If 2 similar procedures are performed at one time, the 2nd procedure may be claimed at 75% of the listed benefit unless otherwise indicated in the schedule.
If 2 different procedures are performed by one surgeon through separate incisions under one anesthetic, the claim for the lesser procedure may be claimed at 75% of the listed benefit.
If 2 unrelated procedures are performed through the same incision, the benefit for the lesser procedure may be claimed at the rate of 75% of the listed benefit.
If 2 unrelated procedures are performed by 2 physicians in different anatomical areas utilizing the same anesthetic, the benefit for each procedure may be claimed according to the listed benefit.
If multiple related procedures are performed through one incision, by one physician, a benefit may be claimed for the major procedure only.
If multiple unrelated abdominal procedures are performed through one incision, by more than one physician, the benefit for the major procedure may be claimed in full by the physician most responsible for the patient's care and at 75% by the other physician, irrespective of the value of either procedure.
The section on multiple procedures does not apply where the lesser or secondary procedure is:
16.09N | 16.09O | 16.09P | 16.3 A | 16.3 B | 16.43D |
16.43E | 16.49B | 16.49C | 16.49D | 16.49E | 16.49F |
16.49G | 17.08A | 17.39C | 17.5 D |
52.12 | 52.13 | 52.42 | 65.04C | 65.1 A |
90.00A | 90.01 | 90.02B | 90.02C | 90.03A | 90.03C |
90.04 | 90.05A | 90.06A | 90.06B | 90.07A | 90.07B |
90.09A | 90.09B | 90.09C | 90.2 A | 90.32A | 90.32B |
90.34A | 90.34B | 90.39A | 90.5 A | 90.5 B | 90.6 D |
92.32B | 92.32C | 92.32D | 92.40 | 92.41 | 92.44 |
92.45 | 92.46 | 92.8 A | 92.8 B | 92.8 C | 92.8 D |
93.01A | 93.01B | 93.02A | 93.02B | 93.05D | 93.05E |
93.06A | 93.09B | 93.09C | 93.09D | 93.09E | 93.09F |
93.09G | 93.09H | 93.11A | 93.12A | 93.12B | 93.12C |
93.13A | 93.14 | 93.16A | 93.18A | 93.18B | 93.21 |
93.22 | 93.23 | 93.24 | 93.25 | 93.26A | 93.39B |
93.39C | 93.41A | 93.44A | 93.45A | 93.45B | 93.45C |
93.45D | 93.45E | 93.45F | 93.45G | 93.45H | 93.45J |
93.45K | 93.47A | 93.47C | 93.49A | 93.49B |
93.49C | 93.59A | 93.6 A | 93.6 B | 93.69A | 93.69B |
93.69C | 93.71A | 93.71D | 93.8 A | 93.81A | 93.81B |
93.83B | 93.83C | 93.83D | 93.83E | 93.83F | 93.83G |
93.83H | 93.83I | 93.83N | 93.83O | 93.84A | 93.85A |
93.87A | 93.87E | 93.87J | 93.87K | 93.96B | 93.96C |
93.96D |
93.96E | 93.96F | 93.96G | 93.96H | 93.96I | 93.96J |
93.96K | 93.96L | 94.01B | 94.35A |
Group A
Group B
Group C
Group D
Unless otherwise stated in the schedule, if a surgical procedure and related diagnostic procedure are performed by the same physician, utilizing the same anesthetic, only the greater benefit may be claimed.
Claims may not be submitted for incidental procedures.
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