July 29, 2022

State of Alabama
Press Release: Medicaid

Rate Increase for ENT Procedure Codes



TO: Ear, Nose, and Throat (ENT) Providers

RE: Rate Increase for ENT Procedure Codes

Effective August 1, 2022, Alabama Medicaid will increase the reimbursement rates for the current ENT procedure codes listed below.

ENT Procedure Codes

ENT Procedure Codes

Procedure Code Description

Current Medicaid Reimbursement

Medicaid Reimbursement Rate
Eff 8/1/22

10005

FNA BX W/US GDN 1ST LES

$95.02

$122.74

10006

FNA BX W/US GDN EA ADDL

$45.90

$57.96

11442

EXC FACE-MM B9+MARG 1.1-2 CM

$122.00

$179.73

11446

EXC FACE-MM B9+MARG >4 CM

$250.00

$372.17

15115

Epidermal Autograft, First 100sq cm

$468.50

$768.06

15120

Split-thickness Autograft, First 100sq cm

$603.00

$811.64

15769

Grafting of Autologous Soft Tissue (eg. Fat, Dermis, Fascia)

$309.00

$463.95

21552

Excision of Mass/Tumor, Soft Tissue of Neck, 3cm+

$274.51

$430.16

21555

Excision of Mass/Tumor, Soft Tissue of Neck, < 3cm

$287.00

$404.34

21556

Exc Neck Tum Deep < 5 CM

$290.00

$509.67

30130

Tubinoplasty

$255.00

$372.72

30300

Remove Nasal Foreign Body

$154.00

$176.76

30310

Remove Nasal Foreign Body

$144.00

$192.30

30465

Nasal Valve Repair, Reconstruction

$536.00

$954.01

30520

Septoplasty

$368.00

$613.40

30630

REPAIR OF OPENINGS OF NASAL CARTILAGE

$337.00

$650.20

30802

Ablate Inf Turbinate Submuc

$185.00

$258.67

30901

Control Nasal Hemorrhage, Ant/Simple

$75.00

$134.45

30905

Control Nasal Hemorrhage, Post/Simple-Initial

$155.00

$314.94

31231

Nasal Endoscopy DX

$123.00

$179.37

31237

Nasal/Sinus Endoscopy Surg

$232.00

$239.44

31240

Excision of Concha Bullosa

$146.00

$153.17

31253

Total w/ Frontal

$376.75

$489.91

31254

Anterior Ethmoidectomy

$253.00

$397.98

31257

Total w/ Sphenoid W/O Rem

$335.53

$436.20

31259

Total w/ Sphenoid W/ Rem

$355.58

$461.73

31295

Balloon Maxillary

$1,510.22

$1,726.14

31298

Balloon Frontal & Sphenoid

$2,819.58

$3,290.02

31525

Direct Laryngoscopy, Diagnostic

$179.00

$237.50

31526

Micro Direct Laryngoscopy, Diagnostic

$143.00

$151.09

31535

Direct Laryngoscopy W/ Bx

$173.00

$182.70

31536

Micro Direct Laryngoscopy W/ Bx

$194.00

$203.50

31540

DL W/ Exc of Lesion/Stripping VC

$224.00

$233.88

31541

Micro DL W/ Exc of Lesion/Stripping VC

$245.00

$255.30

31575

Diagnostic Laryngoscopy

$88.00

$114.95

31579

Laryngoscopy Telescopic

$171.00

$181.00

38500

Lymph Node Bx or Excision, Superficial

$220.00

$320.10

38510

Lymph Node Bx or Excision, Deep Cervical

$356.00

$503.25

38724

Lymphadenectomy, Cervical (Mod Radical Dissection)

$734.00

$1,406.36

40806

Incision Of Lip Fold

$58.00

$92.03

40819

Excise Lip Or Cheek Fold

$185.00

$267.20

41100

Tongue Bx, Ant 2/3

$116.00

$164.92

41105

Tongue Bx, Post 1/3

$106.00

$166.73

41520

Reconstruction Tongue Fold

$209.00

$334.75

42140

Excision Of Uvula

$149.00

$263.19

42145

Repair Palate Pharynx/Uvula

$510.00

$665.76

42305

Drainage of Abscess, Parotid (Complicated)

$319.00

$412.72

42330

Sialolithotomy, Intraoral, Simple (Subman/Subling/Parotid)

$153.00

$219.80

42335

Sialolithotomy, Intraoral, Comp. (Submandibular)

$235.00

$381.21

42340

Sialolithotomy, Extroral or Comp. Intraoral, Parotid

$221.00

$470.04

42410

Parotidectomy, Lateal Lobe, W/O Nerve Diss.

