366 124370 124371 124400 124410 124420 124430 124435 124470 124495 124498 124500 124505 124515 124516 124530 124535 1

Page 20 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

24538 124545 124546 124560 124565 124566 124575 124576 124577 124579 124582 124586 124587 124600 124605 124615 124620 124635 124640 124650 124655 124665 124666 124670 124675 124685 124800 124802 124900 124920 124925 124930 124931 124935 124940 125000 225001 125020 125023 125024 125025 125031 225035 225040 125065 525066 325071 325073 325076 5

Page 21 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

25077 125078 125085 125100 125101 125105 125107 125110 325111 125112 125115 125116 125119 125120 125125 125126 125130 125135 125136 125145 125150 125151 125170 125210 225215 125230 125240 125246 125248 325250 125251 125259 125275 225295 925300 125301 125315 125316 125320 125332 125335 125337 125350 125355 125360 125365 125370 125375 125390 1

Page 22 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

25391 125392 125393 125394 125400 125405 125415 125420 125425 125426 125430 125431 225440 125441 125442 125443 125444 125445 125446 125449 125450 125455 125490 125491 125492 125500 125505 125515 125520 125525 125526 125530 125535 125545 125560 125565 125574 125575 125600 125605 125606 125607 125608 125609 125622 125624 125628 125630 125635 1

Page 23 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

25645 125650 125651 125652 125660 125670 125671 125675 125676 125680 125685 125690 125695 125800 125805 125810 125820 125825 125830 125900 125905 125907 125909 125915 125920 125922 125924 125927 125929 125931 126010 326011 326025 126030 126034 226035 326037 126040 126045 126070 326100 226105 226110 326116 226117 226118 126121 126123 126185 1

Page 24 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

26200 226205 126210 226215 226230 226235 226236 226250 226260 126262 126341 326357 326358 326390 326392 326416 226428 226432 226433 226434 326494 126496 126497 226498 126508 126516 126517 126518 126548 326550 126551 126553 126554 126555 226556 226560 226561 226562 226580 126641 126645 126650 126665 126740 326742 326746 326820 126841 126842 1

Page 25 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

26860 126862 126990 226991 226992 227000 127001 127003 127005 127006 127025 127027 127030 127033 127035 127036 127040 227041 327043 327045 327048 227049 127050 127052 127054 127057 127059 127060 127062 127065 127066 127067 127070 127071 127075 127076 127077 127078 127080 127086 227087 227090 127091 127093 127095 127096 127097 127098 127100 1

Page 26 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27105 127110 127111 127120 127122 127125 127130 127132 127134 127137 127138 127140 127146 127147 127151 127156 127158 127161 127165 127170 127175 127176 127177 127178 127179 127181 127185 127187 127193 127194 127200 127202 127220 127222 127226 127227 127228 127230 127232 127235 127236 127238 127240 127244 127245 127246 127248 127250 127252 1

Page 27 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27253 127254 127256 127257 127258 127259 127265 127266 127267 127268 127269 127275 227280 127282 127284 127286 127290 127295 127303 227305 127306 127307 127310 127325 127326 127329 127330 127331 127332 127333 127334 127335 127340 127345 127347 127350 127355 127356 127357 127358 127360 227364 127365 127370 127380 227381 227385 227386 227390 1

Page 28 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27391 127392 127393 127394 127395 127396 127397 127400 127403 127405 227407 227409 127412 127415 127416 127418 127420 127422 127424 127425 127427 127428 127429 127430 127435 127437 127438 127440 127441 127442 127443 127445 127446 127447 127448 127450 127454 127455 127457 127465 127466 127468 127470 127472 127475 127477 127479 127485 127486 1

Page 29 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27487 127488 127495 127496 127497 127498 127499 127500 127501 127502 127503 127506 127507 127508 127509 127510 127511 127513 127514 127516 127517 127519 127520 127524 127530 127532 127535 127536 127538 127540 127550 127552 127556 127557 127558 127560 127562 127566 127570 127580 127590 127591 127592 127594 127596 127598 127600 127601 127602 1

Page 30 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27604 227605 127606 127607 227610 127612 127615 127616 127620 127625 127626 127630 227635 127637 127638 127640 127641 127645 127646 127647 127648 127650 127652 127654 127656 227658 227659 227664 227665 227675 127676 127680 327681 127685 227686 227687 127690 227691 227695 127696 127698 227700 127702 127703 127704 127705 127707 127709 127712 1

Page 31 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27715 127720 127722 127724 127725 127726 127727 127730 127732 127734 127740 127742 127745 127750 127752 127756 127758 127759 127760 127762 127766 127767 127768 127769 127780 127781 127784 127786 127788 127792 127808 127810 127814 127816 127818 127822 127823 127824 127825 127826 127827 127828 127829 127830 127831 127832 127840 127842 127846 1

Page 32 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

27848 127860 127870 127871 127880 127881 127882 127884 127886 127888 127889 127892 127893 127894 128001 228002 328003 228005 328008 228035 128039 328041 328046 128047 128052 228054 228055 128060 128062 128086 228088 228090 228092 228100 128102 128103 128104 228106 128107 128108 228110 128111 128113 128114 128116 128118 128119 128120 228122 4

Page 33 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

28124 428130 128171 128173 228175 228192 228193 228202 228210 228220 128222 128225 128226 128230 128238 128240 128250 128260 128261 128262 128264 128280 128285 428286 128289 128290 128292 128293 128294 128296 128297 128298 128299 128300 128302 128304 128305 128306 128307 128309 128310 128315 128320 128322 228340 228341 228344 128360 128400 1

Page 34 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

28405 128406 128415 128420 128430 128435 128436 128445 128446 128490 128495 128496 128505 128530 128531 128540 128545 128546 128555 128570 128575 128576 128585 128600 228605 228630 228635 228705 128715 128725 128730 128735 128737 128750 128755 128760 128800 128805 128825 1028890 129000 129010 129015 129020 129025 129035 129040 129044 129046 1

Page 35 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

29049 129055 129058 129065 129075 129085 129086 229105 129125 129126 129130 329131 229200 129240 129260 129280 229305 129325 129345 129355 129358 129365 129405 129425 129435 129440 129445 129450 129505 129515 129520 129530 129540 129550 129580 129581 129582 129583 129584 129700 229705 129710 129715 129720 129730 229740 129750 129800 129804 1

Page 36 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

29805 129806 129807 129819 129820 129821 129822 129823 129824 129825 129826 129827 129828 129830 129834 129835 129836 129837 129838 129840 129843 129844 129845 129846 129847 129848 129850 129851 129855 129856 129860 129861 129862 129863 129866 129867 129868 129870 129871 129873 129874 129875 129876 129877 129879 129880 129881 129882 129883 1

Page 37 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

29884 129885 129886 129887 129888 129889 129891 129892 129893 129894 129895 129897 129898 129899 129900 229901 229902 229904 129905 129906 129907 129914 129915 129916 130000 130020 130100 330110 130115 130117 230118 230120 130124 230125 130130 130140 130150 130160 130200 130210 130220 130300 130310 130320 130400 130410 130420 130430 130435 1

Page 38 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

30450 130460 130462 130465 130520 130540 130545 130560 130580 230600 130620 130630 130801 130802 130901 130903 130905 130906 130915 130920 130930 131000 131002 131020 131030 131032 131040 131050 131051 131070 131075 131080 131081 131084 131085 131086 131087 131090 131200 131201 131205 131225 131230 131231 131233 131235 131237 131238 131239 1

Page 39 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

31240 131254 131255 131256 131267 131276 131287 131288 131290 131291 131292 131293 131294 131295 131296 131297 131300 131320 131360 131365 131367 131368 131370 131375 131380 131382 131390 131395 131400 131420 131500 231502 131505 131510 131511 131512 131513 131515 131520 131525 131526 131527 131528 131529 131530 131531 131535 131536 131540 1

Page 40 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

31541 131545 131546 131560 131561 131570 131571 131575 131576 131577 131578 131579 131580 131582 131584 131587 131588 131590 131595 131600 131601 131603 131605 131610 131611 131612 131613 131614 131615 131620 131622 131623 131624 131625 131626 131627 131628 131629 131630 131631 131632 231633 231634 131635 131636 131637 231638 231640 131641 1

Page 41 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

31643 131645 131646 231647 131648 131660 131661 131717 131720 131725 131730 131750 131755 131760 131766 131770 231775 131780 131781 131785 131786 131800 131805 131820 131825 131830 132035 132036 132096 132097 132098 132100 132110 132120 132124 132140 132141 132150 132151 132160 132200 232215 132220 132225 132310 132320 132400 232405 232440 1

Page 42 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

32442 132445 132480 132482 132484 232486 132488 132491 132501 132503 132504 132505 132506 332507 232540 132550 232552 232553 132554 332555 332556 332557 332560 132561 132562 132601 132604 132606 132607 132608 132609 132650 132651 132652 132653 132654 132655 132656 132658 132659 132661 132662 132663 132664 132665 132666 132667 332668 232669 2

Page 43 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

32670 132671 132672 132673 132674 132701 132800 132810 132815 132820 132850 132851 132852 132853 132854 132855 132856 132900 132905 132906 132940 132960 132997 132998 133010 133011 133015 133020 133025 133030 133031 133050 133120 133130 133140 133141 133202 133203 133206 133207 133208 133210 133211 133212 133213 133214 133215 233216 133217 1

Page 44 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

33218 133220 133221 133222 133223 133224 133225 133226 133227 133228 133229 133230 133231 133233 133234 133235 133236 133237 133238 133240 133241 133243 133244 133249 133250 133251 133254 133255 133256 133257 133258 133259 133261 133262 133263 133264 133265 133266 133282 133284 133300 133305 133310 133315 133320 133321 133322 133330 133332 1

Page 45 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

33335 133361 133362 133363 133364 133365 133366 133367 133368 133369 133400 133401 133403 133404 133405 133406 133410 133411 133412 133413 133414 133415 133416 133417 133420 133422 133425 133426 133427 133430 133460 133463 133464 133465 133468 133470 133471 133472 133474 133475 133476 133478 133496 133500 133501 133502 133503 133504 133505 1

