October 1997 Bulletin

1997-1998 Medicare payment changes for top 100 orthopaedic procedures


1997-1998 percentage change
CPT DESCRIPTOR due only to global work increase due only to PE 100% cap due only to single CF=$36.39 Total change = global increase + PE decrease + single CF
11044 Debridement; skin, subcutaneous tissue, muscle, and bone 14.0% n/a -10.4% 2.1%
20550 Injection, tendon sheath, ligament, trigger points or ganglion cyst n/a n/a 8.4% 8.4%
20600 Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst (eg, fingers, toes) n/a n/a -10.4% -10.4%
20605 Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa) n/a n/a -10.4% -10.4%
20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) n/a n/a 8.4% 8.4%
20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 1.4% n/a -10.4% -9.2%
20902 Bone graft, any donor area; major or large 6.5% n/a -10.4% -4.6%
20931 Allograft for spine surgery only; structural n/a n/a -10.4% -10.4%
22310 Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing 14.8% n/a -10.4% 2.8%
22554 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2 3.4 n/a -10.4% -7.4%
22558 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); lumbar 2.4% n/a -10.4% -8.3%
22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique) 1.8% n/a -10.4% -8.8%
22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) n/a n/a -10.4% -10.4%
22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminal wires); 3 to 6 vertebral segments n/a n/a -10.4% -10.4%
22845 Anterior instrumentation; 2 to 3 vertebral segments n/a n/a -10.4% -10.4%
23120 Claviculectomy; partial 3.8% n/a -10.4% -7.0%
23130 Acromioplasty or acromionectomy, partial 2.9% n/a -10.4% -7.8%
23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff); acute 2.2% n/a -10.4% -8.4%
23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff); chronic 2.2% n/a -10.4% -8.5%
23415 Coracoacromial ligament release, with or without acromioplasty 3.0% n/a -10.4% -7.8%
23420 Repair of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) 2.4% -0.2% -10.4% -8.5%
23470 Arthroplasty with proximal humeral implant (eg, Neer type operation) 2.9% n/a -10.4% -7.8%
23472 Arthroplasty with glenoid and proximal humeral replacement (eg, total shoulder) 2.0% -4.8% -10.4% -12.9%
23600 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation 3.0% n/a -10.4% -7.8%
23605 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction 3.1% n/a -10.4% -7.7%
23615 Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or without internal or external fixation, with or without repair of tuberosity(-ies); 4.6% -2.2% -10.4% -8.1%
23616 Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or without internal or external fixation, with or without repair of tuberosity(-ies); with proximal humeral prosthetic replacement 3.0% n/a -10.4% -7.7%
24516 Open treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws 3.3% n/a -10.4% -7.5%
24685 Open treatment of ulnar fracture proximal end (olecranon process), with or without internal or external fixation 2.5 n/a -10.4% -8.2%
25447 Interposition arthroplasty, intercarpal or carpometacarpal joints 2.4% n/a -10.4 -8.3%
25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation 2.6% n/a -10.4% -8.1%
25605 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid; with manipulation 4.5% n/a -10.4% -6.4%
25611 Percutaneous skeletal fixation of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid, requiring manipulation, with or without external fixation 4.7% n/a -10.4% -6.2%
25620 Open treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid, with or without internal or external fixation 2.4% n/a -10.4% -8.3%
26055 Tendon sheath incision (eg, for trigger finger) 2.0% n/a -10.4% -8.6%
26121 Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft) 1.1% -6.0% -10.4% -14.9%
26123 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); 3.4% n/a -10.4% -7.4%
26531 Arthroplasty, metacarpophalangeal joint; with prosthetic implant, single, each 2.2% n/a -10.4% -8.4%
27091 Removal of hip prosthesis; complicated, including total hip and methylmethacrylate, when applicable 3.8% n/a -10.4% -7.0%
27125 Partial hip replacement, prosthesis (eg, femoral stem prosthesis, bipolar arthroplasty) 4.5% -2.3% -10.4% -8.5%
27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip replacement), with or without autograft or allograft 3.1% -3.8% -10.4% -11.1%
27132 Conversion of previous hip surgery to total hip replacement, with or without autograft or allograft 3.4% -3.4% -10.4% -10.3%
27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 2.4% -0.1% -10.4% -8.4%
27137 Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft 2.4% -1.3% -10.4% -9.4%
27138 Revision of total hip arthroplasty; femoral component only, with or without allograft 2.3% n/a -10.4% -8.3%
27193 Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation 12.4% n/a -10.4% 0.6%
27235 Percutaneous skeletal fixation of femoral fracture, proximal end, neck, undisplaced, mildly displaced, or impacted fracture 4.1% -2.6% -10.4% -9.1%
27236 Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement (direct fracture exposure) 4.3% n/a -10.4% -6.6%
27244 Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage 4.8% n/a -10.4% -6.2%
27245 Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage 4.2% n/a -10.4% -6.6%