$465.00

$603.56

42415

Parotidectomy, Lateal Lobe, W/ Nerve Diss.

$827.00

$1,023.51

42420

Parotidectomy, Total, W/ Nerve Diss.

$953.00

$1,150.76

42440

Excison of Submandibular Gland

$361.00

$397.60

42700

Drainage Of Tonsil Abscess

$121.00

$180.22

42800

Oropharyngeal Bx

$101.00

$148.58

42804

Oropharyngeal Bx, Visible Lesion

$72.00

$185.26

42820

Removal of tonsils and adenoids, < age 12

$225.00

$278.17

42821

Removal of tonsils and adenoids, age 12+

$248.00

$290.09

42825

Tonsillectomy < age 12

$206.00

$252.18

42826

Tonsillectomy age 12+

$211.00

$241.67

42830

Adenoidectomy, Primary < age 12

$149.00

$199.08

42831

Adenoidectomy, Primary age 12+

$161.00

$215.31

42835

Adenoidectomy, Secondary < age 12

$139.00

$184.21

42836

Adenoidectomy, Secondary age 12+

$179.00

$231.23

60210

Partial Lobectomy, Unilateral

$534.00

$685.24

60220

Total Lobectomy, Unilateral

$593.00

$684.14

60240

Thyroidectomy, Total or Complete

$726.00

$892.31

60252

Thyroidectomy, For Malignancy, W/ Limited Neck Diss.

$938.00

$1,284.20

60260

Thyroidectomy, Rem of All Remaining Tissue (Subq. Proc.)

$561.00

$1,060.57

60500

Explore Parathyroid Glands

$774.00

$938.92

60502

Re-Explore Parathyroids

$805.00

$1,258.44

60512

Autotransplant Parathyroid

$189.00

$237.49

61782

Navigation

$143.29

$170.46

69205

Removal of Foreign Body, External Auditory Canal

$76.00

$92.67

69222

Clean Out Mastoid Cavity

$145.00

$197.57

69421

Incision Of Eardrum

$112.00

$140.56

69433

Create Eardrum Opening

$129.00

$185.15

69436

Tympanostomy W/ Tube Placement

$123.00

$149.95

69610

Repair of Tymp Perforation, W/ or W/O Paper Patch

$287.00

$358.73

69631

Repair Eardrum Structures

$627.00

$836.24

69706

Dilation of Canal Between Middle Ear and Throat (Eustachian Tube) on Both Sides of Body, Using Endoscope Inserted Through Nose

$217.05

$236.65

69930

Implant Cochlear Device

$923.00

$1,170.04

92504

Ear Microscopy Examination

$18.00

$26.96

92540

Basic Vestibular Evaluation

$64.78

$103.15

92552

Pure Tone Audiometry Air

$14.00

$28.49

92553

Audiometry Air & Bone

$17.00

$34.58

92555

Speech Threshold Audiometry

$11.00

$21.43

92556

Speech Audiometry Complete

$15.00

$34.26

92557

Comprehensive Hearing Test

$35.00

$36.86

92567

Tympanometry

$14.00

$15.17

92612

Endoscopy Swallow (Fees) Vid

$109.00

$186.48

95004

Percut Allergy Skin Tests

$2.48

$3.82

95024

Icut Allergy Test Drug/Bug

$4.00

$7.35

95027

Icut Allergy Titrate-Airborn

$4.00

$4.47

95165

Antigen Therapy Services

$6.20

$13.33

96372

Ther/Proph/Diag Inj SC/IM

$10.00

$13.45



The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association and © 2022 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.




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