Page 46 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

33506 133507 133508 133510 133511 133512 133513 133514 133516 133517 133518 133519 133521 133522 133523 133530 133533 133534 133535 133536 133542 133545 133548 133572 333600 133602 133606 133608 133610 133611 133612 133615 133617 133619 133620 133621 133622 133641 133645 133647 133660 133665 133670 133675 133676 133677 133681 133684 133688 1

Page 47 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

33690 133692 133694 133697 133702 133710 133720 133722 133724 133726 133730 133732 133735 133736 133737 133750 133755 133762 133764 133766 133767 133768 133770 133771 133774 133775 133776 133777 133778 133779 133780 133781 133782 133783 133786 133788 133800 133802 133803 133813 133814 133820 133822 133824 133840 133845 133851 133852 133853 1

Page 48 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

33860 133863 133864 133870 133875 133877 133880 133881 133883 133884 333886 133889 133891 133910 133915 133916 133917 133920 133922 133924 133925 133926 133930 133933 133935 133940 133944 133945 133960 133961 133967 133968 133970 133971 133973 133974 133975 133976 133977 133978 133979 133980 133981 133982 133983 133990 133991 133992 133993 1

Page 49 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

34001 134051 134101 134111 234151 234201 134203 134401 134421 134451 134471 134490 134501 134502 134510 234520 134530 134800 134802 134803 134804 134805 134806 134808 134812 134813 134820 134825 234826 434830 134831 134832 134833 134834 134841 134842 134843 134844 134845 134846 134847 134848 134900 135001 135002 135005 135011 135013 135021 1

Page 50 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

35022 135045 235081 135082 135091 135092 135102 135103 135111 135112 135121 235122 135131 135132 135141 135142 135151 135152 135180 235182 235184 235188 235189 135190 235201 235206 235207 335211 335216 335221 335226 335231 235236 235241 235246 235251 235256 235261 135266 235271 235276 235281 235286 235301 235302 135303 135304 135305 135306 2

Page 51 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

35311 135321 135331 135341 335351 135355 135361 135363 135371 135372 135390 135400 135450 235452 135458 335471 335472 135500 235501 135506 135508 135509 135510 135511 135512 135515 135516 135518 135521 135522 135523 135525 135526 135531 235533 135535 135536 135537 135538 135539 135540 135556 135558 135560 135563 135565 135566 135570 135571 2

Page 52 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

35572 235583 135585 235587 235600 235601 135606 135612 135616 135621 135623 135626 335631 435632 135633 135634 135636 135637 135638 135642 135645 135646 135647 135650 135654 135656 135661 135663 135665 135666 235671 235681 135682 135683 135685 235686 135691 135693 135694 135695 135697 235700 235701 135721 135741 135761 235800 235820 235840 2

Page 53 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

35860 235870 135875 235876 235879 235881 235883 135884 135901 135903 235905 135907 136002 236005 236010 236013 236014 236100 236120 236160 236200 236221 136222 136223 136224 136225 136226 136227 136251 136252 136253 136254 136260 136261 136262 136400 136405 136406 136410 336420 236425 136430 136440 136450 136455 136468 136469 136470 136471 1

Page 54 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

36475 136478 136479 236481 136510 136511 136512 136513 136514 136515 136516 136522 136555 236556 236557 236558 236560 236561 236563 236565 236566 236568 236569 236570 236571 236575 236576 236578 236580 236581 236582 236583 236584 236585 236589 236590 236591 236592 136593 236595 236596 236597 236598 236620 336625 236640 136660 136680 136800 1

Page 55 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

36810 136815 136818 136819 136820 136821 236822 136823 136825 136830 236831 136832 236833 136835 136838 136860 236861 236870 237140 137145 137160 137180 137181 137182 137183 137184 137185 237186 237187 137188 137191 137192 137193 137195 137197 237200 237211 137212 137213 137214 137215 137217 137220 237221 237222 237223 237224 237225 237226 2

Page 56 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

37227 237228 237229 237230 237231 237232 237233 237234 237235 237236 137238 137250 137500 137565 137600 137605 137606 137607 137609 137615 237616 137617 337618 237619 137650 137660 137700 137718 137722 137735 137760 137761 137765 137766 137780 137785 137788 137790 138100 138101 138102 138115 138120 138200 138205 138206 138220 138221 138230 1

Page 57 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

38232 138240 138241 138242 138243 138300 238305 238308 138380 138381 138382 138500 238505 338510 138520 138525 138530 138542 138550 138555 138562 138564 138570 138571 138572 138700 138720 138724 138740 138745 138746 138747 138760 138765 138770 138780 138790 138792 138794 138900 139000 139010 139200 139220 139400 139501 139503 139540 139541 1

Page 58 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

39545 139560 139561 140490 340500 240510 240520 240525 240527 240530 240650 240652 240654 240700 140701 140702 140720 140761 140800 240801 240804 240805 240806 240808 440810 440812 440814 440816 240818 240819 240820 540830 240831 240840 140842 140843 140844 140845 141000 241005 241006 241007 241008 241009 241010 141015 241016 241017 241018 2

Page 59 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

41019 141100 341105 341108 241110 241112 241113 241114 241115 141116 241120 141130 141135 141140 141145 141150 141153 141155 141250 241251 241252 241500 141510 141512 141520 141530 141800 241805 341806 341820 441821 241822 141823 141825 241826 241827 241828 441830 241850 241870 241872 441874 442000 142100 342104 342106 242107 242120 142140 1

Page 60 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

42145 142160 242180 142182 142200 142205 142210 142215 142220 142225 142226 142227 142235 142260 142280 142281 142300 242305 242310 242320 242330 242335 242340 142400 242405 242408 142409 142410 142415 142420 142425 142426 142440 142450 242500 242505 242507 142508 142509 142510 142550 242600 242650 242660 242665 242700 242720 142725 142800 3

Page 61 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

42804 342806 142808 242809 142810 142815 142820 142821 142825 142826 142830 142831 142835 142836 142842 142844 142845 142860 142870 142890 142892 142894 142900 142950 142953 142955 142960 142961 142962 142970 142971 142972 143020 143030 143045 143100 143101 143107 143108 143112 143113 143116 143117 143118 143121 143122 143123 143124 143130 1

Page 62 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

43135 143191 143192 143193 143194 143195 143196 143197 143198 143200 143201 143202 143204 143205 143206 143211 143212 143213 143214 143215 143216 143217 143220 143226 143227 143229 143231 143232 143233 143235 143236 143237 143238 143239 143240 143241 143242 143243 143244 143245 143246 143247 143248 143249 143250 143251 143252 143253 143254 1

Page 63 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

43255 243257 143259 143260 143261 143262 243263 143264 143265 143266 143270 143273 143275 143277 343278 143279 143280 143281 143282 143283 143300 143305 143310 143312 143313 143314 143320 143325 143327 143328 143330 143331 143332 143333 143334 143335 143336 143337 143338 143340 143341 143350 143351 143352 143360 143361 143400 143401 143405 1

Page 64 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

43410 143415 143420 143425 143450 143453 143460 143496 143500 143501 143502 143510 143520 143605 143610 243611 243620 143621 143622 143631 143632 143633 143634 143635 143640 143641 143644 143645 143647 143648 143651 143652 143653 143752 243753 143754 143755 143756 143757 143760 243761 243770 143771 143772 143773 143774 143775 143800 143810 1

Page 65 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

43820 143825 143830 143831 143832 143840 243843 143845 143846 143847 143848 143850 143855 143860 143865 143870 143880 143881 143882 143886 143887 143888 144005 144010 144015 144020 244021 144025 144050 144055 144100 144110 144111 144120 144121 444125 144126 144127 144128 244130 344132 144133 144135 144136 144137 144139 144140 244141 144143 1

Page 66 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

44144 144145 144146 144147 144150 144151 144155 144156 144157 144158 144160 144180 144186 144187 144188 144202 144203 244204 244205 144206 144207 144208 144210 144211 144212 144213 144227 144300 144310 244312 144314 144316 144320 144322 144340 144345 144346 144360 144361 144363 144364 144365 144366 144369 144370 144372 144373 144376 144377 1

Page 67 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

44378 144379 144380 144382 144383 144385 144386 144388 144389 144390 144391 144392 144393 144394 144397 144500 144602 144603 144604 144605 144615 444620 244625 144626 144640 244650 244660 144661 144680 144700 144701 144705 144715 144720 244721 244800 144820 144850 144900 144950 144955 144960 144970 145000 145005 145020 145100 245108 145110 1

Page 68 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

45111 145112 145113 145114 145116 145119 145120 145121 145123 145126 145130 145135 145136 145150 145160 145171 245172 245190 145300 145303 145305 145307 145308 145309 145315 145317 145320 145321 145327 145330 145331 145332 145333 145334 145335 145337 145338 145339 145340 145341 145342 145345 145355 145378 145379 145380 145381 145382 145383 1

Page 69 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

45384 145385 145386 145387 145391 145392 145395 145397 145400 145402 145500 145505 145520 145540 145541 145550 145560 145562 145563 145800 145805 145820 145825 145900 145905 145910 145915 145990 146020 246030 146040 246045 246050 246060 246070 146080 146083 246200 146220 146221 146230 146250 146255 146257 146258 146260 146261 146262 146270 1

Page 70 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

46275 146280 146285 146288 146320 246500 146505 146600 146604 146606 146608 146610 146611 146612 146614 146615 146700 146705 146706 146707 146710 146712 146715 146716 146730 146735 146740 146742 146744 146746 146748 146750 146751 146753 146754 146760 146761 146762 146900 146910 146916 146917 146922 146924 146930 146940 146942 146945 146946 1

Page 71 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

46947 147000 347001 347010 347015 147100 347120 247122 147125 147130 147133 147135 147136 147140 147141 147142 147143 147144 147145 147146 347147 247300 247350 147360 147361 147362 147370 147371 147380 147381 147382 147400 147420 147425 147460 147480 147490 147500 247505 247510 247511 247525 347530 247550 147552 147553 147554 147555 147556 1

Page 72 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

47560 147561 147562 147563 147564 147570 147600 147605 147610 147612 147620 147630 147700 147701 147711 147712 147715 147720 147721 147740 147741 147760 147765 147780 147785 147800 147801 147802 147900 148000 148001 148020 148100 148102 148105 148120 148140 148145 148146 148148 148150 148152 148153 148154 148155 148400 148500 148510 148520 1

