TITLE 140

COMMONWEALTH HEALTHCARE CORPORATION

Chapter 140-10          Division of Public Health

Subchapter 140-10.1             Americans with Disabilities Act and Rehabilitation Act Grievance Procedure

Subchapter 140-10.2             Alien Employee Screening Requirements Rules and Regulations

Subchapter 140-10.3             Communicable Diseases Rules and Regulations

Subchapter 140-10.4             Interments and Dead Bodies Regulations

Subchapter 140-10.5             Living Will Policy Rules and Regulations

Subchapter 140-10.6             Maintenance and Release of Patient Health Care Information Rules and Regulations

Subchapter 140-10.7             Medical Referral Program Rules and Regulations

Subchapter 140-10.8             Schedule of Medical and Other Related Fees

Subchapter 140-10.9             Sliding Fee Scale Program Regulations

Subchapter 140-10.10           Transitional Living Center; Ability to Pay Rules and Regulations

Subchapter 140-10.11           Medical Malpractice Coverage Rules and Regulations

Chapter 140-20          Division of Public Health; Bureau of Environmental Health Environmental Health and Sanitation Standards

Subchapter 140-20.1             General Provisions

Subchapter 140-20.2             Cemeteries and Mortuaries Rules and Regulations

Subchapter 140-20.3             Food Handlers Rules and Regulations

Subchapter 140-20.4             Schools and Child Care Facilities Regulations

Subchapter 140-20.5             Standard Governing the Importation, Sale and Distribution of Foreign Bottled Water for Human Consumption

Subchapter 140-20.6             Water and Ice Manufacturing Rules and Regulations

Subchapter 140-20.7             Rules and Regulations Governing the Manufacturing, Packing, Importation, Distribution, Warehousing or the Holding of Food for Human Consumption

Subchapter 140-20.8             Smoke-Free Air Act Rules and Regulations

Chapter 140-30          Medicaid Division

Subchapter 140-30.1             Medicaid Drug Formulary Rules and Regulations

Subchapter 140-30.2             Medical Assistance for the Needy Program (Medicaid) Rules and Regulations

Chapter 140-40          Office of Medical Examiner

Subchapter 140-40.1             Investigation of Deaths and the Performance of Autopsies Rules and Regulations [Reserved]

Chapter 140-50          Medical Profession Licensing Board

Subchapter 140-50.1             Health Care Professionals Licensing Rules and Regulations

Subchapter 140-50.2             Importation, Storage, Sales, and Distribution of Drugs and Pharmaceutical Products Rules and Regulations

Subchapter 140-50.3             Commonwealth Health Care Professions Licensing Board Regulations

Chapter 140-60          Commonwealth Board of Nurse Examiners

Subchapter 140-60.1             Commonwealth Board of Nurse Examiners Administrative Regulations

Subchapter 140-60.2             Commonwealth Board of Nurse Examiners Rules and Regulations

Chapter 140-70          Tobacco Prevention and Control Program

Subchapter 140-70.1             Minor Assisted Undercover Purchase of Tobacco Products Regulations

Chapter 140-80          Procurement

Subchapter 140-80.1             Procurement Regulations

 

Chapter 140-90          Personnel Regulations

            Subchapter 140-90.1             Human Resource Rules and Regulations

 

CHAPTER 140-10

DIVISION OF PUBLIC HEALTH

 

SUBCHAPTER 140-10.1

AMERICANS WITH DISABILITIES ACT AND REHABILITATION ACT GRIEVANCE PROCEDURE

 


Part 001          General Provisions

 

§ 140-10.1-001            Compliance with § 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990

 

 

 

Part 100          Grievance Procedure

 

§ 140-10.1-101            Grievance Procedure


 

Subchapter Authority: 1 CMC §§ 2603 and 2605.

 

Subchapter History: Amdts Adopted 20 Com. Reg. 16305 (Dec. 15, 1998); Amdts Adopted 18 Com. Reg. 14468 (Nov. 15, 1996); Adopted 17 Com. Reg. 13554 (July 15, 1995).

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2603(f) grants the Department the power and duty to administer all government-owned health care facilities. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles, and effected numerous other revisions. According to Executive Order 94-3 §§ 105 and 305:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

 

Section 305. Department of Public Health.

 

(a)           Board of Public Health and Environmental Quality. The Board of Public Health and Environmental Quality is abolished and its functions transferred to the Secretary of Public Health.

 

(b)           Federally-Mandated Councils. The State Planning Council on Development Disabilities and the State Rehabilitation Advisory Council are allocated to the Department of Public Health for the purposes of administration and coordination.

 

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

§ 140-10.1-001            Compliance with § 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990

 

(a)        It is the policy of the Department of Public Health to comply with the requirements of § 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, and regulations promulgated thereunder at 45 CFR part 84, and title II of the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12131-12134, and regulations promulgated thereunder at 28 CFR part 35. These regulations provide, in part, that “[n]o qualified handicapped person shall, on the basis of handicap, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity which receives or benefits from Federal financial assistance,” and that “[n]o qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subject to discrimination by any public entity.” See 45 CFR § 84.4(a), and 28 CFR § 35.130(a), respectively.

 

(b)        If any individual has reason to believe that the Department of Public Health is not complying with the requirements of § 504 of the Rehabilitation Act of 1973 or title II of the Americans with Disabilities Act of 1990, and their respective regulations, he or she may file a grievance pursuant to the procedure set forth below. Any person wishing to examine the above referenced statutes and regulations may contact Ms. Terri Tripp, Deputy Secretary for Hospital Administration, at the Commonwealth Health Center (phone: 234-8950). Ms. Tripp is one of the individuals designated to coordinate the efforts of the Department of Public Health in complying with the regulations implementing § 504 of the Rehabilitation Act of 1973 and title II of the Americans with Disabilities Act of 1990.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 20 Com. Reg. 16305 (Dec. 15, 1998); Amdts Adopted 18 Com. Reg. 14468 (Nov. 15, 1996); Adopted 17 Com. Reg. 13554 (July 15, 1995).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) and (b). The 1996 and 1998 amendments republished the grievance procedure in its entirety. The 1996 and 1998 amendments amended subsection (b). The Commission corrected the citation to title II of the Americans with Disabilities Act pursuant to 1 CMC § 3806(g).

 

Part 100 -       Grievance Procedure

 

§ 140-10.1-101            Grievance Procedure

 

(a)        Any person who believes he or she has been subjected to discrimination on the basis of disability (the “complainant”), in contradiction of the policies stated above, may file a grievance under the procedure in this part. It is against the law for the Department of Public Health to retaliate against anyone who files a grievance or cooperates in the investigation of a grievance.

 

(b)        The complainant must submit his or her grievance to Ms. Terri Tripp* (the “compliance coordinator”), within 30 days from the date the complainant becomes aware of the alleged discriminatory action.

 

(c)        The grievance must be in writing, contain the name and address of the complainant, provide a complete description of the problem or action alleged to be discriminatory, including any documents to support the claim, and state the remedy or relief sought by the complainant. The complainant should also state in the grievance whether he or she would like to present evidence at a hearing.

 

(d)       If the complainant has requested a hearing, the compliance coordinator shall schedule a hearing within ten days from the date the grievance is submitted by the complainant. The compliance coordinator and two other Department of Public Health administrators shall preside at the hearing. The complainant may then present evidence through oral testimony, witnesses, and exhibits. The complainant shall have the right to be represented by a person of his or her choice at the hearing.

 

(e)        The compliance coordinator, or his or her designee, shall conduct an investigation of the grievance to determine its validity. This investigation may be informal, but it must be thorough, affording all interested persons an opportunity to submit evidence relevant to the grievance. The compliance coordinator shall maintain the files and records of the Department of Public Health relating to such grievances.

 

(f)        The compliance coordinator shall issue a written decision on the grievance no later than thirty days from the date the written grievance is submitted, or if a hearing is requested, thirty days from the date the hearing is held.

 

(g)        The complainant may appeal the decision of the compliance coordinator by filing an appeal with the Deputy Attorney General for Administration, Office of the Attorney General, Administration Building, Second Floor, Capitol Hill, within 15 days of receiving the compliance coordinator’s decision. The person hearing the appeal shall be impartial as demonstrated by the absence of prior involvement in substantive aspects of the filed grievance.

 

(h)        The Deputy Attorney General for Administration shall issue a written decision in response to the appeal no later than thirty days from receipt of the appeal.

 

(i)         The availability and use of this grievance procedure does not preclude a person from filing a complaint of discrimination on the basis of disability or any action prohibited by the regulations implementing § 504 of the Rehabilitation Act of 1973 and title II of the Americans with Disabilities Act of 1990 with the U.S. Department of Health and Human Services, Office for Civil Rights, 50 United Nations Plaza, Room 322, San Francisco, California, 94102; telephone number (415) 556-8586 - Voice and TDD; FAX (415) 556-5165.

 

(j)         The compliance coordinator shall be responsible for ensuring that arrangements are made to enable disabled persons to participate in or make use of this grievance process on the same basis as non-disabled individuals. Such arrangements may include, but are not limited to, the provision of interpreters for the deaf, providing taped cassettes of material for the blind, and assuring a barrier-free location for the proceedings.

 

* So in original.

 

Modified, 1 CMC § 3806(d), (e), (f).

 

History: Amdts Adopted 20 Com. Reg. 16305 (Dec. 15, 1998); Amdts Adopted 18 Com. Reg. 14468 (Nov. 15, 1996); Adopted 17 Com. Reg. 13554 (July 15, 1995).

 

Commission Comment: The 1996 and 1998 grievance procedure amendments amended subsection (b).

 


 

 

SUBCHAPTER 140-10.2

ALIEN EMPLOYEE SCREENING REQUIREMENTS RULES AND REGULATIONS

 


Part 001          General Provisions

§ 140-10.2-001            Purpose and Findings

§ 140-10.2-005            Definitions

 

Part 100          Physical Examination

§ 140-10.2-101            Period for Obtaining Physical Examination

§ 140-10.2-105            Filing of Physical Examination Forms

§ 140-10.2-110            Cost of Physical Examination

 

Part 200          Screening for Communicable Disease

§ 140-10.2-201            Introduction

§ 140-10.2-205            Procedures for Screening

§ 140-10.2-210            Filing of Screening Test Results with the Division

§ 140-10.2-215            Cost of Screening Tests

§ 140-10.2-220            Required Screening Tests for Communicable Diseases

 

Part 300          Issuance of Health Certificates

§ 140-10.2-301            Alien Employee Health Certificates

§ 140-10.2-305            Suspension of Issuance of Health Certificate for Alien Employees Found to Have a Communicable Disease

§ 140-10.2-310            Cost of Health Certificates

§ 140-10.2-315            Employer to Maintain Files

 

Part 400          Division Record Keeping and Tracking Measures

§ 140-10.2-401            Public Health Notification Form

§ 140-10.2-405            Database Records

§ 140-10.2-410            Notice of Noncompliance

§ 140-10.2-415            Inspections by Duly Authorized Representatives

 

Part 500          Alien Employees with Positive Test Results

§ 140-10.2-501            Handling of Alien Employees with Positive Test Results

§ 140-10.2-505            Procedure When Infection Is Suspected

 

Part 600          Screening Required for Dependents

§ 140-10.2-601            Physical Examinations and Screening Tests Required for Dependents

§ 140-10.2-605            Exceptions for Dependents Age Twelve or Younger

§ 140-10.2-610            Filing of Dependents’ Physical Examination Forms and Screening Test Results

§ 140-10.2-615            Issuance of Health Certificates to Dependents

§ 140-10.2-620            Cost of Dependents’ Physical Examinations, Screening Tests, and Health Certificate

§ 140-10.2-625            Notice of Noncompliance

§ 140-10.2-630            Positive Test Results

 

Part 700          Miscellaneous Provisions

§ 140-10.2-701            Application of These Rules and Regulations to Alien Employees and Their Dependents Currently Residing in the CNMI

§ 140-10.2-705            Penalties for Violations of These Rules and Regulations

§ 140-10.2-710            Severability


 

Subchapter Authority: 1 CMC §§ 2603 and 2605.

 

Subchapter History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 21* Com. Reg. 16559 (Feb. 18, 1999); Amdts Proposed 20 Com. Reg. 16395 (Dec. 15, 1998); Amdts Adopted 20 Com. Reg. 15955 (June 15, 1998); Amdts Emergency and Proposed 20 Com. Reg. 15842 (Feb. 15, 1998) (effective for 120 days from Feb. 13, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 15, 1996).

 

*Commonwealth Register volume 21, number 2, pages 16459-16571 are mislabeled as volume 20.

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2603(a) and (b) authorizes the Department to maintain and improve health conditions and minimize and control communicable disease in the CNMI. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles and effected numerous other revisions. According to Executive Order 94-3 §§ 105 and 305:

 

Section 105. Department of Public Health. The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

Section 305. Department of Public Health.

(a)           Board of Public Health and Environmental Quality. The Board of Public Health and Environmental Quality is abolished and its functions transferred to the Secretary of Public Health.

(b)           Federally-Mandated Councils. The State Planning Council on Development Disabilities and the State Rehabilitation Advisory Council are allocated to the Department of Public Health for the purposes of administration and coordination.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Section 702 of the Consolidated Natural Resources Act of 2008 (Pub. L. No. 110-229, codified at 48 U.S.C. § 1806) removed the CNMI’s authority to create and manage its own immigration laws. On March 22, 2010, the Governor signed PL 17-1, removing all references to immigration and deportation functions from the Commonwealth Code. To the extent these regulations conflict with Pub. L. No. 110-229 or PL 17-1, they are superseded.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

§ 140-10.2-001            Purpose and Findings

 

(a)        The purpose of the rules and regulations in this subchapter is to establish procedures and protocols for the issuance of health certificates to all alien employees. Upon adoption of these rules and regulations, all alien employees, and their family members entering the CNMI, will be required to obtain a general physical examination and health screenings for specified communicable diseases before a health certificate is issued to them. These new requirements are intended not only to maintain the health of all alien employees who enter and reside in the CNMI to provide employee services to employers pursuant to the provisions of the Nonresident Worker Act, 3 CMC §§ 4411, et seq., but also to ensure the health of CNMI residents by preventing the spread of certain infectious and communicable diseases. It is the intent of the Division of Public Health to provide minimum requirements for the protection of life, health, safety, and welfare of CNMI residents by instituting these rules and regulations.

 

(b)        The Division of Public Health has determined that many alien employees and their families are coming from countries that have endemic communicable diseases that could ultimately become a public health concern for the residents of the CNMI. Furthermore, the Division of Public Health has found that diseases transmitted by alien employees frequently originate from an infected employee who shows little outward appearance of being ill. As a result, a wide range of communicable diseases and infections may be unknowingly transmitted by infected personnel to other employees and the general public. The Division of Public Health has thus concluded that an effective means of controlling the spread of specific communicable diseases is to screen the alien employees and their families for these diseases upon their entry into the CNMI, and every year subsequent.

 

(c)        The health screening of the alien employees will not only be beneficial to these workers and the residents of the CNMI, but will also be advantageous to employers. By overseeing compliance with the health screenings of alien employees required by the rules and regulations in this subchapter, the employer can minimize the high costs of medical treatment here in the CNMI, and avoid the added cost of deportation in the event the alien employee is later found to have a communicable disease. Also relevant to employers is that alien employees afflicted with communicable diseases are less productive. By ensuring that alien employees obtain the required health screenings, employers can assure the relative health of the alien employees they employ.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) through (c).

 

The 2001 amendments readopted and republished the Alien Employee Screening Requirements Rules and Regulations in their entirety. The Commission, therefore, cites the 2001 amendments in the history sections throughout this subchapter.

 

§ 140-10.2-005            Definitions

 

As used throughout the rules and regulations in this subchapter, the following terms shall have the meanings set forth below:

 

(a)        “Adequate” means the Secretary’s determination that a recommended action will sufficiently fulfill the requirements for a proposed objective.

 

(b)        “Alien employee” means any foreign national, other than those citizens from United States Compact of Free Association Nations, who has entered the CNMI for the purpose of providing services or labor in exchange for remuneration by an employer.

 

(c)        “Communicable disease” means a disease caused by an infectious agent or the toxic product of an infectious agent and which can be transmitted directly or indirectly from one individual to another.

 

(d)       “Department” means the Department of Public Health, a department within the executive branch of the CNMI government.

 

(e)        “Dependent” means the alien employee’s spouse, children under the age of 21, or parents who are not United States citizens.

 

(f)        “Deportation” means the return of an alien to his or her country of origin as provided by the Commonwealth Entry and Deportation Act of 1983, specifically 3 CMC § 4341.

 

(g)        “Division” means the Division of Public Health, a division within the Department of Public Health.

 

(h)        “Duly authorized representative” means the Deputy Secretary of Public Health Administration, the Medical Director of Public Health, the Sanitation Services Officer, or Sanitarian, as appointed by the Secretary.

 

(i)         “Employer” means any individual, partnership, association, corporation, or other legal entity which hires, employs, or otherwise engages for compensation any individual to perform services or labor within the Commonwealth, including any branch, agency, or instrumentality of the Commonwealth, but does not include the United States government.

 

(j)         “Health certificate” means an authorization issued by the Secretary to an alien employee certifying that the alien employee has been examined and found to be in good health, and free of specified communicable diseases.

 

(k)        “HIV” means the human immunodeficiency virus which infects humans principally through sexual intercourse, the exchange of bodily fluids, including blood and blood products, or the sharing of needles among intravenous drug users, and which may eventually lead to the development of acquired immuno-deficiency syndrome (AIDS).

 

(l)         “Person-in-charge” means the individual present in a place of employment who is the apparent supervisor of the business establishment and the supervisor of the alien employees at the time of inspection, or in the event no designated supervisor is present, then any employee working at the place of employment.

 

(m)       “Physical examination” means a medical examination performed by a physician.

 

(n)        “Physically fit and in good health” means a condition of sufficient physical and mental health to enable the individual to perform the work he or she is being hired to do without compromising his or her health.

 

(o)        “Physician” means a CNMI licensed physician.

 

(p)        “Secretary” means the Secretary of the Department of Public Health, or a duly authorized representative.

 

(q)        Syphilis means a sexually transmitted disease caused by the organism Treponema pallidum, and screened by means of a rapid plasma reagin (RPR) test.

 

(r)        Tuberculosis means a potentially communicable disease caused by the organism Mycobacterium tuberculosis, which may be diagnosed based on clinical, laboratory, radiological, and tuberculin skin testing. Active tuberculosis is considered communicable and highly contagious.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 20 Com. Reg. 15955 (June 15, 1998); Amdts Emergency and Proposed 20 Com. Reg. 15842 (Feb. 15, 1998) (effective for 120 days from Feb. 13, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: The 1998 amendments deleted former subsections (a) and (m), re-designated the remaining subsections accordingly and amended subsection (r). The 2001 amendments added a new subsection (n).

 

The Commission inserted quotation marks around terms defined.

 

Part 100 -       Physical Examination

 

§ 140-10.2-101            Period for Obtaining Physical Examination

 

Within ten days after authorized entry into the CNMI for employment, an alien employee shall schedule an appointment for a physical examination as required by the Nonresident Worker Act, 3 CMC § 4438(b) to establish that he or she is physically fit and in good health. A record of the physical examination shall be completed by the physician on a physical examination form approved by the Division. Yearly physical examinations for alien employees shall be performed at least forty-five days prior to the annual renewal of the employment contract, or forty-five days prior to the anniversary of the entry date into the CNMI, whichever date is first.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-105            Filing of Physical Examination Forms

 

The physician performing the alien employee’s physical examination shall provide the Division with a copy of the completed physical examination form for the alien employee in a sealed envelope marked “confidential” within forty-five days from the date of the alien employee’s initial physical examination, and forty-five days from the date of each annual physical examination thereafter.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 21 Com. Reg. 16559 (Feb. 18, 1999); Amdts Proposed 20 Com. Reg. 16395 (Dec. 15, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-110            Cost of Physical Examination

 

The cost of the alien employee’s physical examination shall be the financial responsibility of the alien employee’s employer.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Part 200 -       Screening for Communicable Disease

 

§ 140-10.2-201            Introduction

 

All alien employees entering the CNMI shall be screened for specified communicable diseases which can not only jeopardize the health and life of the alien employees, but also threaten the resident CNMI population and tourists visiting the CNMI. Screenings shall be limited to those communicable diseases which can be easily tested and monitored, including tuberculosis, HIV, syphilis, and any other communicable disease specified by the Secretary through health advisories as being a potential risk to the CNMI community.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: This section was originally the introduction to part IV, codified at part 200. The Commission created the section title.

 

§ 140-10.2-205            Procedures for Screening

 

Concurrent with the performance of the physical examination, the alien employee shall obtain health screening tests for the communicable diseases specified in the rules and regulations in this subchapter, and any others required by the Secretary through health advisories. All chest radiographs required by these rules and regulations shall be read by a physician, or may be sent to the center for tuberculosis and lung disease at the Commonwealth Health Center for reading.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-210            Filing of Screening Test Results with the Division

 

The alien employee’s physician shall provide the Division with a copy of all screening test results required by this part 200 and by the Secretary’s health advisories within forty-five days from the date of the alien employee’s initial physical examination, and forty-five days from the date of each annual physical examination thereafter. The screening test results shall be included in the sealed envelope marked “confidential” containing the physical examination form.

 

Modified, 1 CMC § 3806(c), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 21 Com. Reg. 16559 (Feb. 18, 1999); Amdts Proposed 20 Com. Reg. 16395 (Dec. 15, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-215            Cost of Screening Tests

 

The cost of the alien employee’s screening tests for the communicable diseases set forth in the rules and regulations in this subchapter, and any other tests required by the Secretary through health advisories shall be the financial responsibility of the alien employee’s employer.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-220            Required Screening Tests for Communicable Diseases

 

At a minimum, all alien employees shall obtain screening tests for the following communicable diseases:

 

(a)        Tuberculosis Screening. Every alien employee shall obtain a single view PA chest radiograph upon entry into the CNMI, and then annually thereafter. The yearly test shall be performed at least forty-five days prior to the annual renewal of the employment contract, or forty-five days prior to the anniversary of the entry date into the CNMI, whichever date is first.

