101 CMR 316.00 — Rates for Surgery and Anesthesia Services

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Section

316.01: General Provisions 316.02: General Definitions 316.03: General Rate Provisions 316.04: Maximum Allowable Fees - Anesthesia Services 316.05: Maximum Allowable Fees - Surgical Services 316.06: Severability

101 CMR 316.00 Rates for Surgery and Anesthesia Services

316.01 General Provisions

316.01: General Provisions

(1) Scope and Purpose. (a) 101 CMR 316.00 governs the payment rates used by all governmental units for surgery and anesthesia services provided to publicly aided patients. Rates for services provided to individuals covered by the Workers’ Compensation Act, M.G.L. c. 152, are not set forth in 101 CMR 316.00, but are at 114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Worker’s Compensation Act. (b) The following laboratory services have a professional and technical component: 83020, 84165, 84166, 84181, 84182, 85390, 85576, 86255, 86256, 86320, 86325, 86327, 86334, 86335, 87164, 87207, 88371, 88372, and 89060. Payment rates for the professional component are contained herein. Payment rates for the technical component for these codes are contained in 101 CMR 320.00: Rates for Clinical Laboratory Services.

(2) Applicable Dates of Service. Rates contained in 101 CMR 316.00 apply for dates of service on or after January 1, 2025, except as otherwise noted.

(3) Coverage. (a) Payment rates in 101 CMR 316.00 are used to pay for surgical and anesthesia services rendered to patients in a private medical office; freestanding ambulatory surgical center; licensed clinic, hospital, or other inpatient or outpatient facility or department; or other appropriate setting by an individual eligible provider, when an eligible provider bills for the medical services rendered and no other payment method applies. (b) The rates of payment under 101 CMR 316.00 are full compensation for patient care rendered to publicly aided patients as well as for any related administrative or supervisory duties in connection with patient care. The rates of payment also reimburse all overhead expenses associated with the service provided, without regard to where the care is rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 316.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 316.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided patients.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including but not limited to the American Medical Association’s Current Procedural Terminology (CPT).

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(a) The publication of such updates and corrections will list

codes for which the code numbers change, with the corresponding cross references between the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;
deleted codes for which there are no corresponding new codes; and
codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed. (b) For entirely new codes that require new pricing and have Medicare-assigned relative value units (RVUs) (or, for applicable services, Medicare rates), EOHHS may list these codes and price them according to the rate methodology used in setting physician rates. When Medicare RVUs (or, for applicable services, Medicare rates) are not available, EOHHS may apply individual consideration in reimbursing for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive provisions of 101 CMR 316.00. EOHHS may also issue administrative bulletins to clarify to which duly licensed or certified health care professionals or students the rate methods in 101 CMR 316.00 apply.

316.02 General Definitions

316.02: General Definitions

Meaning of Terms. The five-digit procedure codes and two-digit modifiers included in 101 CMR 316.00, and their corresponding descriptions, utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level I CPT-4 codes are obtained from the Physicians’ 2023 Current Procedural Terminology (CPT), copyright 2022, by the American Medical Association (AMA), unless otherwise specified. Level II codes are obtained from the 2023 HCPCS, maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other health care professionals, as well as associated nonphysician services. No fee schedules, basic unit value, relative value guides, conversion factors, or scales are included in any part of the Physicians’ Current Procedure Terminology. For code descriptions, see the anesthesia and surgery service code spreadsheets at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services. In addition, terms used in 101 CMR 316.00 have the meanings set forth in 101 CMR 316.02.

Accountable Care Organization (ACO). An entity that enters into a population-based payment model contract with EOHHS as an accountable care organization, wherein the entity is held financially accountable for the cost and quality of care for an attributed or enrolled member population. ACOs include Accountable Care Partnership Plans, Primary Care ACOs, and MCO-administered ACOs.

Eligible Provider. The rates established in 101 CMR 316.00 apply in accordance with 101 CMR 316.01 to the following types of providers who meet conditions of participation of the

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

governmental unit purchasing such services, and to the extent specified by such governmental unit. Eligible providers must provide such services in accordance with generally accepted professional standards and in accordance with state licensing requirements and certification by national credentialing bodies as required by law. (a) A licensed physician (other than an intern, resident, fellow, or house officer), licensed podiatrist, and licensed dentist. (b) A provider of radiation oncology services. Radiation oncology services may be rendered by eligible providers such as, but not limited to, independent radiation oncology centers. These eligible providers must be physically and financially independent of a hospital or a physician’s office. (c) A clinic licensed by the Massachusetts Department of Public Health in accordance with 105 CMR 140.000: Licensure of Clinics to provide surgical diagnostic services. (d) A freestanding birth center facility that is not operating under a hospital’s license, and is licensed as a birth center by the Massachusetts Department of Public Health pursuant to 105 CMR 140.000. (e) An advanced practice registered nurse who is authorized by the Board of Registration in Nursing to practice as a certified nurse practitioner, certified nurse midwife, clinical nurse specialist, psychiatric clinical nurse specialist, or a certified registered nurse anesthetist (CRNA). (f) A licensed physician assistant who is authorized by the Board of Registration for Physician Assistants to practice as a physician assistant.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Facility Setting Fee. Payments for services provided by an individual eligible provider in a hospital (including without limitation a hospital inpatient department, outpatient department, emergency department, and hospital licensed health center), or skilled nursing facility or freestanding ambulatory surgical center (ASC), will be made according to a facility setting fee when an applicable facility setting fee has been established for that procedure.

Global Delivery. Includes direct provision and supervision of case management, maternal education (including but not limited to nutrition, pregnancy and childbirth, and reproductive health), and obstetrical risk assessment and monitoring, in addition to pelvic or Cesarean-section delivery, all routine prenatal visits, and one postpartum visit.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (I.C.). Surgical procedures that are authorized but not listed in 101 CMR 316.00, surgical procedures performed in unusual circumstances, and services designated I.C. are individually considered items. The governmental unit or purchaser analyzes the eligible provider’s report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The governmental unit or purchaser determines appropriate payment for procedures designated I.C. in accordance with the following standards and criteria: (a) the amount of time required to perform the service; (b) the degree of skill required to perform the service;

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(c) the severity or complexity of the patient’s disease, disorder, or disability; (d) any applicable relative-value studies; (e) any complications or other circumstances that may be deemed relevant; (f) the policies, procedures and practices of other third party insurers; (g) the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs; and (h) a copy of the current invoice from the supplier.

Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two-digit number or letters to the procedure code.

Primary Care Clinician (PCC) Plan. A managed care option administered by the MassHealth agency through which enrolled members receive primary care and certain other medical services.

Publicly Aided Individual (or Publicly Aided Patient). A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Separate Procedure. Some of the listed procedures are commonly carried out as an integral part of a total service, and as such do not warrant a separate identification. When, however, such a procedure is performed independently of, and is not immediately related to, other services, it may be listed as a separate procedure in the procedure description. Thus, when a procedure that is ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be considered to be a separate procedure.

Surgical Team Fee. Reimbursement for highly complex surgical procedures requiring the expertise of several physicians (usually of different specialties) and other highly skilled, specially trained personnel. More than one surgeon may be performing parts of the procedure simultaneously. The unit fee is payable to the director of the surgical team and includes all assistant surgeon fees; there are no separate payments for assisting surgical services. The director of the surgical team is expected to distribute the unit fee to the members of the surgical team.

Unlisted Procedure or Service. A service or procedure that may be provided that is not listed in 101 CMR 316.05. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service.

316.03 General Rate Provisions

316.03: General Rate Provisions

(1) Rate Determination. Rates of payment for services for which 101 CMR 316.00 applies are the lowest of (a) the eligible provider's usual fee to patients other than publicly aided patients; (b) the eligible provider's actual charge submitted; or (c) the allowable fees in accordance with 101 CMR 316.04 (for anesthesia services), or the schedule of allowable fees set forth in 101 CMR 316.05 (for surgical services), as applicable,

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

and taking into account appropriate modifiers and any other applicable rate provision(s) in accordance with 101 CMR 316.03. (2) Supplemental Payment. (a) Eligibility. An eligible provider who is a physician, certified nurse practitioner, physician assistant, or CRNA is eligible for a supplemental payment for services to publicly aided individuals eligible under Titles XIX and XXI of the Social Security Act if the following conditions are met:

the eligible provider is employed by a nonprofit group practice that was established in accordance with St.1997 c.163 and is affiliated with a Commonwealth-owned medical school;
such nonprofit group practice must have been established on or before January 1, 2000, in order to support the purposes of a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school; and
the services are provided at a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school. (b) Payment Method. This supplemental payment may not exceed the difference between
payments to the eligible provider made pursuant to the rates applicable under 101 CMR 316.03(1), 101 CMR 317.03(1): Rate Determination, and 101 CMR 318.03(1): Rate Determination; and
the federal upper payment limit established by the Centers for Medicare & Medicaid Services.

(3) Rate Variations Based on Practice Site. Payments for certain services provided by individual eligible providers that can be routinely furnished in physicians’ offices are reduced when such services are furnished in facility settings. 101 CMR 316.05 establishes facility setting fees applied to services rendered in a facility when a practice site differential is warranted.

(4) Allowable Fee for Certain Eligible Providers. Payment for services provided by eligible providers who are certified nurse practitioners, clinical nurse specialists, psychiatric clinical nurse specialists, and physician assistants as specified in 101 CMR 316.02, is 85% of the fees contained in 101 CMR 316.05.

(5) Global Surgical Package. The payment for a surgical procedure includes a standard package of preoperative, intraoperative, and postoperative services. Reimbursement for these procedures includes payment for services related to the surgery when furnished by the eligible provider who performs the surgery. The services included in the global surgical package may be furnished in any setting, e.g., in hospitals, ASCs, physicians' offices. Included in the global fee are preoperative period of one day for major surgery and the postoperative period of 90 days for major surgery, as determined by the Centers for Medicare & Medicaid Services (CMS). The postoperative period for minor surgery is either 0 or 10 days depending on the procedure, as determined by CMS. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon.

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(6) Obstetrical Services. Obstetrical fees contained in 101 CMR 316.05 are intended to include only the procedure or procedures performed and care to the publicly aided patient while hospitalized with the exception of global delivery (59400, 59510, 59610, 59618). Outpatient antepartum and postpartum obstetrical care may be billed under the appropriate medical procedure code in accordance with 101 CMR 317.00: Rates for Medicine Services. Medical problems complicating labor and delivery management or medical complications of pregnancy may require additional resources or services and should be identified by utilizing the appropriate procedure codes in 101 CMR 317.00: Rates for Medicine Services in addition to the procedure codes for maternity care listed in 101 CMR 316.05.

(7) Casts and Appliances. All maximum allowable fees include the initial application of a cast, traction device, or similar appliance.

(8) CPT Category III Codes. All surgery-related CPT category III codes are included as a part of 101 CMR 316.00 and have an assigned fee of I.C.

(9) PCC Plan Enhanced Fee. Primary Care Clinicians (PCCs) receive an enhanced rate for certain types of primary and preventive care visits provided to their PCC Plan members enrolled with the PCC on the date of service. The enhanced fee specified in 101 CMR 353.03(A) is added to the rate for the procedure code billed. The MassHealth agency pays PCCs an enhanced fee for delivering primary care services in accordance with the terms of the PCC provider contract.

(10) Primary Care ACO-participating PCPs Enhanced Fee. Primary Care ACO-participating Primary Care Providers (participating PCPs) receive an enhanced rate for certain types of primary and preventive care visits provided to Primary Care ACO members enrolled with the participating PCP on the date of service. The enhanced fee specified in 101 CMR 353.03(B) is added to the rate for the procedure code billed. The MassHealth agency pays participating PCPs an enhanced fee for delivering primary care services in accordance with the terms of the participating PCP contract.

(11) Multiple Endoscopy Procedures. When multiple endoscopy procedures are performed through the same endoscope, payment is made for the endoscopy with the highest rate plus the difference between the next highest rate and the base endoscopy. When two related endoscopies and an unrelated endoscopy are performed, the special endoscopic payment rules apply to the related endoscopies. Unrelated endoscopic procedures are treated as a separate surgery and reimbursed using the payment rules for multiple surgery claims.

316.04 Maximum Allowable Fees - Anesthesia Services

316.04: Maximum Allowable Fees - Anesthesia Services

(1) Anesthesia Services. Anesthesia services may include but are not limited to general, regional, supplementation of local anesthesia, or other supportive services in order to afford the patient the anesthesia care deemed optimal by the anesthesiologist or CRNA during any procedure. These services include the usual preoperative and postoperative visits, the anesthesia care during the procedure, the administration of fluids, and/or blood incident to the anesthesia or surgery, and the usual monitoring procedures. Unusual forms of monitoring (e.g., intra-arterial, central venous, and Swan-Ganz) are not included.

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(2) Rate Determination. The administration of anesthesia is reported by the use of the anesthesia five-digit procedure code (00100-01999) listed in 101 CMR 316.05(4)(a) and modifiers applicable to anesthesia services listed in 101 CMR 316.04(7). Payment for anesthesia services is determined by a system of base anesthesia units and time anesthesia units. The total anesthesia reimbursement (the “Total Anesthesia Fee”) is the sum of the number of base anesthesia units multiplied by the base anesthesia unit fee, plus the number of time anesthesia units multiplied by the time anesthesia unit fee. Anesthesia time units are measured in minutes and one time anesthesia unit equals one minute. Payable anesthesia time starts when the anesthesiologist or CRNA begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist or CRNA is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.

(3) Maximum Unit Fee. The maximum allowable fee for anesthesia services under 101 CMR 316.00 is $19.90 per base anesthesia unit and $1.33 per one minute time anesthesia unit.

(4) Multiple Surgery Procedures. When anesthesia is administered for multiple surgery procedures, only the base anesthesia units for the procedure with the largest number of units is used for the base anesthesia unit portion of the Total Anesthesia Fee calculation.

(5) Personally Performed Anesthesia Services. Personally performed anesthesia services are anesthesia procedures that are personally performed alone by either an anesthesiologist or a CRNA. For a CRNA, personally performed anesthesia services are those that a CRNA performs alone without medical direction of an anesthesiologist. Payment for personally performed anesthesia services of an anesthesiologist, or for personally performed anesthesia services of a CRNA for which the governmental unit provides separate payment, may be claimed by appending the appropriate anesthesia modifier to the anesthesia procedure code. Payment for personally performed anesthesia services by an anesthesiologist, or by a CRNA, is 100% of the Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the personally performed anesthesia service is provided, governmental units may specify other payment rules for the CRNA’s services, including, without limitation, specifying that there is no separate payment for the CRNA’s services.

(6) Medical Direction of CRNA Anesthesia Services. Payment for an anesthesiologist’s medical direction of a CRNA, or for the services of a CRNA performed with medical direction of an anesthesiologist for which the governmental unit provides separate payment, may be claimed by appending the appropriate anesthesia modifier to the anesthesia procedure code. If an anesthesiologist provides medical direction of a CRNA, payment for the anesthesiologist’s services is 50% of the Total Anesthesia Fee. Payment for the CRNA’s services performed with medical direction of an anesthesiologist is 50% of the Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the anesthesia service is performed, governmental units may specify other payment rules for the CRNA’s services, including, without limitation, specifying that there is no separate payment for the CRNA’s services.

(7) Modifiers. For modifiers and related descriptions applicable to anesthesia services (AA, QK, QY, QX, and QZ), see 101 CMR 316.05(3).

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

316.05 Maximum Allowable Fees - Surgical Services

316.05: Maximum Allowable Fees - Surgical Services

(1) Surgical and Obstetrical Services. Except as provided elsewhere in this 101 CMR 316.05(1), the allowable fees for surgical and obstetrical services are the fees listed in 101 CMR 316.05(4)(b), subject to 101 CMR 316.03 and appropriate modifiers, as applicable. (Anesthesia procedure codes (00100-01999) and corresponding base anesthesia units for purposes of 101 CMR 316.04 are listed in 101 CMR 316.05(4)(a)). Certain codes in 101 CMR 316.05(4)(b) are identified with an asterisk (*). The allowable fees for these codes are as set forth in 101 CMR 316.05(4)(b), except when any of those codes are billed as part of a facial feminization surgery to treat gender dysphoria, in which case the allowable fees are those set forth in 101 CMR 316.05(4)(c).

(2) Unless otherwise specified, guidelines, notes, and definitions provided in the 2023 CPT Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as well as their corresponding descriptions. For code descriptions, see the anesthesia and surgery service code spreadsheets at www.mass.gov/regulations/101-CMR-31600-surgery-and- anesthesia-services.

(3) Modifiers. (a) 26: Professional Component. The component of a service or procedure representing the physician’s or other qualified health care professional’s work interpreting or performing the service or procedure. (When the physician or other qualified health care professional component is reported separately, the addition of modifier 26 to the procedure code will allow payment of the professional component allowable fee (PC Fee) contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable.) (b) 50: Bilateral Procedure. Payment for bilateral procedures performed at the same operative session must be identified by the appropriate service code and modifier 50. Only one claim line is billed for both procedures. (The addition of modifier 50 to the bilateral code will allow payment of 150% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible provider for performance of both bilateral procedures.) (c) 51: Multiple Procedures. This modifier must be used to report multiple procedures performed at the same session. The service code for the major procedure or service must be reported without a modifier. The secondary, additional, or lesser procedure(s) must be identified by adding modifier 51 to the end of the service code for the secondary procedure(s). (The addition of modifier 51 to the second and subsequent procedure codes allows payment of 50% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible provider. Note: This modifier should not be used with designated “add-on” codes or with codes in which the narrative begins with “each additional.”) (d) 52: Reduced Services. Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician's or other qualified health care professional’s election. Under these circumstances, the service provided can be identified by its usual procedure number and addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(e) 54: Surgical Care Only. When one eligible physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the appropriate procedure code. (This allows payment of 85% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the physician or other qualified health care professional performing the surgery.) (f) 55: Postoperative Management Only. When one eligible physician or other qualified health care professional performs the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the appropriate procedure code. (This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the physician or other qualified health care professional.) (g) 58: Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period. It may be necessary to indicate the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: for treatment of a problem that requires a return to the operating/procedure room (e.g., unanticipated clinical condition), see modifier 78. (h) 59: Distinct Procedural Service. To identify a procedure distinct or independent from other services performed on the same day, add modifier 59 to the end of the appropriate service code. Modifier 59 is used to identify services/procedures that are not normally reported together, but are appropriate under certain circumstances; for example, different site or organ system. However, when another already established modifier is appropriate, it should be used rather than modifier 59. (i) 62: Two Surgeons. When two eligible surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report their distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the procedure once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate codes(s) may also be reported with modifier 62 added.) (The addition of modifier 62 to the procedure code allows payment of 57.5% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to each surgeon. No separate payment will be made for assisting surgical services in these cases; it is included in the total surgical fee listed.) (j) 66: Surgical Team. This modifier must be used to identify highly complex procedures (requiring the concomitant services of several eligible physicians, often of different specialties, plus other highly skilled, specially trained personnel, and various types of complex equipment) carried out under the “surgical team” concept. The unit fee is payable to the director of the surgical team and includes all assistant surgeon fees; there are no separate payments for assisting surgical services. The director of the surgical team is expected to distribute the unit fee to the eligible members of the surgical team. (k) 76: Repeat Procedure by Same Physician or Other Qualified Health Care Professional. The physician or other qualified health care professional may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

circumstance may be reported by adding modifier 76 to the repeated procedure/service or the separate five-digit modifier code 09976 may be used. (l) 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. The physician or other qualified health care professional may need to indicate that a basic procedure or service performed by another physician or other qualified health care professional had to be repeated. This situation may be reported by adding modifier 77 to the repeated procedure/service or the separate five-digit modifier code 09977 may be used. (m) 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period. The physician or other qualified health care professional may need to indicate that another procedure was performed during that postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding modifier 78 to the related procedure, or by using the separate five-digit modifier 09978. (For repeat procedures on the same day, see modifier 76.) (n) 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period. The physician or other qualified health care professional may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79 or by using the separate five-digit modifier 09979. (For repeat procedures on the same day, see modifier 76.) (o) 80: Assistant Surgeon. Surgical assistant services may be identified by adding modifier 80 to the usual procedure code. (This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible assistant surgeon.) (p) 82: Assistant Surgeon (when qualified resident surgeon not available). Surgical assistant services may be identified by adding modifier 82 to the usual procedure code when a qualified resident surgeon is not available. (This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible assistant surgeon.) (q) AA: Anesthesia Services Performed Personally by an Anesthesiologist. This allows payment of 100% of the Total Anesthesia Fee for the anesthesiologist’s services. (r) AS: Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery. This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, for services of the eligible physician assistant, certified nurse practitioner, or clinical nurse specialist assisting in surgery. (s) E1: Upper left, eyelid. (t) E2: Lower left, eyelid. (u) E3: Upper right, eyelid. (v) E4: Lower right, eyelid. (w) F1: Left hand, second digit. (x) F2: Left hand, third digit. (y) F3: Left hand, fourth digit. (z) F4: Left hand, fifth digit. (aa) F5: Right hand, thumb.

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(bb) F6: Right hand, second digit. (cc) F7: Right hand, third digit. (dd) F8: Right hand, fourth digit. (ee) F9: Right hand, fifth digit. (ff) FA: Left hand, thumb. (gg) LC: Left circumflex coronary artery. (hh) LD: Left anterior descending coronary artery. (ii) LT: Left side. Used to identify procedures performed on the left side of the body. (jj) PA: Surgical or Other Invasive Procedure Performed on the Wrong Body Part. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services. (kk) PB: Surgical or Other Invasive Procedure Performed on the Wrong Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services. (ll) PC: Wrong Surgical or Other Invasive Procedure Performed on a Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services. (mm) QK: Medical Direction by a Physician of Two, Three, or Four Concurrent Anesthesia Procedures. Used to indicate physician medical direction of multiple CRNAs. This allows payment of 50% of the Total Anesthesia Fee for the physician’s services. (nn) QY: Medical Direction of One CRNA by a Physician. Used to indicate physician medical direction of one CRNA. This allows payment of 50% of the Total Anesthesia Fee for the physician’s services. (oo) QX: CRNA Anesthesia Services with Medical Direction by a Physician. Used to indicate CRNA anesthesia services with medical direction by a physician. This allows payment of 50% of the Total Anesthesia Fee for the CRNA’s services. Not for use if CRNA is employed by the facility in which the anesthesia services were performed. (pp) QZ: CRNA Anesthesia Services without Medical Direction by a Physician. This allows payment of 100% of the Total Anesthesia Fee for the CRNA’s services. Not for use if CRNA is employed by the facility in which the anesthesia services were performed. (qq) RC: Right Coronary Artery. (rr) RT: Right side. Used to identify procedures performed on the right side of the body. (ss) SA: Nurse Practitioner Rendering Service in Collaboration with a Physician. This modifier is to be applied to service codes billed by a physician that were performed by a certified nurse practitioner employed by the physician (the physician employer must be practicing as an individual and not practicing as a professional corporation or as a member of a group practice). A certified nurse practitioner billing under his/her own individual provider number, or a group practice, should not use this modifier. (tt) T1: Left foot, second digit. (uu) T2: Left foot, third digit. (vv) T3: Left foot, fourth digit. (ww) T4: Left foot, fifth digit. (xx) T5: Right foot, great toe. (yy) T6: Right foot, second digit. (zz) T7: Right foot, third digit. (aaa) T8: Right foot, fourth digit.

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(bbb) T9: Right foot, fifth digit. (ccc) TA: Left foot, great toe. (ddd) TC: Technical Component. The component of a service or procedure representing the cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and other overhead expenses of the service or procedures, excluding the physician’s professional component. (When the technical component is reported separately, the addition of modifier TC to the procedure code will allow payment of the technical component allowable fee (TC Fee) contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable.) (eee) XE: Separate Encounter. A service that is distinct because it occurred during a separate encounter. (fff) XS: Separate Structure. A service that is distinct because it was performed on a separate organ/structure. (ggg) XP: Separate Practitioner. A service that is distinct because it was performed by a different practitioner. (hhh) XU: Unusual Non-overlapping Service. The use of a service that is distinct because it does not overlap usual components of the main service.

(4) Procedure Codes; Fee Schedules. (a) Anesthesia Services – List of Procedure Codes and Base Anesthesia Units.

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00100 5 00102 6 00103 5 00104 4 00120 5 00124 4 00126 4 00140 5

00142 4 00144 6 00145 6 00147 4 00148 4 00160 5 00162 7 00164 4 00170 5 00172 6 00174 6 00176 7

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00190 5 00192 7 00210 11 00211 10 00212 5 00214 9 00215 9 00216 15 00218 13 00220 10 00222 6 00300 5 00320 6 00322 3 00326 7 00350 10 00352 5 00400 3 00402 5 00404 5 00406 13 00410 4 00450 5 00452 6 00454 3 00470 6 00472 10 00474 13 00500 15 00520 6 00522 4 00524 4 00528 8 00529 11 00530 4 00532 4 00534 7 00537 7 00539 18 00540 12 00541 15

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00542 15 00546 15 00548 17 00550 10 00560 15 00561 25 00562 20

00563 25

00566 25 00567 18 00580 20 00600 10 00604 13 00620 10 00622 13 00625 13 00626 15 00630 8 00632 7 00634 10 00635 4 00640 3 00670 13 00700 4 00702 4 00730 5 00731 5

00732 5

00750 4 00752 6 00754 7 00756 7 00770 15 00790 7 00792 13 00794 8 00796 30 00797 11 00800 4 00802 5 00811 5

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00812 5

00813 5

00820 5 00830 4 00832 6 00834 5 00836 6 00840 6 00842 4 00844 7 00846 8 00848 8

00851 6

00860 6 00862 7 00864 8 00865 7 00866 10 00868 10 00870 5 00872 7 00873 5 00880 15 00882 10 00902 5 00904 7 00906 4 00908 6 00910 3 00912 5 00914 5 00916 5 00918 5 00920 3 00921 3 00922 6 00924 4 00926 4 00928 6 00930 4 00932 4

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00934 6 00936 8 00938 4 00940 3 00942 4 00944 6 00948 4 00950 5 00952 4 01112 5 01120 6 01130 3 01140 15 01150 10 01160 4 01170 8 01173 12 01200 4 01202 4 01210 6 01212 10 01214 8 01215 10 01220 4 01230 6 01232 5 01234 8 01250 4 01260 3 01270 8 01272 4 01274 6 01320 4 01340 4 01360 5 01380 3 01382 3 01390 3 01392 4 01400 4 01402 7

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 01404 5 01420 3 01430 3 01432 6 01440 8 01442 8 01444 8 01462 3 01464 3 01470 3 01472 5 01474 5 01480 3 01482 4

01484 4

01486 7 01490 3 01500 8 01502 6 01520 3 01522 5 01610 5 01620 4 01622 4 01630 5 01634 9 01636 15 01638 10 01650 6 01652 10 01654 8 01656 10 01670 4 01680 3 01710 3 01712 5 01714 5 01716 5 01730 3 01732 3 01740 4

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 01742 5 01744 5 01756 6 01758 5 01760 7 01770 6 01772 6 01780 3 01782 4 01810 3 01820 3 01829 3 01830 3 01832 6 01840 6 01842 6

01844 6 01850 3 01852 4 01860 3 01916 5 01920 7 01922 7 01924 5 01925 7 01926 8 01930 5 01931 7 01932 6 01933 7 01937 5 01938 5 01939 5 01940 5 01941 5 01942 5 01951 3 01952 5 01953 1 01958 5 01960 5

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Anesthesia Table Code Units Description (see anesthesia service code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 01961 7 01962 8 01963 8 01964 4 01965 4 01966 4 01967 5 01968 2 01969 5 01990 7 01991 3 01992 5 01995 5 01996 3 01999 0

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

(b) Surgical Services – Fee Schedule.

NFAC – “Nonfacility”. These amounts apply when service is performed in a non- facility setting.
FAC – “Facility”. These amounts, also known as the Facility Setting Fee, apply when service is performed in a facility setting.
Global Fee. These amounts apply when no site of service differential rate is specified.