Page 73 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

48540 148545 148547 148548 148550 148551 148552 248554 148556 149000 149002 149010 149020 249040 249060 249062 149082 149083 249084 149180 249203 149204 149205 149215 149220 149250 149255 149320 149321 149322 149323 149324 149325 149326 149327 149400 149402 149411 149412 149418 149419 149421 149422 149423 249424 349425 149426 149427 149428 1

Page 74 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

49429 149435 149436 149440 149441 149442 149446 149450 149451 149452 149460 149465 149491 149492 149495 149496 149500 149501 149505 149507 149520 149521 149525 149540 149550 149553 149555 149557 149560 249561 249565 249566 249568 249570 149572 149580 149582 149585 149587 149590 149600 149605 149606 149610 149611 149650 149651 149652 249653 2

Page 75 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

49654 249655 249656 249657 249900 149904 149905 149906 150010 150020 150040 150045 150060 150065 150070 150075 150080 150081 150100 150120 150125 150130 150135 150200 150205 150220 150225 150230 150234 150236 150240 150250 150280 150290 150300 150320 150323 150325 150327 150328 150329 150340 150360 150365 150370 150380 150382 150384 150385 1

Page 76 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

50386 150387 150389 150390 250391 150392 150393 150394 150395 150396 150398 150400 150405 150500 150520 150525 150526 150540 150541 150542 150543 150544 150545 150546 150547 150548 150551 150553 150555 150557 150561 150562 150570 150572 150574 150575 150576 150580 150590 150592 150593 150600 150605 150610 150620 150630 150650 150660 150684 1

Page 77 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

50686 250688 250690 250700 150715 150722 150725 150727 150728 150740 150750 150760 150770 150780 150782 150783 150785 150800 150810 150815 150820 150825 150830 150840 150845 150860 150900 150920 250930 250940 150945 150947 150948 150951 150953 150955 150957 150961 150970 150972 150974 150976 150980 151020 151030 151040 151045 251050 151060 1

Page 78 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

51065 151080 151100 151101 151102 151500 151520 151525 151530 151535 151550 151555 151565 151570 151575 151580 151585 151590 151595 151596 151597 151600 151605 151610 151700 151701 251702 251703 251705 151710 151715 151720 151725 151726 151727 151728 151729 151736 151741 151784 151785 151792 151797 151798 151800 151820 151840 151841 151845 1

Page 79 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

51860 151865 151880 151900 151920 151925 151940 151960 151980 151990 151992 152000 152001 152005 252007 152010 152204 152214 152224 152234 152235 152240 152250 152260 152265 152270 152275 152276 152277 152281 152282 152283 152285 152287 152290 152300 152301 152305 152310 152315 252317 152318 152320 152325 152327 152330 152332 152334 152341 1

Page 80 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

52342 152343 152344 152345 152346 152351 152352 152353 152354 152355 152356 152400 152402 152450 152500 152601 152630 152640 152647 152648 152649 152700 153000 153010 153020 153025 153040 153060 153080 153085 153200 153210 153215 153220 153230 153235 153240 153250 153260 153265 153270 153275 153400 153405 153410 153415 153420 153425 153430 1

Page 81 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

53431 153440 153442 153444 153445 153446 153447 153448 153449 153450 153460 153500 153502 153505 153510 153515 153520 153600 153601 153605 153620 153621 153660 153661 153665 153850 153852 153855 153860 154000 154001 154015 154050 154055 154056 154057 154060 154065 154100 254105 254110 154111 154112 154115 154120 154125 154130 154135 154150 1

Page 82 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

54160 154161 154162 154163 154164 154200 154205 154220 154230 154231 154235 154240 154250 154300 154304 154308 154312 154316 154318 154322 154324 154326 154328 154332 154336 154340 154344 154348 154352 154360 154380 154385 154390 154400 154401 154405 154406 154408 154410 154411 154415 154416 154417 154420 154430 154435 154440 154450 154500 1

Page 83 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

54505 154512 154520 154522 154530 154535 154550 154560 154600 154620 154640 154650 154660 154670 154680 154690 154692 154700 154800 154830 154840 154860 154861 154865 154900 154901 155000 155040 155041 155060 155100 255110 155120 155150 155175 155180 155200 155250 155300 155400 155450 155500 155520 155530 155535 155540 155550 155600 155605 1

Page 84 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

55650 155680 155700 155705 155706 155720 155725 155801 155810 155812 155815 155821 155831 155840 155842 155845 155860 155862 155865 155866 155870 155873 155875 155876 155920 156405 256420 156440 156441 156442 156501 156515 156605 156606 656620 156625 156630 156631 156632 156633 156634 156637 156640 156700 156740 156800 156805 156810 156820 1

Page 85 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

56821 157000 157010 157020 157022 157023 157061 157065 157100 357105 257106 157107 157109 157110 157111 157112 157120 157130 157135 257150 157155 157156 157160 157170 157180 157200 157210 157220 157230 157240 157250 157260 157265 157267 257268 157270 157280 157282 157283 157284 157285 157287 157288 157289 157291 157292 157295 157296 157300 1

Page 86 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

57305 157307 157308 157310 157311 157320 157330 157335 157400 157410 157415 157420 157421 157423 157425 157426 157452 157454 157455 157456 157460 157461 157500 157505 157510 157511 157513 157520 157522 157530 157531 157540 157545 157550 157555 157556 157558 157700 157720 157800 158100 158110 158120 158140 158145 158146 158150 158152 158180 1

Page 87 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

58200 158210 158240 158260 158262 158263 158267 158270 158275 158280 158285 158290 158291 158292 158293 158294 158301 158321 158322 158323 158340 158345 158346 158350 158353 158356 158400 158410 158520 158540 158541 158542 158543 158544 158545 158546 158548 158550 158552 158553 158554 158555 158558 158559 158560 158561 158562 158563 158565 1

Page 88 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

58570 158571 158572 158573 158600 158605 158611 158615 158660 158661 158662 158670 158671 158672 158673 158700 158720 158740 158750 158752 158760 158770 158800 158805 158820 158822 158825 158900 158920 158925 158940 158943 158950 158951 158952 158953 158954 158956 158957 158958 158960 158970 158974 158976 259000 159001 159012 159015 159020 2

Page 89 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

59025 359030 459050 159051 159070 259072 259074 159076 159100 159120 159121 159130 159135 159136 159140 159150 159151 159160 159200 159300 159320 159325 159350 159400 159409 259410 159412 159414 159425 159426 159430 159510 159514 159515 159525 159610 159612 259614 159618 159620 159622 159812 159820 159821 159830 159840 159841 159850 159851 1

Page 90 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

59852 159855 159856 159857 159866 159870 159871 160000 160200 260210 160212 160220 160225 160240 160252 160254 160260 160270 160271 160280 160281 160500 160502 160505 160512 160520 160521 160522 160540 160545 160600 160605 160650 161000 161001 161020 261026 261050 161055 161070 261105 261107 261108 261120 161140 261150 261151 261154 261156 2

Page 91 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

61210 161215 161250 161253 161304 161305 161312 261313 261314 261315 161316 161320 261321 261322 161323 161330 161332 161333 161334 161340 161343 161345 161440 161450 161458 161460 161470 161480 161490 161500 361501 161512 361514 261516 261517 161518 261519 261520 161521 161522 261524 261526 161530 161531 161533 261534 161535 261536 161537 1

Page 92 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

61538 161539 161540 161541 161542 161543 161544 261545 161546 161548 161550 161552 161556 161557 161558 161559 161563 261564 161566 161567 161570 261571 261575 161576 161580 161581 161582 161583 161584 161585 161586 161590 161591 161592 161595 161596 161597 161598 161600 161601 161605 161606 161607 161608 161609 161610 161611 161612 161613 1

Page 93 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

61615 161616 161618 261619 261623 261624 261626 261630 261635 261680 161682 161684 161686 161690 161692 161697 361698 261700 361702 261703 161705 161708 261710 261711 161720 261735 261750 261751 361760 161770 161781 161782 161783 161790 161791 161796 161798 161800 161850 161860 161863 161864 161867 161868 261870 161875 161880 161885 261886 1

Page 94 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

61888 262000 162005 162010 162100 162115 162116 162117 162120 162121 162140 162141 162142 262143 262145 262146 262147 262148 262160 162161 162162 162163 162164 162165 162180 162190 162192 162194 262200 162201 162220 162223 162225 262230 262252 262256 162258 162263 162264 162267 262268 162269 262270 262272 162273 262280 162281 162282 162284 1

Page 95 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

62287 162290 562292 162294 262310 162311 162318 162319 162350 162351 162355 162360 162361 162362 162365 162367 162368 162369 162370 163001 163003 163005 163011 163012 163015 163016 163017 163020 163030 163035 663040 163042 163043 463044 463045 163046 163047 163048 963050 163051 163055 163056 163057 863064 163066 363075 163076 463077 163078 5

Page 96 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

63081 163082 663085 163086 463087 163088 563090 163101 163102 163170 163172 163173 163180 163182 163185 163190 163191 163194 163195 163196 163197 163198 163199 163200 163250 163251 163252 163265 163266 163267 163268 163270 163271 163272 163273 163275 163276 163277 163278 163280 163281 163282 163283 163285 163286 163287 163290 163295 163300 1

Page 97 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

63301 163302 163303 163304 163305 163306 163307 163308 463600 263610 163615 163620 163621 263650 263655 163661 163662 163663 163664 163685 263688 263700 163702 163704 163706 163707 163709 163710 163740 163741 163744 163746 164400 464402 164405 164408 164410 164412 164413 164415 164416 164417 164418 164420 364421 364425 164430 164435 164445 1

Page 98 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

64446 164447 164448 164449 164455 164479 164483 164490 164491 164492 164493 164494 164495 164505 164508 164510 164517 164520 164530 164550 164553 164555 264561 164565 264566 164568 164569 164570 164575 264580 264581 264585 264590 164595 164600 264605 164610 164611 164612 164615 164616 164617 164630 164632 164633 164635 164642 164643 364644 1

Page 99 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

64645 364646 164647 164650 164653 164680 164681 164702 264712 164713 164714 164718 164719 164721 164726 264727 364732 164734 164736 164738 164740 164742 164744 164746 164752 164755 164760 164761 164763 164766 164771 264772 264774 364776 164778 364782 264783 264786 164790 164792 264795 264802 164804 164809 164818 164821 164822 164823 164831 1

