"Appendix Table 1: Estimated Procedure Shares Under Procedure-Only Modifier -54, Surgical Services with 90-day Global Periods"							
HCPCS Code	Short descriptor	Clean proc. (n)	Work RVUs	Approach A (status quo) procedure share (%)	Approach B (time file) procedure share (%)	Approach C (99024) procedure share (%)	Approach D (minutes) procedure share (%)
N/A	All 90-day codes (n=188)	"8,248,480"	"4,203,782"	83.0	62.7	90.9	53.4
66984	Xcapsl ctrc rmvl w/o ecp	"1,695,026"	"117,269"	80.0	58.4	88.1	35.7
66821	After cataract laser surgery	"809,320"	"77,094"	80.0	43.3	100.0	43.9
27447	Total knee arthroplasty	"472,305"	"766,262"	79.0	64.4	88.1	50.0
27130	Total hip arthroplasty	"262,710"	"451,153"	79.0	64.4	88.1	50.4
66982	Xcapsl ctrc rmvl cplx wo ecp	"169,400"	"23,411"	80.0	60.7	91.3	40.6
64721	Carpal tunnel surgery	"157,561"	"31,888"	87.0	38.4	82.4	52.6
26055	Incise finger tendon sheath	"148,208"	"15,000"	79.0	32.8	73.1	51.3
33208	Insrt heart pm atrial & vent	"132,076"	"85,370"	93.0	57.3	100.0	56.3
14060	Tis trnfr e/n/e/l 10 sq cm/<	"118,472"	"36,412"	81.0	68.6	100.0	57.4
63047	Lam facetec & foramot lumbar	"118,080"	"71,763"	87.0	58.8	86.3	53.9
23472	Reconstruct shoulder joint	"117,693"	"179,474"	79.0	65.7	91.4	54.7
27245	Treat thigh fracture	"111,233"	"193,053"	79.0	50.7	94.5	45.1
47562	Laparoscopic cholecystectomy	"108,174"	"84,985"	90.0	70.8	91.6	67.7
29827	Sho arthrs srg rt8tr cuf rpr	"92,474"	"23,401"	79.0	80.5	92.9	70.4
19301	Partial mastectomy	"89,478"	"22,489"	81.0	69.8	91.4	62.5
49650	Lap ing hernia repair init	"85,991"	"38,637"	90.0	84.9	92.5	78.2
14040	Tis trnfr f/c/c/m/n/a/g/h/f	"85,144"	"16,168"	81.0	66.3	100.0	65.0
27236	Treat thigh fracture	"81,494"	"129,469"	79.0	53.4	94.2	46.7
28285	Repair of hammertoe	"80,119"	"1,995"	79.0	37.0	72.0	48.9
15260	Skin full graft een & lips	"76,946"	"23,012"	81.0	58.3	100.0	57.9
38525	Biopsy/removal lymph nodes	"73,982"	"1,653"	84.0	67.5	87.0	67.4
15823	Revision of upper eyelid	"69,606"	"18,346"	81.0	55.2	100.0	44.1
20680	Removal of support implant	"67,184"	"10,269"	79.0	73.2	89.3	71.8
14041	Tis trnfr f/c/c/m/n/a/g/h/f	"65,584"	"17,610"	81.0	64.2	100.0	69.6
33533	Cabg arterial single	"65,111"	"185,524"	91.0	52.9	84.3	43.0
22612	Arthrd pst tq 1ntrspc lumbar	"63,630"	"5,341"	79.0	67.1	90.6	57.1
14301	Tis trnfr any 30.1-60 sq cm	"63,376"	"13,561"	81.0	68.1	92.9	63.8
29848	Wrist endoscopy/surgery	"58,732"	"15,911"	79.0	54.5	84.8	61.5
52601	Prostatectomy (turp)	"58,019"	"57,983"	91.0	80.4	92.2	72.5
50590	Fragmenting of kidney stone	"56,424"	"37,790"	91.0	68.7	91.1	60.9