 

(b)        HIV Screening. Every alien employee shall obtain an HIV antibody test first upon entry into the CNMI, and then annually thereafter. The yearly test shall be performed at least forty-five days prior to the annual renewal of the employment contract, or forty-five days prior to the anniversary of the entry date into the CNMI, whichever date is first.

 

(c)        Syphilis Screening. Every alien employee shall obtain a rapid plasma reagin (RPR) test first upon entry into the CNMI, and then annually thereafter. The yearly test shall be performed at least forty-five days prior to the annual renewal of the employment contract, or forty-five days prior to the anniversary of the entry date into the CNMI, whichever date is first.

 

(d)       Other Communicable Diseases. All alien employees who contract other infectious or communicable diseases should be seen promptly by a physician. Any physician who diagnoses an alien employee as having a communicable disease shall immediately report the alien employee to the Division.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 20 Com. Reg. 15955 (June 15, 1998); Amdts Emergency and Proposed 20 Com. Reg. 15842 (Feb. 15, 1998) (effective for 120 days from Feb. 13, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: The 1998 amendments amended subsection (a).

 

Part 300 -       Issuance of Health Certificates

 

§ 140-10.2-301            Alien Employee Health Certificates

 

Within ten working days of receiving the alien employee’s physical examination form, the Division shall determine whether the alien employee qualifies to receive a health certificate. If the alien employee has been found to be physically fit and in good health, and free from communicable diseases covered by the rules and regulations in this subchapter, the Secretary shall issue the alien employee a health certificate. The health certificate shall be valid for a period of one year from the date of issue.

 

Modified, 1 CMC § 3806(d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-305            Suspension of Issuance of Health Certificate for Alien Employees Found to Have a Communicable Disease

 

Alien employees who test positive for a communicable disease covered by the rules and regulations in this subchapter shall be issued a health certificate subject to the recommendations of the Division.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-310            Cost of Health Certificates

 

The cost of an alien employee health certificate shall be twenty dollars, payable to the Department upon issuance of the health certificate. The employer of the alien employee shall be responsible for the cost of the health certificate.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-315            Employer to Maintain Files

 

The employer shall maintain the health certificates of all its alien employees in their respective employment files at all times. The employer shall be prepared to show these health certificates to a duly authorized representative, upon request during an inspection.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Part 400 -       Division Record Keeping and Tracking Measures

 

§ 140-10.2-401            Public Health Notification Form

 

A “public health notification form” shall be completed in triplicate by every alien employee and every dependent entering the CNMI. The original public health notification form shall be given to the alien employee. One copy of the public health notification form shall be provided to the Division of Labor, Department of Labor and Immigration, and the second copy shall be provided to the Division.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-405            Database Records

 

The information contained on the public health notification form shall be used by the Division to develop an alien employee health database. The database shall be used to track all alien employees and dependents for compliance with the health screening requirements established in the rules and regulations in this subchapter. All public health notification forms shall be submitted to the Division within ten days of entry.

 

Modified, 1 CMC § 3806(d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-410            Notice of Noncompliance

 

If a review of the Division’s database indicates that an alien employee has not been issued a health certificate within ninety days from the alien employee’s date of entry into the CNMI, Division staff shall send written notice to the alien employee of noncompliance with the rules and regulations in this subchapter. The alien employee shall have twenty days from the date of the notice to come into compliance with the requirements of these rules and regulations. Failure to respond to the Division’s notice shall subject the alien employee to penalties as set forth in § 140-10.2-705 of this subchapter. This section shall not apply to those alien employees who have not been issued health certificates because they are undergoing treatment for a communicable disease, and who remain fully compliant with the Division’s prescribed treatment regimen for the duration of treatment. An alien employee undergoing treatment shall be issued a letter by the Division setting forth the date treatment is anticipated to be completed and when a health certificate can be issued.

 

Modified, 1 CMC § 3806(c), (d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 21 Com. Reg. 16559 (Feb. 18, 1999); Amdts Proposed 20 Com. Reg. 16395 (Dec. 15, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-415            Inspections by Duly Authorized Representatives

 

From time to time an employer’s place of employment may be inspected by a duly authorized representative of the Department. Upon request by the duly authorized representative, the employer or person-in-charge shall grant the duly authorized representative access to the alien employees’ employment files for purposes of inspecting the health certificates. Any alien employee who does not have a valid health certificate in his or her employment file shall be reported to the Division.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Part 500 -       Alien Employees with Positive Test Results

 

§ 140-10.2-501            Handling of Alien Employees with Positive Test Results

 

(a)        If an alien employee is found to have a communicable disease covered by the rules and regulations in this subchapter, the Division shall establish a treatment regimen for the alien employee to the extent treatment is available within the CNMI. If the alien employee fails to comply with the Division’s treatment regimen, the Department shall prepare a written advisory to the Department of Labor and Immigration recommending that such alien employee be immediately deported back to his or her country of origin. The costs associated with the alien employee’s deportation shall be the financial responsibility of the employer.

 

(b)        Positive test results for tuberculosis, HIV, and syphilis shall be handled by the Division as follows:

(1)        Tuberculosis. Alien employees found to have tuberculosis shall be required to comply with the Center for Tuberculosis and Lung Disease protocol for treating tuberculosis for the duration of their stay in the CNMI. Any alien employee diagnosed with tuberculosis who does not comply with prescribed treatment and therapy for tuberculosis, or who fails to comply with recommendations made by the Division may be referred by the Division to the Department of Labor and Immigration for deportation.

(2)        HIV. Alien employees who test positive for HIV shall comply with the Division’s protocol for HIV patients.

(3)        Syphilis. Alien employees who test positive for syphilis shall be required to report to the Division for treatment. Any alien employee diagnosed with syphilis who does not comply with prescribed treatment and therapy for syphilis may be referred by the Division to the Department of Labor and Immigration for Deportation.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 20 Com. Reg. 15955 (June 15, 1998); Amdts Emergency and Proposed 20 Com. Reg. 15842 (Feb. 15, 1998) (effective for 120 days from Feb. 13, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) and (b). The 1998 amendments amended subsection (b)(1).

 

With respect to the references to the Department of Labor and Immigration, see Executive Order 03-01 (effective May 9, 2003), the “Department of Labor and Immigration Reorganization Plan of 2003,” returning the immigration functions of the executive branch to the Office of the Attorney General and renaming the Department of Labor. See also NMIAC chapter 80-10.1.

 

§ 140-10.2-505            Procedure When Infection Is Suspected

 

When the Secretary has probable cause to suspect disease transmission by an alien employee, the Secretary may require a medical history, physical examination, and any necessary screening tests required to confirm that the suspected alien employee has a communicable disease. If the alien employee is confirmed to have a communicable disease, the Secretary may require any or all of the following measures:

 

(a)        Restriction of the alien employee’s services to an area of the establishment where there would be no danger of him or her transmitting the disease;

 

(b)        Adequate physical examinations and health screenings of other employees working in the same establishment as the alien employee pursuant to the Rules and Regulations Governing Communicable Diseases [NMIAC, title 140, subchapter 10.3];

 

(c)        The immediate exclusion of the alien employee from employment pursuant to the Rules and Regulations Governing Communicable Diseases [NMIAC, title 140, subchapter 10.3];

 

(d)       The immediate closing of the place of employment concerned until, in the opinion of the Secretary, no further danger of disease outbreak exists pursuant to the Rules and Regulations Governing Communicable Diseases [NMIAC, title 140, subchapter 10.3];

 

(e)        Confinement of the alien employee in the Commonwealth Health Center or his or her home pursuant to the Rules and Regulations Governing Communicable Diseases [NMIAC, title 140, subchapter 10.3];

 

(f)        Referral of the alien employee to the Department of Labor and Immigration for immediate deportation back to his or her country of origin.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: With respect to the reference to the Department of Labor and Immigration, see Executive Order 03-01 (effective May 9, 2003), the “Department of Labor and Immigration Reorganization Plan of 2003,” returning the immigration functions of the executive branch to the Office of the Attorney General and renaming the Department of Labor. See also NMIAC chapter 80-10.1.

 

Part 600 -       Screening Required for Dependents

 

§ 140-10.2-601            Physical Examinations and Screening Tests Required for Dependents

 

Within ten days after the dependents’ authorized entry into the CNMI, the accountable alien employee shall schedule appointments for physical examinations for the dependents as required by the Nonresident Worker Act, 3 CMC § 4438(b) and part 100 of this subchapter, and screening tests for communicable diseases as set forth in part 200 of this subchapter.

 

Modified, 1 CMC § 3806(c), (d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-605            Exceptions for Dependents Age Twelve or Younger

 

Notwithstanding § 140-10.2-601, dependents age twelve or younger shall only be required to obtain:

 

(a)        A physical examination;

 

(b)        A Mantoux tuberculin skin test using derivative (PPD), which if found positive (greater than or equal to 10 millimeters induration) when read within seventy-two hours after the test is performed, then tuberculosis screening as set forth in § 140-10.2-220(a) of this subchapter will be required; and

 

(c)        Those childhood vaccinations required by Department advisories for which the dependent does not have adequate documentation demonstrating that such vaccination was provided in his or her country of origin. The alien employee shall be responsible for submitting all vaccination documentation for his or her dependents age fifteen or younger to the Division for inspection.

 

Modified, 1 CMC § 3806(c), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: The 2001 amendments amended the opening sentence and subsection (b).

 

§ 140-10.2-610            Filing of Dependents’ Physical Examination Forms and Screening Test Results

 

The physician performing the physical examination shall provide the Division with copies of the completed physical examination forms and all screening test results for each of the alien employee’s dependents in the CNMI in a sealed envelope marked “confidential” within forty-five days from the date of the dependents’ initial physical examination, and then for physical examinations yearly thereafter.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-615            Issuance of Health Certificates to Dependents

 

Health certificates shall be issued by the Secretary to dependents as provided in §§ 140-10.2-301 and 140-10.2-305 of this subchapter. It shall be the responsibility of the alien employee to maintain the health certificates for his or her dependents.

 

Modified, 1 CMC § 3806(c), (d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-620            Cost of Dependents’ Physical Examinations, Screening Tests, and Health Certificate

 

The cost of the physical examinations, screening tests, and health certificates for dependents shall be the responsibility of either the alien employee or the employer, as agreed to between them.

 

Modified, 1 CMC § 3806(f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-625            Notice of Noncompliance

 

If a review of the Division’s database indicates that a dependent of an alien employee has not been issued a health certificate within ninety days from the dependent’s date of entry into the CNMI, Division staff shall send written notice to the dependent and alien employee of noncompliance with the rules and regulations in this subchapter. The Dependent shall have twenty days from the date of the notice to come into compliance with the requirements of these rules and regulations. Failure to respond to the Division’s notice shall subject the dependent and the alien employee to penalties as set forth in § 140-10.2-705 of this subchapter. This section shall not apply to those dependents who have not been issued health certificates because they are undergoing treatment for a communicable disease, and who remain fully compliant with the Division’s prescribed treatment regimen for the duration of treatment. A dependent undergoing treatment shall be issued a letter by the Division setting forth the date treatment is anticipated to be completed and when a health certificate can be issued.

 

Modified, 1 CMC § 3806(c), (d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-630            Positive Test Results

 

Dependents with positive test results who fail to comply with the treatment recommendations of the Division or the Center for Tuberculosis and Lung Disease shall be subject to deportation as provided in § 140-10.2-501 of this subchapter. However, the costs associated with the dependent’s deportation shall be the financial responsibility of the alien employee.

 

Modified, 1 CMC § 3806(c), (d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Part 700 -       Miscellaneous Provisions

 

§ 140-10.2-701            Application of These Rules and Regulations to Alien Employees and Their Dependents Currently Residing in the CNMI

 

Upon the effective date of the rules and regulations in this subchapter, all alien employees and their dependents currently residing in the CNMI shall have ninety days to obtain a health certificate in order to be in compliance with the requirements of these rules and regulations. Those alien employees and their dependents who have already had a physical examination or screening tests required by these rules and regulations in the CNMI for the year shall not be required to obtain new ones, but the alien employee shall be required to bring the results of the physical examination and/or screening test results to the Division for entry into the database and for issuance of the health certificate.

 

Modified, 1 CMC § 3806(d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 21 Com. Reg. 16559 (Feb. 18, 1999); Amdts Proposed 20 Com. Reg. 16395 (Dec. 15, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

§ 140-10.2-705            Penalties for Violations of These Rules and Regulations

 

(a)        Penalties for Alien Employees. Alien employees who are found to be in violation of the rules and regulations in this subchapter shall be reported to the Division of Immigration, Department of Labor and Immigration and recommended for deportation back to their country of origin. The costs associated with deportation shall be the financial responsibility of the employer.

 

(b)        Penalties for Dependents. Dependents age eighteen or older who are found to be in violation of the rules and regulations in this subchapter shall be reported to the Division of Immigration, Department of Labor and Immigration and recommended for deportation back to their country of origin. Dependents under age eighteen who are found to be in violation of these rules and regulations shall be reported to the Division of Immigration, Department of Labor and Immigration and recommended for deportation back to their country of origin along with an adult dependent, or if there is no adult dependent legally responsible for the minor in the CNMI, then with the alien employee. The costs associated with deportation shall be the financial responsibility of the dependent or the alien employee.

 

(c)        Penalties for Other Violations. Any person found by the Department to have obtained a health certificate by fraudulent means; forged or altered information on a physical examination form or screening test; refused or failed to comply with any order issued by the Secretary or duly authorized representative pursuant to these rules and regulations, or violated these rules and regulations in any other manner, shall be liable for a civil penalty of up to $1,000.00 for each violation of the rules and regulations.

 

Modified, 1 CMC § 3806(d), (e), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Amdts Adopted 21 Com. Reg. 16559 (Feb. 18, 1999); Amdts Proposed 20 Com. Reg. 16395 (Dec. 15, 1998); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).

 

Commission Comment: The 1999 amendments deleted former subsection (b) and re-designated the remaining subsections accordingly.

 

With respect to the references to the Department of Labor and Immigration and the Division of Immigration, see Executive Order 03-01 (effective May 9, 2003), the “Department of Labor and Immigration Reorganization Plan of 2003,” returning the immigration functions of the executive branch to the Office of the Attorney General and renaming the Department of Labor. See also NMIAC chapter 80-10.1.

 

§ 140-10.2-710            Severability

 

If any provision of the rules and regulations in this subchapter or the application of any such provision to any person or circumstance should be held invalid by a court of competent jurisdiction, the remainder of these rules and regulations or the application of its provisions to persons or circumstances other than those to which it is held invalid shall not be affected hereby.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Amdts Adopted 23 Com. Reg. 17706 (Feb. 23, 2001); Amdts Proposed 22 Com. Reg. 17591 (Dec. 20, 2000); Adopted 19 Com. Reg. 15167 (Feb. 15, 1997); Proposed 18 Com. Reg. 14183 (July 17, 1996).


 

SUBCHAPTER 140-10.3

COMMUNICABLE DISEASES RULES AND REGULATIONS

 


Part 001          General Provisions

§ 140-10.3-001            Definitions

 

Part 100          Duty to Report

§ 140-10.3-101            Duty to Report

§ 140-10.3-105            Dispensaries, Hospitals, Private Clinics, Etc.

§ 140-10.3-110            Laboratories

§ 140-10.3-115            Keeper of Boarding or Lodging Houses, Government Departments and Other Working Institutions

§ 140-10.3-120            Master of Vessel Captain of Aircraft

 

Part 200          Investigation

§ 140-10.3-201            Investigation

§ 140-10.3-205            Access to Records, Reports, Etc.

 

Part 300          Isolation and Quarantine; Other Requirements

§ 140-10.3-301            Isolation and Quarantine; Regulations

§ 140-10.3-305            Same; Authority of Director

§ 140-10.3-310            Placarding

§ 140-10.3-315            Violation of Isolation or Quarantine

§ 140-10.3-320            Director of Public Safety

§ 140-10.3-325            Disinfection of Premises

§ 140-10.3-330            Destruction of Property

§ 140-10.3-335            Compensation

§ 140-10.3-340            Closing of Schools

§ 140-10.3-345            Disposal of Bodies

§ 140-10.3-350            Responsibility of Person in Charge of Minor

§ 140-10.3-355            Willful Exposure

§ 140-10.3-360            Concealing Disease

§ 140-10.3-365            Vaccination and Immunization

§ 140-10.3-370            Prenatal Test

§ 140-10.3-375            Report as to Prenatal Test

§ 140-10.3-380            Prevention of Blindness at Childbirth

§ 140-10.3-385            Immunization Audit

§ 140-10.3-390            Same; Confidentiality

§ 140-10.3-395            Autopsy

 

Part 400          Penalties; Miscellaneous Provisions

§ 140-10.3-401            Penalty


 

Subchapter Authority: 1 CMC § 2605; 3 CMC § 2148.

 

Subchapter History: Amdts Adopted 25 Com. Reg. 21447 (Oct. 15, 2003); Amdts Emergency and Proposed 25 Com. Reg. 20248 (July 15, 2003) (effective for 120 days from June 25, 2003); Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2603(b) grants the Department the power and duty to minimize and control communicable disease. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction, including quarantine of communicable disease and inspection. 1 CMC § 2605(n).

 

3 CMC § 2148 provides that persons suffering from contagious diseases, and persons exposed to such diseases, may be isolated and quarantined in accordance with regulations issued pursuant to Commonwealth Code, title 3, division 2.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles and effected numerous other revisions. According to Executive Order 94-3 § 105:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

§ 140-10.3-001            Definitions

 

As used in this subchapter:

(a)        “Communicable disease” includes any of the following diseases or conditions which are dangerous to public health:

(1)        Acquired immune deficiency syndrome (AIDS);

(2)        Amebiasis (amoebic dysentery);

(3)        Anthrax;

(4)        Brucellosia (undulant fever);

(5)        Chancroid;

(6)        Chickenpox;

(7)        Cholera;

(8)        Cholonorchiasis (liver-fluke);

(9)        Conjunctivitis, acute infectious (pink eye);

(10)      Dengue;

(11)      Diarrhea of newborn (epidemic infantile);

(12)      Diphtheria;

(13)      Encephalitis, primary (infectious);

(14)      Erysipelas;

(15)      Favus;

(16)      Filariasis;

(17)      Fish (ciguatera) poisoning;

(18)      Food poisoning (bacterial);

(19)      Glanders (farcy);

(20)      Gonorrhea;

(21)      Gonorrheal ophthalmia;

(22)      Granuloma inguinale;

(23)      Hemophilus influenza B.;

(24)      Hepatitis A (infectious);

(25)      HIV-seropositive condition;

(26)      Hepatitis B (serum);

(27)      Hepatitis C (serum);

(28)      Hookworm disease;

(29)      Impetigo contagious (in institution);

(30)      Influenza;

(31)      Japanese encephalitis;

(32)      Kerato-conjunctivitis (infectious);

(33)      Leprosy (Hansen’s disease);

(34)      Leptospirosis (Wells disease or hemorrhagic jaundice);

(35)      Malaria;

(36)      Measles (rubella);

(37)      Melioidosis;

(38)      Meningitis, aseptic;

(39)      Meningitis, cerebrospinal (meningococcic);

(40)      Meningitis, other infectious;

(41)      Mononucleosis, infectious;

(42)      Mumps;

(43)      Paratyphoid fever;

(44)      Pertussis (whooping cough);

(45)      Plague;

(46)      Poliomyelitis, acute anterior (infantile paralysis);

(47)      Psittacosis-ornithosis;

(48)      Puerperal septicemia;

(49)      Rabies;

(50)      Relapsing fever;

(51)      Rheumatic fever (active);

(52)      Rickettsial disease;

(53)      Ringworm of the scalp (tinea capitis);

(54)      Rubella (German measles);

(55)      Salmonellosis;

(56)      Scabies;

(57)      Scarlet fever;

(58)      Septic sore throat (streptococcus);

(59)      Shigellosis (bacillary dysentery);

(60)      Smallpox;

(61)      Syphilis;

(62)      Tetanus;

(63)      Trachoma;

(64)      Trichinosis;

(65)      Tuberculosis (pulmonary);

(66)      Tuberculosis (other than pulmonary);

(67)      Tularemia;

(68)      Typhoid fever;

(69)      Typhus fever;

(70)      Yaws;

(71)      Yellow fever;

(72)      SARS (severe acute respiratory syndrome);

(73)      Any other disease deemed by the Secretary to be dangerous to the public health.

 

(b)        “Isolation” means the separation of persons suffering from a communicable disease or carriers of such a disease from other persons for the period of communicability in such places and under such conditions as will prevent the transmission of the causative agent; and

 

(c)        “Quarantine” means the limitation of freedom of movement of those who have been exposed to a communicable disease, whether a person or animal, for a period of time equal to the longest usual incubation period of the disease, in such manner as to prevent effective contacts with those not so exposed.

 

Modified, 1 CMC § 3806(d), (f), (g).

 

History: Amdts Adopted 25 Com. Reg. 21447 (Oct. 15, 2003); Amdts Emergency and Proposed 25 Com. Reg. 20248 (July 15, 2003) (effective for 120 days from June 25, 2003); Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The 2003 amendments added a new subsection (a)(72) and re-designated and amended (a)(73). In subsection (a)(3), the Commission corrected the spelling of “anthrax.” In subsections (a)(1) and (a)(19), the Commission inserted the final semi-colons. In subsections (a)(25) and (a)(58), the Commission changed the final periods to semi-colons. In subsection (a)(73), the Commission changed the final semi-colon to a period in order to ensure consistent punctuation in this section.

