Wyoming - Noridian

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Wyoming - Noridian
Jurisdiction F Medicare Ambulatory Surgical Center (ASC) Fee Updates
View ASC Fee Schedule Updates below.

July 2016 Updates per CMS CR 9668
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

CBSA 53 – Rural Wyoming
CBSA 16220 – Casper, WY; Natrona County, WY
CBSA 16940 – Cheyenne, WY; Laramie County, WY
CPT codes, descriptors and other data are copyright 2015 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply.
.©
Noridian Healthcare Solutions, LLC
Page | 1
Jurisdiction F Medicare Ambulatory Surgical Center (ASC) Fee Updates
July - For Dates of Service on/after 7/1/16 and processed on/after 7/5/16
CBSA 53:
HCPCS /
CPT Code
HCPCS
Modifier
Procedure
Indicator
Amount
FC HCPCS
Modifier
Amount
FB HCPCS
Modifier
Amount
Penalty
Price
FC Mod
Penalty
Price
FB Mod
Penalty
Price
0438T
S
$1,200.59
$0.00
$0.00
$1,176.64
$0.00
$0.00
0440T
S
$745.22
$0.00
$0.00
$730.35
$0.00
$0.00
0441T
S
$745.22
$0.00
$0.00
$730.35
$0.00
$0.00
0442T
S
$745.22
$0.00
$0.00
$730.35
$0.00
$0.00
0443T
S
$806.15
$0.00
$0.00
$790.06
$0.00
$0.00
FC HCPCS
Modifier
Amount
FB HCPCS
Modifier
Amount
CBSA 16220:
HCPCS /
CPT Code
HCPCS
Modifier
Procedure
Indicator
Amount
Penalty
Price
FC Mod
Penalty
Price
FB Mod
Penalty
Price
0438T
S
$1,259.42
$0.00
$0.00
$1,234.31
$0.00
$0.00
0440T
S
$781.74
$0.00
$0.00
$766.15
$0.00
$0.00
0441T
S
$781.74
$0.00
$0.00
$766.15
$0.00
$0.00
0442T
S
$781.74
$0.00
$0.00
$766.15
$0.00
$0.00
0443T
S
$845.66
$0.00
$0.00
$828.78
$0.00
$0.00
FC HCPCS
Modifier
Amount
FB HCPCS
Modifier
Amount
CBSA 16940:
HCPCS /
CPT Code
HCPCS
Modifier
Procedure
Indicator
Amount
Penalty
Price
FC Mod
Penalty
Price
FB Mod
Penalty
Price
0438T
S
$1,232.83
$0.00
$0.00
$1,208.24
$0.00
$0.00
0440T
S
$765.23
$0.00
$0.00
$749.97
$0.00
$0.00
0441T
S
$765.23
$0.00
$0.00
$749.97
$0.00
$0.00
0442T
S
$765.23
$0.00
$0.00
$749.97
$0.00
$0.00
0443T
S
$827.80
$0.00
$0.00
$811.28
$0.00
$0.00
CPT codes, descriptors and other data are copyright 2015 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply.
.©
Noridian Healthcare Solutions, LLC
Page | 2

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