Minnesota Administrative Rules

2740.9919 TABLE OF SURGICAL FACTORS TO DEVELOP SURG VALUE.

CPT4 Code	Surgical Factor		Description
SKIN
10060	.7710		Abscess, incision, and drainage, simple
11400	2.0161		Benign lesion removal of (up to 0.5 cm.)
11750	.4368		Nail, permanent removal of
12011	1.9732		Simple wound, simple repair (up to 2.5 cm.)
17100	4.6520		Benign skin lesion, destruction of
MUSCULOSKELETAL
20610	1.9226		Major joint or bursa, injection or aspiration of
27130	.1565		Total hip joint replacement, simple
29425	1.0286		Application walking cast
CARDIOVASCULAR
33512	.1111		Coronary bypass, three arteries
93547	.2166		Left heart catheterization with coronary angiogram
DIGESTIVE SYSTEM
43235	.4514		Gastroscopy, diagnostic
43844	.0569		Stomach bypass for morbid obesity
44950	.2618		Appendectomy
45300	2.7170		Proctosigmoidoscopy, diagnostic
47600	.3765		Gallbladder, removal of
49505	.3086		Inguinal hernia repair, unilateral
URINARY SYSTEM
52601	.1579		Prostate resection (TUR), complete
53670	3.5273		Urinary bladder catheterization
MALE GENITAL
54150	.8509		Circumcision by clamp, newborn
FEMALE GENITAL
58120	.8470		Uterus, dilation and curettage (D & C), nonobstetrical
58150	.4792		Uterus, removal of
58980	.9455		Laparoscopy, diagnostic
NERVOUS SYSTEM
63030	.0694		Laminotomy herniated disc, lumbar
64721	.1988		Carpal tunnel syndrome repair
EYE
66980	.2003		Cataract removal, intraocular lens insertion
EAR
69437	.3934		Tympanostomy with ventilating tube insertion

Statutory Authority:

MS s 62E.09

History:

10 SR 474

Published Electronically:

September 18, 2013