Subpart 1. No facility fee. Procedures whose codes are listed in subpart 2b are predominantly performed in office settings and, therefore, no additional facility fees are payable when the procedure is performed by the employee's treating health care provider, unless it is an emergency or medically necessary to perform the procedure in a nonoffice setting or after normal office hours. This part does not preclude payment of a facility fee where the employee is treated by emergency room or urgent care staff.
Subp. 1a. Payment of facility fee. Except where the facility fee is precluded from payment in subpart 1, fees for ambulatory surgical center and hospital outpatient surgical center are paid in accordance with part 5221.0500, subpart 2.
A. Services and supplies included in facility fee. The services in subitems (1) to (8) are included in the facility fee. There may be no separate payment for these services and supplies:
(1) nursing, technician, and related services;
(2) use of the facilities where the surgical procedures are performed;
(3) drugs, biologicals, surgical dressings, supplies, splints, casts, appliances, and equipment directly related to the provision of surgical procedures;
(4) diagnostic or therapeutic services or items directly related to the provision of a surgical procedure;
(5) administrative, recordkeeping, and housekeeping items and services;
(6) materials for anesthesia;
(7) intraocular lenses (IOLs); and
(8) supervision of the services of an anesthetist by the operating surgeon.
B. Services and supplies in subitems (1) to (7) are paid separately from the facility fee:
(1) physician services;
(2) laboratory, X-ray, or diagnostic procedures, other than those directly related to performance of the surgical procedure;
(3) prosthetic devices, except IOLs;
(4) ambulance services;
(5) leg, arm, back, and neck braces and artificial limbs;
(6) durable medical equipment for use in the patient's home or take-home supplies; and
(7) anesthetist services.
Subp. 2b. Procedure codes subject to limitation.
10040 Acne surgery 10060 Drainage of skin abscess 10061 Drainage of skin abscess 10080 Drainage of pilonidal cyst 10081 Drainage of pilonidal cyst 10120 Remove foreign body 10121 Remove foreign body 10140 Drainage of hematoma/fluid 10160 Puncture drainage of lesion 11000 Surgical cleansing of skin 11001 Additional cleansing of skin 11040 Surgical cleansing, abrasion 11041 Surgical cleansing of skin 11050 Trim skin lesion 11051 Trim 2 to 4 skin lesions 11052 Trim over 4 skin lesions 11100 Biopsy of skin lesion 11101 Biopsy, each added lesion 11200 Removal of skin tags 11201 Removal of added skin tags 11300 Shave skin lesion 11301 Shave skin lesion 11302 Shave skin lesion 11303 Shave skin lesion 11305 Shave skin lesion 11306 Shave skin lesion 11307 Shave skin lesion 11308 Shave skin lesion 11310 Shave skin lesion 11311 Shave skin lesion 11312 Shave skin lesion 11313 Shave skin lesion 11400 Removal of skin lesion 11401 Removal of skin lesion 11402 Removal of skin lesion 11403 Removal of skin lesion 11420 Removal of skin lesion 11421 Removal of skin lesion 11422 Removal of skin lesion 11423 Removal of skin lesion 11440 Removal of skin lesion 11441 Removal of skin lesion 11442 Removal of skin lesion 11443 Removal of skin lesion 11600 Removal of skin lesion 11601 Removal of skin lesion 11602 Removal of skin lesion 11603 Removal of skin lesion 11620 Removal of skin lesion 11621 Removal of skin lesion 11622 Removal of skin lesion 11623 Removal of skin lesion 11640 Removal of skin lesion 11641 Removal of skin lesion 11642 Removal of skin lesion 11643 Removal of skin lesion 11730 Removal of nail plate 11731 Removal of second nail plate 11732 Removal of additional nail plate 11740 Drain blood from under nail 11750 Removal of nail bed 11752 Removal of nail bed/finger tip 11760 Reconstruction of nail bed 11762 Reconstruction of nail bed 11765 Excision of nail fold, toe 11900 Injection into skin lesions 11901 Added skin lesion injections 12031 Layer closure of wound(s) 12032 Layer closure of wound(s) 12041 Layer closure of wound(s) 12042 Layer closure of wound(s) 12051 Layer closure of wound(s) 12052 Layer closure of wound(s) 15780 Abrasion treatment of skin 15781 Abrasion treatment of skin 15782 Abrasion treatment of skin 15783 Abrasion treatment of skin 15786 Abrasion treatment of lesion 15787 Abrasion, added skin lesions 15851 Removal of sutures 15852 Dressing change, not for burn 16000 Initial treatment of burn(s) 16010 Treatment of burn(s) 16020 Treatment of burn(s) 16025 Treatment of burn(s) 17000 Destroy benign/premal lesion 17001 Destruction of additional lesions 17002 Destruction of additional lesions 17010 Destruction of skin lesion(s) 17100 Destruction of skin lesion 17101 Destruction of second lesion 17102 Destruction of additional lesions 17104 Destruction of skin lesions 17105 Destruction of skin lesions 17106 Destruction of skin lesions 17107 Destruction of skin lesions 17110 Destruction of skin lesions 17200 Electrocautery of skin tags 17201 Electrocautery added lesions 17250 Chemical cautery, tissue 17260 Destruction of skin lesions 17261 Destruction of skin lesions 17262 Destruction of skin lesions 17263 Destruction of skin lesions 17264 Destruction of skin lesions 17266 Destruction of skin lesions 17270 Destruction of skin lesions 17271 Destruction of skin lesions 17272 Destruction of skin lesions 17273 Destruction of skin lesions 17274 Destruction of skin lesions 17276 Destruction of skin lesions 17280 Destruction of skin lesions 17281 Destruction of skin lesions 17282 Destruction of skin lesions 17283 Destruction of skin lesions 17284 Destruction of skin lesions 17286 Destruction of skin lesions 17304 Chemosurgery of skin lesion 17305 Second stage chemosurgery 17306 Third stage chemotherapy 17307 Follow-up skin lesion therapy 17310 Extensive skin chemosurgery 17340 Cryotherapy of skin 17360 Skin peel therapy 19000 Drainage of breast lesion 17001 Drain added breast lesion 20000 Incision of abscess 20500 Injection of sinus tract 20520 Removal of foreign body 20550 Inject tendon/ligament/cyst 20600 Drain/inject joint/bursa 20605 Drain/inject joint/bursa 20610 Drain/inject joint/bursa 20615 Treatment of bone cyst 20974 Electrical bone stimulation 21029 Contour of face bone lesion 21030 Removal of face bone lesion 21031 Remove exostosis, mandible 21032 Remove exostosis, maxilla 21079 Prepare face/oral prosthesis 21080 Prepare face/oral prosthesis 21081 Prepare face/oral prosthesis 21082 Prepare face/oral prosthesis 21083 Prepare face/oral prosthesis 21084 Prepare face/oral prosthesis 21085 Prepare face/oral prosthesis 21086 Prepare face/oral prosthesis 21087 Prepare face/oral prosthesis 21088 Prepare face/oral prosthesis 21089 Prepare face/oral prosthesis 21110 Interdental fixation 23031 Drain shoulder bursa 24200 Removal of arm foreign body 24650 Treat radius fracture 25500 Treat fracture of radius Back to rule page | Page two (next) | Page three | Page four