29823	Sho arthrs srg xtnsv dbrdmt	"54,566"	"3,631"	79.0	61.7	78.1	61.6
22633	Arthrd cmbn 1ntrspc lumbar	"52,723"	"69,064"	79.0	69.2	91.2	56.0
29881	Knee arthroscopy/surgery	"52,017"	"24,570"	79.0	56.5	87.6	58.2
49505	Prp i/hern init reduc >5 yr	"50,012"	"24,716"	90.0	73.7	89.5	70.7
67210	Treatment of retinal lesion	"49,308"	"4,764"	80.0	54.2	100.0	34.9
66991	Xcapsl ctrc rmvl insj 1+	"48,637"	"3,369"	80.0	56.3	100.0	39.5
22551	Arthrd ant ntrbdy cervical	"48,199"	"77,075"	79.0	77.7	91.1	62.8
47563	Laparo cholecystectomy/graph	"47,048"	"45,249"	90.0	81.8	92.7	75.6
33228	Remv&replc pm gen dual lead	"45,724"	"20,689"	93.0	70.8	100.0	67.4
14061	Tis trnfr e/n/e/l10.1-30sqcm	"45,597"	"16,015"	81.0	62.0	100.0	69.7
22558	Arthrd ant ntrbd min dsc lum	"44,002"	"5,906"	79.0	52.5	88.1	54.3
33249	Insj/rplcmt defib w/lead(s)	"43,579"	"42,477"	93.0	80.5	100.0	71.1
29824	Sho arthrs srg dstl claviclc	"40,884"	"1,554"	79.0	60.6	91.2	56.9
29880	Knee arthroscopy/surgery	"38,613"	"19,236"	79.0	58.6	88.2	59.3
67904	Repair eyelid defect	"37,869"	"10,361"	80.0	61.7	100.0	51.4
64718	Revise ulnar nerve at elbow	"37,051"	"4,407"	87.0	37.7	86.2	55.6
25600	Treat fracture radius/ulna	"35,984"	"8,882"	79.0	13.7	82.7	25.9
58571	Tlh w/t/o 250 g or less	"34,433"	"16,755"	86.0	82.8	93.1	73.0
67042	Vit for macular hole	"33,115"	"19,400"	80.0	66.4	93.9	48.5
35301	Rechanneling of artery	"33,042"	"50,678"	93.0	68.8	93.8	55.7
25447	Repair wrist joints	"32,684"	"4,790"	79.0	63.9	86.9	59.4
23430	Repair biceps tendon	"32,063"	244	79.0	65.2	84.5	59.1
23600	Cltx prox humrl fx w/o mnpj	"31,113"	"8,442"	79.0	19.7	79.9	29.0
29828	Sho arthrs srg bicp tenodsis	"30,919"	855	79.0	73.1	88.0	61.5
57288	Repair bladder defect	"30,207"	"6,999"	86.0	66.8	92.6	57.7
15734	Muscle-skin graft trunk	"29,672"	"3,864"	81.0	51.2	90.2	47.8
36821	Av fusion direct any site	"29,447"	"14,637"	93.0	82.4	93.0	75.1
44970	Laparoscopy appendectomy	"29,058"	"20,903"	90.0	57.9	89.5	57.0
30520	Repair of nasal septum	"28,856"	"8,552"	86.0	49.5	88.8	53.9
44120	Removal of small intestine	"28,515"	"20,029"	90.0	33.0	88.8	36.7
67036	Removal of inner eye fluid	"28,094"	"6,490"	80.0	54.7	91.8	46.4
14021	Tis trnfr s/a/l 10.1-30 sqcm	"27,902"	"5,735"	81.0	60.1	90.0	68.1
55866	Laps surg prst8ect rpbic rad	"27,477"	"9,658"	91.0	88.5	90.8	82.0
19303	Mast simple complete	"26,363"	"3,720"	81.0	72.8	84.5	62.9
25609	Treat fx radial 3+ frag	"25,838"	"21,340"	79.0	61.9	88.3	60.1
28470	Treat metatarsal fracture	"25,569"	"3,508"	79.0	29.1	76.4	37.7
26160	Remove tendon sheath lesion	"24,962"	"3,634"	79.0	41.5	76.6	52.1