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 0404T - - I.C. - - 10004 $38.13 $31.16 - - - 10005 $104.50 $53.88 - - - 10006 $44.97 $36.66 - - - 10007 $232.93 $64.72 - - - 10008 $111.57 $37.65 - - - 10009 $343.38 $79.55 - - - 10010 $186.69 $51.70 - - - 10011 - - I.C. - - 10012 - - I.C. - - 10021 $78.37 $40.34 - - - 10030 $514.00 $98.31 - - - 10035 $292.97 $61.83 - - - 10036 $245.12 $31.11 - - - 10040 $90.70 $38.48 - - - 10060 $97.09 $80.48 - - - 10061 $162.94 $138.84 - - - 10080 $198.93 $79.47 - - - 10081 $268.48 $127.86 - - - 10120 $117.64 $80.14 - - - 10121 $203.52 $137.63 - - - 10140 $130.80 $89.02 - - - 10160 $100.43 $73.11 - - - 10180 $203.11 $134.27 - - - 11000 $44.69 $19.78 - - - 11001 $21.00 $10.82 - - - 11004 - - $411.28 - - 11005 - - $557.85 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 11006 - - $505.96 - - 11008 - - $196.76 - - 11010 $349.60 $205.77 - - - 11011 $382.07 $217.62 - - - 11012 $498.93 $306.09 - - - 11042 $100.25 $44.27 - - - 11043 $176.69 $112.94 - - - 11044 $234.18 $164.81 - - - 11045 $30.18 $18.39 - - - 11046 $54.46 $39.73 - - - 11047 $89.91 $70.35 - - - 11055 $56.51 $11.51 - - - 11056 $64.74 $15.99 - - - 11057 $70.28 $20.73 - - - 11102 $79.70 $28.01 - - - 11103 $39.30 $16.00 - - - 11104 $98.66 $34.64 - - - 11105 $46.23 $18.91 - - - 11106 $122.21 $41.59 - - - 11107 $55.87 $22.66 - - - 11200 $70.82 $58.50 - - - 11201 $13.79 $12.19 - - - 11300 $79.84 $25.20 - - - 11301 $95.55 $37.96 - - - 11302 $107.46 $44.25 - - - 11303 $118.85 $52.42 - - - 11305 $82.86 $27.42 - - - 11306 $96.21 $36.22 - - - 11307 $108.65 $46.24 - - - 11308 $113.95 $51.27 - - - 11310 $91.49 $33.91 - - - 11311 $107.01 $46.47 - - - 11312 $122.01 $55.58 - - - 11313 $140.82 $70.65 - - - 11400 $100.23 $64.34 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 11401 $121.72 $80.74 - - - 11402 $133.58 $87.78 - - - 11403 $153.03 $113.12 - - - 11404 $173.30 $124.28 - - - 11406 $243.28 $185.42 - - - 11420 $99.47 $62.51 - - - 11421 $124.23 $82.98 - - - 11422 $139.01 $103.12 - - - 11423 $157.88 $118.24 - - - 11424 $181.28 $134.41 - - - 11426 $251.34 $201.52 - - - 11440 $112.28 $81.74 - - - 11441 $135.27 $101.52 - - - 11442 $149.98 $111.68 - - - 11443 $175.98 $135.27 - - - 11444 $217.07 $169.67 - - - 11446 $291.49 $236.59 - - - 11450 $336.30 $197.82 - - - 11451 $409.29 $249.93 - - - 11462 $325.90 $187.96 - - - 11463 $415.32 $251.67 - - - 11470 $355.66 $217.18 - - - 11471 $419.15 $263.27 - - - 11600 $153.85 $92.25 - - - 11601 $177.28 $111.66 - - - 11602 $189.68 $121.38 - - - 11603 $215.32 $144.88 - - - 11604 $239.49 $159.13 - - - 11606 $341.72 $234.32 - - - 11620 $154.64 $92.76 - - - 11621 $178.26 $112.37 - - - 11622 $195.65 $127.08 - - - 11623 $227.97 $156.73 - - - 11624 $259.00 $177.31 - - - 11626 $310.80 $216.26 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 11640 $158.18 $95.51 - - - 11641 $183.88 $116.92 - - - 11642 $206.95 $136.24 - - - 11643 $241.99 $169.67 - - - 11644 $297.71 $209.86 - - - 11646 $384.33 $288.98 - - - 11719 $10.79 $5.43 - - - 11720 $25.24 $10.51 - - - 11721 $33.84 $17.24 - - - 11730 $89.31 $39.49 - - - 11732 $25.64 $12.51 - - - 11740 $44.68 $24.32 - - - 11750 $123.31 $75.64 - - - 11755 $94.74 $44.39 - - - 11760 $145.22 $83.08 - - - 11762 $222.01 $139.79 - - - 11765 $129.10 $69.90 - - - 11770 $277.00 $138.53 - - - 11771 $483.91 $337.67 - - - 11772 $595.42 $437.67 - - - 11900 $44.20 $22.23 - - - 11901 $53.60 $33.78 - - - 11920 $149.08 $81.31 - - - 11921 $172.91 $97.64 - - - 11922 $47.21 $21.50 - - - 11950 $62.53 $38.70 - - - 11951 $82.55 $53.89 - - - 11952 $110.05 $75.50 - - - 11954 $121.20 $82.63 - - - 11960 - - $773.63 - - 11970 - - $424.45 - - 11971 - - $418.04 - - 11976 $110.18 $67.86 - - - 11980 $71.85 $40.78 - - - 11981 $76.64 $45.84 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 11982 $85.48 $54.15 - - - 11983 $107.40 $75.79 - - - 12001 $72.71 $32.80 - - - 12002 $87.49 $42.76 - - - 12004 $101.19 $52.98 - - - 12005 $135.18 $68.22 - - - 12006 $156.64 $84.05 - - - 12007 $175.68 $104.70 - - - 12011 $86.71 $40.11 - - - 12013 $90.31 $42.10 - - - 12014 $109.52 $53.81 - - - 12015 $131.61 $67.86 - - - 12016 $167.15 $92.15 - - - 12017 - - $110.61 - - 12018 - - $124.81 - - 12020 $232.80 $141.47 - - - 12021 $136.11 $106.38 - - - 12031 $205.83 $114.50 - - - 12032 $236.77 $143.30 - - - 12034 $259.63 $153.84 - - - 12035 $301.25 $179.91 - - - 12036 $332.49 $209.02 - - - 12037 $371.35 $242.52 - - - 12041 $206.34 $108.84 - - - 12042 $240.84 $146.83 - - - 12044 $296.89 $159.76 - - - 12045 $321.09 $206.19 - - - 12046 $385.34 $236.95 - - - 12047 $421.26 $262.70 - - - 12051 $221.34 $127.60 - - - 12052 $245.47 $149.85 - - - 12053 $283.48 $161.34 - - - 12054 $298.71 $163.45 - - - 12055 $393.61 $223.53 - - - 12056 $449.01 $288.57 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 12057 $470.35 $313.67 - - - 13100 $265.39 $149.95 - - - 13101 $309.24 $185.76 - - - 13102 $89.60 $52.64 - - - 13120 $276.45 $174.40 - - - 13121 $330.11 $191.91 - - - 13122 $97.51 $60.82 - - - 13131 $301.01 $180.21 - - - 13132 $364.54 $225.53 - - - 13133 $127.85 $91.96 - - - 13151 $327.31 $207.32 - - - 13152 $382.93 $249.54 - - - 13153 $141.00 $100.56 - - - 13160 - - $594.51 - - 14000 $488.38 $380.18 - - - 14001 $619.53 $490.43 - - - 14020 $540.27 $427.78 - - - 14021 $662.93 $533.02 - - - 14040 $581.29 $469.33 - - - 14041 $704.64 $572.33 - - - 14060 $586.40 $500.69 - - - 14061 $760.25 $614.82 - - - 14350 - - $505.42 - - 15002 $264.41 $161.29 - - - 15003 $52.65 $32.83 - - - 15004 $301.17 $191.63 - - - 15005 $87.16 $65.19 - - - 15040 $204.75 $91.45 - - - 15050 $457.83 $350.69 - - - 15100 $662.59 $536.97 - - - 15101 $143.32 $81.72 - - - 15110 $629.58 $531.29 - - - 15111 $82.95 $74.12 - - - 15115 $605.13 $512.73 - - - 15116 $113.99 $101.40 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 15120 $644.03 $516.27 - - - 15121 $160.62 $99.02 - - - 15130 $553.99 $451.41 - - - 15131 $72.39 $65.96 - - - 15135 $669.12 $570.29 - - - 15136 $71.32 $65.96 - - - 15150 $529.66 $474.75 - - - 15151 $86.48 $78.98 - - - 15152 $110.51 $103.01 - - - 15155 $603.52 $548.08 - - - 15156 $115.94 $108.18 - - - 15157 $129.43 $118.18 - - - 15200 $640.84 $504.78 - - - 15201 $108.56 $56.07 - - - 15220 $590.56 $459.59 - - - 15221 $100.36 $50.54 - - - 15240 $710.75 $600.13 - - - 15241 $132.76 $77.32 - - - 15260 $763.37 $636.68 - - - 15261 $157.76 $100.44 - - - 15271 $118.26 $61.21 - - - 15272 $18.25 $12.09 - - - 15273 $237.16 $142.88 - - - 15274 $63.36 $32.56 - - - 15275 $121.46 $68.16 - - - 15276 $24.36 $18.20 - - - 15277 $262.86 $164.03 - - - 15278 $73.01 $40.60 - - - 15570 $693.07 $547.90 - - - 15572 $672.28 $553.89 - - - 15574 $668.15 $551.64 - - - 15576 $597.06 $487.78 - - - 15600 $265.59 $162.74 - - - 15610 $288.05 $187.34 - - - 15620 $347.68 $249.12 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 15630 $358.38 $261.69 - - - 15650 $418.77 $306.54 - - - 15730 $1,103.7 2 $687.23 - - - 15731 $853.48 $749.83 - - - 15733 - - $770.44 - - 15734 - - $1,113.55 - - 15736 - - $911.34 - - 15738 - - $946.21 - - 15740 $771.47 $632.46 - - - 15750 - - $693.94 - - 15756 - - $1,700.44 - - 15757 - - $1,690.41 - - 15758 - - $1,685.04 - - 15760 $647.47 $527.21 - - - 15769 - - $361.50 - - 15770 - - $508.52 - - 15771 $463.43 $383.08 - - - 15772 $144.20 $109.11 - - - 15773 $455.45 $377.78 - - - 15774 $141.19 $106.11 - - - 15775 $289.22 $189.32 - - - 15776 $389.89 $258.38 - - - 15777 - - $157.53 - - 15778 - - $279.60 - - 15780 $652.26 $501.73 - - - 15781 $416.72 $326.46 - - - 15782 $375.98 $280.89 - - - 15783 $347.12 $269.18 - - - 15786 $178.53 $100.86 - - - 15787 $23.21 $12.23 - - - 15788 $306.87 $165.72 - - - 15789 $411.17 $311.27 - - - 15792 $262.87 $161.36 - - - 15793 $366.83 $270.67 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 15819 - - $603.61 - - 15820 $444.15 $391.92 - - - 15821 $475.03 $417.44 - - - 15822 $356.07 $304.38 - - - 15823 $476.45 $418.59 - - - 15824 - - I.C. - - 15825 - - I.C. - - 15826 - - I.C. - - 15828 - - I.C. - - 15829 - - I.C. - - 15830 - - $876.41 - - 15832 - - $693.25 - - 15833 - - $661.45 - - 15834 - - $673.08 - - 15835 - - $700.37 - - 15836 - - $601.89 - - 15837 $663.54 $541.14 - - - 15838 - - $492.32 - - 15839 $679.82 $556.08 - - - 15840 - - $761.00 - - 15841 - - $1,331.28 - - 15842 - - $2,010.01 - - 15845 - - $799.81 - - 15847 - - I.C. - - 15851 $41.92 $48.35 - - - 15852 - - $33.56 - - 15853 - - $9.04 - - 15854 - - $12.72 - - 15860 - - $77.71 - - 15876 - - I.C. - - 15877 - - I.C. - - 15878 - - I.C. - - 15879 - - I.C. - - 15920 - - $483.96 - - 15922 - - $604.03 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 15931 - - $527.63 - - 15933 - - $655.00 - - 15934 - - $710.52 - - 15935 - - $871.42 - - 15936 - - $674.49 - - 15937 - - $782.35 - - 15940 - - $531.30 - - 15941 - - $707.05 - - 15944 - - $706.60 - - 15945 - - $770.06 - - 15946 - - $1,208.09 - - 15950 - - $483.53 - - 15951 - - $681.34 - - 15952 - - $692.30 - - 15953 - - $762.37 - - 15956 - - $872.20 - - 15958 - - $885.89 - - 15999 - - I.C. - - 16000 $59.95 $33.43 - - - 16020 $66.12 $41.75 - - - 16025 $119.51 $82.02 - - - 16030 $150.26 $97.23 - - - 16035 - - $142.01 - - 16036 - - $60.07 - - 17000 $52.03 $41.85 - - - 17003 $5.26 $1.52 - - - 17004 $131.49 $74.71 - - - 17106 $264.00 $208.56 - - - 17107 $342.35 $270.57 - - - 17108 $482.61 $394.76 - - - 17110 $89.25 $51.48 - - - 17111 $103.69 $62.71 - - - 17250 $68.75 $28.04 - - - 17260 $77.47 $53.36 - - - 17261 $115.30 $65.22 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 17262 $138.59 $82.88 - - - 17263 $149.56 $91.44 - - - 17264 $160.13 $97.45 - - - 17266 $182.17 $114.67 - - - 17270 $116.22 $71.76 - - - 17271 $129.22 $79.14 - - - 17272 $146.12 $90.68 - - - 17273 $161.61 $102.42 - - - 17274 $188.69 $125.21 - - - 17276 $218.35 $150.59 - - - 17280 $108.87 $64.95 - - - 17281 $139.27 $88.65 - - - 17282 $158.96 $102.18 - - - 17283 $186.97 $126.97 - - - 17284 $212.11 $148.09 - - - 17286 $269.95 $199.51 - - - 17311 $525.58 $262.83 - - - 17312 $320.55 $140.03 - - - 17313 $494.32 $235.58 - - - 17314 $307.51 $129.40 - - - 17315 $60.53 $37.23 - - - 17340 $39.60 $36.92 - - - 17360 $95.13 $69.68 - - - 17380 - - I.C. - - 17999 - - I.C. - - 19000 $79.28 $31.07 - - - 19001 $19.65 $15.10 - - - 19020 $364.68 $237.45 - - - 19030 $128.18 $55.86 - - - 19081 $396.71 $119.23 - - - 19082 $310.23 $60.07 - - - 19083 $397.35 $112.10 - - - 19084 $305.98 $56.62 - - - 19085 $613.86 $130.68 - - - 19086 $480.25 $65.64 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 19100 $116.64 $49.95 - - - 19101 $253.31 $167.06 - - - 19105 $1,864.2 3 $152.20 - - - 19110 $375.51 $265.96 - - - 19112 $356.81 $244.32 - - - 19120 $394.70 $312.47 - - - 19125 $434.02 $344.83 - - - 19126 - - $115.59 - - 19281 $188.63 $72.12 - - - 19282 $135.23 $36.39 - - - 19283 $204.03 $72.52 - - - 19284 $151.77 $36.33 - - - 19285 $295.65 $61.83 - - - 19286 $244.31 $31.11 - - - 19287 $511.18 $91.74 - - - 19288 $397.80 $46.13 - - - 19294 - - $118.51 - - 19296 $2,991.9 1 $153.07 - - - 19297 - - $68.19 - - 19298 $690.36 $236.10 - - - 19300 $449.69 $328.63 - - - 19301 - - $489.91 - - 19302 - - $672.18 - - 19303 - - $708.74 - - 19305 - - $854.68 - - 19306 - - $907.22 - - 19307 - - $875.35 - - 19316 - - $595.55 - - 19318 - - $819.01 - - 19325 - - $465.17 - - 19328 - - $418.67 - - 19330 - - $487.30 - - 19340 - - $571.92 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 19342 - - $573.87 - - 19350 $636.04 $508.28 - - - 19355 $578.21 $465.45 - - - 19357 - - $877.07 - - 19361 - - $1,163.94 - - 19364 - - $2,022.76 - - 19367 - - $1,321.44 - - 19368 - - $1,614.61 - - 19369 - - $1,501.02 - - 19370 - - $506.46 - - 19371 - - $536.66 - - 19380 - - $608.43 - - 19396 $213.40 $105.99 - - - 19499 - - I.C. - - 20100 - - $440.23 - - 20101 $457.20 $155.07 - - - 20102 $475.42 $187.76 - - - 20103 $435.05 $256.94 - - - 20150 - - $750.83 - - 20200 $170.10 $69.93 - - - 20205 $235.52 $113.65 - - - 20206 $177.57 $42.31 - - - 20220 $184.95 $64.42 - - - 20225 $303.63 $94.72 - - - 20240 - - $102.92 - - 20245 - - $253.21 - - 20250 - - $291.26 - - 20251 - - $315.40 - - 20500 $95.54 $67.15 - - - 20501 $113.75 $26.70 - - - 20520 $168.16 $111.65 - - - 20525 $362.69 $185.38 - - - 20526 $62.50 $42.15 - - - 20527 $66.85 $48.91 - - - 20550 $43.93 $28.67 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 20551 $43.93 $28.67 - - - 20552 $40.26 $27.40 - - - 20553 $46.61 $31.34 - - - 20555 - - $249.58 - - 20560 $19.82 $10.98 - - - 20561 $28.76 $16.44 - - - 20600 $40.26 $26.06 - - - 20604 $63.16 $33.70 - - - 20605 $41.95 $27.22 - - - 20606 $68.40 $38.13 - - - 20610 $49.06 $33.26 - - - 20611 $76.40 $43.99 - - - 20612 $49.14 $30.39 - - - 20615 $196.16 $121.70 - - - 20650 $174.51 $123.62 - - - 20660 - - $175.42 - - 20661 - - $394.57 - - 20662 - - $397.68 - - 20663 - - $367.09 - - 20664 - - $668.09 - - 20665 $90.41 $74.07 - - - 20670 $282.25 $110.03 - - - 20680 $463.35 $315.77 - - - 20690 - - $447.63 - - 20692 - - $844.18 - - 20693 - - $335.77 - - 20694 $332.58 $260.00 - - - 20696 - - $877.69 - - 20697 - - $1,470.17 - - 20700 - - $61.94 - - 20701 - - $47.33 - - 20702 - - $104.22 - - 20703 - - $75.17 - - 20704 - - $107.47 - - 20705 - - $91.24 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 20802 - - $2,032.83 - - 20805 - - $2,411.41 - - 20808 - - $2,904.06 - - 20816 - - $1,522.23 - - 20822 - - $1,318.96 - - 20824 - - $1,525.18 - - 20827 - - $1,354.08 - - 20838 - - $2,065.38 - - 20900 $304.35 $134.27 - - - 20902 - - $203.46 - - 20910 - - $364.03 - - 20920 - - $304.18 - - 20922 $463.29 $370.08 - - - 20924 - - $383.00 - - 20930 - - I.C. - - 20931 - - $80.02 - - 20932 - - $551.64 - - 20933 - - $506.58 - - 20934 - - $551.40 - - 20936 - - I.C. - - 20937 - - $121.40 - - 20938 - - $132.51 - - 20939 - - $51.00 - - 20950 $208.01 $65.51 - - - 20955 - - $1,830.87 - - 20956 - - $1,955.02 - - 20957 - - $2,037.14 - - 20962 - - $1,986.30 - - 20969 - - $2,018.14 - - 20970 - - $2,107.30 - - 20972 - - $2,101.10 - - 20973 - - $2,218.18 - - 20974 $63.84 $38.13 - - - 20975 - - $129.42 - - 20979 $43.16 $23.61 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 20982 $2,817.9 0 $266.73 - - - 20983 $4,120.4 3 $248.27 - - - 20985 - - $105.96 - - 20999 - - I.C. - - 21010 - - $561.35 - - 21011 $290.98 $198.84 - - - 21012 - - $256.85 - - 21013 $413.85 $304.83 - - - 21014 - - $394.88 - - 21015 - - $526.77 - - 21016 - - $754.03 - - 21025 $602.58 $497.32 - - - 21026 $410.96 $324.72 - - - 21029 $590.73 $471.27 - - - 21030 $354.07 $273.98 - - - 21031 $297.85 $207.86 - - - 21032 $287.58 $197.86 - - - 21034 $985.64 $845.82 - - - 21040 $359.02 $276.26 - - - 21044 - - $650.05 - - 21045 - - $902.06 - - 21046 - - $748.49 - - 21047 - - $909.36 - - 21048 - - $752.15 - - 21049 - - $859.86 - - 21050 - - $657.32 - - 21060 - - $595.03 - - 21070 - - $463.45 - - 21073 $291.14 $182.94 - - - 21076 $648.18 $522.29 - - - 21077 $1,586.7 1 $1,283.5 2