Page 100 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

64834 164835 164836 164837 364840 164856 264857 364858 164859 264861 164862 164864 264865 164866 164868 164870 164872 364874 164876 164885 164886 164890 264891 264892 264893 264895 264896 264897 264898 264901 264905 164907 164910 364911 265091 165093 165101 165103 165105 165110 165112 165114 165125 165130 165135 165140 165150 165155 165175 1

Page 101 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

65205 165210 165220 165222 165235 165260 165265 165270 165272 165273 165275 165280 165285 165286 165290 165400 165410 165420 165426 165430 165435 165436 165450 165600 165710 165730 165750 165755 165756 165757 165770 165772 165775 165778 165779 165780 165781 165782 165800 165810 165815 165820 165850 165855 165860 165865 165870 165875 165880 1

Page 102 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

65900 165920 165930 166020 166030 166130 166150 166155 166160 166165 166170 166172 166174 166175 166180 166183 166185 166220 166225 166250 166500 166505 166600 166605 166625 166630 166635 166680 166682 166700 166710 166711 166720 166740 166761 166762 166770 166820 166821 166825 166830 166840 166850 166852 166920 166930 166940 166982 166983 1

Page 103 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

66984 166985 166986 166990 167005 167010 167015 167025 167027 167028 167030 167031 167036 167039 167040 167041 167042 167043 167101 167105 167107 167108 167110 167112 167113 167115 167120 167121 167141 167145 167208 167210 167218 167220 167221 167225 167227 167228 167229 167250 167255 167311 167312 167314 167316 167318 167320 267331 267332 2

Page 104 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

67334 267335 267340 267343 167345 167346 167400 167405 167412 167413 167414 167415 167420 167430 167440 167445 167450 167500 167505 167515 167550 167560 167570 167700 467710 167715 167800 167801 167805 167808 167820 167825 167830 367835 167850 467875 167880 167882 167900 167901 167902 167903 167904 167906 167908 167909 167911 467912 167914 1

Page 105 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

67915 167916 167917 167921 167922 167923 167924 167930 267935 267938 267950 267961 467966 467971 167973 167974 167975 168020 168040 168100 168110 168115 168130 168135 168200 168320 168325 168326 268328 268330 168335 168340 168360 168362 168371 168400 168420 168440 268500 168505 168510 168520 168525 168530 168540 168550 168700 168705 268720 1

Page 106 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

68745 168750 168760 468761 468770 168801 468810 168811 168815 168816 168840 168850 169000 169005 169020 169100 369105 169110 169120 169140 169145 169150 169155 169200 169205 169210 169220 169222 169300 169310 169320 169400 169401 169405 169420 169421 169424 169433 169436 169440 169450 169501 169502 169505 169511 169530 169535 169540 169550 1

Page 107 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

69552 169554 169601 169602 169603 169604 169605 169610 169620 169631 169632 169633 169635 169636 169637 169641 169642 169643 169644 169645 169646 169650 169660 169661 169662 169666 169667 169670 169676 169700 169711 169714 169715 169717 169718 169720 169725 169740 169745 169801 169805 169806 169820 169840 169905 169910 169915 169930 169950 1

Page 108 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

69955 169960 169970 169990 170010 170015 170030 270100 170110 170120 270130 270134 170140 170150 170160 170170 270190 170200 170210 170220 170240 170250 170260 170300 170310 170320 170328 170330 170332 270336 170350 170355 170360 170370 170371 170373 170380 270390 270450 370460 170470 270480 170481 170482 170486 170487 170488 170490 170491 1

Page 109 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

70492 170496 170498 170540 170542 170543 170544 170545 170546 170547 170548 170549 170551 170552 170553 170554 170555 170557 170558 170559 171015 271021 171022 171023 271030 271034 171035 271100 171101 171110 171111 171120 171130 171250 171260 171270 171275 171550 171551 171552 171555 172010 172020 472040 372050 172052 172069 172070 172072 1

Page 110 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

72074 172080 172090 172100 172110 172114 172120 172125 172126 172127 172128 172129 172130 172131 172132 172133 172141 172142 172146 172147 172148 172149 172156 172157 172158 172170 172190 172191 172192 172193 172194 172195 172196 172197 172198 172200 172202 172220 172240 172255 172265 172270 172275 372292 373000 273010 273020 273030 273040 2

Page 111 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

73050 173060 273070 273080 273085 273090 273092 273100 273110 273115 273120 273130 273140 273200 273201 273202 273206 273218 273219 273220 273221 273222 273223 273500 173510 273520 273525 273530 273540 173550 273560 273562 273564 273565 173580 273590 273592 273600 273610 273615 273620 273630 273650 273660 273700 273701 273702 273706 273718 2

Page 112 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

73719 273720 273721 473722 273723 473725 274000 374010 274020 274022 274150 174160 174170 174174 174175 174176 174177 174178 174181 174182 174183 174185 174190 174210 174220 174230 174235 174240 174241 174245 174246 174247 174249 174250 174251 174260 174261 174262 174270 174280 174283 174290 174291 174300 174301 274305 174320 174327 174328 1

Page 113 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

74329 174330 174340 174355 174360 174363 274400 174410 174415 174420 274425 174430 174440 174445 174450 174455 174470 274475 274480 274485 274710 174740 174742 274775 175557 175559 175561 175563 175565 175571 175572 175573 175574 175600 175605 175625 175630 175635 175658 275710 175716 175726 375731 175733 175736 275741 175743 175746 175756 2

Page 114 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

75791 175801 175803 175805 175807 175809 175810 175820 175822 175825 175827 175831 175833 175840 175842 175860 275870 175872 175880 275885 175887 175889 175891 175896 375898 175901 175902 275945 175952 175953 475954 275956 175957 175958 275959 175962 175964 475966 175968 275970 275980 175982 275984 275989 276000 376001 276010 276080 276100 2

Page 115 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

76101 176102 176120 176125 176376 276377 276380 176506 176510 276511 276512 276513 276514 176516 176519 276529 276536 176604 176645 176700 176705 276770 176775 276776 176800 176801 176802 376805 176810 376811 176812 376813 176814 376815 176817 176830 176831 176856 176857 176870 176872 176873 176881 276882 276885 176886 176930 176932 176936 2

Page 116 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

76937 276940 176942 176945 176946 176948 176950 176965 276970 176975 176977 176998 177001 177002 177003 177011 177012 177013 177014 277021 177022 177051 177052 177053 277054 277055 177056 177057 177058 177059 177071 177072 177073 177074 177075 177076 177077 177078 177080 177081 177082 177084 177261 177262 177263 177280 277285 177290 177293 1

Page 117 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

77295 177301 177305 277310 277315 277321 177326 177327 177328 177332 477333 477336 177338 177370 177371 177372 177373 177401 277402 277403 277404 277406 277407 277408 277409 277411 277412 277413 277414 277416 277417 177418 277421 277422 177423 177424 177425 177427 177431 177432 177435 177469 177470 177520 177522 177523 177525 177600 177605 1

Page 118 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

77610 177615 177620 177750 177761 177762 177763 177776 177777 177778 177785 377786 377787 377789 277790 278012 178013 178014 178015 178016 178018 178020 178070 178071 178072 178075 178102 178103 178104 178110 178111 178120 178121 178122 178130 178135 178140 178185 178190 178191 178195 178201 178202 178205 178206 178215 178216 178226 178227 1

Page 119 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

78230 178231 178232 178258 178261 178262 178264 178267 178268 178270 178271 178272 178278 278282 178290 178291 178300 178305 178306 178315 178320 178414 178428 178445 178451 178452 178453 178454 178456 178457 178458 178459 178466 178468 178469 178472 178473 178481 178483 178491 178492 178494 178496 178579 178580 178582 178597 178598 178600 1

Page 120 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

78601 178605 178606 278607 178608 178610 178630 278635 178645 178647 178650 178660 178700 178701 278707 178708 178709 178710 178725 178730 178740 178761 178800 178801 178802 178803 178804 178805 178806 178807 178808 178811 178812 178813 178814 178815 178816 179005 179101 179200 179300 179403 179440 179445 180047 280048 280051 280053 180061 1

Page 121 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

80069 180074 180076 180100 080101 080102 1080103 280104 180150 280152 280154 280156 280157 280158 280160 280162 280164 280166 280168 280170 280172 280173 280174 280176 180178 280182 280184 280185 280186 280188 280190 280192 280194 280195 280197 280198 280200 280201 280202 280299 380400 180402 180406 180408 180410 180412 180414 180415 180416 1

Page 122 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

80417 180418 180420 180422 180424 180426 180428 180430 180432 180434 180435 180436 180438 180439 180440 180500 180502 181000 281001 281002 281003 281005 281007 181015 281020 181025 181050 281161 181200 181201 181202 181203 181205 181206 181207 181208 181209 181210 181211 181212 181213 181214 181215 281216 181217 281220 181221 181222 181223 1

Page 123 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

81224 181225 181226 181227 181228 181229 181235 181240 181241 181242 181243 181244 181245 181250 181251 181252 181253 181254 181255 181256 181257 181260 181261 181262 181263 181264 181265 181266 381267 181270 181275 181280 181281 181282 181287 181290 181291 181292 181293 181294 181295 181296 181297 181298 181299 181300 181301 181302 181303 1

Page 124 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

81304 181310 181315 181316 181317 181318 181319 181321 181322 181323 181324 181325 181326 181330 181331 181332 181340 181341 181342 181350 181355 181370 181371 181372 181373 281374 381375 181377 381378 181379 181380 281383 381400 281401 281402 181403 481404 581405 281406 281407 181408 281500 181503 181504 181506 181507 181508 181509 181510 1

Page 125 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

81511 181512 182000 182003 282009 182010 482013 182016 182017 182030 182040 182042 282043 182044 182045 182055 282075 282085 182088 282101 182103 182104 182105 182106 482107 182108 182120 182127 282128 282131 382135 182136 382139 382140 282143 282145 282150 482154 182157 182160 182163 182164 182172 382175 282180 182190 482205 282232 282239 1

Page 126 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

82240 182247 282248 282252 182261 182270 182271 182272 182274 182286 182300 182306 182308 382310 282330 282331 182340 182355 382360 382365 382370 382373 182374 282375 182376 182378 182379 182380 182382 182383 182384 282387 182390 182415 182435 282436 182438 182441 182465 182480 282482 182485 182486 282487 282488 182489 282491 482492 282495 1