27487	Revise/replace knee joint	"24,502"	"45,057"	79.0	66.9	93.4	55.8
60500	Explore parathyroid glands	"23,573"	"31,231"	91.0	80.4	100.0	74.1
28308	Incision of metatarsal	"23,366"	515	79.0	65.0	82.5	61.2
22600	Arthrd pst tq 1ntrspc crv	"23,239"	"1,009"	79.0	44.1	89.8	49.0
14020	Tis trnfr s/a/l 10 sq cm/<	"23,136"	"2,758"	81.0	46.3	100.0	58.7
63030	Low back disk surgery	"22,971"	"15,372"	87.0	66.0	90.3	65.6
28232	Incision of toe tendon	"22,970"	625	79.0	65.8	100.0	62.6
67108	Repair detached retina	"22,825"	"13,961"	80.0	68.0	94.2	54.6
13160	Late closure of wound	"22,793"	"2,071"	81.0	41.4	92.2	50.4
28270	Release of foot contracture	"21,702"	335	79.0	65.9	100.0	61.4
67917	Repair eyelid defect	"21,626"	"2,010"	80.0	56.7	87.6	47.9
52648	Laser surgery of prostate	"20,613"	"21,214"	91.0	76.0	92.0	72.3
28810	Amputation toe & metatarsal	"19,062"	"2,517"	79.0	28.9	89.8	43.4
36832	Av fistula revision open	"18,982"	"6,858"	93.0	77.3	93.5	70.7
65756	Corneal trnspl endothelial	"18,827"	"9,026"	80.0	70.4	90.9	46.7
33264	Rmvl & rplcmt dfb gen mlt ld	"18,576"	"10,236"	93.0	74.6	100.0	72.0
27446	Revision of knee joint	"18,297"	"22,389"	79.0	76.2	86.4	66.1
27786	Treatment of ankle fracture	"18,295"	"4,693"	79.0	44.4	84.1	50.9
43281	Lap paraesophag hern repair	"18,162"	"30,297"	90.0	79.8	91.9	66.0
28122	Partial removal of foot bone	"17,722"	"1,190"	79.0	47.6	88.4	57.8
33405	Replacement aortic valve opn	"17,705"	"24,503"	93.0	56.9	91.4	43.2
15240	Skin full grft face/genit/hf	"17,511"	"3,310"	81.0	47.4	91.9	50.3
36830	Artery-vein nonautograft	"16,323"	"6,195"	93.0	82.6	93.1	76.6
63045	Lam facetec & foramot crv	"16,077"	"3,518"	87.0	64.7	94.1	57.7
67900	Repair brow defect	"15,908"	"1,303"	80.0	64.5	100.0	65.0
34705	Evac rpr a-biiliac ndgft	"15,875"	"28,722"	93.0	79.3	95.9	66.4
44205	Lap colectomy part w/ileum	"15,854"	"24,212"	90.0	71.6	93.7	56.6
27235	Treat thigh fracture	"15,789"	"16,978"	79.0	43.2	89.2	41.1
67041	Vit for macular pucker	"15,536"	"9,782"	80.0	66.4	87.8	48.5
27486	Revise/replace knee joint	"15,456"	"16,938"	79.0	57.6	91.5	51.1
19125	Excision breast lesion	"15,383"	"6,235"	81.0	71.0	85.5	76.5
50360	Transplantation of kidney	"15,191"	"23,130"	91.0	62.6	100.0	47.5
67113	Repair retinal detach cplx	"14,786"	"6,935"	80.0	66.0	94.8	54.9
15100	Skin splt grft trnk/arm/leg	"14,700"	"3,356"	81.0	50.1	91.7	51.6
27134	Revise hip joint replacement	"14,374"	"19,319"	79.0	68.6	94.3	60.0
44160	Removal of colon	"14,093"	"14,205"	90.0	44.9	83.5	41.4
27880	Amputation of lower leg	"13,750"	"7,593"	79.0	42.2	94.2	40.0
33207	Insert heart pm ventricular	"13,693"	"6,310"	93.0	53.3	100.0	56.7