 

Part 100 -       Duty to Report

 

§ 140-10.3-101            Duty to Report

 

Any person licensed or registered to practice any healing art under § 7 of PL 3-30 who has knowledge of or suspects the presence of any communicable disease or any other disease dangerous to the public health, shall report the same to the Director within forty-eight hours after diagnosis, unless a different time is prescribed by regulation, together with the name, age and sex of the person afflicted, the house or other place in which such person may be found, and such other information as may be required by regulation.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-105            Dispensaries, Hospitals, Private Clinics, Etc.

 

The superintendent, chief medical officer, nurse in charge or other person in charge of any hospital, clinic, dispensary, infirmary, medical aid station or other establishment providing medical care, either to the general public or otherwise, who has knowledge or suspected knowledge of the presence of any communicable disease or any other disease dangerous to the public health shall report the same to the Director in accordance with § 140-10.3-101. When the patient is hospitalized, the person in charge of the hospital in which he is hospitalized shall make the report.

 

Modified, 1 CMC § 3806(c).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-110            Laboratories

 

The Director, administrator, chief officer or other person in charge of any laboratory, public or private, performing any tests or examinations upon persons or their blood, urine, feces, or any other body products shall, upon identification or suspected identification of an etiologic agent, antigen, antibody, or any other substance or combination of substances generally accepted as being diagnostic of the presence of a communicable disease, report same to the Director in accordance with § 140-10.3-101.

 

Modified, 1 CMC § 3806(c), (g).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission deleted the repeated word “shall.” The Commission inserted commas after the words “feces” and “antibody” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-115            Keeper of Boarding or Lodging Houses, Government Departments and Other Working Institutions

 

Any owner, keeper, or other person in charge of the operation of a hotel, boarding house, or dormitory government departments and other working institutions shall immediately report to the Director the presence therein of any person he has reason to believe to be sick of, or to have died of any contagious, infectious, communicable, or other disease dangerous to the public health.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission inserted commas after the words “keeper,” “house,” and “communicable” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-120            Master of Vessel Captain of Aircraft

 

Any master of a vessel or captain of an aircraft, or ships shall immediately report to the Director or his representative the presence aboard such vessel or aircraft of any person he has reason to believe to be sick or to have died of any communicable disease.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Part 200 -       Investigation

 

§ 140-10.3-201            Investigation

 

When a complaint is made or a reasonable belief exists that a communicable disease or other disease dangerous to the public health prevails in any house or elsewhere which has not been reported, the Director shall make an inspection for the purpose of discovering whether any such disease exists.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-205            Access to Records, Reports, Etc.

 

When the Director has reason to believe that a communicable disease exists but that full and complete information as required by § 140-10.3-101 of this subchapter has not been provided, the Director or his representative may examine any and all records or reports deemed necessary to fully investigate the disease.

 

Modified, 1 CMC § 3806(c), (d), (f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Part 300 -       Isolation and Quarantine; Other Requirements

 

§ 140-10.3-301            Isolation and Quarantine; Regulations

 

Isolation and quarantine shall be imposed in accordance with regulations. Such regulations shall designate the disease for which isolation or quarantine is necessary, and such other requirements concerning diagnosis, treatment, release and other pertinent matters as may be necessary.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-305            Same; Authority of Director

 

(a)        Notwithstanding § 140-10.3-301, when a person has or is suspected of having or is suspected of being a carrier of any communicable disease or any other disease dangerous to the public health, the Director may impose isolation on such person and may impose quarantine on anyone who has had contact with such person. The extent and duration of isolation and quarantine imposed in a given case and release therefrom shall be within the discretion of the Director depending upon the disease. The Director may, in his discretion, determine the persons subject to isolation and quarantine, specify the places or areas to which or in which they are restricted in their movements, prescribe other conditions and requirements to be observed, decide the duration of isolation and quarantine and release therefrom and issue other necessary instructions. He shall insure that provisions are made for medical observation of such persons as frequently as necessary during isolation and quarantine. He may, in his discretion, terminate isolation and quarantine or amend the degree thereof and other restrictions imposed in connection therewith at any time.

 

(b)        When a person has or is suspected of having or is suspected of being a carrier of any communicable disease or any other disease dangerous to the public health, the Director may, in his discretion and for the safety of the public, remove such person, with or without his consent, to a licensed hospital or other designated premises for the purpose of isolation and treatment until the disease is no longer communicable by such person. If the Director should determine that removal of such person is not practicable, such person may be allowed to remain where he is and the Director may take such measures as he may deem advisable to provide for his care for the public health by way of isolation and quarantine.

 

Modified, 1 CMC § 3806(c).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-310            Placarding

 

When a person has been isolated or quarantine and is restricted thereby to his residence or other building, the Director may place in a conspicuous position on the exterior of the premises when such person is isolated or quarantine a placard having printed on it in large letter the name of the disease and warning all unauthorized persons to remain off the premises. Such placard shall be in English and Chamorro and in any other languages the Director deems appropriate. No person shall remove, deface, or destroy such placard until authorized by the Director. Except as authorized by the Director or regulation, no person shall enter or leave any premises which has been placarded.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission inserted a comma after the word “deface” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-315            Violation of Isolation or Quarantine

 

No person who has been isolated or quarantined shall leave the premises or area to which he has been restricted without the written permission of the Director until he has been released from such isolation or quarantine.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-320            Director of Public Safety

 

Upon the request of the Director, it shall be the duty of the Director of Public Safety to act and assist in the enforcement of isolation and quarantine, using such force as may be reasonably necessary.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-325            Disinfection of Premises

 

The Director may, if he deems it advisable, order the premises and content thereof in which any person has been ill or has died of a communicable disease or any other room, building, premises or area, any contents thereof, which may be infective by contact with any communicable disease, to be disinfected and purified in such manner as he may direct. It shall be the duty of the owner or occupant or such premises to comply with any such order.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-330            Destruction of Property

 

The Director may destroy any infective clothing, bedding or to* other article which cannot be made safe by disinfection. He shall furnish to the owner thereof a receipt showing the number, character, condition and estimated value of the article so destroyed. A copy of such receipt shall be retained by the Director.

 

* So in original.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-335            Compensation

 

Upon the presentation of the original receipt for articles destroyed under § 140-10.3-330 and approval by the Attorney General, the Director shall pay to the owner of such property, out of such appropriations of the Department of Public Health and Environmental Services as may be available, the value of such destroyed articles.

 

Modified, 1 CMC § 3806(c).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: With respect to the reference to the Department of Public Health and Environmental Services, see Executive Order 94-3 (effective August 23, 1994). See also the general commission comment to this chapter.

 

§ 140-10.3-340            Closing of Schools

 

During an epidemic or threatening epidemic or when a dangerous communicable disease is unusually prevalent, the Director may close any public or private school and prohibit any public or private gathering for such time as may be necessary in the interests of the public health.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-345            Disposal of Bodies

 

The Director, in his discretion, may require that the body of a person, who has died of a communicable disease or any other disease dangerous to the public health, be buried or cremated immediately or within such period of time and in conformity with such procedures for the protection of the public health, as he may designate.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-350            Responsibility of Person in Charge of Minor

 

Where any person suffering from a communicable disease is required to remain isolated or quarantine or to do or refrain from doing any act or thing whereby spread of the disease may be enhanced and such person because of his tender age or of physical or mental disability is unable to comprehend or comply with such requirements, it shall be the duty of the parent, guardian, or other person, including any attendant having such patient under his care, custody, or control to comply or cause compliance with the isolation or quarantine so imposed and pertinent provisions of this subchapter.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission inserted commas after the words “guardian” and “custody” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-355            Willful Exposure

 

No person having a communicable disease or any other disease dangerous to the public health or being in charge of any other person afflicted with such a disease, shall willfully expose himself or such person in any public place, street, or highway except as may be authorized by the Director.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission inserted a comma after the word “street” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-360            Concealing Disease

 

No person shall conceal any person having any communicable disease or any other disease dangerous to the public health, including any sexual transmitted disease. No parent, guardian, or other person having custody or care of a minor child shall conceal the fact of a minor child having any such disease.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission inserted a comma after the word “guardian” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-365            Vaccination and Immunization

 

No child shall be enrolled in any public or private school within the Commonwealth unless evidence is presented to the enrolling officer that the child has had all such vaccinations or immunizations, including but not limited to diphtheria, pertussis, tetanus, polio, measles (rubeola), mumps and rubella (German measles, hepatitis B) or against other communicable disease as the Director shall, by regulation, require, except that exemption may be granted upon certification by a parent or legal guardian that such vaccination or immunization would be against their religious belief or a child that has been certified by a licensed medical doctor that said child shall be exempt from this section where medical contraindication to receiving a specific vaccine exists. The Director may require vaccination and immunization of any person or persons suspected as carriers of a communicable disease upon entering or leaving the Commonwealth which the Director believes may present a risk to the public health of the Commonwealth. The Director, in case of an epidemic or to control a possible epidemic of a communicable disease, may direct that the general population be vaccinated and immunized against said disease.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-370            Prenatal Test

 

Any licensed or registered physician attending a pregnant woman for condition relating to her pregnancy during this period of gestation or at delivery shall take or cause to be taken a sample of the blood of such woman and submit such sample to the Department of Public Health and Environmental Services laboratory or other laboratory approved by the Director for a standard serologic test for syphilis. Any other person permitted by law to attend pregnant women, but not permitted by law to take blood samples, shall cause a sample of blood of every pregnant woman attended by him to be taken by a duly licensed or registered physician or at the Department of Public Health and Environmental Services laboratory approved by the Director for a standard serologic test for syphilis. Such samples of blood shall be taken at the time of the first visit of the pregnant woman or within fourteen days thereafter. Every pregnant woman shall permit such samples of her blood to be taken as provided in this section.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: With respect to the reference to the Department of Public Health and Environmental Services, see Executive Order 94-3 (effective August 23, 1994). See also the general commission comment to this chapter.

 

§ 140-10.3-375            Report as to Prenatal Test

 

In reporting any birth or stillbirth, any physician or other person required to make such reports shall state in a report accompanying the certificate whether, according to his knowledge or information, a blood test for syphilis has been made upon a specimen of blood taken from the woman who bore the child for which the birth or date when the specimen was taken. The Director is authorized to investigate the circumstances surrounding the birth of any baby on whose mother no serologic test, as required by the provision of this subchapter, appears to have been taken.

 

Modified, 1 CMC § 3806(d).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-380            Prevention of Blindness at Childbirth

 

Any physician, midwife, or any other person in attendance at childbirth immediately after birth shall administer (1%) silver nitrate solution to both eyes of the newborn child. Preparations other than one percent silver nitrate may be used only on approval of the Director and subject to such conditions and restrictions as the Director may impose.

 

Modified, 1 CMC § 3806(e).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission inserted a comma after the word “midwife” pursuant to 1 CMC § 3806(g).

 

§ 140-10.3-385            Immunization Audit

 

Annually, the Director shall conduct an immunization audit. The sample audits shall be private clinic records and private physicians’ record to determine if:

 

(a)        One consolidated immunization records is posted on the inside front cover of the patient’s medical record if the patient is under the age of eighteen, and

 

(b)        That the record of any child found to be deficient in immunizations indicates:

(1)        That progress towards immunization is being made;

(2)        A record of scheduled return appointment for the child; or

(3)        A reason for the lack of immunization.

 

Modified, 1 CMC § 3806(e), (f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

§ 140-10.3-390            Same; Confidentiality

 

The immunization audit shall be done by the Director who may delegate his duty to the Immunization Coordinator of the Division of Public Health. The Director shall be responsible for assuring the confidentiality of individual patient record is preserved. The Department of Public Health and Environmental Services shall be responsible for compiling statistics of the audit.

 

Modified, 1 CMC § 3806(g).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Commission Comment: The Commission deleted the word “a” before “statistics of the audit.”

 

With respect to the reference to the Department of Public Health and Environmental Services, see Executive Order 94-3 (effective August 23, 1994). See also the general commission comment to this chapter.

 

§ 140-10.3-395            Autopsy

 

The Director may order an autopsy to determine if the deceased died of a communicable disease or whenever, in his discretion, the public interest justifies it.

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 

Part 400 -       Penalties; Miscellaneous Provisions

 

§ 140-10.3-401            Penalty

 

A person who violates any of the provisions of this subchapter or regulations issued pursuant thereto shall be deemed guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than five hundred dollars or imprisoned for not more than one year, or both.

 

Modified, 1 CMC § 3806(d), (e), (f).

 

History: Adopted 15 Com. Reg. 11091 (Nov. 15, 1993); Emergency and Adopted 15 Com. Reg. 11074 (Nov. 15, 1993) (effective for 120 days from Oct. 26, 1993); Adopted 15 Com. Reg. 10706 (June 15, 1993); Proposed 13 Com. Reg. 7858 (Sept. 15, 1991).

 


 

SUBCHAPTER 140-10.4

INTERMENTS AND DEAD BODIES REGULATIONS

 


Part 001          General Provisions

§ 140-10.4-001            Authority

 

Part 100          Bodies Abandoned in the Commonwealth Health Center Morgue

§ 140-10.4-101            Bodies Abandoned in the Commonwealth Health Center Morgue


 

Subchapter Authority: 1 CMC 2605(f).

 

Subchapter History: Adopted 17 Com. Reg. 13388 (May 15, 1995); Proposed 17 Com. Reg. 13019 (Mar. 15, 1995); Emergency and Proposed 17 Com. Reg. 12696 (Jan. 15, 1995) (effective for 120 days from Jan. 6, 1995).

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2605(f) directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction, including interments and dead bodies.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles, and effected numerous other revisions. According to Executive Order 94-3 § 105:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

§ 140-10.4-001            Authority

 

The Department of Public Health is authorized to implement the regulations governing interments and dead bodies codified in this subchapter pursuant to 1 CMC § 2605(f).

 

Modified, 1 CMC § 3806(d), (g).

 

History: Adopted 17 Com. Reg. 13388 (May 15, 1995); Proposed 17 Com. Reg. 13019 (Mar. 15, 1995); Emergency and Proposed 17 Com. Reg. 12696 (Jan. 15, 1995) (effective for 120 days from Jan. 6, 1995).

 

Commission Comment: The Commission inserted the final period.

 

Part 100 -       Bodies Abandoned in the Commonwealth Health Center Morgue

 

§ 140-10.4-101            Bodies Abandoned in the Commonwealth Health Center Morgue

 

(a)        Upon the death of an individual within the CNMI, Commonwealth Health Center staff will attempt to locate family members or friends to advise them about the death, and to request that they take possession of the body.

 

(b)        If Commonwealth Health Center staff are unable to locate the decedent’s family members or friends within the period of two weeks, the Commonwealth Health Center shall place a public notice in a newspaper of general circulation announcing the person’s death, and that the body is being held at the Commonwealth Health Center morgue.

 

(c)        If, after one week following the announcement in the newspaper, the body remains unclaimed, the Department of Public Health shall have the power to supervise and conduct a burial of the decedent within the CNMI.

 

(d)       In those instances where the Commonwealth Health Center staff have made significant efforts to locate family members and friends of the decedent, but have been unsuccessful in locating such individuals, and maintaining the remains of the decedent in the Commonwealth Health Center morgue poses an immediate threat of communicable disease, the Commonwealth Health Center may dispense with the requirement of public notice and may supervise and conduct a burial of the decedent after the body has remained unclaimed in the morgue for a period of two weeks.

 

History: Adopted 17 Com. Reg. 13388 (May 15, 1995); Proposed 17 Com. Reg. 13019 (Mar. 15, 1995); Emergency and Proposed 17 Com. Reg. 12696 (Jan. 15, 1995) (effective for 120 days from Jan. 6, 1995).

 


 

SUBCHAPTER 140-10.5

LIVING WILL POLICY RULES AND REGULATIONS

 


Part 001          General Provisions

§ 140-10.5-001            Policy

§ 140-10.5-005            Findings and Declarations

 

Part 100          Living Will Policy

§ 140-10.5-101            Preparing a Living Will

§ 140-10.5-105            Operative Effect of a Living Will

§ 140-10.5-110            Revocation of a Living Will

§ 140-10.5-115            Recording the Living Will in the Medical Record

§ 140-10.5-120            Patient’s Right to Self-determination; Pregnant Patients

§ 140-10.5-125            Physician or Health Care Provider Unwilling to Comply with the Living Will Policy; Transfer of Patient

§ 140-10.5-130            Health Care Provider Acting in Good Faith

§ 140-10.5-135            Health Care Provider Not Acting in Good Faith

§ 140-10.5-140            Policy Consistent with Other Rights and Laws

§ 140-10.5-145            Living Will Presumed to Be in Compliance with Policy and Valid

§ 140-10.5-150            Instruments Executed in Other States

§ 140-10.5-155            Instruments Executed in the CNMI Prior to Adoption of this Policy

 

Exhibit A        Living Will


 

Subchapter Authority: 1 CMC § 2605.

 

Subchapter History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2603(f) grants the Department the power and duty to administer all government-owned health care facilities. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles, and effected numerous other revisions. According to Executive Order 94-3 § 105:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

§ 140-10.5-001            Policy

 

The rules and regulations in this subchapter shall be referred to as the “Living Will Policy.”

 

Modified, 1 CMC § 3806(d), (f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-005            Findings and Declarations

 

(a)        An adult person has the fundamental right to control the decisions about his or her own medical care, including the decision to have life-sustaining treatment started, withheld or withdrawn in instances where the person is afflicted with a terminal condition or is in a permanent unconscious condition.

 

(b)        Prolonging the process of dying for a person afflicted with a terminal condition or in a permanent unconscious condition, when continued medical treatment will not improve the prognosis for recovery, may violate patient dignity and cause unnecessary pain and suffering, while providing nothing medically necessary or beneficial to the person. It is therefore the objective of this policy to protect individual autonomy by allowing persons to make decisions about their treatment and their death.

 

(c)        In recognition of the dignity and privacy that a person has a right to expect, this policy is aimed at upholding the right of an adult person to make a declaration instructing his or her physician regarding life sustaining treatment, including the right to initiate, maintain, or withdraw such treatment, in the event of a terminal condition or permanent unconscious condition, or in the event that the person is unable to make those decisions for himself or herself.

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

Part 100 -       Living Will Policy

 

§ 140-10.5-101            Preparing a Living Will

 

(a)        A person who is 18 years or older, and who is of sound mind, may state verbally or in writing his or her wishes regarding life sustaining treatment, including the withdrawal or maintenance of such treatment, as provided in this policy. Persons are encouraged to document their decisions in writing.

 

(b)        A person’s verbal statements regarding life sustaining treatment must be made to a family member or friend, and witnessed by at least one other individual.

 

(c)        A form for a written living will is attached to this policy as exhibit A. The living will forms can be found throughout the Commonwealth Health Center, including the Hospital Administrator’s office.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-105            Operative Effect of a Living Will

 

(a)        A living will becomes operative when:

(1)        It is communicated to the attending physician by the patient or the patient’s family members or friends to whom the patient has communicated his or her desires; and

(2)        The patient is diagnosed and certified in writing by the attending physician, and a second physician who has personally examined the patient, and both concur that the patient is:

(i)         Close to death, and that starting or maintaining life support would postpone death;

(ii)        Unconscious, and it is very unlikely that the patient will become conscious again; or

(iii)       In an advanced state of a progressive illness that will be fatal, and that the patient is consistently and permanently unable to communicate by any means, swallow food and water safely, care for himself or herself, recognize family members or other people close to the patient, and it is very unlikely that the patient’s condition will significantly improve; and

(3)        The patient is no longer able to make decisions regarding administration of life-sustaining treatment.

 

(b)        When the living will becomes operative, the attending physician and other health care providers must act in accordance with its provisions, or comply with the transfer requirements set forth in § 140-10.5-125.

 

(c)        This policy does not affect the responsibility of the attending physician or other health care provider to provide treatment for a patient’s comfort care or alleviation of pain.

 

Modified, 1 CMC § 3806(c), (f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) through (c).

 

§ 140-10.5-110            Revocation of a Living Will

 

(a)        A person may revoke a living will at any time and in any manner, without regard to his or her mental or physical condition. A revocation of the living will is effective when the person’s intent to revoke is communicated to the attending physician or other health care provider by the person, or by a witness to the person’s act of revocation.

 

(b)        The attending physician or other health care provider must indicate the person’s revocation of the living will in such person’s medical record.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) and (b).

 

§ 140-10.5-115            Recording the Living Will in the Medical Record

 

When a patient’s attending physician determines that the patient is in a condition described in § 140-10.5-105, the attending physician who knows of a living will must record the living will and the terms of the living will in the patient’s medical record. The medical record of a patient with a living will will contain a sticker on the outside folder indicating that a living will is included inside the medical record. A person who has signed a living will is encouraged to give a copy of the living will to their family members, close friends, or health care provider.

 

Modified, 1 CMC § 3806(c), (f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-120            Patient’s Right to Self-determination; Pregnant Patients

 

(a)        A person who is 18 years or older, and who is of sound mind, may make decisions regarding life-sustaining treatment as long as he or she is able to do so, regardless of whether he or she has signed a living will.

 

(b)        If the patient is pregnant and that diagnosis is known to the attending physician, the living will shall have no force or effect during the course of the pregnancy, unless the patient has explicitly specified in writing that the living will should remain in effect in instances of pregnancy.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) and (b).

 

§ 140-10.5-125            Physician or Health Care Provider Unwilling to Comply with the Living Will Policy; Transfer of Patient

 

An attending physician or other health care provider who is unwilling to comply with the living will policy shall take all reasonable steps as promptly as practicable to transfer care of the patient to another physician or health care provider who is willing to comply with the terms of the patient’s living will.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-130            Health Care Provider Acting in Good Faith

 

(a)        The Department of Public Health will not subject a physician or other health care provider to disciplinary action for unprofessional conduct for acting on the terms of a patient’s living will when the physician or other health care provider clearly demonstrates that he or she had no knowledge of the revocation of the living will.