Page 127 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

82507 182520 282523 182525 282528 182530 282540 182542 682543 282544 282550 382552 382553 382554 182565 282570 382575 182585 182595 182600 182607 182608 182610 182615 182626 182627 182633 182634 182638 182646 182649 182651 182652 182654 182656 182657 382658 282666 182668 182670 282671 182672 182677 182679 182690 182693 282696 182705 182710 1

Page 128 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

82715 382725 182726 182728 182731 182735 182742 182746 182747 182757 182759 182760 182775 182776 182777 182784 682785 182787 482800 182805 282820 182930 182941 182943 182946 182950 382951 182952 382953 182955 182960 182963 182965 182975 182977 182978 182979 182980 182985 183003 583008 183009 183010 183012 183013 183014 183015 183018 783020 2

Page 129 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

83021 283026 183030 183033 183036 183037 183045 183050 183051 183055 183060 183065 183068 183069 183070 183071 183080 283088 183090 283150 183491 183497 183498 283499 183500 183505 183518 283525 483527 183528 183540 283550 183570 183582 183586 183593 183605 383615 283625 183630 183631 183632 183633 183634 183655 283661 483662 483663 483664 4

Page 130 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

83670 183690 283695 183698 183700 183701 183704 183718 183719 183721 183727 183735 483775 183785 183788 383789 483805 283825 283835 283840 283857 183858 183861 283864 183866 183872 283873 183874 283876 183880 183885 283887 283915 183916 283918 283919 183921 283925 483930 283935 283937 183945 283950 183951 183970 283986 283987 183992 283993 1

Page 131 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

84022 284030 184035 184060 184061 184066 184075 284078 184080 184081 184085 184087 184100 384105 184106 184110 184112 184119 184120 184126 184127 184132 384133 284134 184135 184138 184140 184143 284144 184145 184146 384150 284152 184153 184154 184155 184156 184157 384160 284163 184165 184166 284202 184203 184206 184207 184210 184220 184228 1

Page 132 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

84233 284234 284235 184238 384252 184255 284260 184270 184275 184285 184295 384300 284302 184305 184307 184311 284315 284375 184376 184377 184378 284379 184392 184402 184403 284425 184430 184431 184432 184436 184437 184439 184442 184443 484445 184446 184449 184450 184460 184466 184478 184479 184480 184481 184482 184484 284485 184488 184490 1

Page 133 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

84510 184512 184520 484525 184540 284545 184550 184560 284577 184578 184580 184583 184585 184586 184588 184590 184591 184597 184600 284620 184630 284681 184702 284703 184704 184830 185002 185004 285007 185008 185009 185013 285014 285018 285025 285032 385041 285044 185045 185046 185048 285049 285055 185060 185097 285130 185170 185175 185210 2

Page 134 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

85220 285230 285240 285244 185245 285246 285247 285250 285260 285270 285280 285290 285291 185292 185293 185300 285301 185302 185303 285305 285306 285307 285335 285337 185345 185347 585348 185360 185362 285366 185370 185378 185379 285380 185384 285385 185390 385396 185400 185410 185415 285420 285421 185441 185445 185460 185461 185475 185525 2

Page 135 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

85530 185536 185540 185547 185549 185555 185557 185597 185598 185611 285612 185613 185635 185651 185652 185660 185670 285675 185705 185732 485810 286021 186022 186023 386038 186039 186060 186063 186077 186078 186079 186140 186141 186146 386147 486148 386152 186153 186155 186156 186157 186160 486161 386162 186171 286200 186215 186225 186226 1

Page 136 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

86243 186277 186280 186294 186300 286301 186304 186305 186308 186309 186310 186316 386320 186325 286327 186332 186334 186335 286336 186337 186340 186341 186343 186344 186352 186355 186357 186359 186360 186361 186367 186376 286378 186382 386384 186386 186406 286430 286431 286480 186481 186485 186486 286490 186510 186580 186590 186592 286593 2

Page 137 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

86602 386603 286612 286617 286618 286619 286625 286628 386632 386641 286644 186645 186648 286651 286652 286653 286654 286663 286664 286665 286668 286674 386677 386684 286687 286688 286689 286692 286694 286695 286696 286698 386701 286702 286703 186704 186705 186706 286707 186708 186709 186711 286713 386720 286723 286727 286732 286738 286741 2

Page 138 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

86744 286747 286750 486753 386756 286759 286762 286768 586771 286774 286777 286778 286780 286784 286787 286788 286789 286793 286800 186803 286804 186807 286808 186812 186813 186816 186817 186821 186822 186825 186828 286829 286830 286831 286832 286833 186834 186835 186850 386860 286880 486885 386886 386890 186891 186900 186901 186904 286906 1

Page 139 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

86921 286927 286930 286932 286940 186941 186945 386950 186960 186965 186970 186975 286976 286977 286978 186985 187001 187003 187040 287045 387070 387073 387084 287086 387103 387109 387110 287116 287118 387143 287158 187164 287166 287168 287169 287172 187176 287177 387187 387197 187205 387207 387220 387230 387250 387253 287255 287260 187265 1

Page 140 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

87267 187269 187270 187271 187272 187273 187274 187275 187276 187277 187278 187279 187280 187281 187283 187285 187290 187299 187301 187305 187320 187324 187327 187328 187329 187332 187335 187336 187337 187338 187339 187340 187341 187350 187380 187385 187389 187390 187391 187400 287420 187425 187427 287430 187449 387450 287451 287470 187471 1

Page 141 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

87472 187475 187476 187477 187480 187481 187482 187485 187486 187487 187490 187491 187492 187493 187495 187496 187497 187498 187500 187501 187502 187503 187510 187511 187512 187515 187516 187517 187520 187521 187522 187525 187526 187527 187528 187529 187530 187531 187532 187533 187534 187535 187536 187537 187538 187539 187540 187541 187542 1

Page 142 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

87550 187551 187552 187555 187556 187557 187560 187561 187562 187580 187581 187582 187590 187591 187592 187620 187621 187622 187631 187632 187633 187640 187641 187650 187651 187652 187653 187660 187661 187797 387799 387800 287802 287803 387804 287807 287808 187810 287850 187880 287900 187901 187902 187903 187905 287906 287910 187912 188104 4

Page 143 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

88106 388120 288121 288125 188130 188140 188141 188142 188143 188147 188148 188150 188152 188153 188154 188155 188160 488161 488162 388164 188165 188166 188167 188172 388173 388174 188175 188177 288182 288184 188187 188188 188189 188230 288233 388239 388240 388241 388245 188248 188249 188261 288262 288263 188264 288267 288269 288273 388283 2

Page 144 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

88289 188291 188300 288302 288309 388311 488321 188323 188325 188329 488331 1188333 488342 088343 088347 488348 188349 188355 188356 188358 288362 188363 188371 188372 188375 188380 188381 188387 388388 388720 188738 188740 188741 189049 189050 289051 289055 289060 289125 289160 189190 189220 189230 189250 189251 189253 189254 189255 189257 1

Page 145 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

89258 189259 189260 189261 189264 189268 189272 189280 189281 189290 189291 189300 189310 189320 189321 189322 189325 189329 189330 189331 189335 189342 189343 189344 189346 189352 189353 189354 189356 290284 190296 190375 2090376 2090385 190393 190396 190460 390471 190472 490473 190474 190476 190477 190581 190585 190586 190632 190633 190634 1

Page 146 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

90636 190644 190645 190646 190647 190648 190649 190650 190653 190654 190655 190656 190657 190658 190660 190661 190662 190664 190666 190667 190668 190669 190670 190672 190673 190675 190676 190680 190681 190685 190686 190687 190688 190690 190691 190692 190693 190696 190698 190700 190702 190703 190704 190705 190706 190707 190708 190710 190712 1

Page 147 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

90713 190714 190715 190716 190717 190719 190720 190721 190725 190727 190732 190733 190734 190735 190736 190738 190739 190740 290743 190744 190746 190747 290785 190791 190792 190832 190833 190834 190836 190837 190838 190839 190845 190846 190847 190849 190853 190863 190865 190867 190868 190869 190870 190880 190901 190911 190935 190937 190940 2

Page 148 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

90945 190947 190951 190952 190953 190954 190955 190956 190957 190958 190959 190960 190961 190962 190963 190964 190965 190966 190967 190968 190969 190970 190989 190993 190997 191010 191013 191020 191022 191030 191034 191035 191037 191038 191040 191065 291110 191111 191112 191117 191120 191122 191132 191133 192002 192004 192012 192014 192018 1

Page 149 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

92019 192020 192025 192060 192065 192071 292072 192081 192082 192083 192100 192132 192133 192134 192136 292140 192225 292226 292227 192228 192230 292235 292240 292250 192260 192265 192270 192275 192283 192284 192285 192286 192287 192311 192312 192313 192315 192316 192317 192325 192326 292502 192504 192507 192508 192511 192512 192516 192520 1

Page 150 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

92521 192522 192523 192524 192526 192540 192541 192542 192543 492544 192545 192546 192548 192550 192552 192553 192555 192556 192557 192558 192561 192562 192563 192564 192565 192567 192568 192570 192571 192572 192575 192576 192577 192579 192582 192583 192584 192585 192586 192587 192588 192596 192601 192602 192603 192604 192605 092609 192610 1

Page 151 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

92613 192615 192617 192618 092620 192625 192626 192920 192924 192928 192933 192937 392938 392941 192943 192944 192950 392953 292960 292961 192970 192971 192973 292974 192975 192977 192978 192979 292986 192987 192990 192992 192993 192997 192998 293000 393005 393015 293016 293017 293018 293024 193025 193040 393041 293042 393224 193225 193226 1

Page 152 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

93227 193228 193229 193268 193270 193271 193272 193278 193279 193280 193281 193282 193283 193284 193285 193286 293287 293288 193289 193290 193291 193292 193293 193294 193295 193296 193297 193298 193299 193303 193304 193306 193307 193308 193312 193313 193314 193315 193316 193317 193318 193320 193321 193325 193350 193351 193352 193451 193452 1