44207	L colectomy/coloproctostomy	"13,200"	"30,260"	90.0	71.1	92.8	54.5
66180	Aqueous shunt eye w/graft	"12,864"	"7,290"	80.0	53.8	83.7	34.3
44204	Laparo partial colectomy	"12,548"	"23,699"	90.0	72.1	93.0	56.0
32663	Thoracoscopy w/lobectomy	"12,512"	"25,626"	93.0	64.0	89.7	51.3
27506	Treatment of thigh fracture	"12,459"	"16,840"	79.0	46.1	91.0	45.9
38724	Removal of lymph nodes neck	"12,204"	"2,706"	84.0	64.1	95.5	55.7
28124	Partial removal of toe	"12,162"	470	79.0	61.6	90.4	57.6
49507	Prp i/hern init block >5 yr	"12,101"	"6,472"	90.0	77.0	90.8	74.9
44140	Partial removal of colon	"11,887"	"11,634"	90.0	60.6	92.1	50.0
44143	Partial removal of colon	"11,739"	"20,092"	90.0	52.2	91.3	39.5
27814	Treatment of ankle fracture	"11,646"	"5,692"	79.0	47.6	82.5	54.9
27590	Amputate leg at thigh	"11,642"	"6,816"	79.0	17.0	94.6	30.5
26600	Treat metacarpal fracture	"11,211"	"2,291"	79.0	26.2	81.5	31.2
61312	Open skull for drainage	"11,187"	"19,218"	87.0	49.2	96.4	39.2
67924	Repair eyelid defect	"11,096"	"2,123"	80.0	56.7	100.0	50.3
25605	Treat fracture radius/ulna	"11,056"	"2,856"	79.0	43.5	79.5	37.3
61510	Removal of brain lesion	"10,737"	"23,184"	87.0	64.4	96.8	54.3
23500	Cltx clavicular fx w/o mnpj	"10,324"	"1,974"	79.0	45.7	78.3	49.4
37607	Ligation of a-v fistula	"10,283"	"1,538"	93.0	84.6	92.3	86.8
57240	Anterior colporrhaphy	"10,227"	"2,107"	86.0	74.4	89.8	69.2
15120	Skn splt a-grft fac/nck/hf/g	"10,116"	"2,284"	81.0	69.9	91.4	68.6
25607	Treat fx rad extra-articul	"10,091"	"5,401"	79.0	52.8	82.8	56.4
28510	Treatment of toe fracture	"9,815"	538	79.0	38.5	100.0	54.7
44005	Freeing of bowel adhesion	"9,581"	"10,928"	90.0	40.2	86.7	40.6
23412	Repair rotator cuff chronic	"9,487"	"1,014"	79.0	70.3	86.8	66.2
29822	Sho arthrs srg lmtd dbrdmt	"9,278"	"1,371"	79.0	56.5	75.1	57.6
33430	Replacement of mitral valve	"9,149"	"15,585"	93.0	53.1	92.2	40.2
22830	Exploration of spinal fusion	"8,968"	112	79.0	62.2	93.7	58.1
29876	Knee arthroscopy/surgery	"8,684"	931	79.0	60.0	88.6	62.2
28296	Correction hallux valgus	"8,680"	883	79.0	51.3	82.3	53.1
19120	Removal of breast lesion	"8,529"	"2,557"	81.0	75.5	87.8	71.3
27132	Total hip arthroplasty	"8,434"	"14,155"	79.0	51.8	93.4	47.6
23615	Optx prox humrl fx w/int fix	"8,339"	"5,818"	79.0	55.9	85.3	57.7
67040	Laser treatment of retina	"8,239"	"3,857"	80.0	62.1	100.0	50.9
33263	Rmvl & rplcmt dfb gen 2 lead	"7,610"	"3,843"	93.0	73.5	100.0	72.0
15769	Grfg autol soft tiss dir exc	"7,554"	94	79.0	51.9	88.0	51.3
60240	Removal of thyroid	"7,523"	"7,986"	91.0	82.8	93.1	80.1
64581	Opn impltj nea sacral nerve	"7,434"	281	87.0	82.5	88.3	78.1
