43258 CPT Code

CPT^® Medical Code:

Code:	43258
Descr:	CPT codes and descriptions are copyright AMA - subscribe to FindACode.com to view more code information.

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.

Next Code:	43259 CPT Code
Codes In Group:	CPT Code Group: 43
Code Groups:	CPT Medical Codes
Prior Code:	43257 CPT Code

CPT^® Code Context

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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.

Facility   (Hospital, etc.)

Medicare vs. My Fee Evaluation Modifier Medicare Allowed 150% 200% My Fee (none) $270.65 $405.97 $541.29 (your fee) Note:  Subscribers will see the calculated values below. ChiroCode Premium Support subscribers: Sign In to your account to see this information. Or Subscribe to ChiroCode Premium Support 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) $##.## $##.## $##.## $##.##

Non-Facility   (Office, etc.)

Medicare vs. My Fee Evaluation Modifier Medicare Allowed 150% 200% My Fee (none) $270.65 $405.97 $541.29 (your fee) Note:  Subscribers will see the calculated values below. ChiroCode Premium Support subscribers: Sign In to your account to see this information. Or Subscribe to ChiroCode Premium Support 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) $##.## $##.## $##.## $##.##

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.

Facility 7.34  (Hospital, etc.)

RVU Components (by modifier) Modifier Work Practice Expense Malpractice Expense Total (none) 4.54 2.3 0.5 7.34 Note:  Subscribers will see the calculated values below. ChiroCode Premium Support subscribers: Sign In to your account to see this information. Or Subscribe to ChiroCode Premium Support today for instant access to all the coding information you need.  Practitioner Work Component: 4.54 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) ##.## ##.## 4.54  Practice Expense: 2.3 Clinical Labor - Direct Expense Staff Staff Rate Pre Time Intra Time Post Time Total Time* 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 NO EQUIPMENT $##.##   ## years ## min Supplies - Direct Expense Item Unit Price Quantity Unit Amount NO SUPPLIES $##.##   ## na $##.##  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) ##.## ##.## 2.3  Malpractice Component: 0.5 MP RVU Components (by modifier) Modifier National Unadjusted MP RVU MP GPCI Adjusted MP RVU (none) ##.## ##.## 0.5

Non-Facility 7.34  (Office, etc.)

RVU Components (by modifier) Modifier Work Practice Expense Malpractice Expense Total (none) 4.54 2.3 0.5 7.34 Note:  Subscribers will see the calculated values below. ChiroCode Premium Support subscribers: Sign In to your account to see this information. Or Subscribe to ChiroCode Premium Support today for instant access to all the coding information you need.  Practitioner Work Component: 4.54 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) ##.## ##.## 4.54  Practice Expense: 2.3 Clinical Labor (Non-Facility) - Direct Expense Staff Staff Rate Pre Time Intra Time Post Time Total Time* 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 NO EQUIPMENT $##.##   ## years ## min Supplies (Non-Facility) - Direct Expense Item Unit Price Quantity Unit Amount NO SUPPLIES $##.##   ## na $##.##  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) ##.## ##.## 2.3  Malpractice Component: 0.5 MP RVU Components (by modifier) Modifier National Unadjusted MP RVU MP GPCI Adjusted MP RVU (none) ##.## ##.## 0.5

Subscribers may see Crosswalks here for Local Coverage Determinations (LCDs) or Ambulatory Patient Classifications (APCs) with information on covered diagnosis and procedure 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.

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