21079 $1,088.1 0 $863.12 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21080 $1,253.5 0 $981.11 - - - 21081 $1,156.5 6 $898.36 - - - 21082 $1,068.7 3 $821.78 - - - 21083 $1,022.3 3 $762.80 - - - 21084 $1,165.3 2 $881.94 - - - 21085 $512.79 $357.97 - - - 21086 $1,180.8 7 $946.51 - - - 21087 $1,180.8 7 $946.51 - - - 21088 - - I.C. - - 21089 - - I.C. - - 21100 $484.05 $269.51 - - - 21110 $677.60 $558.95 - - - 21116 $172.23 $33.22 - - - 21121 $484.04 $400.74 - - - 21122 - - $571.48 - - 21125 $2,082.9 1 $500.24 - - - 21127 $3,196.5 5 $573.59 - - - 21138 - - $688.26 - - 21141 - - $1,007.10 - - 21142 - - $1,032.91 - - 21143 - - $1,063.61 - - 21145 - - $1,166.82 - - 21146 - - $1,218.58 - - 21147 - - $1,282.17 - - 21150 - - $1,232.75 - - 21151 - - $1,355.04 - - 21154 - - $1,457.80 - - 21155 - - $1,614.77 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21159 - - $1,930.99 - - 21160 - - $2,092.83 - - 21172 - - $1,569.37 - - 21175 - - $1,649.48 - - 21179 - - $1,136.80 - - 21180 - - $1,268.42 - - 21181 - - $559.14 - - 21182 - - $1,575.55 - - 21183 - - $1,712.89 - - 21184 - - $1,840.91 - - 21188 - - $1,194.89 - - 21193 - - $927.62 - - 21194 - - $1,073.01 - - 21195 - - $1,015.54 - - 21196 - - $1,083.54 - - 21198 - - $769.29 - - 21199 - - $762.02 - - 21206 - - $729.43 - - 21215 $3,266.6 7 $590.68 - - - 21230 - - $563.06 - - 21235 $567.22 $432.76 - - - 21240 - - $793.07 - - 21242 - - $765.82 - - 21243 - - $1,266.37 - - 21244 - - $765.21 - - 21245 $946.86 $719.73 - - - 21246 - - $640.51 - - 21247 - - $1,189.40 - - 21248 $747.00 $593.26 - - - 21249 $1,007.7 5 $826.96 - - - 21255 - - $1,014.95 - - 21256 - - $930.67 - - 21260 - - $1,035.11 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21261 - - $1,822.86 - - 21263 - - $1,688.27 - - 21267 - - $1,211.65 - - 21268 - - $1,514.93 - - 21270 $778.56 $562.68 - - - 21275 - - $635.79 - - 21280 - - $447.03 - - 21282 - - $305.58 - - 21295 - - $152.36 - - 21299 - - I.C. - - 21315 $118.77 $44.85 - - - 21320 $170.48 $70.58 - - - 21325 - - $346.09 - - 21330 - - $413.14 - - 21335 - - $546.75 - - 21336 - - $491.09 - - 21337 $326.76 $231.14 - - - 21338 - - $519.99 - - 21339 - - $585.12 - - 21340 - - $568.10 - - 21343 - - $829.39 - - 21344 - - $1,050.26 - - 21345 $618.11 $485.53 - - - 21346 - - $789.49 - - 21347 - - $793.32 - - 21348 - - $821.39 - - 21355 $347.74 $250.78 - - - 21356 $422.58 $307.67 - - - 21360 - - $399.19 - - 21365 - - $812.54 - - 21366 - - $956.82 - - 21385 - - $555.56 - - 21386 - - $521.81 - - 21387 - - $579.42 - - 21390 - - $607.54 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21395 - - $756.81 - - 21400 $168.08 $130.04 - - - 21401 $398.46 $251.95 - - - 21406 - - $443.23 - - 21407 - - $489.59 - - 21408 - - $679.50 - - 21421 $499.56 $419.20 - - - 21422 - - $476.86 - - 21423 - - $602.68 - - 21431 - - $533.65 - - 21432 - - $544.77 - - 21433 - - $1,294.23 - - 21435 - - $1,055.69 - - 21436 - - $1,522.24 - - 21440 $544.27 $435.00 - - - 21445 $614.37 $493.04 - - - 21450 $465.85 $376.39 - - - 21451 $602.86 $500.27 - - - 21452 $594.62 $366.96 - - - 21453 $861.22 $729.71 - - - 21454 - - $368.10 - - 21461 $1,448.3 2 $822.11 - - - 21462 $1,564.3 2 $905.70 - - - 21465 - - $597.00 - - 21470 - - $871.72 - - 21480 $112.42 $22.69 - - - 21485 $768.74 $624.91 - - - 21490 - - $587.95 - - 21497 $557.38 $460.96 - - - 21499 - - I.C. - - 21501 $379.47 $255.73 - - - 21502 - - $377.46 - - 21510 - - $338.74 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21550 $208.45 $118.19 - - - 21552 - - $335.00 - - 21554 - - $546.08 - - 21555 $336.40 $233.01 - - - 21556 - - $400.07 - - 21557 - - $710.78 - - 21558 - - $994.84 - - 21600 - - $427.16 - - 21601 - - $842.43 - - 21602 - - $1,142.95 - - 21603 - - $1,241.76 - - 21610 - - $842.82 - - 21615 - - $454.89 - - 21616 - - $516.04 - - 21620 - - $376.35 - - 21627 - - $409.79 - - 21630 - - $985.01 - - 21632 - - $887.57 - - 21685 - - $739.83 - - 21700 - - $257.87 - - 21705 - - $382.93 - - 21720 - - $402.72 - - 21725 - - $412.07 - - 21740 - - $744.89 - - 21742 - - I.C. - - 21743 - - I.C. - - 21750 - - $493.87 - - 21811 - - $428.86 - - 21812 - - $520.22 - - 21813 - - $709.76 - - 21820 $117.98 $116.10 - - - 21825 - - $411.20 - - 21899 - - I.C. - - 21920 $199.88 $117.12 - - - 21925 $381.24 $286.96 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21930 $387.48 $274.99 - - - 21931 - - $351.23 - - 21932 - - $497.41 - - 21933 - - $550.35 - - 21935 - - $757.05 - - 21936 - - $1,043.90 - - 22010 - - $725.14 - - 22015 - - $713.77 - - 22100 - - $649.21 - - 22101 - - $654.12 - - 22102 - - $584.84 - - 22103 - - $98.28 - - 22110 - - $793.70 - - 22112 - - $849.54 - - 22114 - - $849.54 - - 22116 - - $102.06 - - 22206 - - $1,801.87 - - 22207 - - $1,768.20 - - 22208 - - $425.51 - - 22210 - - $1,326.15 - - 22212 - - $1,128.42 - - 22214 - - $1,128.49 - - 22216 - - $263.11 - - 22220 - - $1,205.24 - - 22222 - - $1,308.00 - - 22224 - - $1,180.30 - - 22226 - - $260.58 - - 22310 $239.01 $227.76 - - - 22315 $676.39 $583.71 - - - 22318 - - $1,223.13 - - 22319 - - $1,354.32 - - 22325 - - $1,100.00 - - 22326 - - $1,123.29 - - 22327 - - $1,145.16 - - 22328 - - $204.68 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 22505 - - $97.38 - - 22510 $1,445.0 1 $317.67 - - - 22511 $1,439.4 3 $298.43 - - - 22512 $577.11 $149.90 - - - 22513 $4,624.0 3 $375.02 - - - 22514 $4,603.8 6 $350.03 - - - 22515 $2,376.7 1 $158.46 - - - 22526 $1,588.3 1 $242.68 - - - 22527 $1,312.5 2 $111.26 - - - 22532 - - $1,330.37 - - 22533 - - $1,229.23 - - 22534 - - $261.26 - - 22548 - - $1,452.25 - - 22551 - - $1,256.73 - - 22552 - - $286.97 - - 22554 - - $937.98 - - 22556 - - $1,237.68 - - 22558 - - $1,128.45 - - 22585 - - $235.77 - - 22586 - - $1,501.26 - - 22590 - - $1,180.37 - - 22595 - - $1,127.08 - - 22600 - - $971.29 - - 22610 - - $955.74 - - 22612 - - $1,173.89 - - 22614 - - $283.32 - - 22630 - - $1,153.85 - - 22632 - - $232.02 - - 22633 - - $1,336.15 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 22634 - - $350.93 - - 22800 - - $1,018.34 - - 22802 - - $1,565.34 - - 22804 - - $1,795.82 - - 22808 - - $1,348.07 - - 22810 - - $1,488.66 - - 22812 - - $1,632.34 - - 22818 - - $1,590.04 - - 22819 - - $1,831.70 - - 22830 - - $615.15 - - 22836 - - $1,276.23 - - 22837 - - $1,404.98 - - 22838 - - $1,423.46 - - 22840 - - $549.50 - - 22841 - - I.C. - - 22842 - - $553.15 - - 22843 - - $592.08 - - 22844 - - $715.82 - - 22845 - - $526.46 - - 22846 - - $547.75 - - 22847 - - $584.28 - - 22848 - - $261.06 - - 22849 - - $968.53 - - 22850 - - $551.31 - - 22852 - - $531.14 - - 22853 - - $187.03 - - 22854 - - $242.90 - - 22855 - - $824.29 - - 22856 - - $1,201.07 - - 22857 - - $1,312.84 - - 22858 - - $367.34 - - 22859 - - $241.43 - - 22860 - - I.C. - - 22861 - - $1,703.20 - - 22862 - - $1,706.85 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 22864 - - $1,522.91 - - 22865 - - $1,666.59 - - 22867 - - $800.56 - - 22868 - - $176.56 - - 22869 - - $323.46 - - 22870 - - $86.60 - - 22899 - - I.C. - - 22900 - - $422.95 - - 22901 - - $495.73 - - 22902 $363.77 $251.55 - - - 22903 - - $329.53 - - 22904 - - $776.69 - - 22905 - - $978.75 - - 22999 - - I.C. - - 23000 $428.42 $272.26 - - - 23020 - - $523.82 - - 23030 $343.02 $192.23 - - - 23031 $340.38 $168.97 - - - 23035 - - $517.65 - - 23040 - - $544.41 - - 23044 - - $432.03 - - 23065 $173.46 $120.16 - - - 23066 $440.94 $279.97 - - - 23071 - - $315.66 - - 23073 - - $522.35 - - 23075 $401.10 $249.23 - - - 23076 - - $410.55 - - 23077 - - $835.69 - - 23078 - - $1,061.68 - - 23100 - - $388.65 - - 23101 - - $350.33 - - 23105 - - $486.35 - - 23106 - - $385.67 - - 23107 - - $502.93 - - 23120 - - $449.17 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 23125 - - $538.64 - - 23130 - - $472.66 - - 23140 - - $424.35 - - 23145 - - $528.48 - - 23146 - - $475.56 - - 23150 - - $507.39 - - 23155 - - $604.57 - - 23156 - - $516.16 - - 23170 - - $431.31 - - 23172 - - $435.96 - - 23174 - - $580.81 - - 23180 - - $499.83 - - 23182 - - $512.43 - - 23184 - - $562.48 - - 23190 - - $439.14 - - 23195 - - $562.49 - - 23200 - - $1,121.21 - - 23210 - - $1,312.19 - - 23220 - - $1,436.28 - - 23330 $236.58 $127.84 - - - 23333 - - $361.33 - - 23334 - - $793.04 - - 23335 - - $946.49 - - 23350 $129.87 $36.66 - - - 23395 - - $961.02 - - 23397 - - $853.25 - - 23400 - - $732.25 - - 23405 - - $467.82 - - 23406 - - $564.09 - - 23410 - - $619.82 - - 23412 - - $643.28 - - 23415 - - $530.82 - - 23420 - - $734.96 - - 23430 - - $564.07 - - 23440 - - $571.14 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 23450 - - $710.68 - - 23455 - - $741.73 - - 23460 - - $818.12 - - 23462 - - $799.87 - - 23465 - - $838.57 - - 23466 - - $843.82 - - 23470 - - $895.70 - - 23472 - - $1,076.84 - - 23473 - - $1,197.28 - - 23474 - - $1,291.45 - - 23480 - - $619.20 - - 23485 - - $716.49 - - 23490 - - $649.10 - - 23491 - - $763.64 - - 23500 $176.74 $180.76 - - - 23505 $281.53 $260.10 - - - 23515 - - $547.30 - - 23520 $190.48 $188.34 - - - 23525 $312.42 $284.56 - - - 23530 - - $439.85 - - 23532 - - $477.69 - - 23540 $189.38 $186.97 - - - 23545 $283.99 $253.19 - - - 23550 - - $436.60 - - 23552 - - $492.54 - - 23570 $185.23 $191.39 - - - 23575 $321.78 $295.80 - - - 23585 - - $733.84 - - 23600 $264.23 $249.77 - - - 23605 $367.46 $331.57 - - - 23615 - - $666.93 - - 23616 - - $924.51 - - 23620 $214.92 $205.55 - - - 23625 $304.53 $277.22 - - - 23630 - - $591.86 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 23650 $260.46 $233.67 - - - 23655 - - $315.73 - - 23660 - - $447.81 - - 23665 $339.60 $310.40 - - - 23670 - - $657.07 - - 23675 $428.14 $385.28 - - - 23680 - - $700.51 - - 23700 - - $148.99 - - 23800 - - $771.77 - - 23802 - - $962.22 - - 23900 - - $1,033.62 - - 23920 - - $842.02 - - 23921 - - $361.31 - - 23929 - - I.C. - - 23930 $280.19 $162.34 - - - 23931 $239.27 $123.56 - - - 23935 - - $393.60 - - 24000 - - $366.30 - - 24006 - - $540.49 - - 24065 $201.44 $123.24 - - - 24066 $484.70 $320.51 - - - 24071 - - $304.96 - - 24073 - - $519.47 - - 24075 $415.96 $250.97 - - - 24076 - - $414.70 - - 24077 - - $769.45 - - 24079 - - $982.20 - - 24100 - - $322.91 - - 24101 - - $387.09 - - 24102 - - $469.13 - - 24105 - - $279.83 - - 24110 - - $451.27 - - 24115 - - $558.88 - - 24116 - - $648.34 - - 24120 - - $407.78 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 24125 - - $474.82 - - 24126 - - $495.27 - - 24130 - - $393.57 - - 24134 - - $566.55 - - 24136 - - $481.58 - - 24138 - - $526.21 - - 24140 - - $534.29 - - 24145 - - $453.22 - - 24147 - - $481.61 - - 24149 - - $891.41 - - 24150 - - $1,149.34 - - 24152 - - $1,002.37 - - 24155 - - $642.37 - - 24160 - - $939.92 - - 24164 - - $548.58 - - 24200 $168.10 $105.96 - - - 24201 $426.95 $279.64 - - - 24220 $150.58 $48.80 - - - 24300 - - $341.38 - - 24301 - - $570.07 - - 24305 - - $442.22 - - 24310 - - $364.20 - - 24320 - - $590.11 - - 24330 - - $544.78 - - 24331 - - $593.59 - - 24332 - - $469.93 - - 24340 - - $457.43 - - 24341 - - $570.40 - - 24342 - - $585.77 - - 24343 - - $545.32 - - 24344 - - $824.32 - - 24345 - - $542.03 - - 24346 - - $833.20 - - 24357 - - $321.22 - - 24358 - - $405.47 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 24359 - - $504.22 - - 24360 - - $681.00 - - 24361 - - $757.72 - - 24362 - - $796.78 - - 24363 - - $1,080.56 - - 24365 - - $487.23 - - 24366 - - $516.33 - - 24370 - - $1,146.74 - - 24371 - - $1,314.15 - - 24400 - - $626.52 - - 24410 - - $795.26 - - 24420 - - $808.91 - - 24430 - - $793.14 - - 24435 - - $813.63 - - 24470 - - $511.29 - - 24495 - - $719.67 - - 24498 - - $653.51 - - 24500 $286.32 $263.01 - - - 24505 $393.68 $350.83 - - - 24515 - - $666.14 - - 24516 - - $647.90 - - 24530 $302.68 $276.16 - - - 24535 $481.23 $439.45 - - - 24538 - - $604.02 - - 24545 - - $698.57 - - 24546 - - $779.40 - - 24560 $264.55 $232.94 - - - 24565 $422.57 $383.73 - - - 24566 - - $550.49 - - 24575 - - $556.83 - - 24576 $279.03 $247.42 - - - 24577 $433.89 $393.18 - - - 24579 - - $632.16 - - 24582 - - $623.59 - - 24586 - - $815.88 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 24587 - - $816.85 - - 24600 $295.14 $265.41 - - - 24605 - - $369.40 - - 24615 - - $541.55 - - 24620 - - $451.64 - - 24635 - - $515.55 - - 24640 $80.28 $60.46 - - - 24650 $209.99 $194.72 - - - 24655 $351.47 $315.05 - - - 24665 - - $502.11 - - 24666 - - $556.48 - - 24670 $232.07 $211.45 - - - 24675 $360.51 $324.62 - - - 24685 - - $498.93 - - 24800 - - $630.75 - - 24802 - - $754.04 - - 24900 - - $557.27 - - 24920 - - $555.04 - - 24925 - - $435.18 - - 24930 - - $584.22 - - 24931 - - $699.57 - - 24935 - - $924.27 - - 24940 - - I.C. - - 24999 - - I.C. - - 25000 - - $269.39 - - 25001 - - $268.90 - - 25020 - - $581.83 - - 25023 - - $1,006.28 - - 25024 - - $585.53 - - 25025 - - $919.14 - - 25028 - - $542.87 - - 25031 - - $284.41 - - 25035 - - $447.71 - - 25040 - - $426.23 - - 25065 $199.58 $120.03 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 25066 - - $283.25 - - 25071 - - $319.88 - - 25073 - - $407.66 - - 25075 $406.30 $241.31 - - - 25076 - - $396.32 - - 25077 - - $664.78 - - 25078 - - $868.60 - - 25085 - - $344.30 - - 25100 - - $270.57 - - 25101 - - $312.16 - - 25105 - - $375.15 - - 25107 - - $473.38 - - 25109 - - $410.59 - - 25110 - - $268.45 - - 25111 - - $252.29 - - 25112 - - $301.21 - - 25115 - - $575.91 - - 25116 - - $462.85 - - 25118 - - $295.83 - - 25119 - - $385.68 - - 25120 - - $385.49 - - 25125 - - $455.02 - - 25126 - - $458.00 - - 25130 - - $348.07 - - 25135 - - $429.00 - - 25136 - - $382.43 - - 25145 - - $399.52 - - 25150 - - $433.74 - - 25151 - - $446.64 - - 25170 - - $1,093.31 - - 25210 - - $379.21 - - 25215 - - $473.23 - - 25230 - - $333.20 - - 25240 - - $330.93 - - 25246 $154.81 $53.30 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 25248 - - $318.07 - - 25250 - - $408.43 - - 25251 - - $545.78 - - 25259 - - $338.09 - - 25260 - - $486.44 - - 25263 - - $484.83 - - 25265 - - $570.46 - - 25270 - - $379.83 - - 25272 - - $428.10 - - 25274 - - $507.47 - - 25275 - - $512.30 - - 25280 - - $432.71 - - 25290 - - $335.21 - - 25295 - - $404.33 - - 25300 - - $526.21 - - 25301 - - $490.60 - - 25310 - - $475.04 - - 25312 - - $545.26 - - 25315 - - $582.49 - - 25316 - - $691.04 - - 25320 - - $752.01 - - 25332 - - $640.05 - - 25335 - - $711.73 - - 25337 - - $675.16 - - 25350 - - $514.01 - - 25355 - - $579.16 - - 25360 - - $499.75 - - 25365 - - $691.82 - - 25370 - - $763.86 - - 25375 - - $718.46 - - 25390 - - $583.00 - - 25391 - - $749.31 - - 25392 - - $762.14 - - 25393 - - $846.21 - - 25394 - - $593.28 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 25400 - - $607.63 - - 25405 - - $779.78 - - 25415 - - $728.86 - - 25420 - - $873.49 - - 25425 - - $725.63 - - 25426 - - $841.51 - - 25430 - - $556.28 - - 25431 - - $596.20 - - 25440 - - $582.45 - - 25441 - - $707.35 - - 25442 - - $613.83 - - 25443 - - $595.46 - - 25444 - - $626.86 - - 25445 - - $547.73 - - 25446 - - $879.74 - - 25447 - - $632.33 - - 25449 - - $777.73 - - 25450 - - $471.32 - - 25455 - - $555.48 - - 25490 - - $545.79 - - 25491 - - $560.09 - - 25492 - - $684.23 - - 25500 $225.86 $203.36 - - - 25505 $397.03 $358.19 - - - 25515 - - $510.66 - - 25520 $448.69 $421.10 - - - 25525 - - $601.22 - - 25526 - - $722.87 - - 25530 $210.49 $192.54 - - - 25535 $387.06 $355.45 - - - 25545 - - $478.30 - - 25560 $230.63 $204.65 - - - 25565 $406.27 $360.74 - - - 25574 - - $515.61 - - 25575 - - $684.90 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 25600 $269.83 $257.51 - - - 25605 $420.41 $395.77 - - - 25606 - - $511.66 - - 25607 - - $564.61 - - 25608 - - $628.87 - - 25609 - - $796.37 - - 25622 $244.43 $224.88 - - - 25624 $385.88 $347.84 - - - 25628 - - $547.42 - - 25630 $241.93 $223.99 - - - 25635 $365.69 $330.07 - - - 25645 - - $436.91 - - 25650 $261.69 $241.60 - - - 25651 - - $377.89 - - 25652 - - $476.35 - - 25660 - - $349.23 - - 25670 - - $463.83 - - 25671 - - $408.68 - - 25675 $357.61 $320.38 - - - 25676 - - $481.38 - - 25680 - - $409.94 - - 25685 - - $557.34 - - 25690 - - $380.59 - - 25695 - - $482.80 - - 25800 - - $556.00 - - 25805 - - $641.06 - - 25810 - - $656.97 - - 25820 - - $500.03 - - 25825 - - $608.24 - - 25830 - - $782.66 - - 25900 - - $544.00 - - 25905 - - $532.12 - - 25907 - - $468.31 - - 25909 - - $520.52 - - 25915 - - $871.90 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 25920 - - $558.60 - - 25922 - - $496.65 - - 25924 - - $545.78 - - 25927 - - $668.61 - - 25929 - - $456.68 - - 25931 - - $620.35 - - 25999 - - I.C. - - 26010 $273.87 $108.34 - - - 26011 $382.84 $142.05 - - - 26020 - - $426.89 - - 26025 - - $322.49 - - 26030 - - $376.23 - - 26034 - - $423.56 - - 26035 - - $653.34 - - 26037 - - $427.54 - - 26040 - - $245.89 - - 26045 - - $363.63 - - 26055 $468.88 $226.22 - - - 26060 - - $198.03 - - 26070 - - $249.77 - - 26075 - - $262.26 - - 26080 - - $308.77 - - 26100 - - $263.14 - - 26105 - - $265.05 - - 26110 - - $252.75 - - 26111 - - $317.02 - - 26113 - - $417.45 - - 26115 $432.16 $255.38 - - - 26116 - - $401.68 - - 26117 - - $561.95 - - 26118 - - $794.56 - - 26121 - - $458.77 - - 26123 - - $638.70 - - 26125 - - $197.45 - - 26130 - - $361.41 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 26135 - - $424.61 - - 26140 - - $390.08 - - 26145 - - $396.09 - - 26160 $487.63 $244.70 - - - 26170 - - $315.25 - - 26180 - - $347.25 - - 26185 - - $428.76 - - 26200 - - $347.02 - - 26205 - - $461.58 - - 26210 - - $345.98 - - 26215 - - $434.18 - - 26230 - - $383.28 - - 26235 - - $377.52 - - 26236 - - $338.89 - - 26250 - - $799.99 - - 26260 - - $601.27 - - 26262 - - $479.56 - - 26320 - - $270.19 - - 26340 - - $279.63 - - 26341 $91.77 $59.89 - - - 26350 - - $586.98 - - 26352 - - $651.36 - - 26356 - - $610.82 - - 26357 - - $681.12 - - 26358 - - $748.25 - - 26370 - - $613.83 - - 26372 - - $712.18 - - 26373 - - $686.99 - - 26390 - - $679.67 - - 26392 - - $775.56 - - 26410 - - $474.74 - - 26412 - - $562.18 - - 26415 - - $662.25 - - 26416 - - $714.32 - - 26418 - - $494.39 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 26420 - - $581.20 - - 26426 - - $386.98 - - 26428 - - $622.84 - - 26432 - - $430.62 - - 26433 - - $451.67 - - 26434 - - $545.13 - - 26437 - - $523.40 - - 26440 - - $513.68 - - 26442 - - $770.68 - - 26445 - - $480.50 - - 26449 - - $535.80 - - 26450 - - $366.79 - - 26455 - - $364.72 - - 26460 - - $354.83 - - 26471 - - $518.13 - - 26474 - - $512.77 - - 26476 - - $506.40 - - 26477 - - $492.48 - - 26478 - - $520.77 - - 26479 - - $530.08 - - 26480 - - $616.25 - - 26483 - - $678.88 - - 26485 - - $653.12 - - 26489 - - $748.85 - - 26490 - - $651.73 - - 26492 - - $718.63 - - 26494 - - $654.20 - - 26496 - - $702.03 - - 26497 - - $701.27 - - 26498 - - $903.82 - - 26499 - - $676.32 - - 26500 - - $519.27 - - 26502 - - $589.44 - - 26508 - - $530.47 - - 26510 - - $505.16 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 26516 - - $580.19 - - 26517 - - $672.38 - - 26518 - - $680.51 - - 26520 - - $538.27 - - 26525 - - $540.48 - - 26530 - - $413.81 - - 26531 - - $483.23 - - 26535 - - $337.33 - - 26536 - - $588.24 - - 26540 - - $547.64 - - 26541 - - $647.11 - - 26542 - - $563.90 - - 26545 - - $572.57 - - 26546 - - $804.87 - - 26548 - - $622.56 - - 26550 - - $1,254.71 - - 26551 - - $2,463.46 - - 26553 - - $2,447.17 - - 26554 - - $2,843.56 - - 26555 - - $1,060.14 - - 26556 - - $2,546.15 - - 26560 - - $499.58 - - 26561 - - $757.89 - - 26562 - - $1,052.23 - - 26565 - - $557.63 - - 26567 - - $562.00 - - 26568 - - $723.90 - - 26580 - - $1,172.07 - - 26587 - - $787.37 - - 26590 - - $1,089.33 - - 26591 - - $386.69 - - 26593 - - $507.07 - - 26596 - - $631.46 - - 26600 $239.52 $227.46 - - - 26605 $261.75 $234.70 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 26607 - - $395.01 - - 26608 - - $372.96 - - 26615 - - $441.62 - - 26641 $329.64 $298.57 - - - 26645 $339.25 $307.37 - - - 26650 - - $374.23 - - 26665 - - $480.60 - - 26670 $273.49 $242.69 - - - 26675 $362.10 $328.62 - - - 26676 - - $395.56 - - 26685 - - $441.69 - - 26686 - - $474.88 - - 26700 $266.79 $244.30 - - - 26705 $344.13 $309.58 - - - 26706 - - $345.94 - - 26715 - - $440.44 - - 26720 $159.97 $149.79 - - - 26725 $269.75 $238.41 - - - 26727 - - $367.70 - - 26735 - - $455.94 - - 26740 $185.04 $174.86 - - - 26742 $294.15 $262.27 - - - 26746 - - $565.40 - - 26750 $149.10 $150.44 - - - 26755 $252.85 $215.09 - - - 26756 - - $330.82 - - 26765 - - $388.31 - - 26770 $226.25 $204.83 - - - 26775 $311.77 $278.29 - - - 26776 - - $349.35 - - 26785 - - $421.82 - - 26820 - - $645.12 - - 26841 - - $603.15 - - 26842 - - $647.03 - - 26843 - - $609.24 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 26844 - - $667.79 - - 26850 - - $573.77 - - 26852 - - $647.48 - - 26860 - - $483.19 - - 26861 - - $74.25 - - 26862 - - $597.38 - - 26863 - - $167.29 - - 26910 - - $593.35 - - 26951 - - $549.67 - - 26952 - - $535.13 - - 26989 - - I.C. - - 26990 - - $521.19 - - 26991 $548.97 $400.58 - - - 26992 - - $762.01 - - 27000 - - $299.58 - - 27001 - - $411.72 - - 27003 - - $456.70 - - 27005 - - $541.13 - - 27006 - - $539.54 - - 27025 - - $694.35 - - 27027 - - $670.22 - - 27030 - - $702.96 - - 27033 - - $729.49 - - 27035 - - $851.42 - - 27036 - - $765.35 - - 27040 $263.83 $149.46 - - - 27041 - - $535.32 - - 27043 - - $351.23 - - 27045 - - $549.76 - - 27047 $380.65 $271.91 - - - 27048 - - $459.09 - - 27049 - - $989.66 - - 27050 - - $312.09 - - 27052 - - $441.47 - - 27054 - - $523.56 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27057 - - $755.28 - - 27059 - - $1,337.41 - - 27060 - - $356.68 - - 27062 - - $347.92 - - 27065 - - $403.58 - - 27066 - - $620.52 - - 27067 - - $779.03 - - 27070 - - $672.54 - - 27071 - - $741.31 - - 27075 - - $1,541.76 - - 27076 - - $1,859.97 - - 27077 - - $2,072.03 - - 27078 - - $1,520.36 - - 27080 - - $386.36 - - 27086 $244.77 $128.80 - - - 27087 - - $462.41 - - 27090 - - $627.36 - - 27091 - - $1,184.90 - - 27093 $185.22 $50.23 - - - 27095 $247.90 $60.14 - - - 27096 $126.08 $61.27 - - - 27097 - - $518.73 - - 27098 - - $528.26 - - 27100 - - $628.48 - - 27105 - - $657.62 - - 27110 - - $730.81 - - 27111 - - $681.29 - - 27120 - - $970.54 - - 27122 - - $826.34 - - 27125 - - $846.69 - - 27130 - - $956.40 - - 27132 - - $1,241.66 - - 27134 - - $1,409.33 - - 27137 - - $1,087.89 - - 27138 - - $1,129.56 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27140 - - $674.52 - - 27146 - - $946.99 - - 27147 - - $1,089.35 - - 27151 - - $1,176.53 - - 27156 - - $1,266.05 - - 27158 - - $1,043.06 - - 27161 - - $912.89 - - 27165 - - $1,027.73 - - 27170 - - $874.50 - - 27175 - - $503.35 - - 27176 - - $695.28 - - 27177 - - $837.18 - - 27178 - - $695.28 - - 27179 - - $736.17 - - 27181 - - $839.86 - - 27185 - - $544.78 - - 27187 - - $748.83 - - 27197 - - $102.12 - - 27198 - - $236.28 - - 27200 $146.28 $147.62 - - - 27202 - - $399.54 - - 27215 - - $451.96 - - 27216 - - $666.97 - - 27217 - - $627.48 - - 27218 - - $858.32 - - 27220 $319.70 $314.61 - - - 27222 - - $741.20 - - 27226 - - $790.51 - - 27227 - - $1,225.97 - - 27228 - - $1,392.51 - - 27230 $375.50 $367.73 - - - 27232 - - $541.25 - - 27235 - - $681.24 - - 27236 - - $891.99 - - 27238 - - $359.37 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27240 - - $718.93 - - 27244 - - $917.31 - - 27245 - - $916.45 - - 27246 $301.10 $297.62 - - - 27248 - - $560.30 - - 27250 - - $129.75 - - 27252 - - $566.68 - - 27253 - - $706.21 - - 27254 - - $949.83 - - 27256 $237.96 $177.42 - - - 27257 - - $270.10 - - 27258 - - $833.16 - - 27259 - - $1,149.53 - - 27265 - - $320.10 - - 27266 - - $444.85 - - 27267 - - $338.52 - - 27268 - - $415.51 - - 27269 - - $924.30 - - 27275 - - $140.06 - - 27278 $9,727.2 5 $351.37 - - - 27279 - - $608.25 - - 27280 - - $1,009.39 - - 27282 - - $649.89 - - 27284 - - $1,189.22 - - 27286 - - $1,221.37 - - 27290 - - $1,209.82 - - 27295 - - $935.03 - - 27299 - - I.C. - - 27301 $519.22 $384.76 - - - 27303 - - $483.26 - - 27305 - - $369.96 - - 27306 - - $256.56 - - 27307 - - $311.63 - - 27310 - - $555.15 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27323 $213.03 $132.68 - - - 27324 - - $313.12 - - 27325 - - $431.60 - - 27326 - - $400.55 - - 27327 $391.03 $239.44 - - - 27328 - - $469.27 - - 27329 - - $775.20 - - 27330 - - $324.62 - - 27331 - - $365.30 - - 27332 - - $491.62 - - 27333 - - $450.07 - - 27334 - - $522.07 - - 27335 - - $579.38 - - 27337 - - $315.12 - - 27339 - - $563.35 - - 27340 - - $289.09 - - 27345 - - $372.10 - - 27347 - - $403.57 - - 27350 - - $498.19 - - 27355 - - $463.29 - - 27356 - - $561.09 - - 27357 - - $620.08 - - 27358 - - $200.69 - - 27360 - - $688.02 - - 27364 - - $1,159.23 - - 27365 - - $1,519.62 - - 27369 $147.81 $29.69 - - - 27372 $457.31 $304.64 - - - 27380 - - $478.76 - - 27381 - - $624.16 - - 27385 - - $467.52 - - 27386 - - $651.03 - - 27390 - - $345.54 - - 27391 - - $442.85 - - 27392 - - $541.34 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27393 - - $383.40 - - 27394 - - $497.08 - - 27395 - - $666.26 - - 27396 - - $470.91 - - 27397 - - $690.39 - - 27400 - - $528.51 - - 27403 - - $490.05 - - 27405 - - $513.42 - - 27407 - - $603.46 - - 27409 - - $728.34 - - 27412 - - $1,228.12 - - 27415 - - $1,027.19 - - 27416 - - $736.53 - - 27418 - - $626.84 - - 27420 - - $565.19 - - 27422 - - $562.03 - - 27424 - - $567.44 - - 27425 - - $349.49 - - 27427 - - $538.23 - - 27428 - - $841.25 - - 27429 - - $947.85 - - 27430 - - $562.27 - - 27435 - - $614.37 - - 27437 - - $502.05 - - 27438 - - $633.79 - - 27440 - - $602.90 - - 27441 - - $622.15 - - 27442 - - $656.72 - - 27443 - - $616.29 - - 27445 - - $936.82 - - 27446 - - $856.94 - - 27447 - - $955.40 - - 27448 - - $624.89 - - 27450 - - $763.15 - - 27454 - - $966.97 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27455 - - $725.06 - - 27457 - - $720.70 - - 27465 - - $932.34 - - 27466 - - $887.46 - - 27468 - - $1,001.34 - - 27470 - - $884.84 - - 27472 - - $945.79 - - 27475 - - $503.79 - - 27477 - - $555.29 - - 27479 - - $690.98 - - 27485 - - $510.15 - - 27486 - - $1,046.62 - - 27487 - - $1,301.31 - - 27488 - - $898.23 - - 27495 - - $846.66 - - 27496 - - $419.92 - - 27497 - - $441.28 - - 27498 - - $499.93 - - 27499 - - $533.16 - - 27500 $403.62 $368.54 - - - 27501 $387.88 $380.91 - - - 27502 - - $567.66 - - 27503 - - $605.43 - - 27506 - - $1,000.82 - - 27507 - - $723.54 - - 27508 $405.80 $383.30 - - - 27509 - - $518.68 - - 27510 - - $515.30 - - 27511 - - $743.44 - - 27513 - - $918.85 - - 27514 - - $721.12 - - 27516 $403.19 $375.60 - - - 27517 - - $525.44 - - 27519 - - $666.53 - - 27520 $257.65 $237.29 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27524 - - $570.23 - - 27530 $244.35 $228.82 - - - 27532 $476.99 $442.44 - - - 27535 - - $670.71 - - 27536 - - $888.54 - - 27538 $377.91 $349.78 - - - 27540 - - $615.87 - - 27550 $399.21 $364.39 - - - 27552 - - $483.37 - - 27556 - - $656.12 - - 27557 - - $778.77 - - 27558 - - $884.48 - - 27560 $293.47 $266.96 - - - 27562 - - $377.45 - - 27566 - - $671.80 - - 27570 - - $117.45 - - 27580 - - $1,106.20 - - 27590 - - $572.02 - - 27591 - - $724.25 - - 27592 - - $492.24 - - 27594 - - $374.99 - - 27596 - - $526.81 - - 27598 - - $512.58 - - 27599 - - I.C. - - 27600 - - $300.39 - - 27601 - - $333.56 - - 27602 - - $350.86 - - 27603 $407.79 $296.63 - - - 27604 $347.15 $243.76 - - - 27605 $255.54 $137.69 - - - 27606 - - $203.26 - - 27607 - - $451.18 - - 27610 - - $487.75 - - 27612 - - $428.71 - - 27613 $195.35 $121.42 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27614 $454.69 $315.14 - - - 27615 - - $763.51 - - 27616 - - $941.98 - - 27618 $379.59 $232.55 - - - 27619 - - $352.88 - - 27620 - - $337.51 - - 27625 - - $431.87 - - 27626 - - $460.39 - - 27630 $414.51 $269.88 - - - 27632 - - $308.23 - - 27634 - - $507.11 - - 27635 - - $439.34 - - 27637 - - $560.13 - - 27638 - - $563.40 - - 27640 - - $625.44 - - 27641 - - $491.14 - - 27645 - - $1,312.19 - - 27646 - - $1,142.42 - - 27647 - - $731.89 - - 27648 $170.27 $37.42 - - - 27650 - - $498.90 - - 27652 - - $497.71 - - 27654 - - $539.58 - - 27656 $417.59 $263.58 - - - 27658 - - $280.84 - - 27659 - - $355.35 - - 27664 - - $277.31 - - 27665 - - $320.70 - - 27675 - - $376.33 - - 27676 - - $458.22 - - 27680 - - $317.31 - - 27681 - - $383.10 - - 27685 $506.15 $352.95 - - - 27686 - - $398.16 - - 27687 - - $344.15 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27690 - - $482.86 - - 27691 - - $562.02 - - 27692 - - $73.21 - - 27695 - - $367.91 - - 27696 - - $413.40 - - 27698 - - $482.30 - - 27700 - - $459.98 - - 27702 - - $720.83 - - 27703 - - $831.37 - - 27704 - - $430.68 - - 27705 - - $568.57 - - 27707 - - $311.34 - - 27709 - - $847.52 - - 27712 - - $826.58 - - 27715 - - $804.54 - - 27720 - - $658.09 - - 27722 - - $674.75 - - 27724 - - $934.78 - - 27725 - - $911.73 - - 27726 - - $717.85 - - 27727 - - $780.96 - - 27730 - - $448.25 - - 27732 - - $348.99 - - 27734 - - $499.87 - - 27740 - - $537.10 - - 27742 - - $588.30 - - 27745 - - $570.82 - - 27750 $274.16 $253.53 - - - 27752 $415.21 $377.44 - - - 27756 - - $440.67 - - 27758 - - $675.88 - - 27759 - - $748.39 - - 27760 $262.08 $240.92 - - - 27762 $376.62 $337.79 - - - 27766 - - $462.49 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27767 $230.85 $229.51 - - - 27768 - - $347.05 - - 27769 - - $549.61 - - 27780 $245.08 $224.72 - - - 27781 $343.24 $314.05 - - - 27784 - - $538.57 - - 27786 $247.59 $225.89 - - - 27788 $332.82 $299.07 - - - 27792 - - $489.96 - - 27808 $265.37 $241.00 - - - 27810 $369.74 $330.63 - - - 27814 - - $578.49 - - 27816 $261.13 $230.59 - - - 27818 $382.87 $338.95 - - - 27822 - - $665.58 - - 27823 - - $746.50 - - 27824 $249.72 $239.55 - - - 27825 $420.94 $376.74 - - - 27826 - - $650.24 - - 27827 - - $849.72 - - 27828 - - $1,001.25 - - 27829 - - $540.47 - - 27830 $306.13 $281.22 - - - 27831 - - $316.67 - - 27832 - - $574.50 - - 27840 - - $299.16 - - 27842 - - $375.81 - - 27846 - - $543.14 - - 27848 - - $590.92 - - 27860 - - $124.24 - - 27870 - - $756.58 - - 27871 - - $523.35 - - 27880 - - $656.87 - - 27881 - - $629.29 - - 27882 - - $432.86 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 27884 - - $428.49 - - 27886 - - $479.14 - - 27888 - - $476.23 - - 27889 - - $466.29 - - 27892 - - $401.23 - - 27893 - - $467.88 - - 27894 - - $605.40 - - 27899 - - I.C. - - 28001 $131.05 $70.51 - - - 28002 $188.75 $103.04 - - - 28003 $287.78 $190.56 - - - 28005 - - $427.92 - - 28008 $328.16 $221.83 - - - 28010 $177.89 $157.27 - - - 28011 $238.61 $209.96 - - - 28020 $421.93 $279.17 - - - 28022 $373.44 $246.75 - - - 28024 $352.49 $231.43 - - - 28035 $406.48 $270.95 - - - 28039 $367.74 $256.05 - - - 28041 - - $338.02 - - 28043 $294.52 $196.50 - - - 28045 $367.69 $261.62 - - - 28046 - - $528.58 - - 28047 - - $764.28 - - 28050 $318.05 $209.57 - - - 28052 $297.72 $191.65 - - - 28054 $281.10 $176.11 - - - 28055 - - $287.87 - - 28060 $395.99 $270.64 - - - 28062 $439.36 $302.76 - - - 28070 $388.39 $258.49 - - - 28072 $376.26 $245.29 - - - 28080 $410.16 $287.49 - - - 28086 $409.07 $267.92 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 28088 $354.67 $221.01 - - - 28090 $357.37 $232.83 - - - 28092 $324.67 $205.48 - - - 28100 $471.77 $316.69 - - - 28102 - - $465.35 - - 28103 - - $289.49 - - 28104 $401.46 $266.20 - - - 28106 - - $317.58 - - 28107 $385.33 $259.45 - - - 28108 $333.05 $217.34 - - - 28110 $353.25 $220.40 - - - 28111 $364.63 $239.81 - - - 28112 $370.78 $236.59 - - - 28113 $447.99 $322.37 - - - 28114 $813.41 $631.27 - - - 28116 $595.38 $443.51 - - - 28118 $461.58 $317.22 - - - 28119 $400.98 $273.75 - - - 28120 $513.22 $374.22 - - - 28122 $450.70 $329.37 - - - 28124 $363.98 $251.48 - - - 28126 $299.81 $187.59 - - - 28130 - - $455.81 - - 28140 $432.46 $318.36 - - - 28150 $320.48 $209.87 - - - 28153 $311.63 $199.41 - - - 28160 $313.53 $201.03 - - - 28171 - - $827.20 - - 28173 - - $535.23 - - 28175 - - $349.36 - - 28190 $186.67 $99.35 - - - 28192 $351.09 $233.24 - - - 28193 $397.86 $274.65 - - - 28200 $379.96 $247.11 - - - 28202 $457.36 $322.37 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 28208 $374.80 $244.09 - - - 28210 $455.60 $320.34 - - - 28220 $344.71 $229.54 - - - 28222 $403.06 $273.69 - - - 28225 $318.04 $199.65 - - - 28226 $479.99 $305.89 - - - 28230 $332.64 $214.79 - - - 28232 $289.87 $181.67 - - - 28234 $315.45 $204.02 - - - 28238 $513.75 $368.31 - - - 28240 $339.99 $221.07 - - - 28250 $449.75 $309.67 - - - 28260 $548.55 $400.70 - - - 28261 $917.48 $706.16 - - - 28262 $1,059.8 8 $841.86 - - - 28264 $666.40 $505.43 - - - 28270 $372.63 $252.11 - - - 28272 $292.95 $188.49 - - - 28280 $390.32 $261.76 - - - 28285 $411.68 $290.62 - - - 28286 $336.95 $222.58 - - - 28288 $462.79 $328.87 - - - 28289 $528.11 $347.05 - - - 28291 $531.72 $363.25 - - - 28292 $532.17 $363.43 - - - 28295 $829.70 $460.62 - - - 28296 $681.97 $384.40 - - - 28297 $792.84 $452.68 - - - 28298 $640.85 $379.44 - - - 28299 $776.57 $443.92 - - - 28300 - - $489.72 - - 28302 - - $542.55 - - 28304 $633.31 $461.89 - - - 28305 - - $502.55 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 28306 $466.77 $305.53 - - - 28307 $608.06 $394.32 - - - 28308 $437.78 $292.07 - - - 28309 - - $673.53 - - 28310 $416.22 $271.85 - - - 28312 $411.41 $256.06 - - - 28313 $405.79 $272.41 - - - 28315 $367.25 $246.19 - - - 28320 - - $460.04 - - 28322 $602.46 $436.13 - - - 28340 $429.53 $304.72 - - - 28341 $497.42 $361.63 - - - 28344 $320.43 $209.82 - - - 28345 $389.46 $270.80 - - - 28360 - - $829.92 - - 28400 $194.46 $180.00 - - - 28405 $351.73 $313.96 - - - 28406 - - $433.77 - - 28415 - - $848.47 - - 28420 - - $979.84 - - 28430 $188.84 $164.74 - - - 28435 $290.43 $255.61 - - - 28436 - - $385.98 - - 28445 - - $779.68 - - 28446 - - $918.00 - - 28450 $165.18 $148.85 - - - 28455 $228.15 $202.17 - - - 28456 - - $292.14 - - 28465 - - $482.12 - - 28470 $171.08 $160.36 - - - 28475 $200.42 $174.98 - - - 28476 - - $303.50 - - 28485 - - $428.56 - - 28490 $111.59 $97.93 - - - 28495 $139.48 $115.38 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 28496 $357.18 $192.19 - - - 28505 $498.27 $373.45 - - - 28510 $94.66 $94.12 - - - 28515 $128.31 $111.43 - - - 28525 $436.52 $307.69 - - - 28530 $90.45 $78.12 - - - 28531 $255.02 $137.17 - - - 28540 $151.50 $135.43 - - - 28545 $244.07 $212.46 - - - 28546 $461.71 $273.42 - - - 28555 $663.40 $501.36 - - - 28570 $186.42 $154.81 - - - 28575 $297.04 $264.90 - - - 28576 - - $297.15 - - 28585 $673.08 $524.16 - - - 28600 $171.44 $144.92 - - - 28605 $269.57 $239.04 - - - 28606 - - $293.89 - - 28615 - - $629.16 - - 28630 $118.76 $83.13 - - - 28635 $135.62 $101.60 - - - 28636 $241.08 $150.28 - - - 28645 $495.53 $364.82 - - - 28660 $96.27 $70.56 - - - 28665 $113.71 $93.89 - - - 28666 - - $133.68 - - 28675 $443.48 $313.31 - - - 28705 - - $908.08 - - 28715 - - $708.23 - - 28725 - - $586.11 - - 28730 - - $548.76 - - 28735 - - $584.86 - - 28737 - - $514.21 - - 28740 $631.91 $464.51 - - - 28750 $598.03 $434.91 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 28755 $387.61 $252.08 - - - 28760 $578.66 $423.85 - - - 28800 - - $393.64 - - 28805 - - $522.91 - - 28810 - - $315.29 - - 28820 $227.19 $130.50 - - - 28825 $222.60 $126.45 - - - 28890 $236.38 $165.67 - - - 28899 - - I.C. - - 29000 $275.23 $147.47 - - - 29010 $213.65 $120.44 - - - 29015 $228.70 $135.23 - - - 29035 $201.33 $108.12 - - - 29040 $228.94 $129.84 - - - 29044 $224.96 $125.86 - - - 29046 $245.85 $141.12 - - - 29049 $77.08 $52.17 - - - 29055 $173.99 $103.28 - - - 29058 $94.86 $69.95 - - - 29065 $74.99 $51.42 - - - 29075 $68.05 $47.43 - - - 29085 $74.52 $50.68 - - - 29086 $59.70 $37.47 - - - 29105 $63.97 $30.75 - - - 29125 $51.74 $30.58 - - - 29126 $60.16 $37.13 - - - 29130 $31.92 $21.74 - - - 29131 $41.18 $25.91 - - - 29200 $24.95 $13.70 - - - 29240 $23.07 $13.43 - - - 29260 $22.40 $14.10 - - - 29280 $22.67 $14.63 - - - 29305 $192.62 $118.97 - - - 29325 $212.24 $132.96 - - - 29345 $104.23 $74.50 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 29355 $109.15 $79.42 - - - 29358 $124.38 $76.97 - - - 29365 $95.63 $65.36 - - - 29405 $61.63 $43.95 - - - 29425 $57.75 $40.60 - - - 29435 $88.60 $60.48 - - - 29440 $32.43 $20.38 - - - 29445 $96.93 $72.56 - - - 29450 $109.76 $83.25 - - - 29505 $68.84 $39.11 - - - 29515 $55.16 $36.95 - - - 29520 $26.82 $13.43 - - - 29530 $22.81 $13.43 - - - 29540 $21.33 $12.76 - - - 29550 $14.56 $8.13 - - - 29580 $48.88 $19.15 - - - 29581 $70.07 $19.71 - - - 29584 $64.75 $11.72 - - - 29700 $48.10 $24.26 - - - 29705 $47.79 $33.06 - - - 29710 $93.38 $60.71 - - - 29720 $66.59 $32.30 - - - 29730 $48.62 $32.82 - - - 29740 $75.21 $50.84 - - - 29750 $81.38 $56.74 - - - 29799 - - I.C. - - 29800 - - $403.84 - - 29804 - - $450.52 - - 29805 - - $357.85 - - 29806 - - $795.07 - - 29807 - - $778.48 - - 29819 - - $445.91 - - 29820 - - $405.14 - - 29821 - - $451.10 - - 29822 - - $411.98 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 29823 - - $450.09 - - 29824 - - $514.46 - - 29825 - - $445.91 - - 29826 - - $126.03 - - 29827 - - $802.13 - - 29828 - - $688.91 - - 29830 - - $347.03 - - 29834 - - $375.56 - - 29835 - - $388.02 - - 29836 - - $445.47 - - 29837 - - $401.58 - - 29838 - - $452.06 - - 29840 - - $346.15 - - 29843 - - $371.70 - - 29844 - - $381.85 - - 29845 - - $446.88 - - 29846 - - $398.92 - - 29847 - - $413.88 - - 29848 - - $391.84 - - 29850 - - $473.98 - - 29851 - - $698.91 - - 29855 - - $590.22 - - 29856 - - $745.29 - - 29860 - - $487.71 - - 29861 - - $536.64 - - 29862 - - $613.84 - - 29863 - - $612.70 - - 29866 - - $792.40 - - 29867 - - $958.67 - - 29868 - - $1,243.83 - - 29870 $425.62 $310.45 - - - 29871 - - $392.68 - - 29873 - - $411.60 - - 29874 - - $406.99 - - 29875 - - $378.10 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 29876 - - $494.16 - - 29877 - - $471.24 - - 29879 - - $500.84 - - 29880 - - $427.41 - - 29881 - - $411.98 - - 29882 - - $521.13 - - 29883 - - $636.21 - - 29884 - - $470.01 - - 29885 - - $572.47 - - 29886 - - $483.11 - - 29887 - - $570.24 - - 29888 - - $731.87 - - 29889 - - $919.50 - - 29891 - - $506.07 - - 29892 - - $482.69 - - 29893 $512.46 $329.80 - - - 29894 - - $374.51 - - 29895 - - $349.52 - - 29897 - - $376.18 - - 29898 - - $422.83 - - 29899 - - $753.10 - - 29900 - - $387.39 - - 29901 - - $414.07 - - 29902 - - $438.12 - - 29904 - - $484.42 - - 29905 - - $383.00 - - 29906 - - $485.11 - - 29907 - - $661.64 - - 29914 - - $745.68 - - 29915 - - $762.66 - - 29916 - - $763.46 - - 29999 - - I.C. - - 30000 $212.59 $92.86 - - - 30020 $215.00 $93.67 - - - 30100 $111.39 $51.13 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 30110 $196.26 $101.18 - - - 30115 - - $365.71 - - 30117 $776.56 $258.56 - - - 30118 - - $611.37 - - 30120 $392.37 $319.52 - - - 30124 - - $236.33 - - 30125 - - $508.48 - - 30130 - - $328.05 - - 30140 $229.90 $132.67 - - - 30150 - - $620.18 - - 30160 - - $628.55 - - 30200 $87.45 $45.13 - - - 30210 $118.38 $79.28 - - - 30220 $242.60 $97.70 - - - 30300 $166.95 $96.78 - - - 30310 - - $162.28 - - 30320 - - $382.32 - - 30400 - - $960.22 - - 30430 - - $845.36 - - 30435 - - $1,042.07 - - 30450 - - $1,347.02 - - 30460 - - $633.70 - - 30462 - - $1,216.08 - - 30468 $2,067.4 1 $126.10 - - - 30469 $2,015.2 7 $112.00 - - - 30520 - - $525.09 - - 30540 - - $575.15 - - 30545 - - $776.78 - - 30560 $258.72 $117.56 - - - 30580 $469.51 $347.91 - - - 30600 $396.25 $288.84 - - - 30620 - - $530.00 - - 30630 - - $521.63 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 30801 $174.07 $119.97 - - - 30802 $219.04 $157.70 - - - 30901 $123.40 $41.45 - - - 30903 $193.97 $56.56 - - - 30905 $278.07 $77.73 - - - 30906 $293.91 $98.12 - - - 30915 - - $465.04 - - 30920 - - $671.22 - - 30930 - - $90.78 - - 30999 - - I.C. - - 31000 $146.28 $84.94 - - - 31002 - - $148.81 - - 31020 $344.05 $277.35 - - - 31030 $495.88 $393.84 - - - 31032 - - $461.22 - - 31040 - - $620.82 - - 31050 - - $402.80 - - 31051 - - $540.67 - - 31070 - - $373.37 - - 31075 - - $641.04 - - 31080 - - $842.89 - - 31081 - - $900.80 - - 31084 - - $930.85 - - 31085 - - $959.12 - - 31086 - - $907.71 - - 31087 - - $860.08 - - 31090 - - $863.46 - - 31200 - - $489.54 - - 31201 - - $617.49 - - 31205 - - $724.74 - - 31225 - - $1,362.02 - - 31230 - - $1,515.07 - - 31231 $148.98 $48.01 - - - 31233 $214.72 $100.62 - - - 31235 $242.59 $118.31 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 31237 $198.28 $119.00 - - - 31238 $192.80 $124.24 - - - 31239 - - $456.95 - - 31240 - - $118.17 - - 31241 - - $327.75 - - 31242 $1,999.2 2 $117.20 - - - 31243 $1,940.3 7 $117.20 - - - 31253 - - $368.89 - - 31254 $340.26 $179.82 - - - 31255 - - $238.87 - - 31256 - - $133.42 - - 31257 - - $328.82 - - 31259 - - $347.86 - - 31267 - - $196.08 - - 31276 - - $278.74 - - 31287 - - $149.26 - - 31288 - - $173.25 - - 31290 - - $856.02 - - 31291 - - $908.82 - - 31292 - - $745.31 - - 31293 - - $805.70 - - 31294 - - $918.86 - - 31295 $1,351.6 4 $116.90 - - - 31296 $1,370.8 7 $132.91 - - - 31297 $1,341.1 2 $106.65 - - - 31298 $2,546.3 2 $189.33 - - - 31299 - - I.C. - - 31300 - - $957.22 - - 31360 - - $1,553.39 - - 31365 - - $1,909.38 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 31367 - - $1,648.89 - - 31368 - - $1,821.58 - - 31370 - - $1,552.31 - - 31375 - - $1,476.03 - - 31380 - - $1,455.96 - - 31382 - - $1,591.98 - - 31390 - - $2,108.68 - - 31395 - - $2,216.72 - - 31400 - - $779.77 - - 31420 - - $633.66 - - 31500 - - $101.87 - - 31502 - - $25.68 - - 31505 $71.17 $37.43 - - - 31510 $168.12 $90.44 - - - 31511 $162.81 $99.86 - - - 31512 $168.17 $96.39 - - - 31513 - - $97.39 - - 31515 $167.72 $83.09 - - - 31520 - - $115.95 - - 31525 $193.12 $118.40 - - - 31526 - - $116.39 - - 31527 - - $144.44 - - 31528 - - $107.08 - - 31529 - - $119.08 - - 31530 - - $147.06 - - 31531 - - $156.78 - - 31535 - - $139.74 - - 31536 - - $155.77 - - 31540 - - $178.56 - - 31541 - - $194.64 - - 31545 - - $266.53 - - 31546 - - $403.30 - - 31551 - - $1,172.36 - - 31552 - - $1,133.29 - - 31553 - - $1,284.30 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 31554 - - $1,285.10 - - 31560 - - $230.19 - - 31561 - - $251.51 - - 31570 $263.26 $169.25 - - - 31571 - - $183.60 - - 31572 $416.56 $133.99 - - - 31573 $224.25 $110.69 - - - 31574 $761.27 $110.96 - - - 31575 $101.35 $51.26 - - - 31576 $211.37 $88.70 - - - 31577 $216.30 $99.52 - - - 31578 $239.52 $110.96 - - - 31579 $153.88 $89.33 - - - 31580 - - $989.65 - - 31584 - - $1,083.20 - - 31587 - - $924.09 - - 31590 - - $722.62 - - 31591 - - $844.61 - - 31592 - - $1,313.45 - - 31599 - - I.C. - - 31600 - - $222.68 - - 31601 - - $332.03 - - 31603 - - $233.45 - - 31605 - - $240.30 - - 31610 - - $733.37 - - 31611 - - $413.46 - - 31612 $72.28 $35.59 - - - 31613 - - $327.04 - - 31614 - - $548.05 - - 31615 $132.81 $85.67 - - - 31622 $190.15 $95.33 - - - 31623 $211.55 $95.31 - - - 31624 $195.81 $96.98 - - - 31625 $269.70 $112.48 - - - 31626 $620.93 $141.49 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 31627 $866.40 $69.04 - - - 31628 $287.10 $126.94 - - - 31629 $351.39 $134.44 - - - 31630 - - $143.46 - - 31631 - - $163.62 - - 31632 $48.38 $35.52 - - - 31633 $59.63 $45.17 - - - 31634 $1,205.1 3 $136.45 - - - 31635 $222.71 $126.29 - - - 31636 - - $156.13 - - 31637 - - $55.48 - - 31638 - - $178.43 - - 31640 - - $179.39 - - 31641 - - $183.86 - - 31643 - - $122.46 - - 31645 $209.30 $106.18 - - - 31646 - - $102.46 - - 31647 - - $148.12 - - 31648 - - $141.88 - - 31649 - - $48.17 - - 31651 - - $55.21 - - 31652 $997.19 $159.12 - - - 31653 $1,035.6 1 $176.38 - - - 31654 $91.85 $47.93 - - - 31660 - - $142.90 - - 31661 - - $144.34 - - 31717 $224.25 $77.20 - - - 31720 - - $35.32 - - 31725 - - $56.86 - - 31730 $852.42 $107.29 - - - 31755 - - $1,341.49 - - 31760 - - $993.64 - - 31766 - - $1,273.53 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 31770 - - $954.07 - - 31775 - - $1,005.66 - - 31780 - - $895.90 - - 31781 - - $1,070.06 - - 31785 - - $800.58 - - 31786 - - $1,035.94 - - 31800 - - $546.15 - - 31805 - - $594.83 - - 31820 $344.22 $251.81 - - - 31825 $473.12 $367.86 - - - 31830 $386.92 $281.93 - - - 31899 - - I.C. - - 32035 - - $538.45 - - 32036 - - $580.23 - - 32096 - - $577.40 - - 32097 - - $579.08 - - 32098 - - $550.02 - - 32100 - - $585.57 - - 32110 - - $1,065.08 - - 32120 - - $633.77 - - 32124 - - $669.21 - - 32140 - - $716.87 - - 32141 - - $1,093.81 - - 32150 - - $734.19 - - 32151 - - $727.27 - - 32160 - - $581.13 - - 32200 - - $827.75 - - 32215 - - $583.91 - - 32220 - - $1,157.84 - - 32225 - - $722.56 - - 32310 - - $666.58 - - 32320 - - $1,161.47 - - 32400 $129.45 $61.16 - - - 32408 $685.16 $110.38 - - - 32440 - - $1,128.92 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 32442 - - $2,175.99 - - 32445 - - $2,522.93 - - 32480 - - $1,065.36 - - 32482 - - $1,139.00 - - 32484 - - $1,029.55 - - 32486 - - $1,671.01 - - 32488 - - $1,711.33 - - 32491 - - $1,062.41 - - 32501 - - $172.00 - - 32503 - - $1,288.50 - - 32504 - - $1,464.90 - - 32505 - - $674.20 - - 32506 - - $110.88 - - 32507 - - $110.88 - - 32540 - - $1,242.27 - - 32550 $623.71 $148.02 - - - 32551 - - $112.08 - - 32552 $137.44 $116.02 - - - 32553 $400.60 $127.40 - - - 32554 $182.75 $64.10 - - - 32555 $247.60 $79.40 - - - 32556 $589.96 $89.64 - - - 32557 $528.34 $108.10 - - - 32560 $199.79 $54.63 - - - 32561 $70.64 $48.95 - - - 32562 $63.16 $43.61 - - - 32601 - - $220.72 - - 32604 - - $341.61 - - 32606 - - $329.51 - - 32607 - - $220.65 - - 32608 - - $270.57 - - 32609 - - $184.03 - - 32650 - - $486.29 - - 32651 - - $790.23 - - 32652 - - $1,195.87 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 32653 - - $765.01 - - 32654 - - $850.36 - - 32655 - - $692.64 - - 32656 - - $583.56 - - 32658 - - $519.52 - - 32659 - - $533.66 - - 32661 - - $578.77 - - 32662 - - $647.23 - - 32663 - - $1,004.61 - - 32664 - - $613.66 - - 32665 - - $885.88 - - 32666 - - $630.36 - - 32667 - - $110.88 - - 32668 - - $110.88 - - 32669 - - $964.74 - - 32670 - - $1,151.42 - - 32671 - - $1,268.93 - - 32672 - - $1,085.58 - - 32673 - - $874.49 - - 32674 - - $151.80 - - 32701 - - $150.48 - - 32800 - - $688.29 - - 32810 - - $653.69 - - 32815 - - $2,013.25 - - 32820 - - $963.42 - - 32850 - - I.C. - - 32851 - - $2,337.44 - - 32852 - - $2,524.73 - - 32853 - - $3,258.37 - - 32854 - - $3,450.66 - - 32855 - - I.C. - - 32856 - - I.C. - - 32900 - - $1,037.49 - - 32905 - - $960.21 - - 32906 - - $1,181.54 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 32940 - - $888.80 - - 32960 $95.59 $66.40 - - - 32994 $3,947.0 0 $315.90 - - - 32997 - - $243.75 - - 32998 $2,500.3 9 $316.69 - - - 32999 - - I.C. - - 33016 - - $167.23 - - 33017 - - $175.56 - - 33018 - - $205.69 - - 33019 - - $152.87 - - 33020 - - $595.59 - - 33025 - - $556.11 - - 33030 - - $1,430.29 - - 33031 - - $1,766.75 - - 33050 - - $727.47 - - 33120 - - $1,490.70 - - 33130 - - $980.97 - - 33140 - - $1,112.43 - - 33141 - - $93.20 - - 33202 - - $557.19 - - 33203 - - $582.97 - - 33206 - - $333.70 - - 33207 - - $349.04 - - 33208 - - $377.83 - - 33210 - - $115.59 - - 33211 - - $120.34 - - 33212 - - $235.52 - - 33213 - - $246.34 - - 33214 - - $351.33 - - 33215 - - $227.02 - - 33216 - - $274.01 - - 33217 - - $271.20 - - 33218 - - $287.81 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33220 - - $275.84 - - 33221 - - $264.00 - - 33222 - - $254.17 - - 33223 - - $300.96 - - 33224 - - $370.26 - - 33225 - - $334.08 - - 33226 - - $352.15 - - 33227 - - $248.89 - - 33228 - - $259.78 - - 33229 - - $274.76 - - 33230 - - $280.81 - - 33231 - - $292.70 - - 33233 - - $173.84 - - 33234 - - $354.72 - - 33235 - - $467.23 - - 33236 - - $570.74 - - 33237 - - $611.02 - - 33238 - - $689.75 - - 33240 - - $267.90 - - 33241 - - $159.07 - - 33243 - - $991.84 - - 33244 - - $632.75 - - 33249 - - $666.37 - - 33250 - - $1,043.78 - - 33251 - - $1,167.36 - - 33254 - - $976.92 - - 33255 - - $1,164.18 - - 33256 - - $1,377.57 - - 33257 - - $422.11 - - 33258 - - $469.43 - - 33259 - - $612.06 - - 33261 - - $1,153.54 - - 33262 - - $273.57 - - 33263 - - $283.86 - - 33264 - - $296.02 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33265 - - $979.33 - - 33266 - - $1,319.18 - - 33267 - - $749.65 - - 33268 - - $92.76 - - 33269 - - $594.06 - - 33270 - - $410.57 - - 33271 - - $328.57 - - 33272 - - $254.12 - - 33273 - - $290.78 - - 33274 - - $350.11 - - 33275 - - $363.20 - - 33276 - - $419.13 - - 33277 - - $217.39 - - 33278 - - $416.54 - - 33279 - - $253.25 - - 33280 - - $155.79 - - 33281 - - $273.21 - - 33285 $3,488.0 7 $63.47 - - - 33286 $99.77 $62.54 - - - 33287 - - $282.39 - - 33288 - - $370.12 - - 33289 - - $238.65 - - 33300 - - $1,735.96 - - 33305 - - $2,902.79 - - 33310 - - $842.08 - - 33315 - - $1,368.53 - - 33320 - - $770.43 - - 33321 - - $854.31 - - 33322 - - $997.05 - - 33330 - - $1,021.69 - - 33335 - - $1,335.20 - - 33340 - - $561.64 - - 33361 - - $859.42 - - 33362 - - $937.24 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33363 - - $970.17 - - 33364 - - $968.68 - - 33365 - - $1,013.31 - - 33366 - - $1,116.91 - - 33367 - - $431.77 - - 33368 - - $522.90 - - 33369 - - $690.31 - - 33370 - - $95.44 - - 33390 - - $1,376.78 - - 33391 - - $1,631.47 - - 33404 - - $1,251.51 - - 33405 - - $1,621.57 - - 33406 - - $2,055.49 - - 33410 - - $1,814.17 - - 33411 - - $2,387.69 - - 33412 - - $2,235.22 - - 33413 - - $2,292.53 - - 33414 - - $1,531.25 - - 33415 - - $1,446.50 - - 33416 - - $1,447.34 - - 33417 - - $1,198.61 - - 33418 - - $1,284.03 - - 33419 - - $300.59 - - 33420 - - $1,040.35 - - 33422 - - $1,192.11 - - 33425 - - $1,947.14 - - 33426 - - $1,701.32 - - 33427 - - $1,739.80 - - 33430 - - $2,000.94 - - 33440 - - $2,416.73 - - 33460 - - $1,706.43 - - 33463 - - $2,192.87 - - 33464 - - $1,739.75 - - 33465 - - $1,963.07 - - 33468 - - $1,746.27 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33471 - - $954.41 - - 33474 - - $1,558.23 - - 33475 - - $1,659.26 - - 33476 - - $1,096.41 - - 33477 - - $961.70 - - 33478 - - $1,132.26 - - 33496 - - $1,192.32 - - 33500 - - $1,118.25 - - 33501 - - $802.36 - - 33502 - - $922.70 - - 33503 - - $959.94 - - 33504 - - $1,056.14 - - 33505 - - $1,465.27 - - 33506 - - $1,461.66 - - 33507 - - $1,228.49 - - 33508 - - $11.40 - - 33509 - - $122.55 - - 33510 - - $1,382.98 - - 33511 - - $1,517.75 - - 33512 - - $1,729.96 - - 33513 - - $1,768.11 - - 33514 - - $1,859.15 - - 33516 - - $1,924.28 - - 33517 - - $132.03 - - 33518 - - $290.80 - - 33519 - - $384.30 - - 33521 - - $460.64 - - 33522 - - $517.44 - - 33523 - - $584.26 - - 33530 - - $371.00 - - 33533 - - $1,339.23 - - 33534 - - $1,571.28 - - 33535 - - $1,745.99 - - 33536 - - $1,878.00 - - 33542 - - $1,870.59 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33545 - - $2,181.60 - - 33548 - - $2,103.01 - - 33572 - - $163.11 - - 33600 - - $1,234.44 - - 33602 - - $1,198.86 - - 33606 - - $1,275.93 - - 33608 - - $1,292.06 - - 33610 - - $1,274.82 - - 33611 - - $1,391.56 - - 33612 - - $1,428.34 - - 33615 - - $1,429.52 - - 33617 - - $1,547.23 - - 33619 - - $1,968.51 - - 33620 - - $1,176.97 - - 33621 - - $668.44 - - 33622 - - $2,437.38 - - 33641 - - $1,171.18 - - 33645 - - $1,237.42 - - 33647 - - $1,297.15 - - 33660 - - $1,253.94 - - 33665 - - $1,364.97 - - 33670 - - $1,402.15 - - 33675 - - $1,405.94 - - 33676 - - $1,443.32 - - 33677 - - $1,498.10 - - 33681 - - $1,325.27 - - 33684 - - $1,347.74 - - 33688 - - $1,340.70 - - 33690 - - $869.05 - - 33692 - - $1,391.75 - - 33694 - - $1,391.56 - - 33697 - - $1,465.39 - - 33702 - - $1,111.73 - - 33710 - - $1,463.14 - - 33720 - - $1,112.22 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33724 - - $1,099.85 - - 33726 - - $1,448.76 - - 33730 - - $1,435.16 - - 33732 - - $1,184.81 - - 33735 - - $936.35 - - 33736 - - $1,014.46 - - 33737 - - $936.13 - - 33741 - - $533.91 - - 33745 - - $762.51 - - 33746 - - $304.78 - - 33750 - - $907.58 - - 33755 - - $951.09 - - 33762 - - $921.36 - - 33764 - - $951.09 - - 33766 - - $957.41 - - 33767 - - $1,020.55 - - 33768 - - $294.18 - - 33770 - - $1,506.63 - - 33771 - - $1,547.27 - - 33774 - - $1,293.07 - - 33775 - - $1,329.85 - - 33776 - - $1,406.05 - - 33777 - - $1,352.69 - - 33778 - - $1,678.34 - - 33779 - - $1,652.32 - - 33780 - - $1,684.24 - - 33781 - - $1,642.19 - - 33782 - - $2,293.15 - - 33783 - - $2,477.26 - - 33786 - - $1,622.80 - - 33788 - - $1,098.53 - - 33800 - - $708.80 - - 33802 - - $785.15 - - 33803 - - $827.25 - - 33813 - - $895.45 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33814 - - $1,097.22 - - 33820 - - $697.65 - - 33822 - - $734.92 - - 33824 - - $853.28 - - 33840 - - $894.69 - - 33845 - - $963.18 - - 33851 - - $918.18 - - 33852 - - $1,007.69 - - 33853 - - $1,315.30 - - 33858 - - $2,412.98 - - 33859 - - $1,735.06 - - 33863 - - $2,235.20 - - 33864 - - $2,284.42 - - 33866 - - $651.48 - - 33871 - - $2,313.84 - - 33875 - - $1,951.27 - - 33877 - - $2,550.47 - - 33880 - - $1,264.51 - - 33881 - - $1,083.89 - - 33883 - - $787.83 - - 33884 - - $275.10 - - 33886 - - $681.55 - - 33889 - - $557.15 - - 33891 - - $671.01 - - 33894 - - $696.76 - - 33895 - - $554.22 - - 33897 - - $412.29 - - 33900 - - $418.30 - - 33901 - - $549.80 - - 33902 - - $531.14 - - 33903 - - $625.98 - - 33904 - - $210.09 - - 33910 - - $1,882.64 - - 33915 - - $984.18 - - 33916 - - $2,966.17 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33917 - - $1,050.55 - - 33920 - - $1,294.41 - - 33922 - - $1,000.23 - - 33924 - - $201.79 - - 33925 - - $1,225.10 - - 33926 - - $1,718.47 - - 33927 - - $1,801.83 - - 33928 - - I.C. - - 33929 - - I.C. - - 33930 - - I.C. - - 33933 - - I.C. - - 33935 - - $3,505.42 - - 33940 - - I.C. - - 33944 - - I.C. - - 33945 - - $3,467.52 - - 33946 - - $220.17 - - 33947 - - $243.42 - - 33948 - - $170.17 - - 33949 - - $165.12 - - 33951 - - $299.47 - - 33952 - - $303.36 - - 33953 - - $333.94 - - 33954 - - $336.68 - - 33955 - - $584.05 - - 33956 - - $591.26 - - 33957 - - $130.39 - - 33958 - - $130.39 - - 33959 - - $165.06 - - 33962 - - $165.06 - - 33963 - - $329.84 - - 33964 - - $348.23 - - 33965 - - $130.39 - - 33966 - - $167.60 - - 33967 - - $183.35 - - 33968 - - $24.09 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 33969 - - $192.64 - - 33970 - - $251.12 - - 33971 - - $511.12 - - 33973 - - $354.48 - - 33974 - - $644.42 - - 33975 - - $918.57 - - 33976 - - $1,117.29 - - 33977 - - $798.34 - - 33978 - - $943.48 - - 33979 - - $1,374.45 - - 33980 - - $1,262.41 - - 33981 - - $585.40 - - 33982 - - $1,375.52 - - 33983 - - $1,635.65 - - 33984 - - $200.79 - - 33985 - - $362.73 - - 33986 - - $370.77 - - 33987 - - $146.57 - - 33988 - - $547.93 - - 33989 - - $348.23 - - 33990 - - $256.52 - - 33991 - - $321.51 - - 33992 - - $132.98 - - 33993 - - $118.36 - - 33995 - - $254.07 - - 33997 - - $112.36 - - 33999 - - I.C. - - 34001 - - $644.87 - - 34051 - - $717.41 - - 34101 - - $425.31 - - 34111 - - $427.06 - - 34151 - - $985.58 - - 34201 - - $722.17 - - 34203 - - $671.23 - - 34401 - - $1,064.17 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 34421 - - $490.96 - - 34451 - - $1,009.18 - - 34471 - - $760.64 - - 34490 - - $468.61 - - 34501 - - $633.47 - - 34502 - - $1,099.42 - - 34510 - - $720.17 - - 34520 - - $698.76 - - 34530 - - $666.31 - - 34701 - - $874.34 - - 34702 - - $1,301.18 - - 34703 - - $970.79 - - 34704 - - $1,612.34 - - 34705 - - $1,076.65 - - 34706 - - $1,599.61 - - 34707 - - $824.56 - - 34708 - - $1,274.08 - - 34709 - - $226.09 - - 34710 - - $562.78 - - 34711 - - $205.96 - - 34712 - - $466.83 - - 34713 - - $86.40 - - 34714 - - $189.76 - - 34715 - - $209.91 - - 34716 - - $262.73 - - 34717 - - $310.02 - - 34718 - - $870.52 - - 34808 - - $141.63 - - 34812 - - $144.28 - - 34813 - - $164.98 - - 34820 - - $234.64 - - 34830 - - $1,237.06 - - 34831 - - $1,354.82 - - 34832 - - $1,329.10 - - 34833 - - $273.46 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