27252 Closed treatment of hip dislocation, traumatic; requiring anesthesia 6.3% n/a -10.4% -4.7%
27266 Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia 4.4% n/a -10.4% -6.5%
27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 2.1% -4.8% -10.4% -12.8%
27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee replacement) 3.6% -3.2% -10.4% -10.0%
27486 Revision of total knee arthroplasty, with or without allograft; one component 2.9% -0.2% -10.4% -8.0%
27487 Revision of total knee arthroplasty, with or without allograft; all components 2.2% n/a -10.4% -8.5%
27488 Removal of knee prosthesis, including total knee, methylmethacrylate and insertion of spacer, when applicable 3.8% n/a -10.4% -7.0%
27506 Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws 4.4% n/a -10.4% -6.5%
27507 Open treatment of femoral shaft fracture with plate/screws, with or without cerclage 3.6% -2.0% -10.4% -9.0%
27511 Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, with or without internal or external fixation 3.7% -3.2% -10.4% -10.0%
27513 Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, with or without internal or external fixation 3.2% n/a -10.4% -7.5%
27514 Open treatment of femoral fracture, distal end, medial or lateral condyle, with or without internal or external fixation 3.9% n/a -10.4% -7.0%
27520 Closed treatment of patellar fracture, without manipulation 2.9% n/a -10.4% -7.8%
27524 Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair 2.9% n/a -10.4% -7.8%
27530 Closed treatment of tibial fracture, proximal (plateau); without manipulation 4.8% n/a -10.4% -3.5%
27535 Open treatment of tibial fracture, proximal (plateau); unicondylar, with or without internal or external fixation 4.8% n/a -10.4% -6.2%
27590 Amputation, thigh, through femur, any level; 8.5% n/a -10.4% -2.9%
27752 Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction 6.1% n/a -10.4% -4.9%
27759 Open treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage 4.1% n/a -10.4% -6.8%
27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation 3.2% n/a -10.4 -7.5%
27792 Open treatment of distal fibular fracture (lateral malleolus), with or without internal or external fixation 4.0% n/a -10.4% -6.9%
27814 Open treatment of bimalleolar ankle fracture, with or without internal or external fixation 3.8% n/a -10.4% -7.1%
27822 Open treatment of trimalleolar ankle fracture, with or without internal or external fixation, medial and/or lateral malleolus; without fixation of posterior lip 3.9% -2.9% -10.4% -9.6%
27870 Arthrodesis, ankle, any method 3.2% n/a -10.4% -7.6%
27880 Amputation, leg, through tibia and fibula; 5.6% n/a -10.4% -5.4%
28285 Hammertoe operation, one toe (eg, interphalangeal fusion, filleting, phalangectomy) 2.0% n/a -10.4% -8.7%
28292 Hallux valgus (bunion) correction, with or without sesamoidectomy; Keller, McBride, or Mayo type procedure 5.7% n/a -10.4% -5.3%
28296 Hallux valgus (bunion) correction, with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures) 2.7% n/a -10.4% -8.1%
28470 Closed treatment of metatarsal fracture; without manipulation, each 6.1% n/a -10.4% -5.0%
29075 Application; elbow to finger (short arm) n/a n/a -10.4% -10.4%
29405 Application of short leg cast (below knee to toes); n/a n/a -10.4% -10.4%
29425 Application of short leg cast (below knee to toes); walking or ambulatory type n/a n/a -10.4% -10.4%
29823 Arthroscopy, shoulder, surgical; debridement, extensive 1.5% -5.3% -10.4% -13.8%
29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release 1.3% -5.6% -10.4% -14.3%
29876 Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (eg, medial or lateral) 2.1% -4.7% -10.4% -12.7%
29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) 1.7% -5.3% -10.4% -13.6%
29879 Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling 2.1% -4.7% -10.4% -12.8%
29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) 2.0% -4.8% -10.4% -13.0%
29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) 1.6% -5.3% -10.4% -13.8%
62289 Injection of substance other than anesthetic, antispasmodic, contrast, or neurolytic solutions; lumbar or caudal epidural (separate procedure) n/a n/a 8.4% 8.4%
63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis 3.0 -2.7% -10.4% -10.1%
63017 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), more than 2 vertebral segments; lumbar 2.7% -7.0% -10.4% -14.4%
63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar 3.1% -7.8% -10.4% -14.7%
63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, re-exploration; lumbar 2.1% -6.7% -10.4% -14.5%
63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; lumbar 3.0% -0.8% -10.4% -8.4%
63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; each additional segment, cervical, n/a -6.9% -10.4% -16.6%
63075 Diskectomy, anterior, with decompression of spinal cord and/ or nerve root(s), including osteophytectomy; cervical, single interspace 2.3% n/a -10.4% -8.4%
63081 Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment 3.1% -0.3% -10.4% -7.9%
64718 Neuroplasty and/or transposition; ulnar nerve at elbow 3.8% -1.0% -10.4% -7.9%
64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 3.1% -1.9% -10.4% -9.3%

CPT codes and descriptors are copyright American Medical Association


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