 

(b)        A physician or other health care provider whose action under this policy is in accord with reasonable medical standards will not be subject to disciplinary action for unprofessional conduct, administrative sanction, or other punishment by the Department of Public Health if the physician or health provider believes in good faith that his or her actions were consistent with this policy and the desires of the patient as expressed in the patient’s living will.

 

Modified, 1 CMC § 3806(f), (g).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

Commission Comment: The original paragraphs were not designated. The Commission designated subsections (a) and (b). In subsection (a), the Commission inserted the first word “The.”

 

§ 140-10.5-135            Health Care Provider Not Acting in Good Faith

 

It is the Department of Public Health’s expectation that all employees will comply with this policy. The Department of Public Health will subject any physician or health care provider to disciplinary action who willfully fails to record the terms of a living will in a person’s medical record. Furthermore, any individual who willfully:

 

(a)        Conceals, cancels, or obliterates the living will of another individual without that individual’s consent; or

 

(b)        Falsifies or forges a revocation of the living will of another individual, will be reported to the Office of the Attorney General for prosecution.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-140            Policy Consistent with Other Rights and Laws

 

(a)        This policy does not affect the right of a person to make decisions regarding the use of life-sustaining treatment, as long as the person is able to do so, or impair or supersede a right or responsibility that a person has to effect the withholding or withdrawal of medical care.

 

(b)        This policy does not require any physician or other health care provider to take any action contrary to reasonable medical standards.

 

(c)        This policy does not condone, authorize, or approve mercy killing or assisted suicide, or permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying.

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-145            Living Will Presumed to Be in Compliance with Policy and Valid

 

In the absence of any knowledge to the contrary, a physician or other health care provider may presume that a living will complies with the policy in this subchapter and is valid.

 

Modified, 1 CMC § 3806(d).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-150            Instruments Executed in Other States

 

An instrument governing the withholding or withdrawal of life-sustaining treatment executed in another jurisdiction in compliance with the laws of that jurisdiction is valid for the purposes of the policy in this subchapter.

 

Modified, 1 CMC § 3806(d).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

§ 140-10.5-155            Instruments Executed in the CNMI Prior to Adoption of this Policy

 

An instrument governing the withholding or withdrawal of life-sustaining treatment executed in the CNMI prior to the adoption of the policy in this subchapter is valid for the purposes of this subchapter.

 

Modified, 1 CMC § 3806(d).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).


 

 

Exhibit A

Living Will

HEALTH CARE INSTRUCTIONS:

I, __________________, hereby set forth my desires about my health care in the event my doctor and another doctor who has personal knowledge about my care confirm that I am in a medical condition described below:

1. If I am close to death and life support would postpone the moment of my death:

A. Initial One

_____ I want to receive artificially administered nutrition and water.

_____ I DO NOT want to receive artificially administered nutrition and water.

B. Initial One

_____ I want other life support that may apply: ____________________________________

_____ I want NO life support.

2. If I am unconscious and it is very unlikely that I will ever become conscious again:

A. Initial One

_____ I want to receive artificially administered nutrition and water.

_____ I DO NOT want to receive artificially administered nutrition and water.

B. Initial One

_____ I want other life support that may apply: ____________________________________

_____ I want NO life support.

3. If I have a progressive illness that will be fatal and is in an advanced state, and I am consistently and permanently unable to communicate by any means, swallow food and water safely, care for myself, and recognize my family and other people, and it is very unlikely that my condition will significantly improve:

A. Initial One

_____ I want to receive artificially administered nutrition and water.

_____ I DO NOT want to receive artificially administered nutrition and water.

B. Initial One

_____ I want other life support that may apply: ____________________________________

_____ I want NO life support.

4. Additional Conditions and Instructions: (Insert description of what you want done.)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

I hereby declare that Living Will was voluntarily prepared by me and that I have independently made the choices specified above on my own after significant thought and consideration.

__________________________        _______________

Signature                                             Date

 

Declaration of Witnesses

We the witnesses to this Living Will hereby declare that the person signing the living will: (a) is personally known to us or has provided proof of identity; (b) signed the Living Will, or instructed another to sign the Living Will on their behalf, in our presence; and (c) appears to be of sound mind and not under duress, fraud, or undue influence:

 

Witnessed By:

__________________________        _______________

Signature of Witness                           Date

__________________________

Printed Name of Witness

__________________________        _______________

Signature of Witness                           Date

__________________________

Printed Name of Witness

 

NOTE: Witnesses must not be related to (by blood, marriage, or adoption) the person signing this Living Will, and must not be entitled to any portion of the person’s estate upon such person’s death.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 19 Com. Reg. 15161 (Feb. 15, 1997); Proposed 18 Com. Reg. 14804 (Dec. 15, 1996).

 

 


 

SUBCHAPTER 140-10.6

MAINTENANCE AND RELEASE OF PATIENT HEALTH CARE INFORMATION RULES AND REGULATIONS

 


Part 001          General Provisions

§ 140-10.6-001            Definitions

 

Part 100          Maintenance and Release of Patient Health Care Information; Requirements

§ 140-10.6-101            Disclosure by Department of Public Health; Restrictions on Disclosure of Medical Records for Mental Health Treatment, Alcohol and Substance Abuse Treatment, and HIV Testing

§ 140-10.6-105            Patient Authorization of Disclosure

§ 140-10.6-110            Patient’s Revocation of Authorization for Disclosure

§ 140-10.6-115            Discovery Request or Compulsory Process

§ 140-10.6-120            Disclosure Without Patient’s Authorization

§ 140-10.6-125            Patient’s Examination and Copying; Requirements

§ 140-10.6-130            Patient’s Request; Denial of Examination and Copying

§ 140-10.6-135            Correction or Amendment of Medical Record

§ 140-10.6-140            Consent by Others; Health Care Representatives

§ 140-10.6-145            Personal Representative of Deceased Patient

§ 140-10.6-150            Safeguards for Security of Health Care Information

§ 140-10.6-155            Retention of Medical Records

§ 140-10.6-160            Severability


 

Subchapter Authority: 1 CMC §§ 2603 and 2605.

 

Subchapter History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2603(f) grants the Department the power and duty to administer all government-owned health care facilities. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles and effected numerous other revisions. According to Executive Order 94-3 § 105:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

§ 140-10.6-001            Definitions

 

(a)        “Audit” means an assessment, evaluation, determination, or investigation of the Department of Public Health by a person not employed by or affiliated with the Department of Public Health to determine compliance with:

(1)        Statutory, regulatory, fiscal, medical, or scientific standards;

(2)        A private or public program of payments to the Department of Public Health; or

(3)        Requirements for licensing, accreditation, or certification.

 

(b)        “Department of Public Health” includes the Commonwealth Health Center, the Tinian Health Center, the Rota Health Center, the Division of Public Health, and the Community Guidance Center.

 

(c)        “Directory information” means information disclosing the presence, and for the purpose of identification, the name, residence, sex, and the general health condition of a particular patient who is an in-patient or who is currently receiving emergency health care at the Commonwealth Health Center.

 

(d)       “General health condition” means the patient’s health status described in terms of “critical,” “poor,” “fair,” “good,” “excellent,” or terms denoting similar conditions.

 

(e)        “Health care” means any care, service, or procedure provided by the Department of Public Health:

(1)        To diagnose, treat, or maintain a patient’s physical, psychological or mental condition; or

(2)        That affects the structure or any function of the human body.

 

(f)        “Health care information” means information whether oral or recorded in any form or medium that identifies or can readily be associated with the identity of a patient and directly relates to the patient’s health care.

 

(g)        “Health care provider” means a person who is licensed, certified, or otherwise authorized by the laws of the CNMI to provide health care in the ordinary course of business or practice of a profession.

 

(h)        “Institutional review board” means a board, committee, or other group formally designated by an institution or authorized under federal or CNMI law to review, approve the initiation of, or conduct periodic review of research programs to ensure the protection of the rights and welfare of human research subjects.

 

(i)         “Legally authorized representative” means

(1)        A parent or legal guardian if the patient is a minor;

(2)        A legal guardian if the patient has been adjudicated incompetent to manage the patient’s personal affairs;

(3)        An agent of the patient authorized under a durable power of attorney for health care;

(4)        A guardian ad litem appointed for the patient;

(5)        An administrator for the estate of the patient or a personal representative designated by the patient if the patient is deceased.

 

(j)         “Maintain” as related to health care information, means to hold, possess, preserve, retain, store, or control that information.

 

(k)        “Medical records” means all records pertaining to the history, diagnosis, treatment, or prognosis of a patient.

 

(l)         “Patient” means an individual who receives or has received health care. The term includes a deceased individual who has received health care.

 

(m)       “Person” means an individual, corporation, business, trust, estate, partnership, association, joint venture, government, governmental subdivision or agency, or any other legal or commercial entity.

 

(n)        “Third party payor” means an insurer authorized to transact business in the CNMI, including a health care service contractor or health maintenance organization, or employee welfare benefit plan, or a state or federal health benefit plan.

 

Modified, 1 CMC § 3806(f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

Part 100 -       Maintenance and Release of Patient Health Care Information; Requirements

 

§ 140-10.6-101            Disclosure by Department of Public Health; Restrictions on Disclosure of Medical Records for Mental Health Treatment, Alcohol and Substance Abuse Treatment, and HIV Testing

 

(a)        Except as authorized in § 140-10.6-115, “Discovery Request or Compulsory Process” or § 140-10.6-120, “Disclosure Without Patient’s Authorization” the Department of Public Health, or an agent or employee of the Department of Public Health, shall not disclose health care information about a patient to any other person without the patient’s written authorization. A disclosure made under a patient’s written authorization must conform to the specifics of that authorization. The Department of Public Health shall chart all disclosures of health care information, except to third party payors, and such chartings shall become part of the health care information.

 

(b)        Notwithstanding § 140-10.6-115, “Discovery Request or Compulsory Process” or § 140-10.6-120, “Disclosure Without Patient’s Authorization,” the Department of Public Health shall not disclose medical records for mental health treatment, alcohol and substance abuse treatment, and HIV testing to any person other than the patient without receiving proof that the requesting party has complied with the following procedures:

(1)        For records pertaining to any mental health treatment, care, or counseling, the person requesting the medical records shall:

(i)         Obtain the patient’s written consent for release of the records; or

(ii)        Obtain a court order for the release of the records, after the court has afforded the patient the opportunity to object to the release of such records as required by the Patient’s Rights Act at 3 CMC § 2561.

(iii)       These restrictions on the release of mental health records shall not apply to the patient’s attorney.

(2)        For records pertaining to any alcohol and substance abuse treatment, care, or counseling, the person requesting the medical records must comply with the requirements established under the federal requirements for confidentiality of patient records, codified at 42 U.S.C. § 290ee-3 and § 290dd-3, and regulations promulgated thereunder at 42 CFR § 2.1 - § 2.67.

(3)        For records pertaining to HIV testing and diagnosis of AIDS, disclosure shall not be made without either the patient’s written consent or a court order, except with respect to disclosures to Department of Public Health employees on an as needed basis.

 

Modified, 1 CMC § 3806(c), (f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

Commission Comment: The final paragraph of subsection (b)(1) was not designated. The Commission designated it subsection (b)(1)(iii).

 

§ 140-10.6-105            Patient Authorization of Disclosure

 

(a)        A patient, or a patient’s legally authorized representative, may authorize the Department of Public Health to disclose the patient’s health care information. The Department of Public Health shall honor an authorization and, if requested, provide a copy of the recorded health information unless the Department of Public Health denies the patient access to health information under § 140-10.6-130 “Patient Request - Denial of Examination and Copying.”

 

(b)        The Department of Public Health may charge a reasonable fee for providing the health care information and shall not be required to honor an authorization until the fee is paid.

 

(c)        To be valid, a disclosure authorization to the Department of Public Health shall:

(1)        Be in writing, dated, and signed by the patient, or the patient’s legally authorized representative;

(2)        Identify the nature of the information to be disclosed;

(3)        Identify the name, address, and institutional affiliation of the person to whom the information is to be disclosed;

(4)        Identify the patient.

 

(d)       The Department of Public Health shall retain each authorization in conjunction with any health care information from which disclosures are made. This requirement shall not apply to disclosures to third party payors.

 

(e)        Except for authorizations given pursuant to an agreement with a treatment or monitoring program or to provide information to third party payors, an authorization may not permit the release of health care information relating to future health care that the patient receives more than six months after the authorization was signed. Patients shall be advised of the period of validity of their authorization on the disclosure authorization form.

 

Modified, 1 CMC § 3806(c), (f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-110            Patient’s Revocation of Authorization for Disclosure

 

A patient, or patient’s legally authorized representative, may revoke in writing a disclosure authorization to the Department of Public Health at any time unless disclosure is required to effectuate payments for health care that has been provided, or other substantial action has been taken in reliance on the authorization. A patient may not maintain an action against the Department of Public Health for disclosures made in good-faith reliance on an authorization if the Department of Public Health had no actual notice of the revocation of the authorization. A revocation is valid only if it is in writing, dated with a date that is later than the date on the original authorization, and signed by the patient or the patient’s legally authorized representative. The Department of Public Health shall retain each revocation in the patient’s medical record.

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-115            Discovery Request or Compulsory Process

 

(a)        Before service of a discovery request or compulsory process demand on the Department of Public Health for health care information, an attorney shall provide advance written notice to the patient or the patient’s attorney through service of process indicating what health care information is sought, and stating that the patient may obtain a protective order to prevent the Department of Public Health from complying. Thereafter the discovery request or compulsory process demand may be served on the Department of Public Health with a copy of the written notice provided to the patient or patient’s attorney attached. The date by which the Department of Public Health must comply with the discovery request or compulsory process demand must allow the patient adequate time to seek a protective order, but in no event be less than fourteen days from the date of service or delivery to the Department of Public Health.

 

(b)        Without the written consent of the patient, the Department of Public Health shall not disclose the health care information sought under subsection (a) of this section if the requestor has not complied with the requirements of such subsection, except upon the order of a court with competent jurisdiction. If the requirements of subsection (a) have been satisfied, and in the absence of a protective order issued by a court of competent jurisdiction forbidding compliance, the Department of Public Health shall disclose the information in accordance with the regulations in this subchapter. The discovery request or compulsory process demand, and any protective order or other related court documents shall be made a part of the patient medical record.

 

Modified, 1 CMC § 3806(c), (d).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-120            Disclosure Without Patient’s Authorization

 

(a)        The Department of Public Health may disclose health care information about a patient without the patient’s authorization to the extent that a recipient needs to know the information, if the disclosure is:

(1)        To a person who the Department of Public Health reasonably believes is providing health care to the patient at the time the request for disclosure is made;

(2)        To any other person who requires health care information for health care education, or to provide planning, quality assurance, peer review, or administrative, legal, financial or actuarial services to the Department of Public Health, or for assisting the Department of Public Health in the delivery of health care and the Department of Public Health reasonably believes that the person:

(i)         Will not use or disclose the health care information for any other purpose; and

(ii)        Will take appropriate steps to protect the health care information;

(3)        To any other health care provider reasonably believed to have previously provided health care to the patient, to the extent necessary to provide health care to the patient, unless the patient has instructed the Department of Public Health in writing not to make the disclosure;

(4)        To any medical or law enforcement personnel if the Department of Public Health reasonably believes that disclosure will avoid or minimize an imminent danger to the health or safety of the patient or any other individual, however there is no obligation under this section on the part of the Department of Public Health or its agents or employees to so disclose;

(5)        Oral, and made by the patient’s treating physician, nurse, or other health care provider to immediate family members of the patient, or any other individual with whom the patient is known to have a close personal relationship, if made in accordance with good medical or other professional practice, unless the patient has instructed the Department of Public Health in writing not to make the disclosure;

(6)        To a hospital or treatment facility that is the successor in interest to the Department of Public Health for the purpose of maintaining the health care information;

(7)        For use in a research project that an institutional review board has determined:

(i)         Is of sufficient importance to outweigh the intrusion into the privacy of the patient that would result from the disclosure;

(ii)        Is impracticable without the use or disclosures of the health care information in individually identifiable form;

(iii)       Contains reasonable safeguards to protect the information from re-disclosure;

(iv)       Contains reasonable safeguards to protect against identifying, directly or indirectly, any patient in any report of the research project; and

(v)        Contains procedures to remove or destroy at the earliest opportunity, consistent with the purposes of the project, information that would enable the patient to be identified, unless an institutional review board authorizes retention of identifying information for purposes of another research project;

(8)        To a person who obtains information for purposes of an audit, if that person agrees in writing to:

(i)         Remove or destroy, at the earliest opportunity consistent with the purpose of the audit, information that would enable the patient to be identified; and

(ii)        Not to disclose the information further, except to accomplish the audit or report unlawful or improper conduct involving fraud in payment for health care by a health care provider or patient, or other unlawful conduct by the health care provider;

(9)        To the Division of Youth Services, Department of Community and Cultural Affairs, pursuant to the terms of the Multi-disciplinary Response Team memorandum of understanding signed by the Department of Public Health to assist in addressing issues regarding sexual abuse and assault;

(10)      To provide directory information, unless the patient has instructed the Commonwealth Health Center not to make the disclosure;

(11)      In cases reported by fire, police, or other public authorities, a report may be provided to them as to the name, residence, sex, age, occupation and general health condition and whether the patient was conscious when admitted;

(12)      To the administrator or designated personal representative of the patient if the patient is deceased;

(13)      To other professionals and personnel under a health care provider’s direction who participate in the diagnosis, evaluation, or treatment of the patient.

 

(b)        The Department of Public Health may disclose health care information about a patient without a patient’s authorization in a judicial or administrative proceeding:

(1)        When the proceedings are brought by the patient against a Department of Public Health health care provider, including but not limited to malpractice proceedings, and in any criminal or license revocation proceeding in which the patient is a complaining witness and in which disclosure is relevant to the claims or defense of a Department of Public Health health care provider;

(2)        When the purpose of the proceedings is to substantiate and collect on a claim for health care services rendered to the patient after a reasonable attempt has been made to collect from the patient;

(3)        In any civil litigation or administrative proceeding against the CNMI government brought by the patient or someone on his behalf if the patient is attempting to recover monetary damages for any physical or mental condition including death of the patient, if the medical records are relevant;

(4)        In any disciplinary investigation or proceeding of a health care provider conducted under or pursuant to the Medical Practice Act, provided that the Medical Profession Licensing Board shall protect the identity of any patient whose medical records are examined, except for those patients covered under any of the subsections in this section or those patients who have submitted written consent to the release of their medical records;

(5)        In any criminal investigation of a health care provider in which the Medical Profession Licensing Board is participating or assisting in the investigation or proceeding by providing certain medical records obtained from the health care provider, provided that the Medical Profession Licensing Board shall protect the identity of any patient whose medical records are provided in the investigation or proceeding except for those patients covered under any of the subsections in this section or those patients who have submitted written consent to the release of their medical records. This subsection does not authorize the release of any confidential information for the purpose of instigating or substantiating criminal charges against a patient;

(6)        In an involuntary civil commitment proceeding, proceeding for court-ordered treatment, or probable cause hearing under the Involuntary Civil Commitment Act of 1994, 3 CMC §§ 2501-2522 or the Patients Rights Act, 3 CMC §§ 2551-2564.

 

(c)        The Department of Public Health shall disclose health care information about a patient without a patient’s authorization if the disclosure is:

(1)        To federal or CNMI public health authorities, when needed to determine compliance with CNMI or federal licensure, certification, or registration rules or laws, or when needed to protect the public health;

(2)        To CNMI law enforcement authorities when necessary to assess whether a patient’s death was the result of a criminal act and whether an autopsy is required;

(3)        Pursuant to compulsory process in accordance with § 140-10.6-115.

 

Modified, 1 CMC § 3806(c), (f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-125            Patient’s Examination and Copying; Requirements

 

(a)        Upon receipt of a written request from a patient to examine or copy all or part of the patient’s recorded health care information, the Department of Public Health, as promptly as required under the circumstances, but no later than fifteen working days after receiving the request shall:

(1)        Make the information available for examination during regular business hours and provide a copy, if requested, to the patient;

(2)        Inform the patient if the information does not exist or cannot be found;

(3)        Inform the patient and provide the name and address, if known, of the health care provider who maintains the record, if the Department of Public Health does not maintain a record of the information;

(4)        If the information is in use or unusual circumstances have delayed handling the request, inform the patient and specify in writing the reasons for the delay and the earliest date, not later than twenty-one working days after receiving the request, when the information will be available for examination or copying or when the request will be otherwise disposed of; or

(5)        Deny the request, in whole or in part, under § 140-10.6-130 and inform the patient.

 

(b)        Upon request, the Department of Public Health shall provide an explanation of any code or abbreviation used in the health care information. However, if a record of the particular health care information requested is not maintained by the Department of Public Health in the requested form, the Department of Public Health is not required to create a new record or reformulate an existing record to make the health care information available in the requested form. The Department of Public Health may charge a reasonable fee for providing the health care information and is not required to permit examination or copying until the fee is paid.

 

Modified, 1 CMC § 3806(c), (e), (f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-130            Patient’s Request; Denial of Examination and Copying

 

(a)        The Department of Public Health may deny access to health care information by a patient if the Department of Public Health reasonably concludes that:

(1)        Knowledge of the health care information would be injurious to the health of the patient;

(2)        Knowledge of the health care information could reasonably be expected to lead to the patient’s identification of an individual who provided the information in confidence and under circumstances in which confidentiality was appropriate;

(3)        Knowledge of the health care information could reasonably be expected to cause danger to the life or safety of any individual;

(4)        The health care information was compiled and is used solely for litigation, quality assurance, peer review, or administrative purposes;

(5)        Access to the health care information is otherwise prohibited by law.

 

(b)        If the Department of Public Health denies a request for examination and copying under this section, it shall, to the extent possible, segregate health care information for which access has been denied under subsection (a) of this section from information for which access cannot be denied and permit the patient to examine or copy the disclosable information.