Page 153 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

93453 193454 193455 193456 193457 193458 193459 193460 193461 193462 193463 193464 193503 293505 193530 193531 193532 193533 193561 193562 393563 193564 193565 193566 193567 193568 193571 193572 293580 193581 193582 193583 193600 193602 193603 193609 193610 193612 193613 193615 193616 193618 193619 193620 193621 193622 193623 193624 193631 1

Page 154 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

93640 193641 193642 193650 193653 193654 193655 193656 193657 193660 193662 193701 193724 293745 193750 193784 193786 193788 193790 193797 293798 293880 193882 193886 193888 193890 193892 193893 193922 193923 193924 193925 193926 193930 193931 193965 193970 193971 193975 193976 193978 193979 193980 193981 193982 193990 294002 194003 194004 1

Page 155 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

94010 194011 194012 194013 194014 194015 194016 194060 194070 194200 194250 194375 194400 194450 194452 194453 194610 294620 194621 194640 494642 194644 194645 294660 194662 194664 194667 194669 494680 194681 194690 194726 194727 194728 194729 194750 194760 194761 194762 194770 194772 194774 194775 194776 194777 194780 194781 195012 295018 19

Page 156 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

95056 195060 195065 195070 195071 195076 195079 295115 195117 195250 195251 195782 195783 195800 195801 195803 195805 195806 195807 195808 195810 195811 195812 195813 195816 195819 195822 195824 195827 195829 195830 195832 195851 395852 195857 195860 195861 195863 195864 195865 195866 195867 195868 195869 195873 195874 195875 295887 195905 2

Page 157 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

95907 195908 195909 195910 195911 195912 195913 195921 195922 195923 195924 195925 195926 195927 195928 195929 195930 195933 195938 195939 195943 195950 195951 195953 195954 195955 195956 195957 195958 195961 195965 195966 195967 395970 195971 195972 195974 195975 295978 195980 195981 195982 195990 295991 295992 196000 196001 196002 196003 1

Page 158 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

96004 196020 196103 196105 396120 196125 296360 196365 196368 196369 196370 396371 196373 296374 196376 096402 296405 196406 196409 196413 196416 196420 296422 296425 196440 196446 196450 196521 296522 196523 196542 196567 196570 196571 396900 196904 196910 196912 196913 196920 196921 196922 197012 197016 197018 197022 197024 197026 197028 1

Page 159 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

97150 197545 197546 297597 197605 197606 197610 198925 198926 198927 198928 198929 198940 198941 198942 199082 199143 299144 299148 299149 299170 199175 199183 199191 199192 199195 299201 199202 199203 199204 199205 199211 199212 199213 199214 199215 199217 199218 199219 199220 199221 199222 199223 199224 199225 199226 199231 199232 199233 1

Page 160 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

99234 199235 199236 199238 199239 199281 199282 199283 199284 199285 199291 199304 199305 199306 199307 199308 199309 199310 199315 199316 199318 199324 199325 199326 199327 199328 199334 199335 199336 199337 199341 199342 199343 199344 199345 199347 199348 199349 199350 199354 199356 199406 199407 199446 199447 199448 199449 199455 199456 1

Page 161 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

99460 199461 199462 199463 199464 199465 199466 199468 199469 199471 199472 199475 199476 199477 199478 199479 199480 199481 199482 199485 199487 199488 199495 199496 199605 099606 099607 0A0382 0A0384 0A0392 0A0394 0A0396 0A0398 0A0420 0A0422 0A0424 0A0426 1A0427 1A0428 1A0429 1A0430 1A0431 1A0432 1A0433 1A0434 1A4221 1A4235 2A4253 0A4255 0

Page 162 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

A4257 0A4258 0A4259 0A4301 1A4356 1A4470 1A4480 1A4555 0A4557 2A4561 1A4562 1A4565 2A4606 1A4611 0A4614 1A4625 30A4633 0A4635 0A4638 0A4640 0A4642 1A4648 5A4650 3A5056 90A5057 90A5120 150A5500 0A5501 0A5503 0A5504 0A5505 0A5506 0A5507 0A5508 0A5510 0A5512 0A5513 0A6501 2A6502 2A6503 2A6504 4A6505 4A6506 4A6507 4A6508 4A6509 2A6510 2A6511 2A6513 0

Page 163 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

A6531 0A6532 0A6545 0A7000 0A7003 0A7005 0A7006 0A7013 0A7014 0A7016 0A7017 0A7020 0A7025 0A7026 0A7027 0A7028 0A7029 0A7032 0A7035 0A7036 0A7037 0A7039 0A7040 2A7041 2A7042 2A7043 10A7044 0A7047 0A7501 0A7504 0A7507 0A7520 0A7524 0A7527 0A9272 0A9284 0A9500 3A9501 3A9502 3A9503 1A9504 1A9507 1A9510 1A9520 1A9521 2A9526 2A9536 1A9537 1A9538 1

Page 164 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

A9539 2A9540 2A9541 1A9542 1A9543 1A9544 1A9545 1A9546 1A9550 1A9551 1A9552 1A9553 1A9554 1A9555 3A9557 2A9559 1A9560 2A9561 1A9562 2A9566 1A9567 2A9569 1A9570 1A9571 1A9579 100A9580 1A9582 1A9584 1A9585 300A9586 1A9599 1A9604 1A9700 2B4083 0B4149 0B4153 0B4157 0B4160 0B4164 0B4176 0B4189 0B4199 0B5200 0C1722 1C1749 1C1767 2C1772 1C1785 1C1813 1

Page 165 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

C1820 2C1830 2C1840 1C1841 1C1886 1C2616 1C5271 1C5272 3C5273 1C5274 35C5275 1C5276 3C5277 1C5278 15C9285 2C9290 266C9352 3C9353 4C9354 300C9355 3C9356 125C9358 800C9359 30C9360 300C9361 10C9362 60C9363 500C9364 600C9600 1C9601 2C9602 1C9603 2C9604 3C9605 3C9606 1C9607 1C9608 1C9733 1C9734 1C9735 1C9737 1E0100 0E0105 0E0110 0E0111 0E0112 0E0113 0E0114 0E0116 0

Page 166 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E0117 0E0118 0E0130 0E0135 0E0140 0E0141 0E0143 0E0144 0E0147 0E0148 0E0149 0E0153 0E0154 0E0155 0E0156 0E0157 0E0158 0E0159 2E0163 0E0165 0E0167 0E0168 0E0170 0E0171 0E0172 0E0175 0E0181 0E0182 0E0184 0E0185 0E0186 0E0187 0E0188 0E0189 0E0190 0E0191 0E0193 0E0194 0E0196 0E0197 0E0198 0E0199 0E0200 0E0202 0E0203 0E0205 0E0210 0E0215 0E0217 0

Page 167 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E0218 0E0221 0E0225 0E0231 0E0232 0E0235 0E0236 0E0239 0E0249 0E0250 0E0251 0E0255 0E0256 0E0260 0E0261 0E0265 0E0266 0E0270 0E0271 0E0272 0E0273 0E0274 0E0275 0E0276 0E0277 0E0280 0E0290 0E0291 0E0292 0E0293 0E0294 0E0295 0E0296 0E0297 0E0300 0E0301 0E0302 0E0303 0E0304 0E0305 0E0310 0E0315 0E0316 0E0325 0E0326 0E0328 0E0329 0E0350 0E0352 0

Page 168 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E0370 0E0371 0E0372 0E0373 0E0424 0E0425 0E0430 0E0431 0E0434 0E0435 0E0439 0E0440 0E0441 0E0442 0E0443 0E0444 0E0445 0E0446 0E0450 0E0455 0E0457 0E0459 0E0460 0E0461 0E0462 0E0463 0E0464 0E0470 0E0471 0E0472 0E0480 0E0481 0E0482 0E0483 0E0484 0E0485 0E0486 0E0487 0E0500 0E0550 0E0555 0E0560 0E0561 0E0562 0E0565 0E0570 0E0572 0E0574 0E0575 0

Page 169 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E0580 0E0585 0E0600 0E0601 0E0602 0E0603 0E0604 0E0605 0E0606 0E0607 0E0610 0E0615 0E0616 1E0617 0E0618 0E0619 0E0620 0E0621 0E0625 0E0627 0E0628 0E0629 0E0630 0E0635 0E0636 0E0637 0E0638 0E0639 0E0640 0E0641 0E0642 0E0650 0E0651 0E0652 0E0655 0E0656 0E0657 0E0660 0E0665 0E0666 0E0667 0E0668 0E0669 0E0670 0E0671 0E0672 0E0673 0E0675 0E0676 1

Page 170 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E0691 0E0692 0E0693 0E0694 0E0705 0E0710 0E0720 0E0730 0E0731 0E0740 0E0744 0E0745 0E0746 1E0747 0E0748 0E0749 1E0755 0E0760 0E0762 0E0764 0E0765 0E0766 0E0769 0E0770 1E0776 0E0779 0E0780 0E0781 1E0782 1E0783 1E0784 0E0785 1E0786 1E0791 0E0840 0E0849 0E0850 0E0855 0E0856 0E0860 0E0870 0E0880 0E0890 0E0900 0E0910 0E0911 0E0912 0E0920 0E0930 0

Page 171 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E0940 0E0941 0E0942 0E0944 0E0945 0E0946 0E0947 0E0948 0E0950 0E0951 0E0952 0E0955 0E0956 0E0957 0E0958 0E0959 0E0960 0E0961 0E0966 0E0967 0E0968 0E0970 0E0971 0E0973 0E0974 0E0978 0E0981 0E0982 0E0983 0E0984 0E0985 0E0986 0E0988 0E0990 0E0992 0E0994 0E0995 0E1002 0E1003 0E1004 0E1005 0E1006 0E1007 0E1008 0E1009 0E1010 0E1011 0E1014 0E1015 0

Page 172 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E1016 0E1017 0E1018 0E1020 0E1028 0E1029 0E1030 0E1031 0E1035 0E1037 0E1038 0E1039 0E1050 0E1060 0E1070 0E1083 0E1084 0E1085 0E1086 0E1087 0E1088 0E1089 0E1090 0E1092 0E1093 0E1100 0E1110 0E1130 0E1140 0E1150 0E1160 0E1161 0E1170 0E1171 0E1172 0E1180 0E1190 0E1195 0E1200 0E1220 0E1221 0E1222 0E1223 0E1224 0E1225 0E1226 0E1228 0E1229 0E1230 0

