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Summary
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43118 CPT Code
CPT® Medical Code:
There may also be notes and more information about this code. For full information about this CPT code (fees, RVUs, NCCI edits, alerts, tips, crosswalks, LMPR, LCD, NCD) subscribe to FindACode.com.
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Chapter/Section Guidelines & Notes
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CPT® Code Context
CPT Context information is available to subscribers and includes, CPT context information (chapter, sub-chapter and section notes), guidelines and more. CPT code information is copyright by the AMA. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need.
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Description:

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43118 - CPT Code
CPT Code information is available to subscribers and includes, CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA.
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My Notes
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Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need.
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Coding Tips
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Subscribers will see the tips about using this code for billing and reimbursement. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need.
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Fees
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Calculated for National Unadjusted (00000)
*
Note: Medicare may or may NOT reimburse you for this code.
The fees provided below are based on values established by CMS/Medicare.
Please check with your local Medicare contact on whether this code is eligible for reimbursement.
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Facility (Hospital, etc.)
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Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|
| (none) | $3,614.96 | $5,422.43 | $7,229.91 | (your fee) |
Note: Subscribers will see the calculated values below. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need. Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays | |
| (none) | $##.## | $##.## | $##.## | |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed @ 95% | Medicare 80% Reimbursement | Patient Pays | Limiting Charge (Amount Billed) |
| (none) | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed @ 95% | Medicare 80% Reimbursement | Patient Pays | Limiting Charge (Amount Billed) |
| (none) | $##.## | $##.## | $##.## | $##.## |
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Non-Facility (Office, etc.)
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Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|
| (none) | $3,614.96 | $5,422.43 | $7,229.91 | (your fee) |
Note: Subscribers will see the calculated values below. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need. Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays | |
| (none) | $##.## | $##.## | $##.## | |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed @ 95% | Medicare 80% Reimbursement | Patient Pays | Limiting Charge (Amount Billed) |
| (none) | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed @ 95% | Medicare 80% Reimbursement | Patient Pays | Limiting Charge (Amount Billed) |
| (none) | $##.## | $##.## | $##.## | $##.## |
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Relative Value Units
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Calculated for National Unadjusted (00000)
*
Note: Medicare may or may NOT reimburse you for this code.
The fees provided below are based on values established by CMS/Medicare.
Please check with your local Medicare contact on whether this code is eligible for reimbursement.
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Facility 100.18 (Hospital, etc.)
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RVU Components (by modifier)
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
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| (none) | 67.07 | 22.77 | 10.34 | 100.18 |
Note: Subscribers will see the calculated values below. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need.
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Practitioner Work Component: 67.07
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Practitioner Labor
| Pre-Service | Intra-Service | Post-Service | Total Time* |
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| ## | ## | ## | ## min | * Total Time may be greater than the displayed components.
Work RVU Components (by modifier)
| Modifier | National Unadjusted Work RVU |
Work GPCI |
Adjusted Work RVU |
| (none) | ##.## | ##.## | 67.07 |
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Practice Expense: 22.77
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Clinical Labor - Direct Expense
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time* |
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| RN/LPN/MTA | $0.37 / min | ## min | ## min | ## min | ## min | * Total Time may be greater than the displayed components.
Equipment - Direct Expense
| Item | Purchase Price | Expected Life | Total Time |
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| table, exam | $##.## | ## years | ## min | | light, exam | $##.## | ## years | ## min |
Supplies - Direct Expense
| Item | Unit Price | Quantity | Unit | Amount |
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| pack, post-op incision care (suture & staple) | $##.## | ## | pack | $##.## | | pack, minimum multi-specialty visit | $##.## | ## | pack | $##.## |
Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.
PE RVU Components (by modifier)
| Modifier | National Unadjusted PE RVU |
PE GPCI |
Adjusted PE RVU |
| (none) | ##.## | ##.## | 22.77 |
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Malpractice Component: 10.34
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MP RVU Components (by modifier)
| Modifier | National Unadjusted MP RVU |
MP GPCI |
Adjusted MP RVU |
| (none) | ##.## | ##.## | 10.34 |
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Non-Facility 100.18 (Office, etc.)
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RVU Components (by modifier)
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|
| (none) | 67.07 | 22.77 | 10.34 | 100.18 |
Note: Subscribers will see the calculated values below. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need.
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Practitioner Work Component: 67.07
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Practitioner Labor
| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|
| ## | ## | ## | ## min | * Total Time may be greater than the displayed components.
Work RVU Components (by modifier)
| Modifier | National Unadjusted Work RVU |
Work GPCI |
Adjusted Work RVU |
| (none) | ##.## | ##.## | 67.07 |
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Practice Expense: 22.77
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Clinical Labor (Non-Facility) - Direct Expense
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time* |
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| RN/LPN/MTA | $0.37 / min | ## min | ## min | ## min | ## min | * Total Time may be greater than the displayed components.
Equipment (Non-Facility) - Direct Expense
| Item | Purchase Price | Expected Life | Total Time |
|---|
| table, exam | $##.## | ## years | ## min | | light, exam | $##.## | ## years | ## min |
Supplies (Non-Facility) - Direct Expense
| Item | Unit Price | Quantity | Unit | Amount |
|---|
| pack, post-op incision care (suture & staple) | $##.## | ## | pack | $##.## | | pack, minimum multi-specialty visit | $##.## | ## | pack | $##.## |
Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.
MP RVU Components (by modifier)
| Modifier | National Unadjusted PE RVU |
PE GPCI |
Adjusted PE RVU |
| (none) | ##.## | ##.## | 22.77 |
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Malpractice Component: 10.34
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MP RVU Components (by modifier)
| Modifier | National Unadjusted MP RVU |
MP GPCI |
Adjusted MP RVU |
| (none) | ##.## | ##.## | 10.34 |
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NCCI Edits
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Subscribers see the NCCI Edit codes for comprehensive, component and mutually exclusive codes. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need. |
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Policies & Guidelines
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Subscribers may see Crosswalks here for Local Coverage Determinations (LCDs) or Ambulatory Patient Classifications (APCs) with information on covered diagnosis and procedure codes. Find-A-Code subscribers: Sign In to your account to see this information. Or Subscribe to Find-A-Code today for instant access to all the coding information you need.
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What are CPT® Codes?
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The Current Procedural Terminology ® (CPT ®) code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
There are three types of CPT codes:
- Category I CPT Code(s)
- Category II CPT Code(s) – Performance Measurement
- Category III CPT Code(s) – Emerging Technology
CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the Health Care Procedure Coding System (HCPCS). The HCPCS code set also includes additional codes that begin with a letter. Those additional codes are used in conjunction with the CPT code set to identify other supplies (including DME - durable medical equipment) and procedures not currently listed in the CPT code set.
CPT is a registered trademark of the American Medical Association. Although the CPT system is mandated by the Centers for Medicare and Medicaid Services (CMS) and HIPAA, and the data for it appears in the Federal Register, the American Medical Association (AMA) maintains that their copyright of the CPT.
The above description is adapted from the Wikepdeia.org entry at http://en.wikipedia.org/wiki/Current_Procedural_Terminology.
For more information about the CPT code set subscribe to FindACode.com.
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