100

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 34834 - - $90.47 - - 34839 - - I.C. - - 34841 - - I.C. - - 34842 - - I.C. - - 34843 - - I.C. - - 34844 - - I.C. - - 34845 - - I.C. - - 34846 - - I.C. - - 34847 - - I.C. - - 34848 - - I.C. - - 35001 - - $799.10 - - 35002 - - $802.09 - - 35005 - - $703.33 - - 35011 - - $718.43 - - 35013 - - $903.62 - - 35021 - - $905.86 - - 35022 - - $1,033.79 - - 35045 - - $691.04 - - 35081 - - $1,220.26 - - 35082 - - $1,523.99 - - 35091 - - $1,251.12 - - 35092 - - $1,817.20 - - 35102 - - $1,321.49 - - 35103 - - $1,563.35 - - 35111 - - $934.77 - - 35112 - - $1,147.69 - - 35121 - - $1,109.82 - - 35122 - - $1,325.83 - - 35131 - - $973.40 - - 35132 - - $1,147.69 - - 35141 - - $772.89 - - 35142 - - $933.83 - - 35151 - - $875.17 - - 35152 - - $982.79 - - 35180 - - $554.90 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

101

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 35182 - - $1,285.76 - - 35184 - - $680.25 - - 35188 - - $946.74 - - 35189 - - $1,060.23 - - 35190 - - $547.29 - - 35201 - - $668.98 - - 35206 - - $565.55 - - 35207 - - $569.39 - - 35211 - - $996.53 - - 35216 - - $1,515.55 - - 35221 - - $1,057.19 - - 35226 - - $592.75 - - 35231 - - $917.07 - - 35236 - - $712.72 - - 35241 - - $1,029.92 - - 35246 - - $1,118.38 - - 35251 - - $1,252.34 - - 35256 - - $725.16 - - 35261 - - $691.77 - - 35266 - - $613.41 - - 35271 - - $993.92 - - 35276 - - $1,046.62 - - 35281 - - $1,153.52 - - 35286 - - $660.94 - - 35301 - - $800.08 - - 35302 - - $791.22 - - 35303 - - $874.31 - - 35304 - - $896.63 - - 35305 - - $863.26 - - 35306 - - $310.76 - - 35311 - - $1,109.62 - - 35321 - - $636.42 - - 35331 - - $1,033.34 - - 35341 - - $977.59 - - 35351 - - $907.05 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

102

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 35355 - - $725.51 - - 35361 - - $1,069.54 - - 35363 - - $1,139.83 - - 35371 - - $577.38 - - 35372 - - $689.78 - - 35390 - - $111.31 - - 35400 - - $103.11 - - 35500 - - $222.14 - - 35501 - - $1,024.26 - - 35506 - - $894.80 - - 35508 - - $934.88 - - 35509 - - $991.10 - - 35510 - - $863.90 - - 35511 - - $787.16 - - 35512 - - $846.72 - - 35515 - - $934.88 - - 35516 - - $857.15 - - 35518 - - $802.72 - - 35521 - - $864.44 - - 35522 - - $821.99 - - 35523 - - $895.78 - - 35525 - - $800.00 - - 35526 - - $1,235.56 - - 35531 - - $1,367.39 - - 35533 - - $1,058.76 - - 35535 - - $1,334.65 - - 35536 - - $1,186.71 - - 35537 - - $1,460.52 - - 35538 - - $1,636.52 - - 35539 - - $1,535.56 - - 35540 - - $1,710.99 - - 35556 - - $983.70 - - 35558 - - $872.79 - - 35560 - - $1,196.39 - - 35563 - - $931.06 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

103

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 35565 - - $924.59 - - 35566 - - $1,170.77 - - 35570 - - $1,035.38 - - 35571 - - $933.32 - - 35572 - - $240.97 - - 35583 - - $1,017.87 - - 35585 - - $1,175.99 - - 35587 - - $963.20 - - 35600 - - $131.28 - - 35601 - - $989.34 - - 35606 - - $829.15 - - 35612 - - $737.09 - - 35616 - - $774.45 - - 35621 - - $774.95 - - 35623 - - $924.76 - - 35626 - - $1,133.11 - - 35631 - - $1,301.50 - - 35632 - - $1,267.11 - - 35633 - - $1,393.23 - - 35634 - - $1,240.51 - - 35636 - - $1,120.33 - - 35637 - - $1,164.32 - - 35638 - - $1,223.04 - - 35642 - - $698.52 - - 35645 - - $668.10 - - 35646 - - $1,202.32 - - 35647 - - $1,095.03 - - 35650 - - $718.85 - - 35654 - - $961.69 - - 35656 - - $759.31 - - 35661 - - $767.29 - - 35663 - - $857.47 - - 35665 - - $829.41 - - 35666 - - $915.15 - - 35671 - - $806.89 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

104

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 35681 - - $55.88 - - 35682 - - $245.98 - - 35683 - - $285.14 - - 35685 - - $138.33 - - 35686 - - $111.97 - - 35691 - - $667.61 - - 35693 - - $592.41 - - 35694 - - $696.66 - - 35695 - - $722.97 - - 35697 - - $102.58 - - 35700 - - $106.01 - - 35701 - - $323.86 - - 35702 - - $297.38 - - 35703 - - $298.77 - - 35800 - - $538.93 - - 35820 - - $1,437.54 - - 35840 - - $882.48 - - 35860 - - $600.09 - - 35870 - - $878.91 - - 35875 - - $422.06 - - 35876 - - $667.24 - - 35879 - - $652.59 - - 35881 - - $724.35 - - 35883 - - $844.55 - - 35884 - - $870.39 - - 35901 - - $340.84 - - 35903 - - $406.81 - - 35905 - - $1,179.56 - - 35907 - - $1,338.05 - - 36000 $23.82 $6.68 - - - 36002 $114.79 $75.41 - - - 36005 $203.17 $34.43 - - - 36010 $428.72 $77.04 - - - 36011 $638.83 $111.45 - - - 36012 $661.01 $123.18 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

105

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 36013 $626.41 $89.66 - - - 36014 $623.84 $108.25 - - - 36015 $675.48 $122.39 - - - 36100 $442.09 $109.17 - - - 36140 $404.44 $63.21 - - - 36160 $445.01 $88.25 - - - 36200 $466.91 $98.10 - - - 36215 $819.45 $152.53 - - - 36216 $837.30 $192.61 - - - 36217 $1,410.7 8 $234.96 - - - 36218 $163.52 $37.10 - - - 36221 $781.57 $141.16 - - - 36222 $959.06 $202.94 - - - 36223 $1,297.7 0 $233.84 - - - 36224 $1,614.9 8 $263.20 - - - 36225 $1,224.1 1 $231.50 - - - 36226 $1,569.4 5 $261.59 - - - 36227 $184.03 $86.00 - - - 36228 $994.77 $175.98 - - - 36245 $985.86 $167.88 - - - 36246 $652.74 $178.13 - - - 36247 $1,124.7 3 $212.20 - - - 36248 $90.87 $34.63 - - - 36251 $1,020.5 7 $182.50 - - - 36252 $1,092.3 5 $253.20 - - - 36253 $1,601.0 2 $252.98 - - - 36254 $1,566.4 1 $294.71 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

106

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 36260 - - $486.40 - - 36261 - - $307.59 - - 36262 - - $236.12 - - 36299 - - I.C. - - 36400 $20.82 $13.85 - - - 36405 $17.90 $10.94 - - - 36406 $13.45 $6.48 - - - 36410 $13.38 $6.68 - - - 36415 - - I.C. - - 36416 - - I.C. - - 36420 - - $33.95 - - 36425 - - $28.91 - - 36430 - - $31.20 - - 36440 - - $36.80 - - 36450 - - $124.31 - - 36455 - - $89.30 - - 36456 - - $71.32 - - 36460 - - $251.40 - - 36465 $1,049.3 1 $84.82 - - - 36466 $1,130.9 6 $109.42 - - - 36468 - - I.C. - - 36470 $89.79 $27.65 - - - 36471 $154.75 $54.31 - - - 36473 $968.23 $128.82 - - - 36474 $200.17 $64.11 - - - 36475 $849.95 $198.03 - - - 36476 $218.03 $95.10 - - - 36478 $769.94 $198.10 - - - 36479 $230.76 $96.30 - - - 36481 $1,385.5 3 $234.89 - - - 36482 $1,336.6 4 $127.08 - - - 36483 $102.47 $62.83 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

107

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 36500 - - $129.74 - - 36510 $65.25 $39.00 - - - 36511 - - $80.83 - - 36512 - - $78.42 - - 36513 - - $77.68 - - 36514 $446.47 $68.28 - - - 36516 $1,408.8 4 $61.60 - - - 36522 $1,084.7 3 $70.96 - - - 36555 $146.54 $61.10 - - - 36556 $166.17 $60.91 - - - 36557 $918.51 $235.52 - - - 36558 $656.24 $189.93 - - - 36560 $976.37 $281.59 - - - 36561 $774.71 $243.05 - - - 36563 $887.78 $266.39 - - - 36565 $641.90 $243.62 - - - 36566 $3,416.9 9 $260.23 - - - 36568 - - $66.04 - - 36569 - - $67.52 - - 36570 $1,159.3 9 $244.45 - - - 36571 $1,001.3 0 $228.85 - - - 36572 $296.98 $58.07 - - - 36573 $305.03 $61.03 - - - 36575 $114.49 $24.23 - - - 36576 $267.41 $134.56 - - - 36578 $337.01 $149.26 - - - 36580 $148.97 $47.46 - - - 36581 $618.14 $133.89 - - - 36582 $693.40 $209.68 - - - 36583 $910.59 $241.53 - - - 36584 $259.98 $42.49 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

108

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 36585 $919.11 $206.65 - - - 36589 $124.49 $100.66 - - - 36590 $167.85 $139.73 - - - 36591 - - $21.36 - - 36592 - - $23.23 - - 36593 - - $26.38 - - 36595 $466.45 $130.58 - - - 36596 $89.20 $32.42 - - - 36597 $85.79 $44.01 - - - 36598 $95.05 $25.95 - - - 36600 $21.09 $10.91 - - - 36620 - - $32.11 - - 36625 - - $76.07 - - 36640 - - $86.15 - - 36660 - - $49.94 - - 36680 - - $42.89 - - 36800 - - $87.53 - - 36810 - - $153.44 - - 36815 - - $95.89 - - 36818 - - $491.96 - - 36819 - - $519.94 - - 36820 - - $516.10 - - 36821 - - $471.67 - - 36823 - - $1,028.66 - - 36825 - - $566.50 - - 36830 - - $475.26 - - 36831 - - $440.02 - - 36832 - - $539.67 - - 36833 - - $575.98 - - 36835 - - $354.05 - - 36836 $5,605.7 8 $254.34 - - - 36837 $7,979.9 2 $331.22 - - - 36838 - - $807.56 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

109

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 36860 $178.87 $79.50 - - - 36861 - - $99.87 - - 36901 $557.17 $120.32 - - - 36902 $957.00 $171.16 - - - 36903 $3,433.7 8 $224.26 - - - 36904 $1,435.1 5 $262.81 - - - 36905 $1,809.2 7 $316.60 - - - 36906 $4,346.7 8 $364.27 - - - 36907 $465.80 $104.21 - - - 36908 $1,128.5 5 $146.65 - - - 36909 $1,530.7 4 $143.07 - - - 37140 - - $1,688.24 - - 37145 - - $1,567.18 - - 37160 - - $1,609.45 - - 37180 - - $1,546.65 - - 37181 - - $1,688.24 - - 37182 - - $585.49 - - 37183 $4,718.1 4 $269.05 - - - 37184 $1,349.2 4 $306.00 - - - 37185 $368.11 $115.27 - - - 37186 $938.62 $171.53 - - - 37187 $1,348.1 8 $280.03 - - - 37188 $1,168.0 6 $200.36 - - - 37191 $1,629.1 3 $158.42 - - - 37192 $1,001.5 6 $240.36 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

110

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 37193 $1,186.4 5 $247.13 - - - 37195 - - I.C. - - 37197 $1,235.6 9 $213.62 - - - 37200 - - $153.82 - - 37211 - - $273.79 - - 37212 - - $239.95 - - 37213 - - $163.70 - - 37214 - - $86.70 - - 37215 - - $706.09 - - 37216 - - $723.24 - - 37217 - - $766.42 - - 37218 - - $589.01 - - 37220 $1,993.4 1 $281.91 - - - 37221 $2,452.5 4 $346.79 - - - 37222 $480.96 $130.35 - - - 37223 $1,012.2 8 $148.49 - - - 37224 $2,327.5 1 $312.82 - - - 37225 $7,035.9 4 $421.64 - - - 37226 $6,550.0 9 $365.13 - - - 37227 $9,014.7 0 $505.16 - - - 37228 $3,311.4 7 $381.03 - - - 37229 $7,143.9 6 $489.75 - - - 37230 $7,153.9 6 $488.50 - - - 37231 $9,464.7 7 $519.72 - - - 37232 $646.46 $140.25 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

111

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 37233 $816.04 $227.60 - - - 37234 $2,913.3 3 $198.23 - - - 37235 $3,173.9 5 $263.60 - - - 37236 $2,185.8 9 $311.55 - - - 37237 $1,026.7 5 $147.70 - - - 37238 $2,765.2 4 $216.75 - - - 37239 $1,373.1 6 $106.28 - - - 37241 $3,742.9 7 $306.05 - - - 37242 $5,726.0 3 $338.70 - - - 37243 $6,959.2 3 $401.71 - - - 37244 $5,295.5 2 $474.67 - - - 37246 $1,441.2 3 $246.40 - - - 37247 $441.39 $121.32 - - - 37248 $1,075.0 9 $211.58 - - - 37249 $344.86 $103.00 - - - 37252 $762.99 $63.12 - - - 37253 $132.06 $50.10 - - - 37500 - - $448.64 - - 37501 - - I.C. - - 37565 - - $534.85 - - 37600 - - $550.31 - - 37605 - - $521.85 - - 37606 - - $547.60 - - 37607 - - $270.67 - - 37609 $240.07 $151.95 - - - 37615 - - $382.87 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

112

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 37616 - - $802.18 - - 37617 - - $951.71 - - 37618 - - $286.65 - - 37619 - - $1,255.41 - - 37650 - - $327.46 - - 37660 - - $959.45 - - 37700 - - $178.95 - - 37718 - - $281.21 - - 37722 - - $334.39 - - 37735 - - $414.13 - - 37760 - - $410.26 - - 37761 - - $391.00 - - 37765 $320.85 $194.96 - - - 37766 $375.18 $238.32 - - - 37780 - - $170.39 - - 37785 $264.61 $186.13 - - - 37788 - - $921.50 - - 37790 - - $357.64 - - 37799 - - I.C. - - 38100 - - $842.95 - - 38101 - - $852.16 - - 38102 - - $189.62 - - 38115 - - $944.04 - - 38120 - - $779.33 - - 38129 - - I.C. - - 38200 - - $94.95 - - 38204 - - $73.59 - - 38205 - - $62.30 - - 38206 - - $61.76 - - 38207 - - $32.90 - - 38208 - - $20.80 - - 38209 - - $8.69 - - 38210 - - $58.18 - - 38211 - - $52.90 - - 38212 - - $34.66 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

113

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 38213 - - $8.69 - - 38214 - - $29.74 - - 38215 - - $34.66 - - 38220 $120.84 $50.13 - - - 38221 $125.48 $51.82 - - - 38222 $135.95 $55.60 - - - 38230 - - $148.37 - - 38232 - - $141.16 - - 38240 - - $178.40 - - 38241 - - $131.63 - - 38242 - - $93.30 - - 38243 - - $91.11 - - 38300 $264.03 $158.77 - - - 38305 - - $370.77 - - 38308 - - $347.45 - - 38380 - - $429.84 - - 38381 - - $585.15 - - 38382 - - $501.90 - - 38500 $256.83 $190.14 - - - 38505 $137.15 $63.22 - - - 38510 $401.67 $311.68 - - - 38520 - - $349.76 - - 38525 - - $328.63 - - 38530 - - $421.72 - - 38531 - - $332.81 - - 38542 - - $392.93 - - 38550 - - $391.60 - - 38555 - - $760.52 - - 38562 - - $525.67 - - 38564 - - $518.65 - - 38570 - - $381.76 - - 38571 - - $486.38 - - 38572 - - $668.78 - - 38573 - - $868.16 - - 38589 - - I.C. - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

114

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 38700 - - $606.09 - - 38720 - - $998.24 - - 38724 - - $1,083.51 - - 38740 - - $520.66 - - 38745 - - $652.04 - - 38746 - - $151.60 - - 38747 - - $191.82 - - 38760 - - $619.06 - - 38765 - - $965.29 - - 38770 - - $593.15 - - 38780 - - $767.74 - - 38790 - - $60.76 - - 38792 $64.12 $23.67 - - - 38794 - - $207.95 - - 38900 - - $99.05 - - 38999 - - I.C. - - 39000 - - $355.74 - - 39010 - - $572.75 - - 39200 - - $627.92 - - 39220 - - $824.03 - - 39401 - - $221.46 - - 39402 - - $288.50 - - 39499 - - I.C. - - 39501 - - $622.74 - - 39503 - - $4,140.57 - - 39540 - - $632.01 - - 39541 - - $681.69 - - 39545 - - $652.87 - - 39560 - - $589.80 - - 39561 - - $917.79 - - 39599 - - I.C. - - 40490 $94.95 $51.29 - - - 40500 $411.38 $283.09 - - - 40510 $379.03 $264.66 - - - 40520 $392.28 $272.02 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

115

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 40525 - - $417.37 - - 40527 - - $475.02 - - 40530 $433.07 $308.52 - - - 40650 $374.98 $239.46 - - - 40652 $404.16 $275.33 - - - 40654 $454.03 $324.13 - - - 40700 - - $757.37 - - 40701 - - $892.23 - - 40702 - - $750.10 - - 40720 - - $770.28 - - 40761 - - $807.93 - - 40799 - - I.C. - - 40800 $159.20 $91.17 - - - 40801 $225.21 $149.95 - - - 40804 $146.65 $86.39 - - - 40805 $220.02 $149.31 - - - 40806 $79.10 $22.05 - - - 40808 $133.37 $67.75 - - - 40810 $171.09 $94.48 - - - 40812 $219.65 $140.10 - - - 40814 $290.11 $216.99 - - - 40816 $312.16 $231.27 - - - 40818 $287.15 $205.19 - - - 40819 $208.81 $151.50 - - - 40820 $204.62 $129.35 - - - 40830 $176.72 $111.10 - - - 40831 $231.30 $153.36 - - - 40840 $667.78 $478.68 - - - 40842 $718.51 $512.00 - - - 40843 $921.60 $652.96 - - - 40844 $1,152.7 6 $884.92 - - - 40845 $1,128.1 6 $904.79 - - - 40899 - - I.C. - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

116

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 41000 $114.59 $80.31 - - - 41005 $189.48 $91.99 - - - 41006 $263.74 $174.55 - - - 41007 $254.16 $166.58 - - - 41008 $304.58 $194.76 - - - 41009 $329.38 $216.35 - - - 41010 $172.80 $85.22 - - - 41015 $307.91 $226.49 - - - 41016 $363.43 $263.79 - - - 41017 $363.43 $262.72 - - - 41018 $407.11 $304.53 - - - 41019 - - $363.36 - - 41100 $147.04 $81.69 - - - 41105 $146.93 $83.72 - - - 41108 $132.91 $69.97 - - - 41110 $181.34 $99.64 - - - 41112 $265.12 $186.64 - - - 41113 $283.41 $202.79 - - - 41114 - - $470.95 - - 41115 $206.32 $112.04 - - - 41116 $262.68 $165.46 - - - 41120 - - $817.19 - - 41130 - - $1,002.47 - - 41135 - - $1,634.96 - - 41140 - - $1,653.05 - - 41145 - - $2,077.89 - - 41150 - - $1,661.85 - - 41153 - - $1,798.47 - - 41155 - - $2,247.04 - - 41250 $223.32 $116.45 - - - 41251 $247.12 $138.92 - - - 41252 $255.42 $157.93 - - - 41510 - - $356.28 - - 41512 - - $515.73 - - 41520 $287.54 $193.53 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

117

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 41530 $733.09 $293.03 - - - 41599 - - I.C. - - 41800 $231.02 $119.33 - - - 41805 $247.20 $154.53 - - - 41806 $323.07 $215.13 - - - 41820 - - I.C. - - 41821 - - I.C. - - 41822 $278.33 $152.98 - - - 41823 $413.72 $280.87 - - - 41825 $173.72 $92.83 - - - 41826 $236.76 $150.79 - - - 41827 $335.46 $218.42 - - - 41828 $273.42 $167.09 - - - 41830 $367.25 $240.83 - - - 41850 - - I.C. - - 41870 - - I.C. - - 41872 $369.41 $233.34 - - - 41874 $296.77 $183.74 - - - 41899 - - I.C. - - 42000 $126.20 $83.35 - - - 42100 $114.04 $84.04 - - - 42104 $170.32 $102.83 - - - 42106 $198.52 $123.53 - - - 42107 $351.11 $249.34 - - - 42120 - - $769.46 - - 42140 $247.23 $125.10 - - - 42145 - - $522.30 - - 42160 $181.80 $109.22 - - - 42180 $198.73 $142.49 - - - 42182 $254.67 $194.94 - - - 42200 - - $700.10 - - 42205 - - $725.67 - - 42210 - - $810.82 - - 42215 - - $533.00 - - 42220 - - $440.01 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

118

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 42225 - - $757.38 - - 42226 - - $697.09 - - 42227 - - $648.38 - - 42235 - - $572.80 - - 42260 $661.97 $506.08 - - - 42280 $138.48 $82.77 - - - 42281 $175.49 $123.26 - - - 42299 - - I.C. - - 42300 $168.38 $119.63 - - - 42305 - - $320.41 - - 42310 $133.55 $103.82 - - - 42320 $204.23 $136.74 - - - 42330 $181.86 $125.88 - - - 42335 $339.57 $200.29 - - - 42340 $416.89 $262.35 - - - 42400 $75.87 $39.71 - - - 42405 $235.07 $171.60 - - - 42408 $425.42 $265.79 - - - 42409 $311.86 $177.41 - - - 42410 - - $475.36 - - 42415 - - $793.69 - - 42420 - - $887.98 - - 42425 - - $631.32 - - 42426 - - $1,007.15 - - 42440 - - $315.11 - - 42450 $366.35 $278.77 - - - 42500 $350.09 $264.92 - - - 42505 $444.66 $349.58 - - - 42507 - - $379.47 - - 42509 - - $621.04 - - 42510 - - $463.13 - - 42550 $122.00 $45.13 - - - 42600 $426.83 $271.21 - - - 42650 $57.75 $44.62 - - - 42660 $89.57 $66.27 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

119

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 42665 $297.05 $166.07 - - - 42699 - - I.C. - - 42700 $150.61 $104.01 - - - 42720 $339.90 $288.74 - - - 42725 - - $598.37 - - 42800 $123.36 $89.07 - - - 42804 $170.64 $94.84 - - - 42806 $189.68 $108.52 - - - 42808 $180.31 $126.21 - - - 42809 $158.48 $95.26 - - - 42810 $304.55 $216.97 - - - 42815 - - $412.10 - - 42820 - - $220.92 - - 42821 - - $231.51 - - 42825 - - $205.48 - - 42826 - - $195.18 - - 42830 - - $162.81 - - 42831 - - $177.51 - - 42835 - - $152.32 - - 42836 - - $187.31 - - 42842 - - $773.62 - - 42844 - - $1,048.32 - - 42845 - - $1,661.23 - - 42860 - - $149.36 - - 42870 - - $458.43 - - 42890 - - $1,076.86 - - 42892 - - $1,410.64 - - 42894 - - $1,787.18 - - 42900 - - $248.98 - - 42950 - - $617.26 - - 42953 - - $739.61 - - 42955 - - $586.46 - - 42960 - - $121.59 - - 42961 - - $319.45 - - 42962 - - $394.15 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

120

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 42970 - - $312.63 - - 42971 - - $343.64 - - 42972 - - $383.67 - - 42975 - - $71.48 - - 42999 - - I.C. - - 43020 - - $421.54 - - 43030 - - $394.79 - - 43045 - - $946.40 - - 43100 - - $480.39 - - 43101 - - $730.12 - - 43107 - - $2,148.04 - - 43108 - - $3,166.93 - - 43112 - - $2,494.45 - - 43113 - - $3,101.28 - - 43116 - - $3,539.29 - - 43117 - - $2,341.60 - - 43118 - - $2,586.20 - - 43121 - - $2,047.75 - - 43122 - - $1,849.53 - - 43123 - - $3,214.23 - - 43124 - - $2,724.20 - - 43130 - - $592.64 - - 43135 - - $1,056.97 - - 43180 - - $408.73 - - 43191 - - $115.77 - - 43192 - - $126.33 - - 43193 - - $125.86 - - 43194 - - $141.19 - - 43195 - - $137.53 - - 43196 - - $145.02 - - 43197 $149.49 $60.03 - - - 43198 $165.53 $72.33 - - - 43200 $208.44 $64.61 - - - 43201 $204.33 $76.04 - - - 43202 $283.21 $75.64 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

121

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 43204 - - $99.14 - - 43205 - - $103.17 - - 43206 $236.44 $97.43 - - - 43210 - - $312.30 - - 43211 - - $171.56 - - 43212 - - $137.70 - - 43213 $987.72 $189.56 - - - 43214 - - $142.26 - - 43215 $309.27 $103.03 - - - 43216 $323.66 $97.60 - - - 43217 $330.27 $116.81 - - - 43220 $724.23 $86.51 - - - 43226 $304.51 $95.32 - - - 43227 $471.15 $120.54 - - - 43229 $563.57 $143.60 - - - 43231 - - $115.54 - - 43232 - - $144.25 - - 43233 - - $166.36 - - 43235 $225.38 $89.85 - - - 43236 $316.22 $100.88 - - - 43237 - - $143.05 - - 43238 - - $169.37 - - 43239 $296.27 $101.28 - - - 43240 - - $284.94 - - 43241 - - $103.66 - - 43242 - - $191.89 - - 43243 - - $172.93 - - 43244 - - $178.80 - - 43245 $470.50 $128.20 - - - 43246 - - $145.90 - - 43247 $298.95 $129.14 - - - 43248 $323.86 $121.37 - - - 43249 $867.39 $112.35 - - - 43250 $354.24 $124.17 - - - 43251 $388.79 $143.18 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

