In relation to either a single surgical procedure or a series of procedures under the same anesthetic, only the surgical or the anesthetic benefit, whichever is the greater, may be claimed.
Notwithstanding GR 6.14.1, in a rural location, a physician may claim both HSC 87.98B and an anesthetic service on the same day when:
A physician acting as both a surgical assistant and a surgeon for separate procedures under one anesthetic may submit a claim for both services.
When complex orthopedic surgery requires the skills of two orthopedic surgeons, the second surgeon may submit a claim using modifier SSOS for his/her services when he/she has actively participated in the planning for and performance of the procedure. Only the second orthopedic surgeon's surgical time may be claimed; time spent in planning the procedure may not be included in the claimed time. Claims shall indicate the total number of time units spent and may not exceed the anesthetic time claimed for the procedure.
Claims for HSCs that do not list modifier SSOS in the Price List may be submitted with supporting information.
