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Governing Rules
Health Service Codes
Modifiers
Explanatory Codes
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1
DEFINITIONS
2
APPLICATIONS
3
EXCLUSIONS
4
VISITS AND CONSULTATIONS
5
EMERGENCY/URGENT/CRITICAL CARE
6
PROCEDURES
6.1
6.2
6.3
6.4
6.5
NON-INVASIVE DIAGNOSTIC PROCEDURES IN HOSPITAL, AACC OR UCC
6.6
DIAGNOSTIC SURGICAL PROCEDURES
6.7
MINOR PROCEDURES
6.8
MAJOR PROCEDURES
6.9
MULTIPLE PROCEDURES
6.10
BILATERAL SURGERY - TWO SURGEONS
6.11
FRACTURES AND DISLOCATIONS
6.12
FRACTURES AND DISLOCATIONS - ATTEMPTED REDUCTION
6.13
FRACTURES AND DISLOCATIONS - OPEN FOLLOWING CLOSED REDUCTION
6.14
SAME PHYSICIAN, SEVERAL FUNCTIONS
6.15
REDO CARDIAC, VASCULAR AND THORACIC SURGERY
6.16
6.17
REDO ORTHOPEDIC SURGERY
6.18
GENERAL SURGERY
7
RECONSTRUCTIVE PLASTIC SURGERY
8
OBSTETRICS AND GYNECOLOGY
9
OPHTHALMOLOGY
10
DENTAL/ORAL SURGICAL RELATED SERVICES
11
LABORATORY/PATHOLOGY/RADIOLOGY
12
ANESTHESIA
13
SURGICAL ASSISTANCE BENEFITS
14
TRAY SERVICE
15
OFF HOURS PREMIUM BENEFITS
16
Deleted
17
TELEHEALTH
18
BODY MASS INDEX (BMI)
19
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Governing Rule: 6.4
Anesthetic benefits for local infiltration are included in the benefit for the procedure.
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