47600	Removal of gallbladder	"7,369"	"5,664"	90.0	47.1	86.8	46.3
46930	Destroy internal hemorrhoids	"7,327"	446	90.0	39.8	100.0	50.0
63042	Laminotomy single lumbar	"7,075"	"3,020"	87.0	65.5	90.1	58.2
66170	Glaucoma surgery	"6,929"	"2,621"	80.0	46.8	83.2	28.8
15733	Musc myoq/fscq flp h&n pedcl	"6,633"	235	81.0	77.4	95.0	68.2
22630	Arthrd pst tq 1ntrspc lum	"6,351"	"10,095"	79.0	62.6	89.3	53.2
29879	Knee arthroscopy/surgery	"6,346"	135	79.0	60.5	88.7	59.4
26720	Treat finger fracture each	"6,265"	815	79.0	45.5	72.7	49.2
27125	Partial hip replacement	"6,175"	"7,505"	79.0	39.9	94.8	40.0
63056	Decompress spinal cord lmbr	"5,894"	"3,170"	87.0	62.2	96.0	56.1
66989	Xcpsl ctrc rmvl cplx insj 1+	"5,890"	667	80.0	66.8	92.6	40.9
36819	Av fuse uppr arm basilic	"5,702"	"2,831"	93.0	84.3	93.7	79.5
19357	Tiss xpndr plmt brst rcnstj	"5,421"	326	81.0	56.5	71.0	51.7
23120	Partial removal collar bone	"5,404"	303	79.0	52.1	89.4	57.3
15771	Grfg autol fat lipo 50 cc/<	"5,072"	370	79.0	71.3	80.9	69.6
63081	Remove vert body dcmprn crvl	"5,043"	339	87.0	39.6	89.9	45.3
44145	Partial removal of colon	"4,960"	"5,973"	90.0	62.4	92.5	52.0
19307	Mast mod rad	"4,905"	"3,814"	81.0	71.9	87.5	62.7
27244	Treat thigh fracture	"4,701"	"4,745"	79.0	50.7	94.5	44.5
33859	As-aort grf f/ds oth/thn dsj	"4,415"	"4,107"	93.0	60.3	90.1	50.1
43644	Lap gastric bypass/roux-en-y	"3,839"	"7,115"	90.0	73.6	92.4	56.8
23650	Cltx sho dslc w/mnpj wo anes	"3,325"	515	79.0	59.2	100.0	63.9
32480	Partial removal of lung	"3,318"	"6,016"	86.0	48.2	79.3	46.4
33426	Repair of mitral valve	"3,014"	"4,674"	93.0	58.9	87.7	43.8
15730	Mdfc flap w/prsrv vasc pedcl	"2,565"	54	81.0	77.4	100.0	64.8
33858	As-aort grf f/aortic dsj	"1,687"	"4,438"	93.0	63.1	96.3	47.2
58575	Laps tot hyst resj mal	"1,635"	"1,434"	86.0	81.3	94.4	67.8
34710	Dlyd plmt xtn prosth 1st vsl	"1,466"	"1,050"	93.0	67.5	93.5	65.5
53850	Prostatic microwave thermotx	"1,114"	38	91.0	46.3	82.1	54.3
34706	Evasc rpr a-biiliac rpt	847	"2,835"	93.0	63.8	96.4	46.0
66179	Aqueous shunt eye w/o graft	846	644	80.0	50.5	76.7	33.1
66711	Ecp ciliary body destruction	844	28	80.0	11.0	100.0	33.5
67255	Reinforce/graft eye wall	834	59	80.0	40.5	100.0	37.0
15773	Grfg autol fat lipo 25 cc/<	736	164	79.0	71.7	90.6	69.4
							
SOURCE: RAND analysis of 2023 fee-for-service Medicare claims data accessed via CMS Integrated Data Repository and procedure shares calculated as described above.							
"NOTE: Approaches A (status quo), B (use time file), C (use 99024), and D (use time) as described in RAND's memo (Figure 3)."							