 

(c)        If the Department of Public Health denies a patient’s request for examination and copying, in whole or in part, under subsection (a)(1) or (a)(3) of this section, it shall permit examination and copying of the medical record by a health care provider not employed by the Department of Public Health, selected by the patient, who is licensed, certified, registered, or otherwise authorized under the laws of the CNMI to treat the patient for the same condition that was treated by the Department of Public Health staff. At the time the patient’s request for health care information is denied, the Department of Public Health shall inform the patient of the patient’s right to select another health care provider under this subsection. The patient shall be responsible for arranging for compensation of the other health care provider so selected.

 

Modified, 1 CMC § 3806(c), (f), (g).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

Commission Comment: In subsection (a)(2), the Commission changed the final period to a semi-colon.

 

§ 140-10.6-135            Correction or Amendment of Medical Record

 

(a)        For purposes of accuracy or completeness, a patient may request in writing that the Department of Public Health correct or amend its medical record of the patient’s health care information to which a patient has access under § 140-10.6-125.

 

(b)        As promptly as required under the circumstances, but no later than ten days after receiving a request from a patient to correct or amend its medical record of the patient’s health care information, the Department of Public Health shall:

(1)        Make the requested correction or amendment and inform the patient of the action;

(2)        Inform the patient if the medical record no longer exists or cannot be found;

(3)        Inform the patient and provide the patient with the name and address if known, of the person who maintains the medical record, if the Department of Public Health does not maintain the medical record;

(4)        If the medical record is in use or unusual circumstances have delayed the handling of the correction or amendment request, inform the patient and specify in writing, the earliest date, not later than twenty-one days after receiving the request, when the correction or amendment will be made or when the request will otherwise by disposed of; or

(5)        Inform the patient in writing of the health care provider’s refusal to correct or amend the medical record as requested and the patient’s right to add a statement of disagreement.

 

(c)        In making a correction or amendment, the Department of Public Health shall:

(1)        Add the amending information as a part of the medical record; and

(2)        Mark the challenged entries as corrected or amended entries and indicate the place in the medical record where the corrected or amended information is located, in a manner practicable under the circumstances.

 

(d)       If the health care provider refuses to make the patient’s proposed correction or amendment, the Department of Public Health shall:

(1)        Permit the patient to file as a part of the medical record of the patient’s health care information a concise statement of the correction or amendment requested and the reasons therefore; and

(2)        Mark the challenged entry to indicate that the patient claims the entry is inaccurate or incomplete and indicate the place in the medical record where the statement of disagreement is located, in a manner practicable under the circumstances.

 

Modified, 1 CMC § 3806(c), (e).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-140            Consent by Others; Health Care Representatives

 

(a)        A person authorized to consent to health care for another may exercise the rights of that person under the regulations in this subchapter to the extent necessary to effectuate the terms or purposes of the grant of authority. If the patient is a minor and is authorized to consent to health care without parental consent under federal or CNMI law, only the minor may exercise the rights of a patient under these regulations as to information pertaining to health care to which the minor lawfully consented. In cases where parental consent is required, the Department of Public Health may rely on the representation of a parent that he or she is authorized to consent to health care for the minor patient regardless of whether:

(1)        The parents are married, unmarried, or separated at the time of the representation;

(2)        The consenting parent is, or is not, a custodial parent of the minor;

(3)        The giving of consent by a parent is, or is not, full performance of any agreement between the parents, or of any order or decree in any action entered in a child custody dispute.

 

(b)        A person authorized to act for a patient shall act in good faith to represent the best interests of the patient.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-145            Personal Representative of Deceased Patient

 

A designated personal representative of a deceased patient may exercise all of the deceased patient’s rights under the regulations in this subchapter. If there is no designated personal representative, or upon discharge of the designated personal representative, a deceased patient’s rights under these regulations may be exercised by the next of kin of the deceased patient in the following order: spouse, children over age 18, parents, siblings.

 

Modified, 1 CMC § 3806(d).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-150            Safeguards for Security of Health Care Information

 

The Department of Public Health shall adopt and implement reasonable safeguards for the security of all health care information it maintains.

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-155            Retention of Medical Records

 

The Department of Public Health shall retain medical records for a minimum of seven years after the date of the last entry on the record. In the case of minor children, the Department of Public Health shall retain the medical records for a minimum of seven years after the date the child reaches 18 years of age unless there are entries on the medical records after the child reaches 18 years of age. X-ray films shall be retained for a minimum of five years.

 

Modified, 1 CMC § 3806(e).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).

 

§ 140-10.6-160            Severability

 

If any provision of the rules and regulations in this subchapter or the application of any such provision to any person or circumstance should be held invalid by a court of competent jurisdiction, the remainder of these rules and regulations or the application of its provisions to persons or circumstances other than those to which it is held invalid shall not be affected hereby.

 

Modified, 1 CMC § 3806(d), (f).

 

History: Adopted 22 Com. Reg. 17546 (Oct. 20, 2000); Proposed 22 Com. Reg. 17211 (May 19, 2000).


 

 

SUBCHAPTER 140-10.7

MEDICAL REFERRAL PROGRAM RULES AND REGULATIONS

 

Subchapter Authority: 1 CMC § 2605.

 

Subchapter History: Amdts Adopted 35 Com. Reg. 34128 (Aug. 28, 2013) (repealing and re-enacting this subchapter at chapter 75-50); Amdts Proposed 35 Com. Reg. 33549 (June 28, 2013); Amdts Adopted 33 Com. Reg. 31503 (Apr. 21, 2011) (repealing and re-enacting this subchapter); Amdts Proposed 33 Com. Reg. 31291 (Jan. 24, 2011); Emergency 33 Com. Reg. 31225 (Jan. 24, 2011); Amdts Adopted 32 Com. Reg. 30092 (Apr. 19, 2010)*; Amdts Proposed 32 Com. Reg. 30062 (Feb. 19, 2010)*; Amdts Adopted 29 Com. Reg. 26511 (Apr 16, 2007); Amdts Proposed 28 Com. Reg. 26211 (Oct. 30, 2006); Amdts Emergency and Proposed 28 Com. Reg. 26308 (Nov. 30, 2006) (effective for 120 days from November 13, 2006);* Amdts Emergency and Proposed 27 Com. Reg. 25187 (Nov. 25, 2005) (effective for 120 days from November 23, 2005);* Amdts Emergency and Proposed 27 Com. Reg. 24705 (Aug. 22, 2005) (effective for 120 days from Aug. 19, 2005);* Amdts Adopted 27 Com. Reg. 24681 (July 20, 2005); Amdts Emergency and Proposed 27 Com. Reg. 24099 (Mar. 17, 2005) (effective for 120 days from March 14, 2005); Amdts Emergency and Proposed 26 Com. Reg. 22836 (Sept. 24, 2004) (effective for 120 days from Sept. 21, 2004);* Amdts Adopted 26 Com. Reg. 22867 (July 26, 2004); Amdts Emergency and Proposed 26 Com. Reg. 22500 (May 24, 2004) (effective for 120 days from Apr. 27, 2004); Amdts Adopted 26 Com. Reg. 21894 (Feb. 23, 2004); Amdts Emergency and Proposed 26 Com. Reg. 21531 (Jan. 22, 2004) (effective for 120 days from Jan. 14, 2004); Amdts Adopted 24 Com. Reg. 19032 (Feb. 28, 2002); Amdts Proposed 23 Com. Reg. 18351 (Sept. 24, 2001); Amdts Adopted 22 Com. Reg. 17349 (July 20, 2000); Amdts Proposed 22 Com. Reg. 17229 (May 19, 2000); Amdts Adopted 20 Com. Reg. 15958 (June 15, 1998); Amdts Emergency and Proposed 20 Com. Reg. 15851 (Feb. 15, 1998) (effective for 120 days from Feb. 13, 1998); Adopted 18 Com. Reg. 14218 (July 15, 1996); Proposed 18 Com. Reg. 14039 (Apr. 15, 1996).

 

*As of August 31, 2007, a notice of permanent adoption had not been published.

 

*As of December 2005, notices of permanent adoption had not been published.

 

*The February 2010 Notice of Proposed Regulations contained only a summary of the proposals to amend the regulations. It did not contain any actual amendments. See 32 Com. Reg. 30062 (Feb. 19, 2010). Despite this, a Notice of Adoption for these non-existent amendments was published in April of 2010. See 32 Com. Reg. 30092.

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction.

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles and effected numerous other revisions. According to Executive Order 94-3 § 105:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

PL 16-51 transferred the Medical Referral Program from the Department of Public Health to the Commonwealth Healthcare Corporation. Executive Order No. 2013-09 (effective May 2, 2013) transferred the Medical Referral Program from the Commonwealth Healthcare Corporation to the Office of the Governor. See 35 Com. Reg. 33542. Section 1.1 of the 2013 amended regulations (codified at section 75-50-005) specified that these new regulations were to be codified at subchapter 140-10.7. However, because this office is now under the supervision of the Office of the Governor, the Commission has moved these regulations to Chapter 75-50.

 

[See chapter 75-50.]


 

 

SUBCHAPTER 140-10.8

SCHEDULE OF MEDICAL AND OTHER RELATED FEES

 


Part 001          General Provisions [Reserved]

 

Part 100          Medical Fees

 

Part 200          Bureau of Dental Health Services; Dental Fees

 

Part 300          Other Fees

§ 140-10.8-301            Room and Board

§ 140-10.8-305            Supplies

§ 140-10.8-310            Special Physical Examinations

§ 140-10.8-315            Certificates

§ 140-10.8-320            Burial Plot

§ 140-10.8-325            Others

§ 140-10.8-330            Refundable Deposits

§ 140-10.8-335            Anesthesia Services

§ 140-10.8-340            Incinerator Fee

§ 140-10.8-345            Alien Health Screening Diagnostic Tests

§ 140-10.8-350            Handling or Conveyance

§ 140-10.8-355            Collection Litigation Fee

§ 140-10.8-360            Penalty Fee

§ 140-10.8-365            Forensic Services Fee

§ 140-10.8-370            Transitional Living Center Fee

 

Part 400          Business Health Permits; Sanitation Services

 

Part 500          Behavioral Health Services Fee Schedules


 

Subchapter Authority: 1 CMC §§ 2603(f) and 2605(j).

 

Subchapter History: Amdts Adopted 33 Com. Reg. 32154 (Dec. 29, 2011); Amdts Proposed 33 Com. Reg. 31985 (Oct. 26, 2011); Amdts Adopted 27 Com. Reg. 25393 (Dec. 30, 2005); Amdts Proposed 27 Com. Reg. 25239 (Nov. 25, 2005); Amdts Adopted 26 Com. Reg. 21895 (Feb. 23, 2004); Amdts Proposed 26 Com. Reg. 21659 (Jan. 22, 2004); Amdts Adopted 25 Com. Reg. 20080 (Mar. 31, 2003); Amdts Proposed 24 Com. Reg. 19495 (Aug. 21, 2002); Amdts Proposed 23 Com. Reg. 18240 (Aug. 16, 2001);* Amdts Proposed 22 Com. Reg. 17094 (Apr. 20, 2000);* Amdts Proposed 21 Com. Reg. 16899 (Aug. 23, 1999);* Amdts Proposed 21 Com. Reg. 16594 (Mar. 18, 1999);* Amdts Adopted 21 Com. Reg. 16627 (Mar. 18, 1999); Amdts Proposed 21 Com. Reg. 16421 (Jan. 18, 1999); Amdts Adopted 21 Com. Reg. 16444 (Jan. 18, 1999); Amdts Proposed 20 Com. Reg. 16302 (Nov. 15, 1998); Amdts Adopted 20 Com. Reg. 16300 (Nov. 15, 1998); Amdts Proposed 20 Com. Reg. 16097 (Aug. 15, 1998); Amdts Adopted 20 Com. Reg. 16101 (Aug. 15, 1998); Amdts Proposed 20 Com. Reg. 15922 (June 15, 1998); Amdts Adopted 20 Com. Reg. 15961 (June 15, 1998); Amdts Emergency and Proposed 20 Com. Reg. 15878 (Mar. 16, 1998) (effective for 120 days from Mar. 16, 1998); Amdts Adopted 20 Com. Reg. 15953 (June 15, 1998); Amdts Proposed 20 Com. Reg. 15861 (Feb. 15, 1998); Amdts Adopted 19 Com. Reg. 15733 (Oct. 15, 1997); Amdts Proposed 19 Com. Reg. 15391 (June 15, 1997); Amdts Adopted 19 Com. Reg. 15420 (July 15, 1997); Amdts Proposed 19 Com. Reg. 15360 (May 15, 1997); Amdts Adopted 19 Com. Reg. 15418 (July 15, 1997); Amdts Proposed 19 Com. Reg. 15367 (May 15, 1997); Amdts Adopted 19 Com. Reg. 14888 (Jan. 15, 1997); Amdts Proposed 18 Com. Reg. 14383 (Oct. 15, 1996); Amdts Adopted 18 Com. Reg. 14203 and 14209 (July 15, 1996); Amdts Proposed 18 Com. Reg. 14156 (June 15, 1996); Amdts Adopted 18 Com. Reg. 13931 (Jan. 15, 1996); Amdts Proposed 17 Com. Reg. 13915 (Dec. 15, 1995); Amdts Adopted 17 Com. Reg. 13922 (Dec. 15, 1995); Amdts Proposed 17 Com. Reg. 13816 (Nov. 15, 1995); Amdts Adopted 17 Com. Reg. 13717 (Sept. 15, 1995); Amdts Proposed 17 Com. Reg. 13657 (Aug. 16, 1995); Amdts Adopted 17 Com. Reg. 13293 (Apr. 15, 1995); Amdts Proposed 17 Com. Reg. 12752 (Feb. 15, 1995).

 

*Notices of adoption for the March 1999, August 1999, April 2000 and August 2001 proposed amendments have not been published.

 

Commission Comment: PL 1-8, tit. 1, ch. 12, codified as amended at 1 CMC §§ 2601-2633, created the Department of Public Health and Environmental Services within the Commonwealth government. See 1 CMC § 2601. 1 CMC § 2603(f) grants the Department the power and duty to administer all government-owned health care facilities. 1 CMC § 2605 directs the Department to adopt rules and regulations regarding those matters over which it has jurisdiction, including hospitals and clinics. See 1 CMC § 2605(j).

 

Executive Order 94-3 (effective August 23, 1994) reorganized the Commonwealth government executive branch, changed agency names and official titles and effected numerous other revisions. According to Executive Order 94-3 § 105:

 

Section 105. Department of Public Health.

 

The Department of Public Health and Environmental Services is re-designated the Department of Public Health.

 

The full text of Executive Order 94-3 is set forth in the commission comment to 1 CMC § 2001.

 

The Department of Public Health (DPH) promulgated a Revised Schedule of Medical and Other Related Fees in 1995. The history sections in this subchapter date from that promulgation. Prior to 1995, the history of medical services and other fees schedule is as follows: Amdts Adopted 14 Com. Reg. 9169 (Mar. 15, 1992) (superseding all previously established hospital fees); Amdts Proposed 14 Com. Reg. 8666 (Jan. 15, 1992); Certified 14 Com. Reg. 8654 (Jan. 15, 1992) (increased public health fees); Amdts Adopted 11 Com. Reg. 6046 (Feb. 15, 1989) (increased public health fees); Amdts Adopted 11 Com. Reg. 6050 (Feb. 15, 1989) (professional service fees); Amdts Proposed 10 Com. Reg. 5605 (Aug. 15, 1988); Amdts Adopted 8 Com. Reg. 4693 (Oct. 22, 1986) (medical service fees); Amdts Proposed 8 Com. Reg. 4636 (Sept. 15, 1986); Amdts Adopted 6 Com. Reg. 3221 (Nov. 15, 1984); Amdts Proposed 6 Com. Reg. 3132 (Aug. 15, 1984); Adopted 3 Com. Reg. 1237 (May 20, 1981) (dental fees); Proposed 3 Com. Reg. 1155 (Mar. 30, 1981); Adopted 2 Com. Reg. 915 (Nov. 17, 1980) (medical fees); Proposed 2 Com. Reg. 842 (July 9, 1980).

 

On September 15, 1996, DPH published a public notice that, effective October 1, 1996, the Rota Health Center and Tinian Health Center would comply with the Department of Public Health’s Schedule of Medical and Other Related Fees. See 18 Com. Reg. 14356 (Sept. 15, 1996).

 

Public Law 16-51 (effective Jan. 15, 2010), the “Commonwealth Healthcare Corporation Act of 2008,” codified at 3 CMC § 2801 et seq., established the Commonwealth Healthcare Corporation, which assumed the duties of the Department of Public Health as of January 15, 2011.

 

Part 001 -       General Provisions

 

[Reserved.]

 

Part 100 -       Medical Fees*

 

CPT #

CPT Description

Fee ($)

10040

Acne surgery (e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)

77.00

10060

Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

72.00

10061

Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple

145.00

10080

Incision and drainage of pilonidal cyst; simple

88.00

10081

Incision and drainage of pilonidal cyst; complicated

167.00

10120

Incision and removal of foreign body, subcutaneous tissues; simple

77.00

10121

Incision and removal of foreign body, subcutaneous tissues; complicated

171.00

10140

Incision and drainage of hematoma, seroma or fluid collection

92.00

10160

Puncture aspiration of abscess, hematoma, bulla, or cyst

72.00

10180

Incision and drainage, complex, postoperative wound

156.00

11000

Debridement of extensive eczematous or infected skin; up to 10% of body surface

61.00

11001

Debridement of extensive eczematous or infected skin; each additional 10% of the body surface

33.00

11040

Debridement; skin, partial thickness

43.00

11041

Debridement; skin, full thickness

66.00

11042

Debridement; skin, and subcutaneous tissue

84.00

11043

Debridement; skin, subcutaneous tissue, and muscle

181.00

11044

Debridement; skin, subcutaneous tissue, muscle, and bone

255.00

11050

Paring or curettement of benign hyperkeratotic skin lesion with or without chemical cauterization (such as verrucae or clavi) not extending through the stratum corneum (e.g., callus or wart) with or without local anesthesia; single lesion

37.00

11051

Paring or curettement of benign hyperkeratotic skin lesion with or without chemical cauterization (such as verrucae or clavi) not extending through the stratum corneum (e.g., callus or wart) with or without local anesthesia; two to four lesions

55.00

11052

Paring or curettement of benign hyperkeratotic skin lesion with or without chemical cauterization (such as verrucae or clavi) not extending through the stratum corneum (e.g., callus or wart) with or without local anesthesia; more than four lesions

59.00

11100

Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed (separate procedure); single lesion

62.00

11101

Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed (separate procedure); each separate/ additional lesion

32.00

11200

Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions

53.00

11201

Removal of skin tags, multiple fibrocutaneous tags, any area; each additional ten lesions

20.00

11300

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less

50.00

11301

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm

72.00

11302

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm

92.00

11303

Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm

126.00

11305

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less

57.00

11306

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

81.00

11307

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm

99.00

11308

Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm

136.00

11310

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less

68.00

11311

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

90.00

11312

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm

110.00

11313

Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm

149.00

11400

Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 cm or less

66.00

11401

Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm

91.00

11402

Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm

116.00

11403

Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm

144.00

11404

Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm

168.00

11406

Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter over 4.0 cm

224.00

11420

Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less

72.00

11421

Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

103.00

11422

Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm

125.00

11423

Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm

162.00

11424

Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm

188.00

11426

Excision benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm

266.00

11440

Excision other benign lesion (unless listed elsewhere), face, ears, eyelids nose, lips, mucous membrane; lesion diameter 0.5 cm or less

84.00

11441

Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

113.00

11442

Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm

139.00

11443

Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm

184.00

11444

Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm

227.00

11446

Excision other benign lesion (unless listed elsewhere), face, ears, eyelids nose, lips, mucous membrane; lesion diameter over 4.0 cm

291.00

11450

Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair

259.00

11451

Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair

326.00

11462

Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair

234.00

11463

Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair

279.00

11470

Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair

288.00

11471

Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair

328.00

11600

Excision, malignant lesion, trunk arms, or legs; lesion diameter 0.5 cm or less

118.00

11601

Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm

154.00

11602

Excision, malignant lesion, trunk, arms, or legs; lesion diameter 1.1 to 2.0 cm

183.00

11603

Excision, malignant lesion, trunk, arms, or legs; lesion diameter 2.1 to 3.0 cm

217.00

11604

Excision, malignant lesion, trunk, arms, or legs; lesion diameter 3.1 to 4.0 cm

245.00

11606

Excision, malignant lesion, trunk, arms, or legs; lesion diameter over 4.0 cm

318.00

11620

Excision, malignant lesion, scalp, neck, hands feet, genitalia; lesion diameter 0.5 cm or less

125.00

11621

Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

174.00

11622

Excision malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm

213.00

11623

Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm

260.00

11624

Excision, malignant lesion, scalp, neck, hands feet, genitalia; lesion diameter 3.1 to 4.0 cm

315.00

11626

Excision, malignant lesion scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm

370.00

11640

Excision malignant lesion face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or less

149.00

11641

Excision malignant lesion face, ears, eyelids, nose, lips; lesion diameter 0.6 to 1.0 cm

212.00

11642

Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0 cm

258.00

11643

Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 2.1 to 3.0 cm

306.00

11644

Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 3.1 to 4.0 cm

379.00

11646

Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter over 4.0 cm

491.00

11700

Debridement of nails, manual; five or less

30.00

11701

Debridement of nails, manual; each additional, five or less

22.00

11710

Debridement of nails, electric grinder; five or less

30.00

11711

Debridement of nails, electric grinder; each additional, five or less

18.00

11730

Avulsion of nail plate, partial or complete, simple; single

73.00

11731

Avulsion of nail plate, partial or complete, simple; second nail plate

51.00

11732

Avulsion of nail plate, partial or complete, simple; each additional nail plate

29.00

11740

Evacuation of subungual hematoma

36.00

11750

Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal

180.00

11752

Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal; with amputation of tuft of distal phalanx

252.00

11755

Biopsy of nail unit, any method (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)

110.00

11760

Repair of nail bed

116.00

11762

Reconstruction of nail bed with graft

257.00

11765

Wedge excision of skin of nail fold (e.g., for ingrown toenail)

55.00

11770

Excision of pilonidal cyst or sinus; simple

258.00

11771

Excision of pilonidal cyst or sinus; extensive

482.00

11772

Excision of pilonidal cyst or sinus; complicated

554.00

11900

Injection, intralesional; up to and including seven lesions

36.00

11901

Injection, intralesional; more than seven lesions

56.00

11920

Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less

255.00

11921

Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm

450.00

11922

Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm

225.00

11950

Subcutaneous injection of “filling” material (e.g., collagen); 1 cc or less

90.00

11951

Subcutaneous injection of “filling”

180.00

11952

Subcutaneous injection of “filling” material (e.g., collagen); 5.1 to 10.0 cc

360.00

11960

Insertion of tissue expander(s) for other than breast, including subsequent expansion

694.00

11970

Replacement of tissue expander with permanent prosthesis

763.00

11971

Removal of tissue expander(s) without insertion of prosthesis

284.00

11975

Insert contraceptive cap insertion, implantable contraceptive capsules

60.00

11976

Removal, implantable contraceptive capsules

80.00

11977

Removal with reinsertion, implantable contraceptive capsules

160.00

12001

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less

92.00

12002

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm

108.00

12004

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm

138.00

12005

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm

179.00

12006

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm

226.00

12007

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm

276.00

12011

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

102.00

12013

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm

123.00

12014

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm

150.00

12015

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm

198.00

12016

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm

256.00

12017

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm

379.00

12018

Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm

506.00

12020

Treatment of superficial wound dehiscence; simple closure

179.00

12021

Treatment of superficial wound dehiscence; with packing

115.00

12031

Layer closure of wounds of scalp axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less

131.00

12032

Layer closure of wounds of scalp axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm

162.00

12034

Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm

204.00

12035

Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm

252.00

12036

Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm

304.00

12037

Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm

373.00

12041

Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less

131.00

12042

Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm

161.00

12044

Layer closure of wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm

197.00

12045

Layer closure of wounds of neck, hands feet and/or external genitalia; 12.6 cm to 20.0 cm

240.00

12046

Layer closure of wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm

336.00

12047

Layer closure of wounds of neck, hands, feet and/or external genitalia; over 30.0 cm

371.00

12051

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

161.00

12052

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm

197.00

12053

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm

227.00

12054

Layer closure of wounds [So in original; see the commission comment to this part.]