122

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 43252 $262.94 $122.86 - - - 43253 - - $191.63 - - 43254 - - $196.86 - - 43255 $494.98 $146.25 - - - 43257 - - $169.12 - - 43259 - - $164.50 - - 43260 - - $234.57 - - 43261 - - $246.40 - - 43262 - - $259.85 - - 43263 - - $260.12 - - 43264 - - $264.78 - - 43265 - - $314.67 - - 43266 - - $158.41 - - 43270 $577.44 $163.63 - - - 43273 - - $86.09 - - 43274 - - $336.24 - - 43275 - - $273.49 - - 43276 - - $350.14 - - 43277 - - $275.27 - - 43278 - - $314.43 - - 43279 - - $935.51 - - 43280 - - $789.65 - - 43281 - - $1,120.97 - - 43282 - - $1,260.08 - - 43283 - - $112.87 - - 43284 - - $482.61 - - 43285 - - $496.35 - - 43286 - - $2,302.13 - - 43287 - - $2,552.66 - - 43288 - - $2,696.25 - - 43289 - - I.C. - - 43290 $2,152.7 1 $131.59 - - - 43291 $362.34 $117.27 - - - 43300 - - $473.66 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

123

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 43305 - - $819.78 - - 43310 - - $1,067.07 - - 43312 - - $1,135.19 - - 43313 - - $2,120.38 - - 43314 - - $2,266.29 - - 43320 - - $1,024.35 - - 43325 - - $996.33 - - 43327 - - $603.22 - - 43328 - - $808.49 - - 43330 - - $980.15 - - 43331 - - $969.04 - - 43332 - - $836.82 - - 43333 - - $916.44 - - 43334 - - $894.09 - - 43335 - - $957.55 - - 43336 - - $1,041.40 - - 43337 - - $1,109.17 - - 43338 - - $81.51 - - 43340 - - $1,011.50 - - 43341 - - $1,011.46 - - 43351 - - $957.66 - - 43352 - - $775.94 - - 43360 - - $1,615.91 - - 43361 - - $1,968.25 - - 43400 - - $1,114.98 - - 43405 - - $1,056.69 - - 43410 - - $775.88 - - 43415 - - $1,860.15 - - 43420 - - $762.30 - - 43425 - - $1,041.65 - - 43450 $146.96 $59.11 - - - 43453 $646.05 $63.77 - - - 43460 - - $155.16 - - 43496 - - I.C. - - 43497 - - $586.09 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

124

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 43499 - - I.C. - - 43500 - - $577.82 - - 43501 - - $987.11 - - 43502 - - $1,117.38 - - 43510 - - $701.24 - - 43520 - - $509.27 - - 43605 - - $612.88 - - 43610 - - $719.36 - - 43611 - - $901.21 - - 43620 - - $1,446.10 - - 43621 - - $1,654.21 - - 43622 - - $1,682.21 - - 43631 - - $1,059.96 - - 43632 - - $1,484.95 - - 43633 - - $1,403.29 - - 43634 - - $1,548.33 - - 43635 - - $81.26 - - 43640 - - $875.71 - - 43641 - - $885.44 - - 43644 - - $1,270.81 - - 43645 - - $1,349.77 - - 43647 - - I.C. - - 43648 - - I.C. - - 43651 - - $486.89 - - 43652 - - $566.14 - - 43653 - - $431.07 - - 43659 - - I.C. - - 43752 - - $29.33 - - 43753 - - $15.56 - - 43754 $189.26 $28.28 - - - 43755 $160.47 $44.23 - - - 43756 $222.00 $37.99 - - - 43757 $297.27 $57.02 - - - 43761 $92.37 $75.76 - - - 43762 $180.93 $26.65 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

125

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 43763 $267.05 $64.29 - - - 43770 - - $830.32 - - 43771 - - $941.21 - - 43772 - - $697.47 - - 43773 - - $941.21 - - 43774 - - $707.10 - - 43775 - - $801.96 - - 43800 - - $682.70 - - 43810 - - $746.48 - - 43820 - - $986.14 - - 43825 - - $962.53 - - 43830 - - $521.86 - - 43831 - - $456.96 - - 43832 - - $766.58 - - 43840 - - $997.43 - - 43842 - - $855.61 - - 43843 - - $943.12 - - 43845 - - $1,433.04 - - 43846 - - $1,212.02 - - 43847 - - $1,324.87 - - 43848 - - $1,414.77 - - 43860 - - $1,197.54 - - 43865 - - $1,249.45 - - 43870 - - $524.98 - - 43880 - - $1,162.06 - - 43881 - - I.C. - - 43882 - - I.C. - - 43886 - - $278.15 - - 43887 - - $250.30 - - 43888 - - $348.96 - - 43999 - - I.C. - - 44005 - - $799.55 - - 44010 - - $627.58 - - 44015 - - $102.32 - - 44020 - - $714.75 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

126

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 44021 - - $713.74 - - 44025 - - $719.19 - - 44050 - - $687.85 - - 44055 - - $1,085.34 - - 44100 - - $77.65 - - 44110 - - $624.78 - - 44111 - - $724.68 - - 44120 - - $893.44 - - 44121 - - $173.76 - - 44125 - - $860.48 - - 44126 - - $1,800.90 - - 44127 - - $2,076.82 - - 44128 - - $175.03 - - 44130 - - $964.37 - - 44132 - - I.C. - - 44133 - - I.C. - - 44135 - - I.C. - - 44136 - - I.C. - - 44137 - - I.C. - - 44139 - - $86.89 - - 44140 - - $982.88 - - 44141 - - $1,329.41 - - 44143 - - $1,210.66 - - 44144 - - $1,290.98 - - 44145 - - $1,205.94 - - 44146 - - $1,536.46 - - 44147 - - $1,407.04 - - 44150 - - $1,361.97 - - 44151 - - $1,576.57 - - 44155 - - $1,515.71 - - 44156 - - $1,685.73 - - 44157 - - $1,601.00 - - 44158 - - $1,640.60 - - 44160 - - $910.30 - - 44180 - - $675.58 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

127

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 44186 - - $480.76 - - 44187 - - $807.72 - - 44188 - - $896.49 - - 44202 - - $1,016.31 - - 44203 - - $174.36 - - 44204 - - $1,123.02 - - 44205 - - $976.41 - - 44206 - - $1,272.56 - - 44207 - - $1,321.24 - - 44208 - - $1,441.19 - - 44210 - - $1,299.28 - - 44211 - - $1,555.13 - - 44212 - - $1,485.47 - - 44213 - - $134.31 - - 44227 - - $1,210.78 - - 44238 - - I.C. - - 44300 - - $619.24 - - 44310 - - $763.25 - - 44312 - - $442.36 - - 44314 - - $740.67 - - 44316 - - $1,037.16 - - 44320 - - $881.25 - - 44322 - - $753.21 - - 44340 - - $468.21 - - 44345 - - $774.41 - - 44346 - - $869.39 - - 44360 - - $105.07 - - 44361 - - $115.80 - - 44363 - - $140.02 - - 44364 - - $149.24 - - 44365 - - $132.87 - - 44366 - - $175.08 - - 44369 - - $179.04 - - 44370 - - $194.93 - - 44372 - - $174.33 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

128

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 44373 - - $139.74 - - 44376 - - $207.06 - - 44377 - - $218.02 - - 44378 - - $279.75 - - 44379 - - $297.91 - - 44380 $155.01 $42.25 - - - 44381 $794.23 $62.50 - - - 44382 $237.75 $54.81 - - - 44384 - - $112.87 - - 44385 $170.11 $53.87 - - - 44386 $246.49 $65.70 - - - 44388 $245.14 $114.17 - - - 44389 $322.39 $125.53 - - - 44390 $313.57 $153.67 - - - 44391 $503.19 $168.39 - - - 44392 $299.85 $145.30 - - - 44394 $339.81 $164.38 - - - 44401 $1,910.4 5 $176.99 - - - 44402 - - $190.89 - - 44403 - - $221.85 - - 44404 $330.16 $125.80 - - - 44405 $438.16 $133.89 - - - 44406 - - $167.37 - - 44407 - - $200.80 - - 44408 - - $168.89 - - 44500 - - $14.10 - - 44602 - - $1,025.13 - - 44603 - - $1,179.88 - - 44604 - - $771.47 - - 44605 - - $948.92 - - 44615 - - $782.08 - - 44620 - - $636.19 - - 44625 - - $741.49 - - 44626 - - $1,161.15 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

129

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 44640 - - $1,018.74 - - 44650 - - $1,051.04 - - 44660 - - $976.33 - - 44661 - - $1,126.24 - - 44680 - - $789.97 - - 44700 - - $733.31 - - 44701 - - $122.03 - - 44705 $85.31 $52.90 - - - 44715 - - I.C. - - 44720 - - $197.16 - - 44721 - - $275.54 - - 44799 - - I.C. - - 44800 - - $574.32 - - 44820 - - $627.51 - - 44850 - - $550.81 - - 44899 - - I.C. - - 44900 - - $579.25 - - 44950 - - $472.82 - - 44955 - - $60.60 - - 44960 - - $644.95 - - 44970 - - $446.43 - - 44979 - - I.C. - - 45000 - - $321.40 - - 45005 $248.48 $126.08 - - - 45020 - - $430.46 - - 45100 - - $228.88 - - 45108 - - $280.58 - - 45110 - - $1,338.65 - - 45111 - - $798.87 - - 45112 - - $1,330.59 - - 45113 - - $1,372.01 - - 45114 - - $1,327.57 - - 45116 - - $1,135.44 - - 45119 - - $1,381.86 - - 45120 - - $1,174.05 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

130

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 45121 - - $1,279.85 - - 45123 - - $822.97 - - 45126 - - $1,998.36 - - 45130 - - $799.19 - - 45135 - - $958.06 - - 45136 - - $1,316.76 - - 45150 - - $317.72 - - 45160 - - $757.20 - - 45171 - - $466.95 - - 45172 - - $617.40 - - 45190 - - $523.62 - - 45300 $101.00 $35.65 - - - 45303 $771.15 $62.98 - - - 45305 $142.84 $53.92 - - - 45307 $167.16 $73.42 - - - 45308 $160.76 $62.20 - - - 45309 $165.28 $65.92 - - - 45315 $177.71 $77.54 - - - 45317 $172.18 $81.11 - - - 45320 $174.34 $76.58 - - - 45321 - - $75.58 - - 45327 - - $85.38 - - 45330 $147.24 $41.72 - - - 45331 $227.57 $53.21 - - - 45332 $217.50 $76.89 - - - 45333 $260.84 $68.80 - - - 45334 $392.25 $86.38 - - - 45335 $232.36 $49.42 - - - 45337 - - $83.33 - - 45338 $234.58 $88.07 - - - 45340 $366.06 $57.77 - - - 45341 - - $90.65 - - 45342 - - $124.89 - - 45346 $1,851.5 8 $117.58 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

131

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 45347 - - $112.44 - - 45349 - - $144.94 - - 45350 $537.82 $73.92 - - - 45378 $262.58 $134.82 - - - 45379 $336.09 $174.05 - - - 45380 $338.09 $146.58 - - - 45381 $345.39 $146.38 - - - 45382 $522.30 $188.84 - - - 45384 $380.09 $165.82 - - - 45385 $350.29 $185.30 - - - 45386 $480.70 $154.47 - - - 45388 $1,972.8 8 $197.37 - - - 45389 - - $211.47 - - 45390 - - $242.17 - - 45391 - - $188.15 - - 45392 - - $221.85 - - 45393 - - $182.90 - - 45395 - - $1,438.46 - - 45397 - - $1,560.04 - - 45398 $654.26 $171.61 - - - 45399 - - I.C. - - 45400 - - $833.11 - - 45402 - - $1,110.85 - - 45499 - - I.C. - - 45500 - - $427.59 - - 45505 - - $454.65 - - 45520 $130.04 $30.40 - - - 45540 - - $775.56 - - 45541 - - $697.06 - - 45550 - - $1,073.17 - - 45560 - - $514.35 - - 45562 - - $839.22 - - 45563 - - $1,221.24 - - 45800 - - $936.71 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

132

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 45805 - - $1,081.64 - - 45820 - - $939.18 - - 45825 - - $1,133.97 - - 45900 - - $158.91 - - 45905 - - $128.34 - - 45910 - - $144.66 - - 45915 $272.90 $172.46 - - - 45990 - - $77.12 - - 45999 - - I.C. - - 46020 - - $86.29 - - 46030 $201.94 $64.27 - - - 46040 $427.54 $322.27 - - - 46045 - - $331.84 - - 46050 $186.96 $76.87 - - - 46060 - - $369.52 - - 46070 - - $208.12 - - 46080 $223.83 $117.76 - - - 46083 $162.77 $82.95 - - - 46200 $371.22 $259.53 - - - 46220 $197.35 $91.82 - - - 46221 $220.93 $146.74 - - - 46230 $243.02 $129.73 - - - 46250 $370.82 $241.45 - - - 46255 $402.65 $268.20 - - - 46257 - - $316.19 - - 46258 - - $362.22 - - 46260 - - $363.53 - - 46261 - - $398.38 - - 46262 - - $441.03 - - 46270 $413.99 $304.98 - - - 46275 $436.35 $320.64 - - - 46280 - - $364.80 - - 46285 $434.54 $320.71 - - - 46288 - - $421.78 - - 46320 $166.62 $84.92 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

133

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 46500 $248.41 $142.88 - - - 46505 $243.13 $190.64 - - - 46600 $94.48 $31.00 - - - 46601 $114.82 $68.75 - - - 46604 $526.73 $48.91 - - - 46606 $223.01 $55.61 - - - 46607 $158.96 $91.47 - - - 46608 $232.01 $62.20 - - - 46610 $220.08 $59.37 - - - 46611 $176.24 $59.47 - - - 46612 $265.09 $69.57 - - - 46614 $133.41 $47.97 - - - 46615 $138.56 $66.77 - - - 46700 - - $492.35 - - 46705 - - $431.36 - - 46706 - - $134.41 - - 46707 - - $380.75 - - 46710 - - $822.14 - - 46712 - - $1,625.84 - - 46715 - - $416.99 - - 46716 - - $920.58 - - 46730 - - $1,469.51 - - 46735 - - $1,685.69 - - 46740 - - $1,600.37 - - 46742 - - $1,843.26 - - 46744 - - $2,587.01 - - 46746 - - $2,846.84 - - 46748 - - $3,082.24 - - 46750 - - $558.38 - - 46751 - - $501.88 - - 46753 - - $463.59 - - 46754 $271.06 $184.01 - - - 46760 - - $824.78 - - 46761 - - $679.74 - - 46900 $186.42 $103.66 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

134

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 46910 $205.70 $101.24 - - - 46916 $204.24 $107.28 - - - 46917 $355.22 $96.76 - - - 46922 $247.41 $103.85 - - - 46924 $434.16 $134.98 - - - 46930 $168.90 $116.40 - - - 46940 $207.56 $108.46 - - - 46942 $198.17 $97.46 - - - 46945 - - $260.44 - - 46946 - - $290.90 - - 46947 - - $291.68 - - 46948 - - $337.69 - - 46999 - - I.C. - - 47000 $238.79 $64.42 - - - 47001 - - $74.73 - - 47010 - - $894.38 - - 47015 - - $859.42 - - 47100 - - $629.77 - - 47120 - - $1,710.86 - - 47122 - - $2,492.61 - - 47125 - - $2,241.32 - - 47130 - - $2,406.51 - - 47133 - - I.C. - - 47135 - - $3,939.16 - - 47140 - - $2,610.18 - - 47141 - - $3,117.21 - - 47142 - - $3,420.33 - - 47143 - - I.C. - - 47144 - - I.C. - - 47145 - - I.C. - - 47146 - - $235.95 - - 47147 - - $274.94 - - 47300 - - $838.71 - - 47350 - - $1,005.53 - - 47360 - - $1,372.23 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

135

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 47361 - - $2,198.24 - - 47362 - - $1,054.11 - - 47370 - - $921.12 - - 47371 - - $924.59 - - 47379 - - I.C. - - 47380 - - $1,059.18 - - 47381 - - $1,084.85 - - 47382 $2,928.8 8 $533.32 - - - 47383 $4,808.7 2 $326.42 - - - 47399 - - I.C. - - 47400 - - $1,571.08 - - 47420 - - $978.80 - - 47425 - - $1,005.31 - - 47460 - - $934.54 - - 47480 - - $651.75 - - 47490 - - $249.22 - - 47531 $340.64 $51.10 - - - 47532 $665.68 $151.69 - - - 47533 $928.57 $190.13 - - - 47534 $1,012.1 0 $265.63 - - - 47535 $707.62 $141.14 - - - 47536 $508.09 $94.82 - - - 47537 $394.10 $70.01 - - - 47538 $3,046.4 9 $168.55 - - - 47539 $3,385.2 4 $304.82 - - - 47540 $3,415.0 7 $315.09 - - - 47541 $919.44 $241.81 - - - 47542 $395.11 $97.54 - - - 47543 $307.65 $103.02 - - - 47544 $668.05 $112.02 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

136

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 47550 - - $118.33 - - 47552 - - $198.93 - - 47553 - - $198.75 - - 47554 - - $323.25 - - 47555 - - $236.53 - - 47556 - - $267.97 - - 47562 - - $487.78 - - 47563 - - $531.32 - - 47564 - - $823.90 - - 47570 - - $572.58 - - 47579 - - I.C. - - 47600 - - $787.69 - - 47605 - - $830.08 - - 47610 - - $919.50 - - 47612 - - $934.01 - - 47620 - - $1,007.70 - - 47700 - - $783.85 - - 47701 - - $1,274.03 - - 47711 - - $1,143.83 - - 47712 - - $1,459.63 - - 47715 - - $979.56 - - 47720 - - $853.30 - - 47721 - - $997.22 - - 47740 - - $966.91 - - 47741 - - $1,084.33 - - 47760 - - $1,645.98 - - 47765 - - $2,156.92 - - 47780 - - $1,805.13 - - 47785 - - $2,358.08 - - 47800 - - $1,144.79 - - 47801 - - $824.15 - - 47802 - - $1,120.56 - - 47900 - - $1,014.99 - - 47999 - - I.C. - - 48000 - - $1,375.49 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

137

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 48001 - - $1,680.65 - - 48020 - - $869.03 - - 48100 - - $654.22 - - 48102 $401.49 $171.42 - - - 48105 - - $2,064.89 - - 48120 - - $818.79 - - 48140 - - $1,148.21 - - 48145 - - $1,195.79 - - 48146 - - $1,384.73 - - 48148 - - $920.32 - - 48150 - - $2,276.21 - - 48152 - - $2,109.67 - - 48153 - - $2,267.06 - - 48154 - - $2,118.24 - - 48155 - - $1,342.69 - - 48160 - - I.C. - - 48400 - - $77.09 - - 48500 - - $849.23 - - 48510 - - $811.04 - - 48520 - - $808.81 - - 48540 - - $958.03 - - 48545 - - $988.83 - - 48547 - - $1,310.24 - - 48548 - - $1,223.49 - - 48550 - - I.C. - - 48551 - - I.C. - - 48552 - - $169.46 - - 48554 - - $1,940.85 - - 48556 - - $953.72 - - 48999 - - I.C. - - 49000 - - $566.49 - - 49002 - - $763.85 - - 49010 - - $672.69 - - 49013 - - $328.52 - - 49014 - - $274.23 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

138

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 49020 - - $1,168.93 - - 49040 - - $739.52 - - 49060 - - $803.97 - - 49062 - - $567.68 - - 49082 $166.74 $53.71 - - - 49083 $231.15 $77.68 - - - 49084 - - $77.58 - - 49180 $135.42 $60.42 - - - 49185 $1,020.8 7 $86.11 - - - 49203 - - $878.87 - - 49204 - - $1,117.06 - - 49205 - - $1,281.41 - - 49215 - - $1,613.17 - - 49250 - - $442.17 - - 49255 - - $587.42 - - 49320 - - $243.72 - - 49321 - - $255.48 - - 49322 - - $277.72 - - 49323 - - $471.22 - - 49324 - - $285.03 - - 49325 - - $303.75 - - 49326 - - $135.30 - - 49327 - - $93.64 - - 49329 - - I.C. - - 49400 $114.58 $65.30 - - - 49402 - - $628.50 - - 49405 $706.84 $140.36 - - - 49406 $707.11 $140.36 - - - 49407 $594.43 $148.48 - - - 49411 $378.39 $134.92 - - - 49412 - - $59.12 - - 49418 $785.60 $145.73 - - - 49419 - - $308.47 - - 49421 - - $163.11 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

139

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 49422 - - $160.05 - - 49423 $475.19 $51.20 - - - 49424 $145.56 $27.17 - - - 49425 - - $577.59 - - 49426 - - $496.89 - - 49427 - - $28.01 - - 49428 - - $318.03 - - 49429 - - $337.59 - - 49435 - - $84.83 - - 49436 $428.52 $138.18 - - - 49440 $663.40 $147.55 - - - 49441 $752.69 $173.36 - - - 49442 $633.70 $151.32 - - - 49446 $638.76 $105.50 - - - 49450 $481.31 $47.95 - - - 49451 $513.02 $63.85 - - - 49452 $621.15 $98.59 - - - 49460 $567.21 $36.08 - - - 49465 $108.25 $22.27 - - - 49491 - - $591.53 - - 49492 - - $708.26 - - 49495 - - $304.59 - - 49496 - - $457.27 - - 49500 - - $312.12 - - 49501 - - $450.78 - - 49505 - - $389.09 - - 49507 - - $436.88 - - 49520 - - $469.21 - - 49521 - - $530.30 - - 49525 - - $426.34 - - 49540 - - $503.70 - - 49550 - - $429.15 - - 49553 - - $469.51 - - 49555 - - $449.04 - - 49557 - - $535.26 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

140

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 49591 - - $249.64 - - 49592 - - $346.48 - - 49593 - - $417.30 - - 49594 - - $542.64 - - 49595 - - $560.55 - - 49596 - - $744.02 - - 49600 - - $544.39 - - 49605 - - $3,566.76 - - 49606 - - $833.29 - - 49610 - - $514.47 - - 49611 - - $454.58 - - 49613 - - $307.59 - - 49614 - - $416.25 - - 49615 - - $465.60 - - 49616 - - $624.50 - - 49617 - - $644.02 - - 49618 - - $901.19 - - 49621 - - $540.79 - - 49622 - - $666.91 - - 49623 - - $143.50 - - 49650 - - $322.97 - - 49651 - - $421.39 - - 49659 - - I.C. - - 49900 - - $610.12 - - 49904 - - $1,026.46 - - 49905 - - $254.80 - - 49906 - - I.C. - - 49999 - - I.C. - - 50010 - - $550.01 - - 50020 - - $744.94 - - 50040 - - $678.27 - - 50045 - - $683.17 - - 50060 - - $831.99 - - 50065 - - $881.65 - - 50070 - - $864.92 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

141

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 50075 - - $1,061.67 - - 50080 - - $511.76 - - 50081 - - $821.90 - - 50100 - - $796.64 - - 50120 - - $694.92 - - 50125 - - $718.82 - - 50130 - - $755.41 - - 50135 - - $819.36 - - 50200 $409.73 $92.34 - - - 50205 - - $556.02 - - 50220 - - $771.41 - - 50225 - - $879.27 - - 50230 - - $932.55 - - 50234 - - $950.88 - - 50236 - - $1,068.84 - - 50240 - - $969.21 - - 50250 - - $889.25 - - 50280 - - $704.67 - - 50290 - - $659.27 - - 50300 - - I.C. - - 50320 - - $1,128.57 - - 50323 - - I.C. - - 50325 - - I.C. - - 50327 - - $156.03 - - 50328 - - $136.37 - - 50329 - - $129.85 - - 50340 - - $713.04 - - 50360 - - $1,785.58 - - 50365 - - $2,133.67 - - 50370 - - $898.62 - - 50380 - - $1,511.95 - - 50382 $799.23 $181.33 - - - 50384 $682.00 $163.46 - - - 50385 $804.62 $156.72 - - - 50386 $595.33 $117.50 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

142

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 50387 $445.53 $59.84 - - - 50389 $333.93 $38.51 - - - 50390 - - $68.40 - - 50391 $93.03 $70.53 - - - 50396 - - $85.24 - - 50400 - - $843.57 - - 50405 - - $1,017.70 - - 50430 $501.80 $111.56 - - - 50431 $257.87 $48.42 - - - 50432 $723.04 $148.26 - - - 50433 $900.67 $183.66 - - - 50434 $724.09 $138.05 - - - 50435 $481.73 $72.73 - - - 50436 - - $108.42 - - 50437 - - $180.38 - - 50500 - - $917.19 - - 50520 - - $853.52 - - 50525 - - $1,079.02 - - 50526 - - $1,154.91 - - 50540 - - $837.40 - - 50541 - - $670.61 - - 50542 - - $853.19 - - 50543 - - $1,087.24 - - 50544 - - $904.07 - - 50545 - - $971.47 - - 50546 - - $879.52 - - 50547 - - $1,191.00 - - 50548 - - $976.20 - - 50549 - - I.C. - - 50551 $269.19 $212.94 - - - 50553 $288.57 $227.51 - - - 50555 $306.21 $246.48 - - - 50557 $311.83 $249.69 - - - 50561 $353.24 $284.41 - - - 50562 - - $418.83 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

143

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 50570 - - $353.69 - - 50572 - - $382.38 - - 50574 - - $406.75 - - 50575 - - $513.67 - - 50576 - - $405.74 - - 50580 - - $436.88 - - 50590 $559.24 $421.57 - - - 50592 $2,273.5 0 $249.44 - - - 50593 $3,043.2 5 $332.45 - - - 50600 - - $685.64 - - 50605 - - $738.63 - - 50606 $381.00 $98.96 - - - 50610 - - $690.74 - - 50620 - - $661.10 - - 50630 - - $653.24 - - 50650 - - $758.42 - - 50660 - - $834.24 - - 50684 $99.89 $37.75 - - - 50686 $109.14 $64.68 - - - 50688 - - $57.49 - - 50690 $92.14 $51.69 - - - 50693 $793.44 $147.14 - - - 50694 $887.62 $192.58 - - - 50695 $1,063.3 6 $246.45 - - - 50700 - - $678.51 - - 50705 $1,480.0 8 $126.42 - - - 50706 $667.39 $129.57 - - - 50715 - - $887.70 - - 50722 - - $755.00 - - 50725 - - $805.26 - - 50727 - - $379.01 - - 50728 - - $515.77 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

144

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 50740 - - $899.84 - - 50750 - - $841.61 - - 50760 - - $829.44 - - 50770 - - $841.61 - - 50780 - - $812.08 - - 50782 - - $785.55 - - 50783 - - $823.05 - - 50785 - - $887.19 - - 50800 - - $679.95 - - 50810 - - $1,035.42 - - 50815 - - $895.58 - - 50820 - - $959.28 - - 50825 - - $1,199.41 - - 50830 - - $1,310.86 - - 50840 - - $900.51 - - 50845 - - $919.09 - - 50860 - - $692.34 - - 50900 - - $618.91 - - 50920 - - $646.73 - - 50930 - - $805.01 - - 50940 - - $651.61 - - 50945 - - $708.57 - - 50947 - - $1,008.11 - - 50948 - - $927.60 - - 50949 - - I.C. - - 50951 $281.35 $221.36 - - - 50953 $297.77 $235.90 - - - 50955 $316.88 $254.21 - - - 50957 $319.94 $255.66 - - - 50961 $289.24 $228.98 - - - 50970 - - $267.17 - - 50972 - - $258.51 - - 50974 - - $340.55 - - 50976 - - $335.50 - - 50980 - - $256.99 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

145

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 51020 - - $349.24 - - 51030 - - $351.11 - - 51040 - - $217.42 - - 51045 - - $372.16 - - 51050 - - $349.13 - - 51060 - - $431.07 - - 51065 - - $428.92 - - 51080 - - $303.83 - - 51100 $56.18 $28.33 - - - 51101 $120.85 $36.75 - - - 51102 $184.60 $104.78 - - - 51500 - - $470.31 - - 51520 - - $440.24 - - 51525 - - $630.75 - - 51530 - - $565.94 - - 51535 - - $573.07 - - 51550 - - $705.22 - - 51555 - - $919.69 - - 51565 - - $941.25 - - 51570 - - $1,073.45 - - 51575 - - $1,323.90 - - 51580 - - $1,379.88 - - 51585 - - $1,533.80 - - 51590 - - $1,403.16 - - 51595 - - $1,587.43 - - 51596 - - $1,714.07 - - 51597 - - $1,671.89 - - 51600 $168.98 $31.85 - - - 51605 - - $28.25 - - 51610 $100.42 $47.39 - - - 51700 $59.14 $21.91 - - - 51701 $34.00 $18.46 - - - 51702 $47.73 $18.26 - - - 51703 $115.39 $55.66 - - - 51705 $74.86 $37.90 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

146

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 51710 $104.68 $58.88 - - - 51715 $286.33 $145.45 - - - 51720 $67.43 $31.80 - - - 51725 - - $178.98 $55.37 $123.61 51726 - - $236.91 $61.61 $175.30 51727 - - $287.34 $76.95 $210.39 51728 - - $286.74 $75.28 $211.46 51729 - - $302.49 $91.30 $211.19 51736 - - $10.19 $5.97 $4.22 51741 - - $10.65 $6.17 $4.49 51784 - - $48.89 $26.99 $21.89 51785 - - $344.29 $66.81 $277.48 51792 - - $214.81 $39.38 $175.43 51797 - - $152.43 $28.95 $123.47 51798 - - $8.50 - - 51800 - - $759.74 - - 51820 - - $794.88 - - 51840 - - $517.59 - - 51841 - - $596.08 - - 51845 - - $429.73 - - 51860 - - $550.52 - - 51865 - - $658.65 - - 51880 - - $343.33 - - 51900 - - $605.67 - - 51920 - - $562.01 - - 51925 - - $806.32 - - 51940 - - $1,194.64 - - 51960 - - $1,010.93 - - 51980 - - $525.45 - - 51990 - - $546.66 - - 51992 - - $614.37 - - 51999 - - I.C. - - 52000 $188.30 $58.40 - - - 52001 $333.95 $207.53 - - - 52005 $236.45 $96.37 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