Page 173 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E1231 0E1232 0E1233 0E1234 0E1235 0E1236 0E1237 0E1238 0E1240 0E1250 0E1260 0E1270 0E1280 0E1285 0E1290 0E1295 0E1310 0E1352 0E1353 0E1354 0E1355 0E1356 0E1357 0E1358 0E1372 0E1390 0E1391 0E1392 0E1405 0E1406 0E1500 0E1510 0E1520 0E1530 0E1540 0E1550 0E1560 0E1570 0E1580 0E1590 0E1592 0E1594 0E1600 0E1610 0E1615 0E1620 0E1625 0E1630 0E1635 0

Page 174 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E1639 0E1700 0E1800 0E1801 0E1802 0E1805 0E1806 0E1810 0E1811 0E1812 0E1815 0E1816 0E1818 0E1820 0E1821 0E1825 0E1830 0E1831 0E1840 0E1841 0E1902 0E2000 0E2100 0E2101 0E2120 0E2201 0E2202 0E2203 0E2204 0E2205 0E2206 0E2207 0E2208 0E2209 0E2210 0E2211 0E2212 0E2213 0E2214 0E2215 0E2216 0E2217 0E2218 0E2219 0E2220 0E2221 0E2222 0E2224 0E2225 0

Page 175 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E2226 0E2227 0E2228 0E2231 0E2291 1E2292 1E2293 1E2294 1E2295 0E2300 0E2301 0E2310 0E2311 0E2312 0E2313 0E2321 0E2322 0E2323 0E2324 0E2325 0E2326 0E2327 0E2328 0E2329 0E2330 0E2331 0E2340 0E2341 0E2342 0E2343 0E2351 0E2358 0E2359 0E2361 0E2363 0E2365 0E2366 0E2367 0E2368 0E2369 0E2370 0E2371 0E2373 0E2374 0E2375 0E2376 0E2377 0E2378 0E2381 0

Page 176 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E2382 0E2383 0E2384 0E2385 0E2386 0E2387 0E2388 0E2389 0E2390 0E2391 0E2392 0E2394 0E2395 0E2396 0E2397 0E2402 0E2500 0E2502 0E2504 0E2506 0E2508 0E2510 0E2511 0E2512 0E2601 0E2602 0E2603 0E2604 0E2605 0E2606 0E2607 0E2608 0E2609 0E2611 0E2612 0E2613 0E2614 0E2615 0E2616 0E2617 0E2619 0E2620 0E2621 0E2622 0E2623 0E2624 0E2625 0E2626 0E2627 0

Page 177 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

E2628 0E2629 0E2630 0E2631 0E2632 0E2633 0G0008 1G0009 1G0010 2G0027 1G0101 1G0102 1G0103 1G0104 1G0105 1G0106 1G0117 1G0118 1G0120 1G0121 1G0123 1G0124 1G0127 1G0128 1G0130 1G0141 1G0143 1G0144 1G0145 1G0147 1G0148 1G0166 2G0168 2G0173 1G0175 1G0177 0G0179 1G0180 1G0181 1G0182 1G0186 1G0202 1G0204 2G0206 2G0235 1G0239 1G0245 1G0246 1G0247 1

Page 178 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

G0248 1G0249 1G0250 1G0251 1G0259 1G0260 1G0268 1G0278 1G0281 1G0283 1G0288 1G0289 1G0293 1G0294 1G0302 1G0303 1G0304 1G0305 1G0306 2G0307 2G0328 1G0329 1G0333 0G0337 1G0339 1G0340 1G0341 1G0342 1G0343 1G0364 2G0365 2G0372 1G0389 1G0396 1G0397 1G0398 1G0399 1G0400 1G0402 1G0403 1G0404 1G0405 1G0406 1G0407 1G0408 1G0412 1G0413 1G0414 1G0415 1

Page 179 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

G0416 1G0417 1G0418 1G0419 1G0420 2G0424 2G0425 1G0426 1G0427 1G0429 1G0431 1G0432 1G0433 1G0434 1G0435 1G0436 1G0437 1G0438 1G0439 1G0448 1G0452 1G0454 1G0455 1G0456 1G0457 1G0458 1G0459 1G0460 1G0461 9G0462 60G0463 0G3001 1G9143 1G9156 1G9157 1G9187 1J0131 400J0178 4J0257 1400J0289 50J0485 1500J0490 160J0638 150J0712 120J0890 0J0897 120J1050 1000J1442 3360J1446 192

Page 180 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

J1556 300J1557 300J1561 300J1568 300J1569 300J1572 300J1725 250J1744 90J2212 240J2265 400J2507 8J2995 0J3010 100J3060 900J3285 1J3465 40J3489 5J7196 175J7301 0J7310 2J7316 4J7326 2J7527 0J7604 0J7607 0J7609 0J7610 0J7615 0J7622 0J7624 0J7627 0J7628 0J7629 0J7632 0J7634 0J7635 0J7636 0J7637 0J7638 0J7640 0J7641 0J7642 0J7643 0J7645 0J7647 0J7650 0J7657 0J7660 0J7665 127

Page 181 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

J7667 0J7670 0J7676 0J7680 0J7681 0J7683 0J7684 0J7685 0J8510 0J9019 60J9042 200J9047 120J9179 50J9228 450J9262 700J9306 840J9354 600J9355 100J9400 600K0001 0K0002 0K0003 0K0004 0K0005 0K0006 0K0007 0K0009 0K0015 0K0017 0K0018 0K0019 0K0020 0K0037 0K0038 0K0039 0K0040 0K0041 0K0042 0K0043 0K0044 0K0045 0K0046 0K0047 0K0050 0K0051 0K0052 0K0053 0K0056 0K0065 0

Page 182 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

K0069 0K0070 0K0071 0K0072 0K0073 0K0077 0K0105 0K0195 0K0455 0K0462 0K0602 0K0605 0K0606 0K0607 0K0608 0K0609 0K0672 0K0730 0K0733 0K0738 0K0743 0K0744 0K0745 0K0746 0K0800 0K0801 0K0802 0K0806 0K0807 0K0808 0K0812 0K0813 0K0814 0K0815 0K0816 0K0820 0K0821 0K0822 0K0823 0K0824 0K0825 0K0826 0K0827 0K0828 0K0829 0K0830 0K0831 0K0835 0K0836 0

Page 183 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

K0837 0K0838 0K0839 0K0840 0K0841 0K0842 0K0843 0K0848 0K0849 0K0850 0K0851 0K0852 0K0853 0K0854 0K0855 0K0856 0K0857 0K0858 0K0859 0K0860 0K0861 0K0862 0K0863 0K0864 0K0868 0K0869 0K0870 0K0871 0K0877 0K0878 0K0879 0K0880 0K0884 0K0885 0K0886 0K0890 0K0891 0K0898 1K0900 0L0112 0L0113 0L0120 0L0130 0L0140 0L0150 0L0160 0L0170 0L0172 0L0174 0

Page 184 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L0180 0L0190 0L0200 0L0220 0L0450 0L0452 0L0454 0L0455 0L0456 0L0457 0L0458 0L0460 0L0462 0L0464 0L0466 0L0467 0L0468 0L0469 0L0470 0L0472 0L0480 0L0482 0L0484 0L0486 0L0488 0L0490 0L0491 0L0492 0L0621 0L0622 0L0623 0L0624 0L0625 0L0626 0L0627 0L0628 0L0629 0L0630 0L0631 0L0632 0L0633 0L0634 0L0635 0L0636 0L0637 0L0638 0L0639 0L0640 0L0641 0

Page 185 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L0642 0L0643 0L0648 0L0649 0L0650 0L0651 0L0700 0L0710 0L0810 0L0820 0L0830 0L0859 0L0861 0L0970 0L0972 0L0974 0L0976 0L0978 0L0980 0L0982 0L0984 0L1000 0L1001 0L1005 0L1010 0L1020 0L1025 0L1030 0L1040 0L1050 0L1060 0L1070 0L1080 0L1085 0L1090 0L1100 0L1110 0L1120 0L1200 0L1210 0L1220 0L1230 0L1240 0L1250 0L1260 0L1270 0L1280 0L1290 0L1300 0

Page 186 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L1310 0L1499 1L1600 0L1610 0L1620 0L1630 0L1640 0L1650 0L1652 0L1660 0L1680 0L1685 0L1686 0L1690 0L1700 0L1710 0L1720 0L1730 0L1755 0L1810 0L1812 0L1820 0L1830 0L1831 0L1832 0L1833 0L1834 0L1836 0L1840 0L1843 0L1844 0L1845 0L1846 0L1847 0L1848 0L1850 0L1860 0L1900 0L1902 0L1904 0L1906 0L1907 0L1910 0L1920 0L1930 0L1932 0L1940 0L1945 0L1950 0

Page 187 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L1951 0L1960 0L1970 0L1971 0L1980 0L1990 0L2000 0L2005 0L2010 0L2020 0L2030 0L2034 0L2035 0L2036 0L2037 0L2038 0L2040 0L2050 0L2060 0L2070 0L2080 0L2090 0L2106 0L2108 0L2112 0L2114 0L2116 0L2126 0L2128 0L2132 0L2134 0L2136 0L2180 0L2182 0L2184 0L2186 0L2188 0L2190 0L2192 0L2200 0L2210 0L2220 0L2230 0L2232 0L2240 0L2250 0L2260 0L2265 0L2270 0

Page 188 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L2275 0L2280 0L2300 0L2310 0L2320 0L2330 0L2335 0L2340 0L2350 0L2360 0L2370 0L2375 0L2380 0L2385 0L2387 0L2390 0L2395 0L2397 0L2405 0L2415 0L2425 0L2430 0L2492 0L2500 0L2510 0L2520 0L2525 0L2526 0L2530 0L2540 0L2550 0L2570 0L2580 0L2600 0L2610 0L2620 0L2622 0L2624 0L2627 0L2628 0L2630 0L2640 0L2650 0L2660 0L2670 0L2680 0L2750 0L2755 0L2760 0