285.00

12055

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm

364.00

12056

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm

476.00

12057

Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm

545.00

13100

Repair, complex, trunk; 1.1 cm to 2.5 cm

197.00

13101

Repair, complex, trunk; 2.6 cm to 7.5 cm

280.00

13120

Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm

217.00

13121

Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm

330.00

13131

Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm

270.00

13132

Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm

419.00

13150

Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less

261.00

13151

Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm

328.00

13152

Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm

550.00

13160

Secondary closure of surgical wound or dehiscence, extensive or complicated

612.00

13300

Repair, unusual, complicated, over 7.5 cm, any area

531.00

14000

Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less

419.00

14001

Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm

605.00

14020

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less

522.00

14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

752.00

14040

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

665.00

14041

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm

894.00

14060

Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less

766.00

14061

Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm

1055.00

14300

Adjacent tissue transfer or rearrangement, more than 30 sq cm, unusual or complicated, any area

1088.00

14350

Filleted finger or toe flap, including preparation of recipient site

736.00

15000

Excisional preparation or creation of recipient site by excision of essentially intact skin (including subcutaneous tissues), scar, or other lesion prior to repair with free skin graft (list as separate service in addition to skin graft)

243.00

15050

Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter

272.00

15100

Split graft, trunk, scalp, arms, legs, hands, and/or feet (except multiple digits); 100 sq cm or less, or each one percent of body area of infants and children (except 15050)

613.00

15101

Split graft, trunk, scalp, arms, legs, hands, and/or feet (except multiple digits); each additional 100 sq cm, or each one percent of body area of infants and children, or part thereof

166.00

15120

Split graft, face, eyelids, mouth, neck, ears, orbits, genitalia, and/or multiple digits; 100 sq cm or less, or each one percent of body area of infants and children (except 15050)

734.00

15121

Split graft, face, eyelids, mouth, neck, ears, orbits, genitalia, and/or multiple digits; each additional 100 sq cm, or each one percent of body area of infants and children, or part thereof

278.00

15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

559.00

15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm

194.00

15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

596.00

15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm

185.00

15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

702.00

15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm

249.00

15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

819.00

15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm

306.00

15350

Application of allograft, skin

293.00

15400

Application of xenograft, skin

279.00

15570

Formation of direct or tubed pedicle, with or without transfer; trunk

675.00

15572

Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs

645.00

15574

Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet

638.00

15576

Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral

364.00

15580

Cross finger flap, including free graft to donor site

497.00

15600

Delay of flap or sectioning of flap (division and inset); at trunk

305.00

15610

Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs

305.00

15620

Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands (except 15625), or feet

370.00

15625

Delay of flap or sectioning of flap (division and inset); section pedicle of cross finger flap

284.00

15630

Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips

401.00

15650

Transfer, intermediate, of any pedicle flap (e.g., abdomen to wrist, “walking” tube), any location

438.00

15732

Muscle, myocutaneous, or faclocutaneous flap; head and neck (e.g., temporalis, masseter, sternocleidomastoid, levator scapulae)

1511.00

15734

Muscle, myocutaneous, or fasclocutaneous flap; trunk

1764.00

15736

Muscle, myocutaneous, or fasclocutaneous flap; upper extremity

1569.00

15738

Muscle, myocutaneous, or fasclocutaneous flap; lower extremity

1307.00

15740

Island pedicle

977.00

15750

Flap; neurovascular pedicle

1119.00

15755

Free flap (microvascular transfer)

2901.00

15760

Graft; composite (e.g., full thickness of external ear or nasal ala), including primary closure, donor area

759.00

15770

Graft; derma-fat-fascia

694.00

15775

Punch graft for hair transplant; 1 to 15 punch grafts

23.00

15776

Punch graft for hair transplant; more than 15 punch grafts

36.00

15780

Dermabrasion; total face (e.g., for acne scarring, fine wrinkling, rhytids, general keratosis)

382.00

15781

Dermabrasion; segmental, face

401.00

15782

Dermabrasion; regional, other than face

251.00

15783

Dermabrasion; superficial, any site, (e.g., tattoo removal)

282.00

15786

Abrasion; single lesion (eg, keratosis, scar)

121.00

15787

Abrasion; each additional four lesions or less

27.00

15788

Chemical peel, facial; epidermal

206.00

15789

Chemical peel, face, dermal

251.00

15792

Chemical peel, nonfacial; epidermal

132.00

15793

Chemical peel, nonfacial; dermal

167.00

15810

Salabrasion; 20 sq cm or less

390.00

15811

Salabrasion; over 20 sq cm

437.00

15819

Cervicoplasty

808.00

15820

Blepharoplasty, lower eyelid

533.00

15821

Blepharoplasty, lower eyelid; with extensive herniated fat pad

612.00

15822

Blepharoplasty, upper eyelid

513.00

15823

Blepharoplasty, upper eyelid; with [So in original]

681.00

15824

Rhytidectomy; forehead

807.00

15825

Rhytidectomy; neck with platysmal tightening (platysmal flap, “p-flap”)

735.00

15826

Rhytidectomy; glabellar frown lines

659.00

15828

Rhytidectomy; cheek, chin, and neck

1581.00

15829

Rhytidectomy; superficial musculoaponeurotic system (smas) flap

1581.00

15831

Excision, excessive skin and subcutaneous tissue (including lipectomy); abdomen (abdominoplasty)

1070.00

15832

Excision, excessive skin and subcutaneous tissue (including lipectomy); thigh

936.00

15833

Excision, excessive skin and subcutaneous tissue (including lipectomy); leg

790.00

15834

Excision, excessive skin and subcutaneous tissue (including lipectomy); hip

844.00

15835

Excision, excessive skin and subcutaneous tissue (including lipectomy); buttock

873.00

15836

Excision, excessive skin and subcutaneous tissue (including lipectomy); arm

716.00

15837

Excision, excessive skin and subcutaneous tissue (including lipectomy); forearm or hand

678.00

15838

Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad

610.00

15839

Excision, excessive skin and subcutaneous tissue (including lipectomy); other area

538.00

15840

Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)

1369.00

15841

Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

1873.00

15842

Graft for facial nerve paralysis; free muscle graft by microsurgical technique

3078.00

15845

Graft for facial nerve paralysis; regional muscle transfer

1368.00

15850

Removal of sutures under anesthesia, same surgeon

48.00

15851

Removal of sutures under anesthesia (other than local), other surgeon

48.00

15852

Dressing change (for other than burns) under anesthesia (other than local)

55.00

15860

Intravenous injection of agent (e.g., fluorescein) to test blood flow in flap or graft

162.00

15876

Suction assisted lipectomy; head and neck

315.00

15877

Suction assisted lipectomy; trunk

563.00

15878

Suction assisted lipectomy; upper extremity

315.00

15879

Suction assisted lipectomy; lower extremity

563.00

15920

Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture

498.00

15922

Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure

743.00

15931

Excision, sacral pressure ulcer, with primary suture

528.00

15933

Excision, sacral pressure ulcer, with primary suture; with ostectomy

819.00

15934

Excision, sacral pressure ulcer, with skin flap closure

927.00

15935

Excision, sacral pressure ulcer, with skin flap closure; with ostectomy

1209.00

15936

Excision, sacral pressure ulcer, with muscle or myocutaneous flap closure

1075.00

15937

Excision, sacral pressure ulcer, with muscle or myocutaneous flap closure; with ostectomy

1325.00

15940

Excision, ischial pressure ulcer, with primary suture

567.00

15941

Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)

846.00

15944

Excision, ischial pressure ulcer, with skin flap closure

967.00

15945

Excision, ischial pressure ulcer, with skin flap closure; with ostectomy

1117.00

15946

Excision, ischial pressure ulcer, with ostectomy, with muscle or myocutaneous flap closure

1805.00

15950

Excision, trochanteric pressure ulcer, with primary suture

473.00

15951

Excision, trochanteric pressure ulcer, with primary suture; with ostectomy

856.00

15952

Excision, trochanteric pressure ulcer, with skin flap closure

850.00

15953

Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy

1017.00

15956

Excision, trochanteric pressure ulcer, with muscle or myocutaneous flap closure

1569.00

15958

Excision, trochanteric pressure ulcer, with muscle or myocutaneous flap closure; with ostectomy

1611.00

16000

Initial treatment, first degree burn, when no more than local treatment is required

51.00

16010

Dressings and/or debridement, initial or subsequent; under anesthesia, small

49.00

16015

Dressings and/or debridement, initial or subsequent; under anesthesia, medium or large, or with major debridement

217.00

16020

Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small

47.00

16025

Dressings and/or debridement, initial or subsequent; without anesthesia, medium (e.g., whole face or whole extremity)

107.00

16030

Dressings and/or debridement, initial or subsequent; without anesthesia, large (e.g., more than one extremity)

122.00

16035

Escharotomy

307.00

16040

Excision burn wound, without skin grafting, employing alloplastic dressing (e.g., synthetic mesh), any anatomic site; up to one percent total body surface area

190.00

16041

Excision burn wound, without skin grafting, employing alloplastic dressing (e.g., synthetic mesh), any anatomic site; greater than one percent and up to nine percent total body surface area

291.00

16042

Excision burn wound, without skin grafting, employing alloplastic dressing (e.g., synthetic mesh), any anatomic site; each additional nine percent total body surface area, or part thereof

269.00

17000

Destruction by any method, including laser, with or without surgical curettement, all benign facial lesions or premalignant lesions in any location, or benign lesions other than cutaneous vascular proliferative lesions, including local anesthesia; one lesion

50.00

17001

Destruction by any method, including laser, with or without surgical curettement, all benign facial lesions or premalignant lesions in any location, or benign lesions other than cutaneous vascular proliferative lesions, including local anesthesia; second and third lesions, each

18.00

17002

Destruction by any method, including laser, with or without surgical curettement, all benign facial lesions or premalignant lesions in any location, or benign lesions other than cutaneous vascular proliferative lesions, including local anesthesia; over three lesions, each additional lesion

14.00

17010

Destruction by any method, including laser, with or without surgical curettement, all benign facial lesions or premalignant lesions in any location, or benign lesions other than cutaneous vascular proliferative lesions, including local anesthesia; complicated lesion(s)

70.00

17100

Destruction by any method, including laser, of benign skin lesions other than cutaneous vascular proliferative lesions on any area other than the face, including local anesthesia; one lesion

42.00

17101

Destruction by any method, including laser, of benign skin lesions other than cutaneous vascular proliferative lesions on any area other than the face, including local anesthesia; second lesion

14.00

17102

Destruction by any method, including laser, of benign skin lesions other than cutaneous vascular proliferative lesions on any area other than the face, including local anesthesia; over two lesions, each additional lesion up to 15 lesions

9.00

17104

Destruction by any method, including laser, of benign skin lesions other than cutaneous vascular proliferative lesions on any area other than the face, including local anesthesia; 15 or more lesions

95.00

17105

Destruction by any method, including laser, of benign skin lesions other than cutaneous vascular proliferative lesions on any area other than the face, including local anesthesia; complicated or extensive lesions

50.00

17106

Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq cm

302.00

17107

Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); 10.0 - 50.0 sq cm

598.00

17108

Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); over 50.0 sq cm

1052.00

17110

Destruction by any method of flat (plane, juvenile) warts or molluscum contagiosum, milia, up to 15 lesions

45.00

17200

Electrosurgical destruction of multiple fibrocutaneous tags; up to 15 lesions

47.00

17201

Electrosurgical destruction of multiple fibrocutaneous tags; each additional ten lesions

24.00

17250

Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)

40.00

17260

Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.5 cm or less

95.00

17261

Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm

120.00

17262

Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm

160.00

17263

Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 2.1 to 3.0 cm

191.00

17264

Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 3.1 to 4.0 cm

216.00

17266

Destruction, malignant lesion any method, trunk, arms or legs; lesion diameter over 4.0 cm

268.00

17270

Destruction, malignant lesion any method, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less

124.00

17271

Destruction malignant lesion any method, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

153.00

17272

Destruction, malignant lesion any method, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm

187.00

17273

Destruction malignant lesion any method, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm

220.00

17274

Destruction malignant lesion any method, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm

276.00

17276

Destruction malignant lesion any method, scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm

322.00

17280

Destruction malignant lesion any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less

133.00

17281

Destruction, malignant lesion any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

179.00

17282

Destruction, malignant lesion any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm

218.00

17283

Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm

267.00

17284

Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm

319.00

17286

Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm

424.00

17304

Chemosurgery (mohs’ micrographic technique); first stage, fresh tissue technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, and microscopic examination of specimens by the surgeon, of up to 5 specimens

542.00

17305

Chemosurgery (mohs’ micrographic technique); second stage, fixed or fresh tissue, up to 5 specimens

240.00

17306

Chemosurgery (mohs’ micrographic technique); third stage, fixed or fresh tissue, up to 5 specimens

198.00

17307

Chemosurgery (mohs’ micrographic technique); additional stage(s), up to 5 specimens, each stage

202.00

17310

Chemosurgery (mohs’ micrographic technique); more than 5 specimens, fixed or fresh tissue, any stage

50.00

17340

Cryotherapy (CO2 slush, liquid N2) for acne

47.00

17360

Chemical exfoliation for acne (e.g., acne paste, acid)

77.00

17380

Electrolysis epilation, each 1/2 hour

90.00

19000

Puncture aspiration of cyst of breast

59.00

19001

Puncture aspiration of cyst of breast; each additional cyst

32.00

19020

Incision of breast lesion

230.00

19030

Injection of breast x-ray

94.00

19100

Biopsy of breast

93.00

19101

Biopsy of breast

269.00

19110

Nipple exploration

324.00

19112

Excise breast duct fistula

283.00

19120

Excision of cyst, fibroadenoma, or other benign or malignant tumor aberrant breast tissue, duct lesion, nipple or areolar lesion, male or female, one or more lesions

426.00

19125

Excision of breast lesion

426.00

19126

Excision, additional breast lesion

213.00

19140

Removal of breast tissue

459.00

19160

Removal of breast tissue

531.00

19162

Removal of breast tissue, node

1098.00

19180

Mastectomy, simple, complete

679.00

19182

Mastectomy, subcutaneous

665.00

19200

Mastectomy, radical, including pectoral muscles, axillary lymph nodes

1210.00

19220

Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (urban type operation)

1244.00

19240

Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

1189.00

19260

Excision of chest wall tumor including ribs

910.00

19271

Excision of chest wall tumor involving ribs, with plastic reconstruction; w/out mediastinal lymphadenectomy

1538.00

19272

Excision of chest wall tumor involving ribs, with plastic reconstruction; with mediastinal lymphadenectomy

1576.00

19290

Preoperative placement of needle localization wire, breast

80.00

20000

Incision of soft tissue abscess (e.g., secondary to osteomyelitis); superficial

126.00

20005

Incision of soft tissue abscess (e.g., secondary to osteomyelitis); deep or complicated

233.00

20100

Exploration of penetrating wour (separate procedure); neck

703.00

20200

Biopsy, muscle; superficial

126.00

20205

Biopsy, muscle; deep

207.00

20206

Biopsy, muscle, percutaneous needle

95.00

20220

Biopsy, bone, trocar or needle; superficial (eg, ilium, sternum, spinous process, ribs)

108.00

20225

Biopsy, bone, trocar or needle; deep (vertebral body, femur)

184.00

20240

Biopsy, excisional; superficial (e.g., ilium, sternum, spinous process, ribs, trochanter of femur)

233.00

20245

Biopsy, excisional; deep (e.g., humerus, ischium, femur)

350.00

20250

Biopsy, vertebral body, open; thoracic

476.00

20251

Biopsy, vertebral body, open; lumbar or cervical

542.00

20500

Injection of sinus tract; therapeutic (separate procedure)

64.00

20501

Injection of sinus tract; diagnostic

49.00

20520

Removal of foreign body in muscle or tendon sheath; simple

118.00

20525

Removal of foreign body in muscle or tendon sheath; deep or complicated

263.00

20550

Injection, tendon sheath, ligament, trigger points or ganglion cyst or ganglion cyst

52.00

20600

Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst (e.g., fingers, toes)

54.00

20605

Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)

54.00

20610

Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa)

52.00

20615

Aspiration and injection for treatment of bone cyst

112.00

20650

Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)

149.00

20661

Application of head brace

398.00

20662

Application of pelvis brace

595.00

20663

Application of thigh brace

468.00

20665

Removal of fixation device

83.00

20670

Removal of support implant

116.00

20680

Removal of support implant

323.00

20900

Bone graft, any donor area; minor or small (e.g., dowel or button)

377.00

20902

Bone graft, any donor area; major or large

569.00

20920

Fascia lata graft; by stripper

423.00

20922

Fascia lata graft; by incision and area exposure, complex or sheet

507.00

20924

Tendon graft, from a distance (e.g., palmaris, toe extensor, plantaris)

562.00

21120

Genioplasty; augmentation (autograft, allograft, prosthetic material)

398.00

21121

Genioplasty; sliding osteotomy, single piece

626.00

21122

Genioplasty; sliding osteotomies, two or more osteotomies (e.g., wedge excision or bone wedge reversal for asymmetrical chin)

690.00

21123

Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)

902.00

21193

Reconstruction of mandibular ramus, horizontal, vertical, “C,” or “L” osteotomy; without bone graft

1364.00

21194

Reconstruction of mandibular ramus, horizontal, vertical, “C,” or “L” osteotomy; with bone graft (includes obtaining graft)

1581.00

21195

Reconstruction of mandibular ramus, sagittal split; without internal rigid fixation

1368.00

21196

Reconstruction of mandibular ramus, sagittal split; with internal rigid fixation

1508.00

21198

Osteotomy, mandible, segmental

1361.00

21206

Osteotomy, maxilla, segmental (e.g., wassmund or schuchard)

1123.00

21208

Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)

996.00

21209

Osteoplasty, facial bones; reduction

529.00

21210

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

1051.00

21325

Open treatment of nasal fracture; uncomplicated

370.00

21343

Open treatment of depressed frontal sinus fracture

1017.00

21344

Open treatment of complicated (e.g., comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches

1305.00

21345

Closed treatment of nasomaxillary comples fracture (Lefort II type), with interdental wire fixation or fixation of denture or splint

743.00

21346

Open treatment of nasomaxillary complex fracture (Lefort II type); with wiring and/or local fixation

926.00

21347

Open treatment of nasomaxillary complex fracture (Lefort II type); requiring multiple open approaches

1073.00

21348

Open treatment of nasomaxillary complex fracture (Lefort II type); with bone grafting (includes obtaining graft)

1327.00

21355

Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation

239.00

21356

Open treatment of depressed zygomatic arch fracture (e.g., gilles approach)

509.00

21360

Open treatment of depressed malar fracture, including zygomatic arch and malar tripod

647.00

21366

Open treatment of complicated (e.g., comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)

1413.00

21431

Closed treatment of craniofacial separation (Lefort III type) using interdental wire fixation of denture or splint

606.00

21432

Open treatment of craniofacial separation (Lefort III type); with wiring and/or internal fixation

712.00

21433

Open treatment of craniofacial separation (Lefort III type); complicated (e.g., comminuted or involving cranial nerve foramina), multiple surgical approaches

1990.00

21435

Open treatment of craniofacial separation (Lefort III type); complicated, utilizing internal and/or external fixation techniques (e.g., head cap, halo device, and/or intermaxillary fixation)

