| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $83 | $83 | $83 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $56 | $56 | $56 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $39 | $39 | $39 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $33 | $33 | $33 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $33 | $33 | $33 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $34 | $34 | $34 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $40 | $54 | $76 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $40 | $40 | $40 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $26 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $17 | $20 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $16 | $26 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $18 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $274 | $292 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $322 | $386 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $95 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $29 | $33 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $94 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $170 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $163 | $201 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $187 | $194 | $216 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $28 | $28 | $28 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $74 | $131 | $172 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $146 | $180 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $116 | $152 | $187 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $163 | $210 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $129 | $179 | $204 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $148 | $193 | $237 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $126 | $213 | $256 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $96 | $116 | $155 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $123 | $165 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $102 | $118 | $165 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $122 | $181 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $88 | $129 | $184 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $96 | $153 | $196 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $101 | $183 | $211 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $27 | $38 | $43 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $56 | $56 | $56 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $320 | $541 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $312 | $397 | $541 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $125 | $227 | $261 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $213 | $261 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $113 | $143 | $205 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $233 | $233 | $233 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $257 | $257 | $257 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $134 | $134 | $134 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $156 | $156 | $156 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $348 | $348 | $348 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $222 | $222 | $222 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $92 | $92 | $92 |