147

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 52007 $354.00 $120.45 - - - 52010 $297.56 $119.98 - - - 52204 $296.01 $102.36 - - - 52214 $592.28 $126.23 - - - 52224 $617.32 $146.19 - - - 52234 - - $177.95 - - 52235 - - $208.60 - - 52240 - - $282.79 - - 52250 - - $173.23 - - 52260 - - $152.87 - - 52265 $291.71 $118.15 - - - 52270 $327.84 $131.51 - - - 52275 $418.85 $179.40 - - - 52276 - - $191.02 - - 52277 - - $233.45 - - 52281 $253.58 $110.56 - - - 52282 - - $243.03 - - 52283 $272.08 $145.93 - - - 52284 $2,137.5 0 $120.13 - - - 52285 $269.97 $141.94 - - - 52287 $302.43 $122.71 - - - 52290 - - $176.44 - - 52300 - - $202.76 - - 52301 - - $209.53 - - 52305 - - $201.42 - - 52310 $246.95 $109.82 - - - 52315 $360.01 $198.77 - - - 52317 $690.86 $249.99 - - - 52318 - - $341.04 - - 52320 - - $177.79 - - 52325 - - $231.07 - - 52327 - - $186.50 - - 52330 $468.95 $190.13 - - - 52332 $313.89 $113.01 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

148

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 52334 - - $132.76 - - 52341 - - $205.59 - - 52342 - - $223.19 - - 52343 - - $248.55 - - 52344 - - $266.08 - - 52345 - - $284.28 - - 52346 - - $321.54 - - 52351 - - $218.46 - - 52352 - - $255.73 - - 52353 - - $282.79 - - 52354 - - $300.58 - - 52355 - - $336.64 - - 52356 - - $299.51 - - 52400 - - $349.07 - - 52402 - - $191.65 - - 52441 $1,010.7 6 $151.53 - - - 52442 $696.46 $36.50 - - - 52450 - - $351.71 - - 52500 - - $364.94 - - 52601 - - $533.93 - - 52630 - - $301.32 - - 52640 - - $241.10 - - 52647 $1,220.8 9 $478.70 - - - 52648 $1,257.7 6 $509.68 - - - 52649 - - $606.97 - - 52700 - - $327.54 - - 53000 - - $110.39 - - 53010 - - $222.14 - - 53020 - - $70.50 - - 53025 - - $50.55 - - 53040 - - $291.14 - - 53060 $142.98 $123.97 - - - 53080 - - $312.25 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

149

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 53085 - - $478.51 - - 53200 $117.89 $103.43 - - - 53210 - - $570.87 - - 53215 - - $679.55 - - 53220 - - $334.65 - - 53230 - - $450.21 - - 53235 - - $467.84 - - 53240 - - $315.23 - - 53250 - - $294.42 - - 53260 $155.77 $134.61 - - - 53265 $172.93 $140.25 - - - 53270 $158.74 $136.78 - - - 53275 - - $194.13 - - 53400 - - $588.54 - - 53405 - - $640.98 - - 53410 - - $717.54 - - 53415 - - $825.66 - - 53420 - - $616.67 - - 53425 - - $685.40 - - 53430 - - $714.60 - - 53431 - - $841.97 - - 53440 - - $553.63 - - 53442 - - $579.77 - - 53444 - - $582.51 - - 53445 - - $558.47 - - 53446 - - $474.39 - - 53447 - - $592.88 - - 53448 - - $932.36 - - 53449 - - $453.43 - - 53450 - - $303.62 - - 53451 - - I.C. - - 53452 - - I.C. - - 53453 - - I.C. - - 53454 - - I.C. - - 53460 - - $338.66 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

150

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 53500 - - $552.95 - - 53502 - - $359.51 - - 53505 - - $359.24 - - 53510 - - $466.83 - - 53515 - - $584.18 - - 53520 - - $413.54 - - 53600 $67.04 $46.69 - - - 53601 $64.96 $38.98 - - - 53605 - - $46.52 - - 53620 $131.32 $63.28 - - - 53621 $126.18 $52.26 - - - 53660 $58.22 $30.63 - - - 53661 $57.13 $29.81 - - - 53665 - - $27.57 - - 53850 $1,123.8 5 $265.16 - - - 53852 $1,095.4 2 $283.87 - - - 53854 $1,327.9 7 $283.67 - - - 53855 $523.12 $59.22 - - - 53860 $1,915.8 6 $163.38 - - - 53899 - - I.C. - - 54000 $125.22 $82.91 - - - 54001 $151.58 $104.44 - - - 54015 - - $224.32 - - 54050 $111.59 $81.32 - - - 54055 $106.32 $72.57 - - - 54056 $111.52 $85.01 - - - 54057 $110.51 $74.09 - - - 54060 $149.77 $98.08 - - - 54065 $170.40 $129.15 - - - 54100 $156.58 $90.16 - - - 54105 $209.17 $157.48 - - - 54110 - - $460.03 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

151

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 54111 - - $586.26 - - 54112 - - $686.75 - - 54115 $341.91 $316.73 - - - 54120 - - $466.11 - - 54125 - - $606.49 - - 54130 - - $872.45 - - 54135 - - $1,100.62 - - 54150 $112.85 $70.27 - - - 54160 $168.12 $107.32 - - - 54161 - - $146.07 - - 54162 $194.82 $148.75 - - - 54163 - - $163.48 - - 54164 - - $145.22 - - 54200 $89.17 $65.33 - - - 54205 - - $393.76 - - 54220 $168.16 $97.45 - - - 54230 $80.40 $58.71 - - - 54231 $107.71 $84.68 - - - 54235 $67.89 $54.77 - - - 54240 - - $81.14 $47.79 $33.34 54250 - - $90.23 $78.78 $11.45 54300 - - $475.65 - - 54304 - - $549.66 - - 54308 - - $527.48 - - 54312 - - $601.79 - - 54316 - - $728.13 - - 54318 - - $524.84 - - 54322 - - $573.89 - - 54324 - - $709.14 - - 54326 - - $690.67 - - 54328 - - $686.22 - - 54332 - - $739.38 - - 54336 - - $869.01 - - 54340 - - $420.91 - - 54344 - - $691.92 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

152

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 54348 - - $739.50 - - 54352 - - $1,031.94 - - 54360 - - $530.73 - - 54380 - - $587.62 - - 54385 - - $683.50 - - 54390 - - $907.66 - - 54400 - - $393.03 - - 54401 - - $494.62 - - 54405 - - $593.67 - - 54406 - - $538.44 - - 54408 - - $582.22 - - 54410 - - $635.06 - - 54411 - - $756.36 - - 54415 - - $393.70 - - 54416 - - $529.40 - - 54417 - - $660.19 - - 54420 - - $517.23 - - 54430 - - $471.36 - - 54435 - - $307.82 - - 54437 - - $501.34 - - 54438 - - $976.65 - - 54440 - - I.C. - - 54450 $50.85 $41.47 - - - 54500 - - $54.76 - - 54505 - - $155.43 - - 54512 - - $396.47 - - 54520 - - $243.74 - - 54522 - - $433.45 - - 54530 - - $377.25 - - 54535 - - $547.52 - - 54550 - - $363.58 - - 54560 - - $506.58 - - 54600 - - $335.43 - - 54620 - - $220.18 - - 54640 - - $317.34 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

153

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 54650 - - $525.27 - - 54660 - - $266.97 - - 54670 - - $304.50 - - 54680 - - $578.84 - - 54690 - - $481.73 - - 54692 - - $554.09 - - 54699 - - I.C. - - 54700 - - $157.77 - - 54800 - - $90.84 - - 54830 - - $277.26 - - 54840 - - $239.79 - - 54860 - - $311.11 - - 54861 - - $420.13 - - 54865 - - $268.37 - - 54900 - - $588.78 - - 54901 - - $775.99 - - 55000 $91.64 $62.18 - - - 55040 - - $251.56 - - 55041 - - $379.42 - - 55060 - - $282.89 - - 55100 $176.53 $125.37 - - - 55110 - - $288.63 - - 55120 - - $264.33 - - 55150 - - $366.41 - - 55175 - - $272.15 - - 55180 - - $508.99 - - 55200 $292.48 $206.24 - - - 55250 $422.22 $244.77 - - - 55300 - - $135.34 - - 55400 - - $369.14 - - 55500 - - $292.35 - - 55520 - - $342.16 - - 55530 - - $261.85 - - 55535 - - $319.46 - - 55540 - - $413.00 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

154

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 55550 - - $318.63 - - 55559 - - I.C. - - 55600 - - $313.31 - - 55605 - - $388.62 - - 55650 - - $528.95 - - 55680 - - $258.29 - - 55700 $185.33 $94.26 - - - 55705 - - $195.38 - - 55706 - - $278.44 - - 55720 - - $334.15 - - 55725 - - $440.95 - - 55801 - - $802.50 - - 55810 - - $953.10 - - 55812 - - $1,172.04 - - 55815 - - $1,282.29 - - 55821 - - $615.04 - - 55831 - - $631.14 - - 55840 - - $854.67 - - 55842 - - $855.07 - - 55845 - - $992.96 - - 55860 - - $641.70 - - 55862 - - $801.41 - - 55865 - - $974.48 - - 55866 - - $872.42 - - 55867 - - $766.63 - - 55870 $132.38 $102.92 - - - 55873 $4,588.7 5 $562.04 - - - 55874 $2,322.5 4 $120.36 - - - 55875 - - $576.18 - - 55876 $115.80 $75.08 - - - 55880 - - $717.42 - - 55899 - - I.C. - - 55920 - - $342.48 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

155

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 55970 - - I.C. - - 55980 - - I.C. - - 56405 $114.33 $97.46 - - - 56420 $145.78 $84.72 - - - 56440 - - $135.60 - - 56441 $141.43 $117.86 - - - 56442 - - $35.65 - - 56501 $151.09 $102.61 - - - 56515 $213.97 $160.94 - - - 56605 $74.19 $43.66 - - - 56606 $29.13 $21.63 - - - 56620 - - $446.93 - - 56625 - - $504.17 - - 56630 - - $721.24 - - 56631 - - $886.04 - - 56632 - - $1,077.19 - - 56633 - - $921.61 - - 56634 - - $966.48 - - 56637 - - $1,129.83 - - 56640 - - $1,137.26 - - 56700 - - $154.53 - - 56740 - - $237.12 - - 56800 - - $190.64 - - 56805 - - $869.45 - - 56810 - - $204.27 - - 56820 $95.83 $62.35 - - - 56821 $128.17 $83.44 - - - 57000 - - $152.77 - - 57010 - - $345.95 - - 57020 $96.63 $58.33 - - - 57022 - - $136.97 - - 57023 - - $239.71 - - 57061 $131.31 $88.72 - - - 57065 $191.04 $140.95 - - - 57100 $79.25 $47.91 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

156

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 57105 $137.19 $112.28 - - - 57106 - - $406.90 - - 57107 - - $1,084.28 - - 57109 - - $1,287.71 - - 57110 - - $673.94 - - 57111 - - $1,287.71 - - 57120 - - $399.60 - - 57130 $179.05 $131.37 - - - 57135 $191.68 $142.40 - - - 57150 $45.18 $18.93 - - - 57155 $303.10 $211.23 - - - 57156 $176.06 $113.12 - - - 57160 $57.00 $33.70 - - - 57170 $85.07 $49.73 - - - 57180 $156.26 $92.52 - - - 57200 - - $252.25 - - 57210 - - $297.54 - - 57220 - - $262.84 - - 57230 - - $317.13 - - 57240 - - $459.46 - - 57250 - - $461.46 - - 57260 - - $581.01 - - 57265 - - $649.47 - - 57267 - - $183.03 - - 57268 - - $382.77 - - 57270 - - $607.96 - - 57280 - - $718.22 - - 57282 - - $518.74 - - 57283 - - $522.88 - - 57284 - - $618.83 - - 57285 - - $517.68 - - 57287 - - $559.50 - - 57288 - - $555.90 - - 57289 - - $595.37 - - 57291 - - $413.36 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

157

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 57292 - - $618.68 - - 57295 - - $377.64 - - 57296 - - $713.89 - - 57300 - - $462.48 - - 57305 - - $736.54 - - 57307 - - $812.57 - - 57308 - - $498.14 - - 57310 - - $369.69 - - 57311 - - $415.32 - - 57320 - - $425.39 - - 57330 - - $568.64 - - 57335 - - $878.37 - - 57400 - - $95.65 - - 57410 - - $78.24 - - 57415 - - $132.85 - - 57420 $101.22 $65.87 - - - 57421 $135.52 $89.19 - - - 57423 - - $690.77 - - 57425 - - $722.53 - - 57426 - - $651.58 - - 57452 $97.17 $67.44 - - - 57454 $128.19 $98.19 - - - 57455 $123.22 $79.83 - - - 57456 $116.38 $74.33 - - - 57460 $245.35 $117.59 - - - 57461 $272.49 $134.55 - - - 57465 $41.38 $31.47 - - - 57500 $120.50 $55.68 - - - 57505 $121.59 $84.09 - - - 57510 $128.85 $83.59 - - - 57511 $154.92 $112.06 - - - 57513 $160.27 $111.80 - - - 57520 $271.52 $224.91 - - - 57522 $232.63 $192.99 - - - 57530 - - $283.70 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

158

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 57531 - - $1,341.69 - - 57540 - - $591.76 - - 57545 - - $622.69 - - 57550 - - $326.95 - - 57555 - - $465.19 - - 57556 - - $442.03 - - 57558 $122.24 $98.13 - - - 57700 - - $273.84 - - 57720 - - $254.56 - - 57800 $60.09 $35.45 - - - 58100 $77.89 $46.28 - - - 58110 $37.32 $29.29 - - - 58120 $228.26 $175.49 - - - 58140 - - $696.17 - - 58145 - - $426.93 - - 58146 - - $858.21 - - 58150 - - $753.93 - - 58152 - - $918.97 - - 58180 - - $712.66 - - 58200 - - $998.13 - - 58210 - - $1,351.53 - - 58240 - - $2,176.55 - - 58260 - - $626.66 - - 58262 - - $690.76 - - 58263 - - $740.33 - - 58267 - - $797.50 - - 58270 - - $667.79 - - 58275 - - $736.98 - - 58280 - - $789.54 - - 58285 - - $1,058.27 - - 58290 - - $855.49 - - 58291 - - $923.79 - - 58292 - - $973.17 - - 58294 - - $904.35 - - 58300 $288.45 $248.71 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

159

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 58301 $120.09 $70.41 - - - 58321 $63.15 $35.57 - - - 58322 $69.84 $42.25 - - - 58323 $11.25 $8.84 - - - 58340 $195.76 $42.83 - - - 58345 - - $216.65 - - 58346 - - $376.16 - - 58350 $121.42 $73.48 - - - 58353 $748.11 $174.13 - - - 58356 $1,343.5 1 $262.51 - - - 58400 - - $349.48 - - 58410 - - $609.53 - - 58520 - - $597.68 - - 58540 - - $683.52 - - 58541 - - $545.81 - - 58542 - - $619.68 - - 58543 - - $628.92 - - 58544 - - $676.41 - - 58545 - - $670.08 - - 58546 - - $825.85 - - 58548 - - $1,397.75 - - 58550 - - $656.87 - - 58552 - - $730.15 - - 58553 - - $830.26 - - 58554 - - $966.30 - - 58555 $284.74 $111.71 - - - 58558 $1,070.4 8 $170.27 - - - 58559 - - $208.66 - - 58560 - - $229.49 - - 58561 - - $262.60 - - 58562 $336.65 $163.09 - - - 58563 $1,710.9 2 $181.02 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

160

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 58565 $2,085.4 2 $489.03 - - - 58570 - - $603.11 - - 58571 - - $677.26 - - 58572 - - $772.29 - - 58573 - - $904.24 - - 58575 - - $1,434.41 - - 58578 - - I.C. - - 58579 - - I.C. - - 58580 $2,468.0 4 $297.94 - - - 58600 - - $395.44 - - 58605 - - $359.99 - - 58611 - - $80.33 - - 58615 - - $270.82 - - 58660 - - $506.41 - - 58661 - - $484.89 - - 58662 - - $530.11 - - 58670 - - $279.27 - - 58671 - - $279.27 - - 58672 - - $542.95 - - 58673 - - $589.15 - - 58674 - - $605.60 - - 58679 - - I.C. - - 58700 - - $597.81 - - 58720 - - $567.25 - - 58740 - - $672.91 - - 58750 - - $677.85 - - 58752 - - $675.98 - - 58760 - - $613.18 - - 58770 - - $643.44 - - 58800 $277.57 $239.00 - - - 58805 - - $323.82 - - 58820 - - $258.16 - - 58822 - - $535.26 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

161

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 58825 - - $531.04 - - 58900 - - $330.66 - - 58920 - - $534.73 - - 58925 - - $573.64 - - 58940 - - $418.93 - - 58943 - - $871.95 - - 58950 - - $861.29 - - 58951 - - $1,071.77 - - 58952 - - $1,225.39 - - 58953 - - $1,484.42 - - 58954 - - $1,604.03 - - 58956 - - $1,010.67 - - 58957 - - $1,181.19 - - 58958 - - $1,230.50 - - 58960 - - $744.06 - - 58970 $181.61 $144.39 - - - 58974 - - I.C. - - 58976 $194.91 $156.34 - - - 58999 - - I.C. - - 59000 $134.97 $84.03 - - - 59001 - - $185.91 - - 59012 - - $209.45 - - 59015 $166.20 $136.53 - - - 59020 - - $76.83 $38.21 $38.62 59025 - - $53.42 $30.72 $22.70 59030 - - $116.09 - - 59050 - - $52.69 - - 59051 - - $43.51 - - 59070 $297.95 $224.03 - - - 59072 - - $377.27 - - 59074 $285.37 $224.03 - - - 59076 - - $377.27 - - 59100 - - $632.97 - - 59120 - - $857.76 - - 59121 - - $857.53 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

162

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 59130 - - $700.43 - - 59136 - - $942.69 - - 59140 - - $312.13 - - 59150 - - $832.42 - - 59151 - - $814.02 - - 59160 $298.48 $199.68 - - - 59200 $305.08 $256.76 - - - 59300 $250.05 $154.10 - - - 59320 - - $158.12 - - 59325 - - $250.86 - - 59350 - - $201.89 - - 59400 - - $2,176.78 - - 59409 - - $839.04 - - 59410 - - $1,098.64 - - 59412 - - $74.83 - - 59414 - - $94.25 - - 59425 $594.97 $447.54 - - - 59426 $1,088.6 9 $821.94 - - - 59430 $284.15 $185.35 - - - 59510 - - $2,405.36 - - 59514 - - $943.39 - - 59515 - - $1,349.66 - - 59525 - - $347.94 - - 59610 - - $2,281.10 - - 59612 - - $942.04 - - 59614 - - $1,180.08 - - 59618 - - $2,435.34 - - 59620 - - $974.84 - - 59622 - - $1,402.33 - - 59812 $390.21 $325.23 - - - 59820 $476.09 $413.78 - - - 59821 $467.19 $402.21 - - - 59830 - - $347.24 - - 59840 $189.45 $166.68 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

163

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 59841 $321.17 $276.44 - - - 59850 - - $290.86 - - 59851 - - $321.01 - - 59852 - - $441.65 - - 59855 - - $316.01 - - 59856 - - $368.28 - - 59857 - - $428.04 - - 59866 - - $173.17 - - 59870 - - $406.75 - - 59871 - - $97.29 - - 59897 - - I.C. - - 59898 - - I.C. - - 59899 - - I.C. - - 60000 $143.86 $120.83 - - - 60100 $83.58 $56.26 - - - 60200 - - $501.40 - - 60210 - - $527.05 - - 60212 - - $757.23 - - 60220 - - $527.89 - - 60225 - - $697.46 - - 60240 - - $680.66 - - 60252 - - $978.41 - - 60254 - - $1,235.71 - - 60260 - - $807.00 - - 60270 - - $1,005.97 - - 60271 - - $781.89 - - 60280 - - $345.72 - - 60281 - - $451.67 - - 60300 $83.34 $35.39 - - - 60500 - - $719.31 - - 60502 - - $962.27 - - 60505 - - $1,035.10 - - 60512 - - $175.92 - - 60520 - - $772.84 - - 60521 - - $815.89 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

164

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 60522 - - $987.29 - - 60540 - - $791.98 - - 60545 - - $916.24 - - 60600 - - $988.01 - - 60605 - - $1,164.17 - - 60650 - - $870.94 - - 60659 - - I.C. - - 60699 - - I.C. - - 61000 - - $83.28 - - 61001 - - $78.81 - - 61020 - - $77.96 - - 61026 - - $78.84 - - 61050 - - $59.19 - - 61055 - - $86.81 - - 61070 - - $41.80 - - 61105 - - $350.50 - - 61107 - - $225.57 - - 61108 - - $678.07 - - 61120 - - $561.16 - - 61140 - - $942.39 - - 61150 - - $998.41 - - 61151 - - $738.34 - - 61154 - - $949.79 - - 61156 - - $910.82 - - 61210 - - $264.98 - - 61215 - - $390.75 - - 61250 - - $647.87 - - 61253 - - $738.34 - - 61304 - - $1,207.17 - - 61305 - - $1,477.34 - - 61312 - - $1,520.78 - - 61313 - - $1,462.50 - - 61314 - - $1,344.43 - - 61315 - - $1,522.59 - - 61316 - - $63.17 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

165

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 61320 - - $1,392.03 - - 61321 - - $1,563.45 - - 61322 - - $1,751.32 - - 61323 - - $1,754.14 - - 61330 - - $1,323.92 - - 61333 - - $1,481.76 - - 61340 - - $1,065.35 - - 61343 - - $1,615.34 - - 61345 - - $1,504.42 - - 61450 - - $1,412.00 - - 61458 - - $1,485.38 - - 61460 - - $1,550.47 - - 61500 - - $967.77 - - 61501 - - $845.40 - - 61510 - - $1,624.96 - - 61512 - - $1,875.56 - - 61514 - - $1,413.82 - - 61516 - - $1,380.46 - - 61517 - - $62.73 - - 61518 - - $2,035.46 - - 61519 - - $2,160.16 - - 61520 - - $2,737.57 - - 61521 - - $2,320.30 - - 61522 - - $1,609.10 - - 61524 - - $1,534.75 - - 61526 - - $2,462.74 - - 61530 - - $2,247.56 - - 61531 - - $912.16 - - 61533 - - $1,128.74 - - 61534 - - $1,221.87 - - 61535 - - $750.58 - - 61536 - - $1,890.60 - - 61537 - - $1,799.16 - - 61538 - - $1,946.95 - - 61539 - - $1,734.20 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

166

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 61540 - - $1,600.45 - - 61541 - - $1,582.71 - - 61543 - - $1,599.19 - - 61544 - - $1,396.84 - - 61545 - - $2,337.53 - - 61546 - - $1,696.45 - - 61548 - - $1,156.24 - - 61550 - - $893.72 - - 61552 - - $1,102.97 - - 61556 - - $1,262.07 - - 61557 - - $1,249.50 - - 61558 - - $1,390.28 - - 61559 - - $1,768.42 - - 61563 - - $1,459.47 - - 61564 - - $1,769.28 - - 61566 - - $1,646.54 - - 61567 - - $1,875.08 - - 61570 - - $1,381.15 - - 61571 - - $1,467.55 - - 61575 - - $1,838.00 - - 61576 - - $3,091.88 - - 61580 - - $1,874.51 - - 61581 - - $2,060.79 - - 61582 - - $2,373.12 - - 61583 - - $2,182.75 - - 61584 - - $2,160.31 - - 61585 - - $2,440.37 - - 61586 - - $1,916.77 - - 61590 - - $2,261.54 - - 61591 - - $2,294.68 - - 61592 - - $2,349.20 - - 61595 - - $1,787.85 - - 61596 - - $1,830.29 - - 61597 - - $2,190.40 - - 61598 - - $2,126.60 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

167

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 61600 - - $1,604.10 - - 61601 - - $1,816.62 - - 61605 - - $1,636.43 - - 61606 - - $2,165.43 - - 61607 - - $1,979.06 - - 61608 - - $2,425.99 - - 61611 - - $337.01 - - 61613 - - $2,429.73 - - 61615 - - $2,100.19 - - 61616 - - $2,475.85 - - 61618 - - $956.86 - - 61619 - - $1,060.66 - - 61623 - - $416.82 - - 61624 - - $837.94 - - 61626 - - $649.41 - - 61630 - - $998.87 - - 61635 - - $1,078.39 - - 61640 - - $335.44 - - 61641 - - $117.81 - - 61642 - - $235.63 - - 61645 - - $608.20 - - 61650 - - $413.23 - - 61651 - - $177.58 - - 61680 - - $1,644.42 - - 61682 - - $3,024.55 - - 61684 - - $2,083.18 - - 61686 - - $3,272.67 - - 61690 - - $1,603.94 - - 61692 - - $2,662.41 - - 61697 - - $3,082.13 - - 61698 - - $3,369.73 - - 61700 - - $2,480.13 - - 61702 - - $2,933.50 - - 61703 - - $1,007.48 - - 61705 - - $1,907.99 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

168

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 61708 - - $1,866.77 - - 61710 - - $1,575.67 - - 61711 - - $1,885.54 - - 61720 - - $942.48 - - 61735 - - $1,180.23 - - 61736 - - $649.42 - - 61737 - - $774.44 - - 61750 - - $1,040.23 - - 61751 - - $1,030.20 - - 61760 - - $1,171.97 - - 61770 - - $1,195.61 - - 61781 - - $170.21 - - 61782 - - $127.23 - - 61783 - - $167.48 - - 61790 - - $659.67 - - 61791 - - $837.16 - - 61796 - - $755.66 - - 61797 - - $157.72 - - 61798 - - $1,017.56 - - 61799 - - $218.22 - - 61800 - - $109.71 - - 61850 - - $733.53 - - 61860 - - $1,153.66 - - 61863 - - $1,115.04 - - 61864 - - $203.77 - - 61867 - - $1,676.12 - - 61868 - - $359.48 - - 61880 - - $442.48 - - 61885 - - $398.39 - - 61886 - - $663.04 - - 61888 - - $297.39 - - 61889 - - $933.62 - - 61891 - - $445.53 - - 61892 - - $618.17 - - 62000 - - $770.12 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

169

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 62005 - - $943.19 - - 62010 - - $1,138.06 - - 62100 - - $1,162.33 - - 62115 - - $1,251.37 - - 62117 - - $1,446.15 - - 62120 - - $1,559.74 - - 62121 - - $1,166.43 - - 62140 - - $759.73 - - 62141 - - $847.74 - - 62142 - - $665.65 - - 62143 - - $777.86 - - 62145 - - $1,046.46 - - 62146 - - $927.07 - - 62147 - - $1,047.67 - - 62148 - - $90.67 - - 62160 - - $135.74 - - 62161 - - $1,125.34 - - 62162 - - $1,393.73 - - 62164 - - $1,546.47 - - 62165 - - $1,126.36 - - 62180 - - $1,181.23 - - 62190 - - $694.42 - - 62192 - - $726.04 - - 62194 - - $373.57 - - 62200 - - $1,018.38 - - 62201 - - $907.07 - - 62220 - - $716.75 - - 62223 - - $772.84 - - 62225 - - $404.82 - - 62230 - - $626.34 - - 62252 - - $63.89 $33.16 $30.73 62256 - - $459.36 - - 62258 - - $825.62 - - 62263 $497.16 $237.35 - - - 62264 $339.86 $180.23 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

170

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 62267 $205.67 $113.00 - - - 62268 - - $188.15 - - 62269 - - $191.46 - - 62270 $102.23 $45.45 - - - 62272 $136.74 $65.76 - - - 62273 $128.55 $83.02 - - - 62280 $254.34 $118.00 - - - 62281 $185.03 $118.34 - - - 62282 $245.32 $105.51 - - - 62284 $148.71 $61.93 - - - 62287 - - $422.83 - - 62290 $272.77 $115.82 - - - 62291 $250.88 $107.05 - - - 62292 - - $431.12 - - 62294 - - $708.72 - - 62302 $200.55 $87.52 - - - 62303 $204.30 $87.52 - - - 62304 $199.30 $86.27 - - - 62305 $217.02 $89.79 - - - 62320 $126.68 $73.91 - - - 62321 $204.48 $78.60 - - - 62322 $106.10 $58.96 - - - 62323 $201.95 $72.85 - - - 62324 $105.12 $65.21 - - - 62325 $197.14 $81.44 - - - 62326 $106.17 $62.78 - - - 62327 $209.95 $77.91 - - - 62328 $180.88 $63.03 - - - 62329 $222.83 $78.73 - - - 62350 - - $296.87 - - 62351 - - $676.59 - - 62355 - - $207.50 - - 62360 - - $239.17 - - 62361 - - $327.52 - - 62362 - - $287.78 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

171

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 62365 - - $222.75 - - 62367 $23.93 $18.04 - - - 62368 $33.00 $25.24 - - - 62369 $71.57 $25.50 - - - 62370 $71.44 $33.68 - - - 62380 - - I.C. - - 63001 - - $913.12 - - 63003 - - $914.11 - - 63005 - - $891.78 - - 63011 - - $815.67 - - 63012 - - $888.62 - - 63015 - - $1,096.77 - - 63016 - - $1,130.74 - - 63017 - - $940.07 - - 63020 - - $818.71 - - 63030 - - $684.08 - - 63035 - - $169.72 - - 63040 - - $1,023.85 - - 63042 - - $962.53 - - 63043 - - I.C. - - 63044 - - I.C. - - 63045 - - $956.47 - - 63046 - - $913.89 - - 63047 - - $824.41 - - 63048 - - $152.49 - - 63050 - - $1,094.07 - - 63051 - - $1,252.75 - - 63052 - - $187.23 - - 63053 - - $165.89 - - 63055 - - $1,200.70 - - 63056 - - $1,104.09 - - 63057 - - $232.69 - - 63064 - - $1,314.21 - - 63066 - - $148.25 - - 63075 - - $1,006.38 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

