Revised Fees for Arteriovenous Fistual Creation

Published 09/28/2022

Palmetto GBA completed a fee review for HCPCS codes G2170 and G2171 under the Jurisdiction M contract. The fee is being retroactively changed effective for dates of service January 1, 2022. The updated pricing will be implemented on October 14, 2022. Palmetto GBA will not be automatically adjusting claims as part of this fee change. At their discretion, providers may use the Palmetto GBA eServices portal to request a claim reopening for affected claims. Affected claims adjusted for any other reason on or after October 14, 2022, will have the updated pricing applied.

HCPCS Code G2170

State

Carrier

Locality

2022 Facility Fee

2022 Non-Facility Fee

S.C.

11202

01

$642.64

$6,910.52

Va.

11302

00

$659.69

$7,566.16

N.C.

11502

00

$659.30

$6,614.82

W. Va.

11402

16

$650.15

$7,091.55


HCPCS Code G2171

State

Carrier

Locality

2022 Facility Fee

2022 Non-Facility Fee

S.C.

11202

01

$677.76

$9,744.29

Va.

11302

00

$697.27

$10,687.52

N.C.

11502

00

$697.79

$9,312.50

W. Va.

11402

16

$686.46

$10,004.00

Inclusion or exclusion of a fee schedule amount for an item or service does not imply any health insurance coverage.


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