1422.00

21436

Open treatment of craniofacial separation (Lefort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)

1953.00

21440

Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

267.00

21445

Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

533.00

21450

Closed treatment of mandibular fracture; without manipulation

267.00

21451

Closed treatment of mandibular fracture; with manipulation

551.00

21452

Percutaneous treatment of mandibular fracture, with external fixation

155.00

21453

Closed treatment of mandibular fracture with interdental fixation

563.00

21454

Open treatment of mandibular fracture with external fixation

909.00

21461

Open treatment of mandibular fracture; without interdental fixation

922.00

21462

Open treatment of mandibular fracture; with interdental fixation

1040.00

21465

Open treatment of mandibular condylar fracture

935.00

21470

Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints

1504.00

21480

Closed treatment of temporomandibular dislocation; initial or subsequent

75.00

21485

Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent

278.00

21490

Open treatment of temporomandibular dislocation

815.00

21493

Treat hyoid bone fracture

129.00

21494

Repair hyoid bone fracture

638.00

21495

Repair hyoid bone fracture

485.00

21501

Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax

255.00

21502

Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomy

519.00

21510

Incision, deep, with opening of bone cortex (e.g., for osteomyelitis or bone abscess), thorax

426.00

21550

Biopsy, soft tissue of neck or thorax

135.00

21555

Excision tumor, soft tissue of neck or thorax; subcutaneous

270.00

21556

Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular

442.00

21557

Radical resection of tumor (e.g., malignant neoplasm), soft tissue of neck or thorax

841.00

21600

Excision of rib, partial

530.00

21610

Costotransversectomy (separate procedure)

659.00

21800

Treatment of rib fracture

80.00

21805

Treatment of rib fracture

188.00

21820

Treatment of sternum fracture

124.00

21920

Biopsy, soft tissue of back or flank; superficial

132.00

21925

Biopsy, soft tissue of back or flank; deep

296.00

21930

Excision, tumor, soft tissue of back or flank

444.00

21935

Radical resection of tumor (e.g., malignant neoplasm), soft tissue of back or flank

1138.00

22305

Closed treatment of vertebral process fracture(s)

212.00

22310

Closed treatment of vertebral body fracture(s), without manipulation

292.00

22315

Closed treatment of vertebral fracture and/or dislocation requiring casting or bracing, with or without anesthesia, by manipulation or traction, each

670.00

22325

Open treatment of vertebral fracture and/or dislocation; lumbar, each

1221.00

22326

Open treatment of vertebral fracture and/or dislocation; cervical, each

1688.00

22327

Open treatment of vertebral fracture and/or dislocation; thoracic, each

1632.00

22505

Manipulation of spine

148.00

22600

Arthrodesis, posterior technique, cervical below c2 segment, local bone or bone allograft and/or internal fixation

1854.00

22610

Arthrodesis, posterior or posterolateral technique, with local bone or bone allograft and/or internal fixation; thoracic

1626.00

22612

Arthrodesis, posterior or posterolateral technique, with local bone or bone allograft and/or internal fixation; lumbar

2027.00

22625

Arthrodesis, lateral transverse process technique, with local bone or bone allograft and/or internal wire fixation, lumbar

2066.00

22630

Arthrodesis, posterior interbody technique with local bone or bone allograft and/or internal wire fixation, lumbar

1935.00

22650

Arthrodesis, posterior, posterolateral or lateral transverse process technique, each additional interspace

592.00

22900

Excision, abdominal wall tumor, subfascial (e.g., desmoid)

464.00

23000

Removal of subdeltoid (or intratendinous) calcareous deposits, open method

357.00

23030

Incision and drainage, shoulder area; deep abscess or hematoma

258.00

23031

Incision and drainage, shoulder area; infected bursa

148.00

23035

Incision, deep, with opening of cortex (e.g., for osteomyelitis or bone abscess), shoulder area

685.00

23040

Arthrotomy, glenohumeral joint, for infection, with exploration, drainage or removal of foreign body

870.00

23044

Arthrotomy, acromioclavicular, sternoclavicular joint, for infection, with exploration, drainage or removal of foreign body

659.00

23065

Biopsy, soft tissue of shoulder area; superficial

136.00

23066

Biopsy, soft tissue of shoulder area; deep

240.00

23075

Excision, tumor, shoulder area; subcutaneous

196.00

23076

Excision, tumor, shoulder area; deep, subfascial or intramuscular

515.00

23077

Radical resection of tumor (e.g., malignant neoplasm), soft tissue of shoulder area

1065.00

23100

Arthrotomy for biopsy, glenohumeral joint

641.00

23101

Arthrotomy for biopsy or for excision of torn cartilage, acromioclavicular, sternoclavicular joint

602.00

23105

Arthrotomy for synovectomy; glenohumeral joint

882.00

23106

Arthrotomy for synovectomy; sternoclavicular joint

505.00

23107

Arthrotomy, glenqhumeral joint, with joint exploration, with or without removal of loose or foreign body

879.00

23120

Claviculectomy; partial

546.00

23125

Claviculectomy; total

849.00

23130

Acromioplasty or acromionectomy, partial

696.00

23140

Excision or curettage of bone cyst or benign tumor of clavicle or scapula

515.00

23145

Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft)

819.00

23146

Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with allograft

618.00

23150

Excision or curettage of bone cyst or benign tumor of proximal humerus; tumor of proximal humerus

703.00

23155

Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft) with autograft (includes obtaining graft)

899.00

23156

Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft

768.00

23170

Sequestrectomy (e.g., for osteomyelitis or bone abscess), clavicle

540.00

23172

Sequestrectomy (e.g., for osteomyelitis or bone abscess), scapula

552.00

23174

Sequestrectomy (e.g., for osteomyelitis or bone abscess), humeral head to surgical neck

841.00

23180

Partial excision (craterization, saucerization, or diaphysectomy) of bone (e.g., for osteomyelitis), clavicle

582.00

23182

Partial excision (craterization, saucerization, or diaphysectomy) of bone (e.g., for osteomyelitis), scapula

689.00

23184

Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis), proximal humerus

861.00

23190

Ostectomy of scapula, partial (e.g., superior medial angle)

630.00

23195

Resection humeral head

881.00

23330

Removal of foreign body, shoulder; subcutaneous

110.00

23331

Removal of foreign body, shoulder; deep (e.g., neer prosthesis removal)

434.00

23332

Removal of foreign body, shoulder; complicated, including “total shoulder”

996.00

23350

Injection procedure for shoulder arthrography

64.00

23395

Muscle transfer, any type for paralysis of shoulder or upper arm; single

1155.00

23397

Muscle transfer, any type for paralysis of shoulder or upper arm; multiple

1436.00

23400

Scapulopexy (e.g., sprengel’s deformity or for paralysis)

1114.00

23405

Tenomyotomy, shoulder area; single

748.00

23406

Tenomyotomy, shoulder area; multiple through same incision

970.00

23410

Repair of ruptured supraspinatus tendon (rotator cuff) or musculotendinous cuff; acute

1119.00

23412

Repair of ruptured supraspinatus tendon (rotator cuff) or musculotendinous cuff; chronic

1284.00

23415

Coracoacromial ligament release, with or without acromioplasty

707.00

23420

Repair of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)

1348.00

23430

Tenodesis for rupture of long tendon of biceps

823.00

23440

Resection or transplantation of long tendon of biceps, for chronic tenosynovitis

838.00

23450

Capsulorrhaphy for recurrent dislocation, anterior; putti-platt procedure or magnuson type operation

1257.00

23455

Capsulorrhaphy for recurrent dislocation, anterior; bankart type operation with or without stapling

1450.00

23460

Capsulorrhaphy for recurrent dislocation anterior, any type; with bone block

1409.00

23462

Capsulorrhaphy for recurrent dislocation, anterior, any type; with coracoid process transfer

1467.00

23465

Capsulorrhaphy for recurrent dislocation posterior, with or without bone block

1436.00

23466

Capsulorrhaphy for recurrent dislocation with any type multi-directional instability

1494.00

23470

Arthroplasty with proximal humeral implant (e.g., neer type operation)

1617.00

23480

Osteotomy, clavicle, with or without internal fixation

827.00

23485

Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation)

1179.00

23490

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle

1005.00

23491

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal humerus and humeral head

1294.00

23500

Closed treatment of clavicular fracture; without manipulation

173.00

23505

Closed treatment of clavicular fracture; with manipulation

295.00

23515

Open treatment of clavicular fracture, with or without internal or external fixation

685.00

23520

Closed treatment of sternoclavicular dislocation; without manipulation

164.00

23525

Closed treatment of sternoclavicular dislocation; with manipulation

257.00

23530

Open treatment of sternoclavicular dislocation, acute or chronic

660.00

23532

Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

728.00

23540

Closed treatment of acromioclavlcular dislocation; without manipulation

175.00

23545

Closed treatment of acromioclavlcular dislocation; with manipulation

243.00

23550

Open treatment of acromioclavlcular dislocation, acute or chronic

756.00

23552

Open treatment of acromioclavlcular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

741.00

23570

Closed treatment of scapular fracture; without manipulation

184.00

23575

Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement)

321.00

23585

Open treatment of scapular fracture (body, glenoid or acromion) with or without internal fixation

792.00

23600

Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation

276.00

23605

Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction

459.00

23610

Treatment of open humeral (surgical or anatomical neck) fracture, with uncomplicated soft tissue closure

535.00

23615

Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or without internal or external fixation, with or without repair of tuberosity(-ies);

950.00

23616

Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or without internal or external fixation, with or without repair of tuberosity(-ies); with proximal humeral prosthetic replacement

2081.00

23620

Closed treatment of greater tuberosity fracture; without manipulation

256.00

23625

Closed treatment of greater tuberosity fracture; with manipulation

367.00

23630

Open treatment of greater tuberosity fracture, with or without internal or external fixation

779.00

23650

Closed treatment of shoulder with manipulation; without anesthesia

254.00

23655

Closed treatment of shoulder dislocation with manipulation; requiring anesthesia

347.00

23660

Open treatment of acute shoulder dislocation

799.00

23665

Closed treatment of shoulder dislocation, with fracture of greater tuberosity, with manipulation

365.00

23670

Open treatment of shoulder dislocation, with fracture of greater tuberosity, with or without internal or external fixation

893.00

23675

Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation open treatment of shoulder

461.00

23680

Dislocation, with surgical or anatomical neck fracture, with or without internal or external fixation

1084.00

23700

Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)

223.00

23800

With or without local bone graft

1470.00

23802

Arthrodesis, shoulder joint; with primary autogenous graft (includes obtaining graft)

1409.00

23920

Disarticulation of shoulder;

1364.00

23930

Incision and drainage, upper arm or elbow area; deep abscess or hematoma

211.00

23931

Incision and drainage, upper arm or elbow area; infected bursa

113.00

23935

Incision, deep, with opening of bone cortex (e.g., for osteomyelitis or bone abscess), humerus or elbow

502.00

24000

Arthrotomy, elbow, for infection, with exploration, drainage or removal of foreign body

671.00

24006

Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)

774.00

24065

Biopsy, soft tissue of upper arm or elbow area; superficial

133.00

24066

Biopsy arm/elbow lesion

278.00

24075

Excision, tumor, upper arm or elbow area; subcutaneous

278.00

24076

Remove arm/elbow lesion

472.00

24077

Remove tumor of arm elbow

1039.00

24100

Arthrotomy, elbow; for synovial biopsy only

437.00

24101

Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign body

689.00

24102

Arthrotomy, elbow; for synovectomy

892.00

24105

Excision, olecranon bursa

356.00

24110

Excision or curettage of bone cyst or benign tumor, humerus; tumor, humerus

728.00

24115

Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft)

814.00

24116

Excision or curettage of bone cyst or benign tumor, humerus; with allograft

1016.00

24120

Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process

608.00

24125

Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft)

628.00

24126

Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with allograft

745.00

24130

Excision, radial head

626.00

24134

Sequestrectomy (e.g., for osteomyelitis or bone abscess), shaft or distal humerus

860.00

24136

Sequestrectomy (e.g., for osteomyelitis or bone abscess), radial head or neck

775.00

24138

Sequestrectomy (e.g., for osteomyelitis or bone abscess), olecranon process

674.00

24140

Partial excision (craterization, saucerization or diaphysectomy) of bone (e.g., for osteomyelitis), humerus

855.00

24145

Partial excision (craterization, saucerization or diaphysectomy) of bone (eg, for osteomyelitis), radial head or neck

661.00

24147

Partial excision (craterization, saucerization or diaphysectomy) of bone (e.g., for osteomyelitis), olecranon process

668.00

24150

Radical resection for tumor, shaft or distal humerus

1308.00

24151

Radical resection for tumor, shaft or distal humerus; with autograft (includes obtaining graft)

1391.00

24152

Radical resection for tumor, radial head or neck

795.00

24153

Radical resection for tumor, radial head or neck; with autograft (includes obtaining graft)

1052.00

24155

Resection of elbow joint (arthrectomy)

1073.00

24160

Implant removal; elbow joint

594.00

24164

Implant removal; radial head

556.00

24200

Removal of arm foreign body

71.00

24201

Removal of arm foreign body

357.00

24220

Injection for elbow x-ray

85.00

24305

Tendon lengthening, upper arm or elbow, single, each

479.00

24310

Tenotomy, open, elbow to shoulder, single, each

416.00

24320

Repair of arm tendon

932.00

24330

Revision of arm muscles

881.00

24340

Tenodesis for rupture of biceps tendon at elbow

715.00

24342

Reinsertion or repair of ruptured or lacerated biceps or triceps tendon, distal, with or without tendon graft

1013.00

24350

Fasciotomy, lateral or medial (e.g., “tennis elbow” or epicondylitis)

454.00

24351

Fasciotomy, lateral or medial (e.g., “tennis elbow” or epicondylitis); with extensor origin detachment

502.00

24352

Fasciotomy, lateral or medial (e.g., “tennis elbow” or epicondylitis); with annular ligament resection

581.00

24354

Fasciotomy, lateral or medial (e.g., “tennis elbow” or epicondylitis); with stripping

580.00

24356

Fasciotomy, lateral or medial (e.g., “tennis elbow” or epicondylitis); with partial ostectomy

675.00

24365

Athroplasty, radial head

757.00

24366

Arthroplasty, radial head; with implant

979.00

24400

Osteotomy, humerus, with or without internal fixation

926.00

24410

Multiple osteotomies with realignment on intramedullary rod, humeral shaft (Sofield type procedure)

1382.00

24420

Osteoplasty, humerus (e.g., shortening or lengthening) (excluding 64876)

1238.00

24430

Repair of nonunion or malunion, humerus; without graft (e.g., compression technique)

1332.00

24435

Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft)

1427.00

24470

Hemiepiphyseal arrest (e.g., for cubitus varus or valgus, distal humerus)

798.00

24495

Decompression fasciotomy, forearm with brachial artery exploration artery exploration

657.00

24498

Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humerus

1060.00

24500

Closed treatment of humeral shaft fracture; without manipulation

269.00

24505

Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction

457.00

24515

Open treatment of humeral shaft fracture with plate/screws, with or without cerclage

1006.00

24516

Open treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws

1006.00

24530

Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation

293.00

24535

Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction

552.00

24538

Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension

823.00

24545

Open treatment of humeral supracondylar or transcondylar fracture, with or without internal or external fixation; without intercondylar extension

965.00

24546

Open treatment of humeral supracondylar or transcondylar fracture, with or without internal or external fixation; with intercondylar extension

1193.00

24560

Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation

231.00

24565

Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation

419.00

24566

Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation

646.00

24575

Open treatment of humeral epicondylar fracture, medial or lateral, with or without internal or external fixation

862.00

24576

Closed treatment of humeral condylar fracture, medial or lateral; without manipulation

234.00

24577

Closed treatment of humeral condylar fracture, medial or lateral; with manipulation

458.00

24579

Open treatment of humeral condylar fracture, medial or lateral, with or without internal or external fixation

936.00

24582

Percutaneous skeletal fixation of humeral condylar fracture, medical or lateral, with manipulation

706.00

24586

Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius)

1431.00

24600

Treatment of closed elbow dislocation; without anesthesia

286.00

24605

Treatment of closed elbow dislocation; requiring anesthesia

352.00

24615

Open treatment of acute or chronic elbow dislocation

889.00

24620

Closed treatment of monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation

499.00

24635

Open treatment of monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with or without internal or external fixation

1149.00

24640

Closed treatment of radial head subluxation in child, “nursemaid elbow,” with manipulation

90.00

24650

Closed treatment of radial head or neck fracture; without manipulation

209.00

24655

Closed treatment of radial head or neck fracture; with manipulation

347.00

24665

Open treatment of radial head or neck fracture, with or without internal fixation or radial head excision

726.00

24666

Open treatment of radial head or neck fracture, with or without internal fixation or radial head excision; with radial head prosthetic replacement

944.00

24670

Closed treatment of ulnar fracture, proximal end (olecranon process); without manipulation

210.00

24675

Closed treatment of ulnar fracture, proximal end (olecranon process); with manipulation

390.00

24685

Open treatment of ulnar fracture proximal end (olecranon process), with or without internal or external fixation

822.00

24800

Arthrodesis, elbow joint; with or without local autograft or allograft

1042.00

24802

Arthrodesis, elbow joint; with autograft (includes obtaining graft other than locally obtained)

1227.00

24900

Amputation, arm through humerus; with primary closure

812.00

24920

Amputation, arm through humerus; open, circular (guillotine)

758.00

24925

Amputation, arm through humerus; secondary closure or scar revision

620.00

24930

Amputation, arm through humerus; re-amputation

852.00

24931

Amputation, arm through humerus; with implant

1125.00

24935

Stump elongation, upper extremity

1379.00

25000

Tendon sheath incision; at radial styloid for Dequervain’s disease

351.00

25005

Tendon sheath incision; at wrist for other stenosing tenosynovitis

370.00

25020

Decompression fasciotomy, forearm and/or wrist; flexor or extensor compartment

486.00

25023

Decompression fasciotomy, forearm and/or wrist; with debridement of nonviable muscle and/or nerve

827.00

25028

Incision and drainage, forearm and/or wrist; deep abscess or hematoma

332.00

25031

Incision and drainage, forearm and/or wrist; infected bursa

212.00

25035

Incision, deep, with opening of bone cortex (e.g., for osteomyelitis or bone abscess), forearm and/or wrist

644.00

25040

Arthrotomy, radiocarpal or mediocarpal joint, for infection, with exploration, drain age, or removal of foreign body

600.00

25065

Biopsy, soft tissue of forearm and/or wrist; superficial

147.00

25066

Biopsy, soft tissue of forearm and/or wrist; deep

256.00

25075

Excision, tumor, forearm and/or wrist area; subcutaneous

280.00

25076

Removal of forearm lesion

419.00

25077

Removal tumor, forarm/wrist

882.00

25085

Capsulotomy, wrist (e.g., for contracture)

476.00

25100

Arthrotomy, wrist joint; for biopsy

416.00

25101

Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body

501.00

25105

Removal of wrist joint lining

630.00

25107

Remove wrist joint cartilage

549.00

25110

Excision, lesion of tendon sheath, forearm and/or wrist

321.00

25111

Excision of ganglion, wrist (dorsal or volar); primary

320.00

25112

Excision of ganglion, wrist (dorsal or volar); recurrent

399.00

25115

Radical excision of bursa, synovla of wrist, or forearm tendon sheaths (e.g., tenosynovitis, fungus, tbc, or other granulomas, rheumatoid arthritis); flexors

666.00

25116

Radical excision of bursa, synovla of wrist, or forearm tendon sheaths (e.g., tenosynovitis, fungus, tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum

728.00

25118

Synovectomy, extensor tendon sheath, wrist, single compartment

490.00

25119

Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulna with resection of distal ulna

653.00

25120

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process)

608.00

25125

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft)

680.00

25126

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograft

685.00

25130

Excision or curettage of bone cyst or benign tumor of carpal bones; tumor of carpal bones

454.00

25135

Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)

592.00

25136

Remove & graft wrist lesion

513.00

25145

Sequestrectomy (e.g., for osteomyelitis or bone abscess), forearm and/or wrist

577.00

25150

Partial excision (craterization, saucerization or diaphysectomy) of bone (e.g., for osteomyelitis); ulna

653.00

25151

Partial excision (craterization, saucerization or diaphysectomy) of bone (e.g., for osteomyelitis); radius

620.00

25210

Removal of wrist bone

511.00

25215

Carpectomy; all bones of proximal row

797.00

25230

Radial styloidectomy (separate procedure)

513.00

25240

Excision distal ulna (darrach type procedure)

504.00

25246

Injection procedure for wrist arthrography

81.00

25248

Exploration for removal of deep foreign body, forearm or wrist

342.00

25250

Removal of wrist prosthesis; (separate procedure)

585.00

25260

Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle

579.00

25263

Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle

644.00

25265

Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle

860.00

25270

Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle

438.00

25272

Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle

489.00

25274

Repair, tendon or muscle, extensor, secondary, with tendon graft (includes obtaining graft), forearm and/or wrist, each tendon or muscle wrist, each tendon or muscle

736.00

25280

Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon

534.00

25290

Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon

360.00

25295

Release wrist/forearm tendon

447.00

25330

Arthroplasty, wrist

982.00

25331

Arthroplasty, wrist; with implant

1350.00

25332

Revise wrist joint

1020.00

25350

Osteotomy, radius; distal third

778.00

25355

Osteotomy, radius; middle or proximal third

918.00

25360

Osteotomy; ulna

695.00

25365

Osteotomy; radius and ulna

1070.00

25370

Multiple osteotomies, with realignment on intramedullary rod (sofield type procedure); radius or ulna

1184.00

25375

Multiple osteotomies, with realignment on intramedullary rod (sofield type procedure); radius and ulna

1207.00

25400

Repair of nonunion or malunion, radius or ulna; without graft (e.g., compression technique)

1,039.00

25405

Repair of nonunion or malunion, radius or ulna; with iliac or other autograft (includes obtaining graft)

