Fee Schedule Maintenance
Our professional and ambulatory surgery center (ASC) fee schedules are based on industry standard pricing methodologies, including resource-based relative value scale (RBRVS), ambulatory payment classifications (APCs), etc. These pricing sources are periodically updated by the Centers for Medicare and Medicaid Services (CMS) and we in turn may incorporate updates to our professional and ASC fee schedules.
We are reminding you of this maintenance to ensure that you have the information your practice needs to understand and calculate your reimbursement. As we look to January 2025, we want to be transparent in your reimbursement, below is a list of new codes for January 2025.
To calculate your reimbursement for these codes, review our Professional Fee Schedule Maintenance Policy located here Professional Reimbursement Updates. In the absence of CMS RBRVS values, Premera will supplement those values with Optum Relative Value Units (RVUs). Your office will want to reference your specific compensation agreement as not all updates may apply.
Please note the new ASC codes will follow our fee schedule maintenance policy and new 2025 codes will be sent in our January news article.
0521U
0522U
0523U
0524U
0525U
0526U
0527U
0528U
0529U
0530U
0901T
0902T
0903T
0904T
0905T
0906T
0907T
0908T
0909T
0910T
0911T
0912T
0913T
0914T
0915T
0916T
0917T
0918T
0919T
0920T
0921T
0922T
0923T
0924T
0925T
0926T
0927T
0928T
0929T
0930T
0931T
0932T
0933T
0934T
0935T
0936T
0937T
0938T
0939T
0940T
0941T
0942T
0943T
0944T
0945T
0946T
0947T
15011
15012
15013
15014
15015
15016
15017
15018
25448
38225
38226
38227
38228
49186
49187
49188
49189
49190
51721
53865
53866
55881
55882
60660
60661
61715
64466
64467
64468
64469
64473
64474
66683
76014
76015
76016
76017
76018
76019
81195
81515
81558
82233
82234
83884
84393
84394
86581
87513
87564
87594
87626
90593
90624
92137
93896
93897
93898
96041
98000
98001
98002
98003
98004
98005
98006
98007
98008
98009
98010
98011
98012
98013
98014
98015
98016
A9615
E1803
E1804
E1807
E1808
E1813
E1814
E1822
E1823
E1826
E1827
E1828
E1829
G0532
G0533
G0534
G0535
G0536
G0537
G0538
G0539
G0540
G0541
G0542
G0543
G0544
G0545
G0546
G0547
G0548
G0549
G0550
G0551
G0552
G0553
G0554
G0555
G0556
G0557
G0558
G0559
G0560
G0561
G0562
G0563
G0564
G0565
H0052
H0053
J0139
J0601
J0602
J0603
J0605
J0607
J0608
J0609
J0615
J0666
J0870
J0901
J1307
J1414
J1552
J2290
J2472
J2802
J3392
J7514
J7601
J9026
J9028
J9076
J9292
M1371
M1372
M1373
M1374
M1375
M1376
M1377
M1378
M1379
M1380
M1381
M1382
M1383
M1384
M1385
M1386
M1387
M1388
M1389
M1390
M1391
M1392
M1393
M1394
M1395
M1396
M1397
M1398
M1399
M1400
M1401
M1402
M1403
M1404
M1405
M1406
M1407
M1408
M1409
M1410
M1411
M1412
M1413
M1414
M1415
M1416
M1417
M1418
M1419
M1420
M1421
M1422
M1423
M1424
M1425
Q0155
Q0521
Q4346
Q4347
Q4348
Q4349
Q4350
Q4351
Q4352
Q4353
Q5139
Q5140
Q5141
Q5142
Q5143
Q5144
Q5145
Q5146
Q9996
Q9997
Q9998
If you have questions or would like a copy of your fee schedule, please email Provider.relations@premera.com.