Page 189 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L2768 0L2780 0L2785 0L2795 0L2800 0L2810 0L2820 0L2830 0L3000 0L3001 0L3002 0L3003 0L3010 0L3020 0L3030 0L3031 0L3040 0L3050 0L3060 0L3070 0L3080 0L3090 0L3100 0L3140 0L3150 0L3160 0L3170 0L3215 0L3216 0L3217 0L3219 0L3221 0L3222 0L3224 0L3225 0L3230 0L3250 0L3251 0L3252 0L3253 0L3300 0L3310 0L3330 0L3332 0L3334 0L3340 0L3350 0L3360 0L3370 0

Page 190 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L3380 0L3390 0L3400 0L3410 0L3420 0L3430 0L3440 0L3450 0L3455 0L3460 0L3465 0L3470 0L3480 0L3485 0L3500 0L3510 0L3520 0L3530 0L3540 0L3550 0L3560 0L3570 0L3580 0L3590 0L3595 0L3600 0L3610 0L3620 0L3630 0L3640 0L3650 0L3660 0L3670 0L3671 0L3674 0L3675 0L3677 0L3678 0L3702 0L3710 0L3720 0L3730 0L3740 0L3760 0L3762 0L3763 0L3764 0L3765 0L3766 0

Page 191 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L3806 0L3807 0L3808 0L3809 0L3900 0L3901 0L3904 0L3905 0L3906 0L3908 0L3912 0L3913 0L3915 0L3916 0L3917 0L3918 0L3919 0L3921 0L3923 0L3924 0L3925 0L3927 0L3929 0L3930 0L3931 0L3933 0L3935 0L3956 0L3960 0L3961 0L3962 0L3967 0L3971 0L3973 0L3975 0L3976 0L3977 0L3978 0L3980 0L3982 0L3984 0L4000 0L4002 0L4010 0L4020 0L4030 0L4040 0L4045 0L4050 0

Page 192 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L4055 0L4060 0L4070 0L4080 0L4090 0L4100 0L4110 0L4130 0L4205 0L4210 0L4350 0L4360 0L4361 0L4370 0L4386 0L4387 0L4392 0L4394 0L4396 0L4397 0L4398 0L4631 0L5000 0L5010 0L5020 0L5050 0L5060 0L5100 0L5105 0L5150 0L5160 0L5200 0L5210 0L5220 0L5230 0L5250 0L5270 0L5280 0L5301 0L5312 0L5321 0L5331 0L5341 0L5400 0L5410 0L5420 0L5430 0L5450 0L5460 0

Page 193 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L5500 0L5505 0L5510 0L5520 0L5530 0L5535 0L5540 0L5560 0L5570 0L5580 0L5585 0L5590 0L5595 0L5600 0L5610 0L5611 0L5613 0L5614 0L5616 0L5617 0L5618 0L5620 0L5622 0L5624 0L5626 0L5628 0L5629 0L5630 0L5631 0L5632 0L5634 0L5636 0L5637 0L5638 0L5639 0L5640 0L5642 0L5643 0L5644 0L5645 0L5646 0L5647 0L5648 0L5649 0L5650 0L5651 0L5652 0L5653 0L5654 0

Page 194 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L5655 0L5656 0L5658 0L5661 0L5665 0L5666 0L5668 0L5670 0L5671 0L5672 0L5673 0L5676 0L5677 0L5678 0L5679 0L5680 0L5681 0L5682 0L5683 0L5684 0L5685 0L5686 0L5688 0L5690 0L5692 0L5694 0L5695 0L5696 0L5697 0L5698 0L5699 0L5700 0L5701 0L5702 0L5703 0L5704 0L5705 0L5706 0L5707 0L5710 0L5711 0L5712 0L5714 0L5716 0L5718 0L5722 0L5724 0L5726 0L5728 0

Page 195 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L5780 0L5781 0L5782 0L5785 0L5790 0L5795 0L5810 0L5811 0L5812 0L5814 0L5816 0L5818 0L5822 0L5824 0L5826 0L5828 0L5830 0L5840 0L5845 0L5848 0L5850 0L5855 0L5856 0L5857 0L5858 0L5859 0L5910 0L5920 0L5925 0L5930 0L5940 0L5950 0L5960 0L5961 0L5962 0L5964 0L5966 0L5968 0L5969 0L5970 0L5971 0L5972 0L5974 0L5975 0L5976 0L5978 0L5979 0L5980 0L5981 0

Page 196 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L5982 0L5984 0L5985 0L5986 0L5987 0L5988 0L5990 0L6000 0L6010 0L6020 0L6025 0L6050 0L6055 0L6100 0L6110 0L6120 0L6130 0L6200 0L6205 0L6250 0L6300 0L6310 0L6320 0L6350 0L6360 0L6370 0L6380 0L6382 0L6384 0L6386 0L6388 0L6400 0L6450 0L6500 0L6550 0L6570 0L6580 0L6582 0L6584 0L6586 0L6588 0L6590 0L6600 0L6605 0L6610 0L6611 0L6615 0L6616 0L6620 0

Page 197 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L6621 0L6623 0L6624 0L6625 0L6628 0L6629 0L6630 0L6632 0L6635 0L6637 0L6638 0L6640 0L6641 0L6642 0L6645 0L6646 0L6647 0L6648 0L6650 0L6655 0L6660 0L6665 0L6670 0L6672 0L6675 0L6676 0L6677 0L6680 0L6682 0L6684 0L6686 0L6687 0L6688 0L6689 0L6690 0L6691 0L6692 0L6693 0L6694 0L6695 0L6696 0L6697 0L6698 0L6703 0L6704 0L6706 0L6707 0L6708 0L6709 0

Page 198 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L6711 0L6712 0L6713 0L6714 0L6715 0L6721 0L6722 0L6805 0L6810 0L6880 0L6881 0L6882 0L6883 0L6884 0L6885 0L6890 0L6895 0L6900 0L6905 0L6910 0L6915 0L6920 0L6925 0L6930 0L6935 0L6940 0L6945 0L6950 0L6955 0L6960 0L6965 0L6970 0L6975 0L7007 0L7008 0L7009 0L7040 0L7045 0L7170 0L7180 0L7181 0L7185 0L7186 0L7190 0L7191 0L7260 0L7261 0L7360 0L7362 0

Page 199 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L7364 0L7366 0L7367 0L7368 0L7400 0L7401 0L7402 0L7403 0L7404 0L7405 0L7900 0L7902 0L8000 0L8001 0L8002 0L8015 0L8020 0L8030 0L8031 0L8032 0L8035 0L8039 0L8040 0L8041 0L8042 0L8043 0L8044 0L8045 0L8046 0L8047 0L8048 1L8049 0L8300 0L8310 0L8320 0L8330 0L8400 0L8410 0L8415 0L8417 0L8420 0L8430 0L8435 0L8440 0L8460 0L8465 0L8470 0L8480 0L8485 0

Page 200 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

L8500 0L8501 0L8507 0L8509 1L8510 0L8511 1L8514 1L8515 1L8600 2L8604 3L8606 5L8609 1L8610 2L8612 2L8613 2L8614 2L8615 2L8616 2L8617 2L8618 2L8619 2L8621 600L8622 2L8627 2L8628 2L8629 2L8631 4L8641 4L8642 2L8658 4L8659 4L8670 4L8679 3L8681 1L8682 2L8683 1L8684 1L8685 1L8686 2L8687 1L8688 1L8689 1L8690 2L8691 1L8692 0L8693 1L8695 1M0064 1P2028 1

Page 201 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

P2029 1P2033 1P2038 1P3000 1P3001 1P9041 5P9043 5P9045 20P9046 25P9047 20P9048 1P9612 1P9615 1Q0035 1Q0091 1Q0111 2Q0112 3Q0113 2Q0114 1Q0115 1Q0144 0Q0478 1Q0479 1Q0480 1Q0481 1Q0482 1Q0483 1Q0484 1Q0485 1Q0486 1Q0487 1Q0488 1Q0489 1Q0490 1Q0491 1Q0492 1Q0493 1Q0494 1Q0495 1Q0497 2Q0498 1Q0499 1Q0501 1Q0502 1Q0503 3Q0504 1Q0507 1Q0508 1Q0509 1

Page 202 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

Q0510 0Q0511 0Q0512 0Q0513 0Q0514 0Q1004 2Q1005 2Q2004 1Q2028 1470Q2034 1Q2035 1Q2036 1Q2037 1Q2038 1Q2039 1Q2043 1Q2050 14Q2052 1Q3014 1Q4001 1Q4002 1Q4003 2Q4004 2Q4025 1Q4026 1Q4027 1Q4028 1Q4074 3Q4105 250Q4108 250Q4110 250Q4115 240Q4122 96Q4123 160Q4124 210Q4125 28Q4128 128Q4129 81Q4130 100Q4131 49Q4132 50Q4133 113Q4134 160Q9955 10R0070 2R0075 2V2020 0V2100 0V2101 0

Page 203 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

V2102 0V2103 0V2104 0V2105 0V2106 0V2107 0V2108 0V2109 0V2110 0V2111 0V2112 0V2113 0V2114 0V2115 0V2118 0V2121 0V2199 2V2200 0V2201 0V2202 0V2203 0V2204 0V2205 0V2206 0V2207 0V2208 0V2209 0V2210 0V2211 0V2212 0V2213 0V2214 0V2215 0V2218 0V2219 0V2220 0V2221 0V2299 0V2300 0V2301 0V2302 0V2303 0V2304 0V2305 0V2306 0V2307 0V2308 0V2309 0V2310 0

Page 204 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

V2311 0V2312 0V2313 0V2314 0V2315 0V2318 0V2319 0V2320 0V2321 0V2399 0V2410 0V2430 0V2499 2V2500 0V2501 0V2502 0V2503 0V2510 0V2511 0V2512 0V2513 0V2520 2V2521 2V2522 2V2523 2V2530 0V2531 0V2599 2V2600 0V2610 0V2615 0V2623 0V2624 0V2625 0V2626 0V2627 0V2628 0V2629 0V2630 2V2631 2V2632 2V2700 0V2710 0V2715 0V2718 0V2730 0V2744 0V2745 0V2750 0

Page 205 of 206

Practitioner Services MUEHCPCS/CPT Code Practitioner Services MUE Values

V2755 0V2761 0V2770 0V2780 0V2781 0V2782 0V2783 0V2784 0V2785 2V2790 1V2797 0V5008 0V5010 0V5011 0V5274 0V5281 0V5282 0V5284 0V5285 0V5286 0V5287 0V5288 0V5289 0

Page 206 of 206