1,270.00

25415

Repair of nonunion or malunion, radius and ulna; without graft (e.g., compression technique)

1,182.00

25420

Repair of nonunion or malunion, radius and ulna; with iliac or other autograft (includes obtaining graft)

1,471.00

25425

Repair of defect with autograft; radius or ulna

1198.00

25426

Repair of defect with autograft; radius and ulna

1309.00

25440

Repair of nonunion, scaphoid (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)

933.00

25443

Arthroplasty with prosthetic replacement; scaphoid (navicular)

945.00

25444

Arthroplasty with prosthetic replacement; lunate

1,021.00

25445

Arthroplasty with prosthetic replacement; trapezium

972.00

25446

Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (“total wrist”)

1,769.00

25447

Interposition arthroplasty, intercarpal or carpometacarpal joints distal radius and ulna

1022.00

25490

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius

875.00

25491

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna

916.00

25492

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius and ulna

1128.00

25500

Closed treatment of radial shaft fracture; without manipulation

224.00

25505

Closed treatment of radial shaft fracture; with manipulation

412.00

25515

Open treatment of radial shaft fracture, with or without internal or external fixation

795.00

25520

Closed treatment of radial shaft fracture, with dislocation of distal radio-ulnar joint (galeazzi fracture/dislocation)

577.00

25525

Open treatment of radial shaft fracture, with internal and/or external fixation and closed treatment of dislocation of distal radio-ulnar joint (galeazzi fracture/dislocation), with or without percutaneous skeletal fixation

1122.00

25526

Open treatment of radial shaft fractures, with internal and/or external fixation and open treatment, with or without internal or external fixation of distal radio-ulnar joint (galeazzi fracture/dislocation), includes repair of triangular cartilage

1193.00

25530

Closed treatment of ulnar shaft fracture; without manipulation

215.00

25535

Closed treatment of ulnar shaft fracture; with manipulation

410.00

25545

Open treatment of ulnar shaft fracture, with or without internal or external fixation

779.00

25560

Closed treatment of radial and ulnar shaft fractures; without manipulation

220.00

25565

Closed treatment of radial and ulnar shaft fractures; with manipulation

485.00

25574

Open treatment of radial and ulnar shaft fractures, with internal or external fixation; of radius or ulna

787.00

25575

Open treatment of radial and ulnar shaft fractures, with internal or external fixation; of radius and ulna

997.00

25600

Closed treatment of distal radial fracture (eg, colles or smith type) or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation

261.00

25605

Closed treatment of distal radial fracture (e.g., colles or smith type) or epiphyseal separation, with or without fracture of ulnar styloid; with manipulation

451.00

25611

Percutaneous skeletal fixation of distal radial fracture (eg, colles or smith type) or epiphyseal separation, with or without fracture of ulnar styloid, requiring manipulation, with or without external fixation

641.00

25620

Open treatment of distal radial (e.g., colles or smith type) or epiphyseal separation, with or without fracture of ulnar styloid, with or without internal or external fixation

747.00

25622

Closed treatment of carpal scaphoid (navicular) fracture; without manipulation

230.00

25624

Closed treatment of carpal scaphoid (navicular) fracture; with manipulation

388.00

25628

Open treatment of carpal scaphoid (navicular) fracture, with or without internal or external fixation

733.00

25630

Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular)); without manipulation, each bone

237.00

25635

Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular)); with manipulation, each bone

365.00

25645

Open treatment of carpal bone fracture (excluding carpal scaphoid (navicular)), each bone

659.00

25650

Closed treatment of ulnar styloid fractures

268.00

25660

Closed treatment of radiocarpal or intercarpal dislocation, one or more bones, with manipulation soft tissue closure

301.00

25670

Open treatment of radiocarpal or intercarpal dislocation, one or more bones

715.00

25675

Closed treatment of distal radioulnar dislocation with manipulation

321.00

25676

Open treatment of distal radioulnar dislocation, acute or chronic

727.00

25680

Closed treatment of transscaphoperilunar type of fracture dislocation, with manipulation

383.00

25685

Open treatment of transscaphoperilunar type of fracture dislocation

886.00

25690

Closed treatment of lunate dislocation, with manipulation

491.00

25695

Open treatment of lunate dislocation

735.00

25800

Arthrodesis, wrist joint (including radiocarpal and/or ulnocarpal fusion); without bone graft

999.00

25805

Arthrodesis, wrist joint (including radiocarpal and/or ulnocarpal fusion); with sliding graft

1,161.00

25810

Arthrodesis, wrist joint (including radio carpal and/or ulnocarpal fusion); with iliac or other autograft (includes obtaining graft)

1,109.00

25825

Intercarpal fusion; with autograft (includes obtaining graft)

993.00

25900

Amputation, forearm, through radius and ulna

752.00

25905

Amputation, forearm, through radius and ulna; open, circular (guillotine)

758.00

25907

Amputation, forearm, through radius and ulna; secondary closure or scar revision

637.00

25909

Amputation, forearm, through radius and ulna; re-amputation

681.00

25915

Krukenberg procedure

735.00

25920

Disarticulation through wrist

741.00

25922

Disarticulation through wrist; secondary closure or scar revision

616.00

25924

Disarticulation through wrist; re-amputation

755.00

25927

Transmetacarpal amputation

718.00

25929

Transmetacarpal amputation; secondary closure or scar revision

584.00

25931

Transmetacarpal amputation; re-amputation

582.00

26010

Drainage of finger abscess; simple

82.00

26011

Drainage of finger abscess; complicated (e.g., felon)

178.00

26020

Drainage of tendon sheath, one digit and/or palm

380.00

26025

Drainage of palmar bursa; single, ulnar or radial

437.00

26030

Drainage of palmar bursa; multiple or complicated

549.00

26034

Incision, deep, with opening of bone cortex (e.g., for osteomyelitis or bone abscess), hand or finger

479.00

26035

Decompression fingers and/or hand, injection injury (eg, grease gun) injury (e.g., grease gun)

656.00

26037

Decompressive fasciotomy, hand (excludes 26035)

641.00

26040

Fasciotomy, palmar, for dupuytren’s contracture; closed (subcutaneous)

293.00

26045

Fasciotomy, palmar, for dupuytren’s contracture; open, partial

496.00

26055

Tendon sheath incision for trigger finger

292.00

26060

Tenotomy, subcutaneous, single, each digit

182.00

26070

Arthrotomy, for infection, with exploration, drainage or removal of foreign body; carpometacarpal joint

297.00

26075

Arthrotomy, for infection, with exploration, drainage or removal of foreign body; metacarpophalangeal joint

357.00

26080

Arthrotomy, for infection, with exploration, drainage or removal of foreign body; interphalangeal joint, each

338.00

26100

Arthrotomy for synovial biopsy; carpometacarpal joint

318.00

26105

Arthrotomy for synovial biopsy; metacarpophalangeal joint

383.00

26110

Arthrotomy for synovial biopsy; interphalangeal joint, each

311.00

26115

Excision, tumor or vascular malformation, hand or finger; subcutaneous

274.00

26116

Excision, tumor or vascular malformation, hand or finger; deep, subfascial, intramuscular

433.00

26117

Remove tumor, hand/finger

647.00

26130

Synovectomy, carpometacarpal joint

501.00

26135

Revise finger joint, each

562.00

26140

Revise finger joint, each

502.00

26145

Tendon excision, palm/finger

525.00

26160

Remove tendon sheath lesion

173.00

26170

Removal of palm tendon, each

359.00

26180

Removal of finger tendon

442.00

26200

Remove hand bone lesion

476.00

26205

Remove/graft bone lesion

667.00

26210

Excision or curettage of bone cyst or benign tumor of proximal, middle or distal phalanx of finger

433.00

26215

Excision or curettage of bone cyst or benign tumor of proximal, middle or distal phalanx of finger; with autograft (includes obtaining graft)

605.00

26230

Partial excision (craterization, saucerization, or diaphysectomy) of bone (e.g., for osteomyelitis); metacarpal

497.00

26235

Partial excision (craterization, saucerization, or diaphysectomy) of bone (e.g., for osteomyelitis); proximal or middle phalanx of finger

487.00

26236

Partial excision (craterization, saucerization, or diaphysectomy) of bone (e.g., for osteomyelitis); distal phalanx of finger

431.00

26260

Radical resection (ostectomy) for tumor, metacarpal

612.00

26320

Removal of implant from hand

357.00

26350

Repair finger/hand tendon

568.00

26352

Repair/graft hand tendon

680.00

26356

Flexor tendon repair or advancement, single, in “no man’s land”; primary, each tendon

705.00

26357

Flexor tendon repair or advancement, single, in “no man’s land”; secondary, each tendon

725.00

26358

Flexor tendon repair or advancement, single, in “no man’s land”; secondary with free graft (includes obtaining graft), each tendon

790.00

26370

Repair finger/hand tendon

662.00

26372

Repair/graft hand tendon

719.00

26410

Extensor tendon repair, dorsum of hand, single, primary or secondary; without free graft, each tendon

372.00

26412

Repair/graft hand tendon

587.00

26415

Excision, hand/finger tendon

476.00

26418

Extensor tendon repair, dorsum of finger, single, primary or secondary; without free graft, each tendon

373.00

26426

Extensor tendon repair, central slip repair, secondary (boutonniere deformity); using local tissues

603.00

26428

Extensor tendon repair, central slip repair, secondary (boutonniere deformity); with free graft (includes obtaining graft)

610.00

26432

Extensor tendon repair, distal insertion (“mallet finger”), closed, splinting with or without percutaneous pinning

342.00

26433

Extensor tendon repair, distal insertion (“mallet finger”), open, primary or secondary repair; without graft

410.00

26437

Extensor tendon realignment, hand

467.00

26440

Release palm/finger tendon

271.00

26445

Release hand/finger tendon

242.00

26450

Incision of palm tendon

281.00

26455

Incision of finger tendon

261.00

26460

Incise hand/finger tendon

243.00

26499

Revision of finger

533.00

26520

Capsulectomy or capsulotomy for contracture metacarpophalangeal joint, single each

459.00

26530

Arthroplasty, metacarpophalangeal joint; single, each

558.00

26540

Primary repair collateral ligament, metacarpophalangeal joint

627.00

26545

Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint

578.00

26548

Repair & reconstruction, finger, volar plate interphalangeal joint

648.00

26567

Osteoplasty for correction of deformity; phalanx of finger

522.00

26591

Repair, intrinsic muscles of hand (specify)

350.00

26600

Closed treatment of metacarpal fracture, single; without manipulation, each bone

162.00

26605

Closed treatment of metacarpal fracture single; with manipulation, each bone

242.00

26607

Closed treatment of metacarpal fracture, with manipulation, with internal or external fixation, each bone

421.00

26608

Percutaneous skeletal fixation of metacarpal fracture, each bone

421.00

26615

Open treatment of metacarpal fracture, single, with or without internal or external fixation, each bone

494.00

26641

Closed treatment of carpometacarpal dislocation, thumb, with manipulation

227.00

26645

Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation

307.00

26650

Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation, with or without external fixation

461.00

26665

Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with or without internal or external fixation

665.00

26670

Closed treatment of carpometacarpal dislocation, other than thumb (Bennett fracture), single, with manipulation; without anesthesia

209.00

26675

Closed treatment of carpometacarpal dislocation, other than thumb (Bennett fracture), single, with manipulation; requiring anesthesia

427.00

26676

Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb (Bennett fracture), single, with manipulation

492.00

26685

Open treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); single, with or without internal or external fixation

601.00

26686

Open treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); complex, multiple or delayed reduction

675.00

26700

Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia

206.00

26705

Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia

275.00

26706

Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation

471.00

26715

Open treatment of metacarpophalangeal dislocation, single, with or without internal or external fixation

468.00

26720

Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each

128.00

26725

Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each

225.00

26727

Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each

352.00

26735

Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without internal or external fixation, each

458.00

26740

Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each

142.00

26742

Closed treatment of articular fractures, involving metacarpophalangeal or interphalangeal joint; with manipulation, each

273.00

26746

Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, with or without internal or external fixation, each

505.00

26750

Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each

115.00

26755

Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each

191.00

26756

Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each

292.00

26765

Open treatment of distal phalangeal fracture, finger or thumb, with or w/out internal or external fixation, each

325.00

26770

Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia

170.00

26775

Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia

219.00

26776

Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation

320.00

26785

Open treatment of interphalangeal joint dislocation, with or without internal or external fixation, single

343.00

26820

Fusion in opposition, thumb, with autogenous graft (includes obtaining graft)

707.00

26841

Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation

635.00

26842

Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft)

806.00

26843

Arthrodesis, carpometacarpal joint, digits, other than thumb; other than thumb

668.00

26844

Arthrodesis, carpometacarpal joint, digits, other than thumb; with autograft (includes obtaining graft)

763.00

26850

Arthrodesis, metacarpophalangeal joint, with or without internal fixation

544.00

26852

Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)

668.00

26860

Arthrodesis, interphalangeal joint, with or without internal fixation; without internal fixation

431.00

26910

Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer

604.00

26951

Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure

354.00

26952

Amputation, finger or thumb, primary or secondary, any joint or phanlanx, single with local advancement flaps (V-Y, hood)

482.00

26990

Incision and drainage, pelvis or hip joint area; deep abscess or hematoma

472.00

26991

Incision and drainage, pelvis or hip joint area; infected bursa

371.00

26992

Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), pelvis and/or hip joint

974.00

27050

Arthrotomy, for biopsy; sacroiliac joint

448.00

27052

Biopsy of hip joint

728.00

27054

Arthrotomy for synovectomy, hip joint

1,009.00

27060

Excision; ischial bursa

420.00

27062

Excision; trochanteric bursa or calcification

440.00

27065

Excision of bone cyst or benign tumor; superficial (wing of ilium, symphysis pubis, or greater trochanter of femur) with or without autograft

522.00

27066

Removal of hip bone lesion

836.00

27086

Removal of foreign body, pelvis or or hip; subcutaneous tissue

113.00

27087

Remove hip foreign body

557.00

27090

Removal of hip prosthesis; (separate procedure)

1026.00

27091

Complicated, including “total hip” and methylmethacrylate, when applicable

1977.00

27093

Injection procedure for hip arthrography; without anesthesia

101.00

27095

Injection procedure for hip arthrography; with anesthesia

104.00

27125

Partial hip replacement, prosthesis (e.g., femoral stem prosthesis, bipolar arthroplasty)

1,526.00

27130

Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip replacement), with or without autograft or allograft

2,250.00

27132

Conversion of previous hip surgery to total hip replacement, with or without autograft or allograft

2,530.00

27134

Revision of total hip arthroplasty; both components, with or without autograft or allograft

2,939.00

27137

Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft

2,303.00

27138

Revision of total hip arthroplasty; femoral component only, with or without allograft

2,265.00

27140

Osteotomy and transfer of greater trochanter (separate procedure)

1,101.00

27161

Osteotomy, femoral neck (separate procedure)

1,448.00

27170

Bone graft, femoral head, neck, etc. (includes obtaining bone graft)

1528.00

27175

Treatment of slipped femoral epiphysis; by traction, without reduction

391.00

27176

Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ

1,046.00

27177

Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft)

1,283.00

27178

Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning

1,036.00

27179

Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure)

1122.00

27181

Open treatment of slipped femoral epiphysis; osteotomy and internal fixation

1324.00

27185

Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter

543.00

27187

Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck and proximal femur

1433.00

27193

Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation

338.00

27194

Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia

598.00

27200

Closed treatment of coccygeal fracture

156.00

27202

Open treatment of coccygeal fracture

617.00

27215

Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s) (e.g., pelvic fracture(s) which do not disrupt the pelvic ring), with internal fixation

1136.00

27216

Percutaneous skeletal fixation of posterior pelvic ring fracture and/or dislocation (includes ilium, sacroiliac joint and/or sacrum)

872.00

27217

Open treatment of anterior ring fracture and/or dislocation with internal fixation, (includes pubic symphysis and/or rami)

1368.00

27218

Open treatment of posterior ring fracture and/or dislocation with internal fixation (includes ilium, sacroiliac joint and/or sacrum)

1625.00

27220

Closed treatment of acetabulum (hip socket) fracture(s); without manipulation

463.00

27222

Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal traction

835.00

27226

Open treatment of posterior or anterior acetabular wall fracture, with internal fixation

1467.00

27227

Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation

1742.00

27230

Closed treatment of femoral fracture, proximal end, neck; without manipulation

394.00

27232

Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction

899.00

27235

Percutaneous skeletal fixation of femoral fracture, proximal end, neck, undisplaced, mildly displaced, or impacted fracture

1301.00

27236

Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement (direct fracture exposure)

1536.00

27238

Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; without manipulation

486.00

27240

Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; without manipulation

1005.00

27244

Open treatment of intertrochanteric, pertrochanteric or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage

1514.00

27245

Open treatment of intertrochanteric, pertrochanteric or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage

1713.00

27246

Closed treatment of greater trochanteric fracture, without manipulation

402.00

27248

Open treatment of greater trochanteric fracture, with or without internal or external fixation

1106.00

27250

Closed treatment of hip dislocation, traumatic; without anesthesia

453.00

27252

Closed treatment of hip dislocation, traumatic; requiring anesthesia

660.00

27253

Open treatment of hip dislocation, traumatic, without internal fixation

1239.00

27254

Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation

1503.00

27256

Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation

269.00

27257

Treatment of spontaneous hip dislocation(developmental, including congenital or pathological), by abduction, splint or traction; with manipulation, requiring anesthesia

463.00

27275

Manipulation, hip joint, requiring general anesthesia

190.00

27280

Arthrodesis, sacroiliac joint (including obtaining graft)

1,076.00

27282

Arthrodesis, symphysis pubis (including obtaining graft)

968.00

27284

Arthrodesis, hip joint (includes obtaining graft)

1480.00

27286

Arthrodesis, hip joint (includes obtaining graft); with subtrochanteric osteotomy

1507.00

27295

Disarticulation of hip

1674.00

27301

Incision and drainage of deep abscess, infected bursa, or hematoma, thigh or knee region

401.00

27303

Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), femur or knee

661.00

27305

Fasciotomy, iliotibial (tenotomy), open

450.00

27306

Tenotomy, subcutaneous, closed, adductor or hamstring, (separate procedure); single

299.00

27307

Tenotomy, subcutaneous, closed, adductor or hamstring, (separate procedure); multiple

 

400.00

 

 

27310

Arthrotomy, knee, for infection, with exploration, drainage or removal of foreign body

882.00

27315

Neurectomy, hamstring muscle

585.00

27323

Biopsy, soft tissue of thigh or knee area; superficial

169.00

27324

Biopsy, soft tissue of thigh or knee area; deep

347.00

27327

Excision, tumor, thigh or knee area; subcutaneous

319.00

27328

Excision, tumor, thigh or knee area; deep, subfascial, or intramuscular

460.00

27330

Arthrotomy, knee; for synovlal biopsy only

590.00

27331

Arthrotomy, knee; with joint exploration, with or without biopsy, with or without removal of loose or foreign bodies

702.00

27332

Arthrotomy, knee, for excision of semilunar cartilage (meniscectomy); medial or lateral

900.00

27333

Arthrotomy, knee, for excision of semilunar cartilage (meniscectomy); medial and lateral

1036.00

27334

Arthrotomy, knee, for synovectomy; anterior or posterior

915.00

27335

Arthrotomy, knee, for synovectomy; anterior and posterior including popliteal area

1050.00

27340

Excision, prepatellar bursa

382.00

27345

Excision of synovlal cyst of popliteal space (baker’s cyst)

555.00

27350

Patellectomy or hemipatellectomy

840.00

27355

Excision or curettage of bone cyst or benign tumor of femur; tumor of femur

722.00

27356

Excision or curettage of bone cyst or benign tumor of femur; with allograft

825.00

27357

Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft)

904.00

27370

Injection procedure for knee arthrography

65.00

27372

Removal of foreign body, deep, thigh region or knee area

399.00

27380

Suture of infrapatellar tendon; primary

721.00

27381

Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft

1035.00

27385

Suture of quadriceps or hamstring muscle rupture; primary

793.00

27386

Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft or tendon graft

1100.00

27390

Tenotomy, open, hamstring, knee to hip; single

453.00

27393

Lengthening of hamstring tendon; single

571.00

27396

Transplant, hamstring tendon to patella; single

705.00

27400

Tendon or muscle transfer, hamstrings to femur (Eggers type procedure)

801.00

27403

Arthrotomy with open meniscus repair

821.00

27405

Repair, primary, torn ligament and/or capsule, knee; collateral

901.00

27407

Repair, primary, torn ligament and/or capsule, knee; cruciate

898.00

27409

Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments

1337.00

27418

Anterior tibial tubercleplasty for chondromalacia patellae (Maquet procedure)

1088.00

27420

Reconstruction for recurrent dislocating patella; (Hauser type procedure)

995.00

27422

Reconstruction for recurrent dislocationg patella; with extensor realignment and/or muscle advancement or release (Campbell, Goldwaite type procedure)

1018.00

27424

Reconstruction for recurrent dislocating patella; with patellectomy

1033.00

27425

Lateral retinacular release (any method)

572.00

27427

Ligamentous reconstruction (augmentation), knee; extra-articular

1077.00

27428

Ligamentous reconstruction (augmentation), knee; intra-articular (open)

1294.00

27429

Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular

1136.00

27430

Quadricepsplasty (bennett or thompson type)

900.00

27435

Capsulotomy, knee, posterior capsular release

769.00

27437

Arthroplasty, patella; without prosthesis

874.00

27438

Arthroplasty, patella; with prosthesis

1163.00

27440

Arthroplasty, knee, tibial plateau

1066.00

27441

Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy

931.00

27442

Arthroplasty, knee, femoral condyles or tibial plateaus

1414.00

27443

Arthroplasty, knee, femoral condyles or tibial plateaus; with debridement and partial synovectomy

1426.00

27445