172

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 63076 - - $176.41 - - 63077 - - $1,126.63 - - 63078 - - $149.01 - - 63081 - - $1,298.71 - - 63082 - - $192.06 - - 63085 - - $1,417.69 - - 63086 - - $137.21 - - 63087 - - $1,772.23 - - 63088 - - $186.79 - - 63090 - - $1,432.52 - - 63091 - - $127.68 - - 63101 - - $1,713.65 - - 63102 - - $1,688.38 - - 63103 - - $213.41 - - 63170 - - $1,179.42 - - 63172 - - $1,045.74 - - 63173 - - $1,274.88 - - 63185 - - $851.73 - - 63190 - - $924.30 - - 63191 - - $1,025.41 - - 63197 - - $1,264.50 - - 63200 - - $1,130.81 - - 63250 - - $2,169.78 - - 63251 - - $2,219.58 - - 63252 - - $2,218.94 - - 63265 - - $1,235.19 - - 63266 - - $1,269.89 - - 63267 - - $1,018.95 - - 63268 - - $1,039.79 - - 63270 - - $1,530.67 - - 63271 - - $1,530.28 - - 63272 - - $1,379.95 - - 63273 - - $1,379.23 - - 63275 - - $1,334.99 - - 63276 - - $1,320.14 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

173

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 63277 - - $1,158.23 - - 63278 - - $1,181.17 - - 63280 - - $1,561.68 - - 63281 - - $1,546.92 - - 63282 - - $1,462.38 - - 63283 - - $1,406.41 - - 63285 - - $1,919.56 - - 63286 - - $1,900.67 - - 63287 - - $2,011.83 - - 63290 - - $2,045.59 - - 63295 - - $238.55 - - 63300 - - $1,341.43 - - 63301 - - $1,625.10 - - 63302 - - $1,605.66 - - 63303 - - $1,701.08 - - 63304 - - $1,728.57 - - 63305 - - $1,837.28 - - 63306 - - $1,806.15 - - 63307 - - $1,767.49 - - 63308 - - $231.17 - - 63600 - - $810.79 - - 63610 - - $421.73 - - 63620 - - $833.97 - - 63621 - - $181.81 - - 63650 $1,828.4 3 $306.84 - - - 63655 - - $627.71 - - 63661 $531.60 $244.21 - - - 63662 - - $635.22 - - 63663 $698.95 $333.88 - - - 63664 - - $661.72 - - 63685 - - $270.86 - - 63688 - - $279.98 - - 63700 - - $977.78 - - 63702 - - $1,065.78 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

174

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 63704 - - $1,239.84 - - 63706 - - $1,372.88 - - 63707 - - $702.83 - - 63709 - - $830.92 - - 63710 - - $805.98 - - 63740 - - $738.34 - - 63741 - - $514.72 - - 63744 - - $509.77 - - 63746 - - $460.41 - - 64400 $86.98 $37.16 - - - 64405 $56.34 $38.39 - - - 64408 $63.42 $33.42 - - - 64415 $103.68 $50.64 - - - 64416 - - $56.58 - - 64417 $124.47 $46.26 - - - 64418 $66.29 $40.85 - - - 64420 $74.78 $43.17 - - - 64421 $24.83 $17.86 - - - 64425 $85.68 $40.41 - - - 64430 $75.90 $40.28 - - - 64435 $62.55 $32.01 - - - 64445 $124.75 $53.77 - - - 64446 - - $55.35 - - 64447 $89.38 $45.99 - - - 64448 - - $52.24 - - 64449 - - $45.28 - - 64450 $57.73 $30.94 - - - 64451 $178.22 $60.10 - - - 64454 $172.86 $60.37 - - - 64455 $37.51 $24.38 - - - 64461 $103.03 $56.69 - - - 64462 $54.38 $35.36 - - - 64463 $181.16 $59.29 - - - 64479 $205.64 $96.36 - - - 64480 $104.10 $44.91 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

175

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 64483 $191.54 $81.99 - - - 64484 $86.48 $37.73 - - - 64486 $86.33 $39.99 - - - 64487 $170.15 $45.87 - - - 64488 $106.66 $49.61 - - - 64489 $279.69 $56.58 - - - 64490 $147.26 $77.62 - - - 64491 $73.92 $43.39 - - - 64492 $74.46 $44.19 - - - 64493 $136.50 $66.86 - - - 64494 $69.34 $37.47 - - - 64495 $69.34 $38.00 - - - 64505 $109.60 $77.72 - - - 64510 $113.49 $57.25 - - - 64517 $148.73 $93.56 - - - 64520 $180.09 $62.77 - - - 64530 $180.56 $70.21 - - - 64553 $2,014.9 8 $293.31 - - - 64555 $1,718.8 2 $240.88 - - - 64561 $577.21 $223.12 - - - 64566 $92.09 $21.91 - - - 64568 - - $449.12 - - 64569 - - $571.57 - - 64570 - - $552.08 - - 64575 - - $230.15 - - 64580 - - $236.54 - - 64581 - - $481.83 - - 64582 - - $639.22 - - 64583 - - $644.43 - - 64584 - - $544.29 - - 64585 $187.36 $107.28 - - - 64590 $202.78 $120.28 - - - 64595 $180.09 $95.72 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

176

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 64596 - - I.C. - - 64597 - - I.C. - - 64598 - - I.C. - - 64600 $361.26 $172.16 - - - 64605 $500.28 $260.30 - - - 64610 $598.43 $354.97 - - - 64611 $99.24 $84.24 - - - 64612 $104.33 $89.60 - - - 64615 $115.34 $89.89 - - - 64616 $103.10 $80.06 - - - 64617 $124.77 $80.31 - - - 64620 $157.91 $131.93 - - - 64624 $304.46 $108.13 - - - 64625 $368.63 $144.18 - - - 64628 - - $337.62 - - 64629 - - $154.83 - - 64630 $194.42 $142.19 - - - 64632 $68.27 $49.53 - - - 64633 $341.20 $141.66 - - - 64634 $202.65 $48.91 - - - 64635 $344.41 $141.93 - - - 64636 $190.77 $43.19 - - - 64640 $191.56 $87.90 - - - 64642 $114.42 $78.26 - - - 64643 $69.69 $51.47 - - - 64644 $134.45 $85.43 - - - 64645 $90.92 $59.58 - - - 64646 $120.56 $84.94 - - - 64647 $137.38 $97.74 - - - 64650 $68.82 $29.98 - - - 64653 $80.86 $38.00 - - - 64680 $270.92 $120.39 - - - 64681 $357.81 $165.24 - - - 64702 - - $393.02 - - 64704 - - $245.62 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

177

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 64708 - - $381.81 - - 64712 - - $449.27 - - 64713 - - $596.26 - - 64714 - - $571.66 - - 64718 - - $460.92 - - 64719 - - $312.17 - - 64721 $341.96 $335.53 - - - 64722 - - $276.75 - - 64726 - - $203.48 - - 64727 - - $132.51 - - 64732 - - $344.72 - - 64734 - - $389.44 - - 64736 - - $249.47 - - 64738 - - $341.74 - - 64740 - - $350.70 - - 64742 - - $373.04 - - 64744 - - $382.75 - - 64746 - - $318.96 - - 64755 - - $677.88 - - 64760 - - $388.94 - - 64763 - - $384.79 - - 64766 - - $473.90 - - 64772 - - $422.82 - - 64774 - - $323.03 - - 64776 - - $301.75 - - 64778 - - $132.06 - - 64782 - - $343.18 - - 64783 - - $157.26 - - 64784 - - $544.75 - - 64786 - - $740.91 - - 64787 - - $172.47 - - 64788 - - $306.98 - - 64790 - - $632.77 - - 64792 - - $791.91 - - 64795 - - $142.45 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

178

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 64802 - - $635.15 - - 64804 - - $887.55 - - 64809 - - $810.28 - - 64818 - - $584.04 - - 64820 - - $577.76 - - 64821 - - $526.58 - - 64822 - - $529.58 - - 64823 - - $597.63 - - 64831 - - $526.58 - - 64832 - - $243.90 - - 64834 - - $552.55 - - 64835 - - $613.20 - - 64836 - - $613.20 - - 64837 - - $265.00 - - 64840 - - $720.99 - - 64856 - - $755.10 - - 64857 - - $787.14 - - 64858 - - $875.09 - - 64859 - - $180.24 - - 64861 - - $1,128.07 - - 64862 - - $1,020.38 - - 64864 - - $645.59 - - 64865 - - $820.07 - - 64866 - - $939.23 - - 64868 - - $751.52 - - 64872 - - $84.31 - - 64874 - - $126.01 - - 64876 - - $142.78 - - 64885 - - $802.46 - - 64886 - - $964.14 - - 64890 - - $804.76 - - 64891 - - $855.09 - - 64892 - - $783.76 - - 64893 - - $834.84 - - 64895 - - $984.43 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

179

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 64896 - - $1,060.54 - - 64897 - - $941.11 - - 64898 - - $1,018.85 - - 64901 - - $432.41 - - 64902 - - $500.93 - - 64905 - - $751.36 - - 64907 - - $965.25 - - 64910 - - $574.00 - - 64911 - - $769.78 - - 64912 - - $674.53 - - 64913 - - $126.90 - - 64999 - - I.C. - - 65091 - - $574.72 - - 65093 - - $570.67 - - 65101 - - $657.09 - - 65103 - - $675.80 - - 65105 - - $735.29 - - 65110 - - $1,006.23 - - 65112 - - $1,149.74 - - 65114 - - $1,199.34 - - 65125 $354.51 $222.73 - - - 65130 - - $658.95 - - 65135 - - $666.51 - - 65140 - - $715.01 - - 65150 - - $544.55 - - 65155 - - $742.86 - - 65175 - - $603.65 - - 65205 - - $21.64 - - 65210 $28.86 $26.72 - - - 65220 $45.90 $30.63 - - - 65222 $51.37 $37.17 - - - 65235 - - $552.33 - - 65260 - - $740.05 - - 65265 - - $832.12 - - 65270 $222.83 $106.05 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

180

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 65272 $408.05 $265.29 - - - 65273 - - $284.87 - - 65275 $450.40 $345.40 - - - 65280 - - $502.71 - - 65285 - - $826.82 - - 65286 $536.80 $371.81 - - - 65290 - - $367.82 - - 65400 $528.43 $454.24 - - - 65410 $109.17 $75.96 - - - 65420 $417.55 $287.38 - - - 65426 $516.37 $359.69 - - - 65430 $86.94 $75.42 - - - 65435 $62.76 $51.78 - - - 65436 $292.82 $277.55 - - - 65450 $250.60 $244.97 - - - 65600 $336.23 $256.15 - - - 65710 - - $860.53 - - 65730 - - $942.19 - - 65750 - - $946.95 - - 65755 - - $943.72 - - 65756 - - $880.06 - - 65757 - - I.C. - - 65760 - - I.C. - - 65765 - - I.C. - - 65767 - - I.C. - - 65770 - - $1,052.48 - - 65771 - - I.C. - - 65772 $347.30 $304.72 - - - 65775 - - $434.24 - - 65778 $1,061.0 2 $38.95 - - - 65779 $908.17 $108.40 - - - 65780 - - $505.95 - - 65781 - - $992.16 - - 65782 - - $857.53 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

181

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 65785 $1,716.1 4 $334.36 - - - 65800 $90.48 $65.57 - - - 65810 - - $349.23 - - 65815 $494.26 $358.46 - - - 65820 - - $628.76 - - 65850 - - $633.15 - - 65855 $185.99 $153.32 - - - 65860 $233.38 $185.17 - - - 65865 - - $361.67 - - 65870 - - $448.73 - - 65875 - - $478.90 - - 65880 - - $502.67 - - 65900 - - $748.15 - - 65920 - - $596.68 - - 65930 - - $483.32 - - 66020 $152.64 $98.80 - - - 66030 $138.02 $84.18 - - - 66130 $538.58 $422.34 - - - 66150 - - $662.73 - - 66155 - - $662.21 - - 66160 - - $742.87 - - 66170 - - $822.40 - - 66172 - - $899.13 - - 66174 - - $470.30 - - 66175 - - $544.67 - - 66179 - - $811.55 - - 66180 - - $854.77 - - 66183 - - $773.82 - - 66184 - - $597.62 - - 66185 - - $641.05 - - 66225 - - $701.27 - - 66250 $578.57 $418.13 - - - 66500 - - $303.40 - - 66505 - - $329.15 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

182

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 66600 - - $690.59 - - 66605 - - $820.68 - - 66625 - - $323.31 - - 66630 - - $426.02 - - 66635 - - $429.76 - - 66680 - - $393.65 - - 66682 - - $546.36 - - 66700 $343.71 $293.62 - - - 66710 $335.94 $293.62 - - - 66711 - - $383.51 - - 66720 $356.79 $310.45 - - - 66740 $333.53 $293.62 - - - 66761 $229.12 $177.69 - - - 66762 $363.04 $319.38 - - - 66770 $401.69 $361.78 - - - 66820 - - $363.72 - - 66821 $255.33 $236.59 - - - 66825 - - $636.43 - - 66830 - - $531.25 - - 66840 - - $519.66 - - 66850 - - $590.63 - - 66852 - - $627.75 - - 66920 - - $560.93 - - 66930 - - $641.96 - - 66940 - - $588.17 - - 66982 - - $557.51 - - 66983 - - I.C. - - 66984 - - $407.64 - - 66985 - - $577.55 - - 66986 - - $675.88 - - 66987 - - I.C. - - 66988 - - I.C. - - 66989 - - $638.21 - - 66990 - - $64.82 - - 66991 - - $511.52 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

183

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 66999 - - I.C. - - 67005 - - $358.45 - - 67010 - - $409.38 - - 67015 - - $458.48 - - 67025 $565.19 $474.39 - - - 67027 - - $633.83 - - 67028 $85.67 $67.99 - - - 67030 - - $424.23 - - 67031 $295.36 $266.44 - - - 67036 - - $670.35 - - 67039 - - $717.03 - - 67040 - - $773.03 - - 67041 - - $851.97 - - 67042 - - $851.70 - - 67043 - - $897.31 - - 67101 $255.28 $214.57 - - - 67105 $224.80 $207.12 - - - 67107 - - $837.27 - - 67108 - - $885.68 - - 67110 $675.76 $611.75 - - - 67113 - - $990.85 - - 67115 - - $375.75 - - 67120 $512.14 $416.79 - - - 67121 - - $675.64 - - 67141 $206.63 $163.51 - - - 67145 $185.20 $163.51 - - - 67208 $453.89 $432.20 - - - 67210 $389.37 $374.64 - - - 67218 - - $1,037.80 - - 67220 $401.22 $374.44 - - - 67221 $205.91 $153.95 - - - 67225 $21.68 $20.34 - - - 67227 $223.68 $190.20 - - - 67228 $255.91 $226.18 - - - 67229 - - $863.89 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

184

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 67250 - - $694.71 - - 67255 - - $519.50 - - 67299 - - I.C. - - 67311 - - $342.02 - - 67312 - - $496.03 - - 67314 - - $342.02 - - 67316 - - $531.52 - - 67318 - - $513.41 - - 67320 - - $151.71 - - 67331 - - $146.65 - - 67332 - - $155.11 - - 67334 - - $144.37 - - 67335 - - $138.19 - - 67340 - - $214.73 - - 67343 - - $505.09 - - 67345 $182.54 $160.57 - - - 67346 - - $142.43 - - 67399 - - I.C. - - 67400 - - $795.30 - - 67405 - - $695.91 - - 67412 - - $762.42 - - 67413 - - $741.86 - - 67414 - - $1,105.69 - - 67415 - - $75.62 - - 67420 - - $1,328.15 - - 67430 - - $1,061.21 - - 67440 - - $1,029.57 - - 67445 - - $1,160.85 - - 67450 - - $1,066.49 - - 67500 $57.41 $46.96 - - - 67505 $65.18 $53.66 - - - 67515 $38.85 $35.10 - - - 67516 $91.35 $72.35 - - - 67550 - - $832.55 - - 67560 - - $848.68 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

185

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 67570 - - $974.20 - - 67599 - - I.C. - - 67700 $224.50 $87.90 - - - 67710 $192.38 $74.53 - - - 67715 $208.79 $81.83 - - - 67800 $98.59 $76.63 - - - 67801 $124.62 $98.64 - - - 67805 $155.07 $122.66 - - - 67808 - - $277.05 - - 67810 $145.19 $50.38 - - - 67820 $14.40 $16.54 - - - 67825 $103.64 $92.12 - - - 67830 $211.44 $103.50 - - - 67835 - - $331.83 - - 67840 $218.96 $118.25 - - - 67850 $169.21 $99.03 - - - 67875 $142.05 $71.08 - - - 67880 $359.21 $276.98 - - - 67882 $437.49 $353.93 - - - 67900 $497.98 $378.52 - - - 67901 $613.79 $443.98 - - - 67902 - - $543.90 - - 67903 $461.54 $359.49 - - - 67904 $566.44 $445.92 - - - 67906 - - $377.88 - - 67908 $416.79 $325.99 - - - 67909 $422.32 $329.65 - - - 67911 - - $418.81 - - 67912 $706.21 $365.25 - - - 67914 $379.78 $248.28 - - - 67915 $247.82 $151.67 - - - 67916 $471.61 $322.70 - - - 67917 $481.22 $342.48 - - - 67921 $372.66 $236.33 - - - 67922 $240.32 $151.94 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

186

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 67923 $471.88 $322.96 - - - 67924 $501.71 $342.35 - - - 67930 $285.27 $175.18 - - - 67935 $458.60 $327.36 - - - 67938 $215.24 $89.62 - - - 67950 $448.94 $347.16 - - - 67961 $451.59 $340.70 - - - 67966 $592.33 $488.94 - - - 67971 - - $537.37 - - 67973 - - $689.53 - - 67974 - - $688.00 - - 67975 - - $509.49 - - 67999 - - I.C. - - 68020 $92.48 $83.10 - - - 68040 $46.79 $35.00 - - - 68100 $140.25 $71.14 - - - 68110 $183.96 $111.64 - - - 68115 $259.40 $137.27 - - - 68130 $425.22 $309.78 - - - 68135 $120.12 $112.89 - - - 68200 $31.55 $25.39 - - - 68320 $573.60 $406.20 - - - 68325 - - $491.54 - - 68326 - - $482.91 - - 68328 - - $527.87 - - 68330 $480.03 $345.84 - - - 68335 - - $484.23 - - 68340 $468.03 $299.56 - - - 68360 $417.69 $308.41 - - - 68362 - - $490.98 - - 68371 - - $310.07 - - 68399 - - I.C. - - 68400 $233.43 $98.44 - - - 68420 $259.27 $124.28 - - - 68440 $80.21 $76.19 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

187

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 68500 - - $806.61 - - 68505 - - $803.12 - - 68510 $347.29 $212.30 - - - 68520 - - $561.16 - - 68525 - - $189.81 - - 68530 $336.11 $189.07 - - - 68540 - - $744.63 - - 68550 - - $927.19 - - 68700 - - $451.64 - - 68705 $203.91 $124.63 - - - 68720 - - $614.49 - - 68745 - - $617.91 - - 68750 - - $653.07 - - 68760 $171.20 $109.86 - - - 68761 $112.73 $88.89 - - - 68770 - - $470.43 - - 68801 $74.45 $60.25 - - - 68810 $123.94 $96.62 - - - 68811 - - $101.38 - - 68815 $293.35 $167.47 - - - 68816 $684.17 $117.96 - - - 68840 $102.40 $89.01 - - - 68841 $28.87 $24.31 - - - 68850 $44.29 $38.67 - - - 68899 - - I.C. - - 69000 $145.85 $95.50 - - - 69005 $170.04 $121.83 - - - 69020 $185.15 $111.50 - - - 69090 - - I.C. - - 69100 $75.13 $34.69 - - - 69105 $114.81 $48.12 - - - 69110 $369.29 $253.05 - - - 69120 - - $300.92 - - 69140 - - $704.74 - - 69145 $325.21 $199.59 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

188

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 69150 - - $769.56 - - 69155 - - $1,234.91 - - 69200 $62.03 $35.25 - - - 69205 - - $73.13 - - 69209 - - $12.25 - - 69210 $36.09 $24.03 - - - 69220 $60.22 $38.26 - - - 69222 $170.47 $105.39 - - - 69300 $504.25 $355.86 - - - 69310 - - $869.94 - - 69320 - - $1,207.53 - - 69399 - - I.C. - - 69420 $150.35 $92.49 - - - 69421 - - $116.88 - - 69424 $100.75 $45.58 - - - 69433 $158.55 $101.50 - - - 69436 - - $122.11 - - 69440 - - $536.13 - - 69450 - - $425.69 - - 69501 - - $545.25 - - 69502 - - $722.64 - - 69505 - - $953.05 - - 69511 - - $974.19 - - 69530 - - $1,288.51 - - 69535 - - $2,026.58 - - 69540 $167.79 $101.36 - - - 69550 - - $825.74 - - 69552 - - $1,218.52 - - 69554 - - $1,922.39 - - 69601 - - $779.84 - - 69602 - - $836.24 - - 69603 - - $994.19 - - 69604 - - $853.84 - - 69610 $295.20 $216.45 - - - 69620 $582.67 $379.91 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

189

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 69631 - - $688.87 - - 69632 - - $835.14 - - 69633 - - $811.13 - - 69635 - - $990.38 - - 69636 - - $1,090.91 - - 69637 - - $1,086.28 - - 69641 - - $802.56 - - 69642 - - $1,027.21 - - 69643 - - $940.15 - - 69644 - - $1,163.82 - - 69645 - - $1,142.66 - - 69646 - - $1,210.80 - - 69650 - - $618.68 - - 69660 - - $709.13 - - 69661 - - $922.85 - - 69662 - - $882.73 - - 69666 - - $622.15 - - 69667 - - $622.40 - - 69670 - - $725.83 - - 69676 - - $644.18 - - 69700 - - $511.57 - - 69705 $2,217.5 4 $129.19 - - - 69706 $2,288.4 6 $179.76 - - - 69710 - - I.C. - - 69711 - - $644.23 - - 69714 - - $375.66 - - 69716 - - $469.53 - - 69717 - - $424.91 - - 69719 - - $486.41 - - 69720 - - $914.18 - - 69725 - - $1,414.68 - - 69726 - - $363.01 - - 69727 - - $403.84 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

190

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 69728 - - $449.06 - - 69729 - - $507.53 - - 69730 - - $519.07 - - 69740 - - $883.74 - - 69745 - - $943.47 - - 69799 - - I.C. - - 69801 $177.84 $92.66 - - - 69805 - - $781.55 - - 69806 - - $703.13 - - 69905 - - $707.03 - - 69910 - - $754.41 - - 69915 - - $1,135.74 - - 69930 - - $922.41 - - 69949 - - I.C. - - 69950 - - $1,312.39 - - 69955 - - $1,486.56 - - 69960 - - $1,418.80 - - 69970 - - $1,604.93 - - 69979 - - I.C. - - 69990 - - $156.63 - - 80503 $20.30 $16.29 - - -

80504 $39.69 $35.13 - - -

80505 $71.46 $66.64 - - -

80506 - - $31.91 - -

83020 - - - $13.01 - 84165 - - - $13.01 - 84166 - - - $13.01 - 84181 - - - $13.01 - 84182 - - - $13.01 - 85060 - - $17.71 - - 85097 $52.21 $35.33 - - - 85390 - - - $26.53 - 85396 - - $14.28 - - 85576 - - - $13.01 - 86077 $39.62 $36.14 - - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

191

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 86078 $39.62 $36.14 - - - 86079 $39.89 $36.40 - - - 86153 - - $24.53 $24.53 - 86255 - - - $13.01 - 86256 - - - $13.01 - 86320 - - - $13.01 - 86325 - - - $13.01 - 86327 - - - $16.11 - 86334 - - - $13.01 - 86335 - - - $13.01 - 86486 - - $5.02 - - 86490 - - $62.34 - - 86510 - - $5.82 - - 86580 - - $7.97 - - 87164 - - - $14.08 - 87207 - - - $13.01 - 88104 - - $53.68 $19.80 $33.88 88106 - - $54.72 $14.08 $40.64 88108 - - $51.62 $16.33 $35.29 88112 - - $51.88 $20.07 $31.80 88120 - - $474.12 $42.37 $431.75 88121 - - $332.83 $35.06 $297.77 88125 - - $21.77 $10.05 $11.72 88141 - - $17.55 - - 88160 - - $58.64 $18.87 $39.77 88161 - - $59.98 $18.60 $41.38 88162 - - $92.86 $28.72 $64.15 88172 - - $42.47 $25.93 $16.54 88173 - - $125.23 $51.04 $74.19 88177 - - $22.27 $15.84 $6.43 88182 - - $125.92 $28.43 $97.49 88184 - - $59.32 - - 88185 - - $19.02 - - 88187 - - $25.88 - - 88188 - - $45.58 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

192

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 88189 - - $61.44 - - 88199 - - I.C. - - 88291 - - $24.38 - - 88299 - - I.C. - - 88300 - - $12.54 $3.23 $9.31 88302 - - $25.81 $4.99 $20.82 88304 - - $33.37 $8.27 $25.11 88305 - - $54.92 $27.14 $27.79 88307 - - $227.22 $60.09 $167.13 88309 - - $342.02 $105.7 9 $236.23 88311 - - $15.65 $9.02 $6.63 88312 - - $88.35 $19.31 $69.03 88313 - - $64.67 $8.75 $55.91 88314 - - $71.15 $14.97 $56.18 88319 - - $106.79 $19.61 $87.18 88321 $72.58 $61.33 - - - 88323 - - $86.19 $63.76 $22.43 88325 $116.11 $97.63 - - - 88329 $42.92 $26.04 - - - 88331 - - $78.22 $45.34 $32.88 88332 - - $42.17 $22.41 $19.75 88333 - - $70.96 $45.32 $25.64 88334 - - $42.98 $27.45 $15.53 88341 - - $67.48 $20.61 $46.87 88342 - - $81.79 - - 88344 - - $132.28 $27.89 $104.39 88346 - - $119.49 $26.09 $93.41 88348 - - $373.50 $56.39 $317.11 88350 - - $91.45 $21.07 $70.37 88355 - - $107.77 $59.43 $48.34 88356 - - $179.04 $89.58 $89.45 88358 - - $108.77 $36.25 $72.52 88360 - - $92.19 $30.39 $61.80 88361 - - $91.96 $31.76 $60.20

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

193

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 88362 - - $176.60 $80.72 $95.88 88363 $17.23 $14.28 - - - 88365 - - $141.87 $31.39 $110.48 88366 - - $219.45 $45.23 $174.23 88367 - - $88.98 $24.23 $64.75 88368 - - $111.34 $30.32 $81.02 88369 - - $95.75 $24.04 $71.71 88371 - - - $14.08 - 88372 - - - $13.01 - 88374 - - $239.85 $31.01 $208.85 88375 - - $35.13 - - 88377 - - $312.90 $46.26 $266.63 88380 - - $95.21 $38.56 $56.65 88381 - - $159.68 $17.19 $142.49 88387 - - $25.49 $19.40 $6.09 88388 - - $28.02 $17.11 $10.91 88399 - - I.C. - - 89049 $219.27 $44.64 - - - 89060 - - - $13.01 - 89220 - - $14.40 - - 89230 - - $2.07 - - 89240 - - I.C. - - 14301 * $826.94 $649.90 - - - 14302 *

- $158.36 - - 20912

- $366.14 - - 21120

$516.70 $391.08 - - - 21123 *

- $645.50 - - 21137

- $566.99 - - 21139

- $821.82 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

194

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery-and- anesthesia) 21208 * $1,288.8 7 $553.11 - - - 21209 * $635.47 $473.96 - - - 21210 * $1,385.8 7 $569.50 21296 *

- $313.37 - - 30410

- $1,097.92 - - 30420

- $1,122.86 - - 30465

- $792.47 - - 31750

- $1,042.44 - - 64716

- $388.19 - - 64771

- $437.32 - - G010 5 $414.57 $204.78 - - - G012 1 $414.80 $205.01 - - - S2260 - - I.C. - - S2265 - - I.C. - -

S2266 - - I.C. - -

S2267 - - I.C. - -

*See 101 CMR 316.05(1)

NFAC – “Nonfacility”. These amounts apply when service is performed in a non- facility setting.
FAC – “Facility”. These amounts, also known as the Facility Setting Fee, apply when service is performed in a facility setting.
Global Fee. These amounts apply when no site of service differential rate is specified.

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

195

Code NFAC FAC Global PC TC Description (see surgery services code spreadsheet at www.mass.gov/regulations/101- CMR-31600-surgery) 14301 $1,182.78 $929.56 - - -

14302

- $226.50 - -

20912

- $523.69 - -

21120 $739.04 $559.37 - - -

21123

- $923.26 - -

21137

- $810.98 - -

21139

- $1,175.46 - -

21208 $1,843.49 $791.12 - - -

21209 $908.92 $677.91 - - -

21210 $1,982.23 $814.56 - - -

21296

- $448.21 - -

30410

- $1,570.36 - -

30420

- $1,606.04 - -

30465

- $1,133.49 - -

31750

- $1,491.02 - -

64716

- $555.23 - -

64771

- $625.51 - -

Final Adoption Date Published in Mass. Register: December 20, 2024

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00: RATES FOR SURGERY AND ANESTHESIA SERVICES

196

316.06 Severability

316.06: Severability

The provisions of 101 CMR 316.00 are severable. If any provision of 101 CMR 316.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 316.00 or application of those provisions to applicable individuals, entities, or circumstances.

REGULATORY AUTHORITY

101 CMR 316.00: M.G.L. c. 118E.

101 CMR 316.00 — Rates for Surgery and Anesthesia Services

101 CMR 316.00 Rates for Surgery and Anesthesia Services

316.01 General Provisions

316.02 General Definitions

316.03 General Rate Provisions

316.04 Maximum Allowable Fees - Anesthesia Services

316.05 Maximum Allowable Fees - Surgical Services

316.06 Severability

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