Category: | M Minor Procedure |
---|---|
Base rate: | $263.71 |
Type | Code | # of calls | Explicit | Action | Amount |
---|---|---|---|---|---|
BMI | BMIANT | Yes | Increase By | 25% | |
ROLE | ANEST | Yes | Replace Base | $18.70 | |
ANU | ANU | 1 | For Each Call Pay Base At | 100% | |
ANU | ANU | 2 - 150 | For Each Call Increase By | $18.70 | |
LVP | LVP75 | Yes | Reduce Base To | 75% |
If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.
If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.
If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.
Benefits may not be claimed for procedures that do not routinely require the services of a surgical assistant or a 2nd surgeon for a 2nd surgical team, unless supporting information detailing unusual circumstances satisfactory to the Minister is provided. Such procedures include but are not limited to the following list:
01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
01.12B | 01.14 | 01.16B | 01.16C | 01.22 | 01.22A |
01.22B | 01.22C | 01.24A | 01.24B | 01.24BA | 01.24BB |
01.32 | 01.34 | 02.84A | 02.84B |
06.35A | 06.35B | 06.39A | 06.39B | 07.09A | 07.27A |
07.27B | 07.29A | 07.29B | 07.51A | 07.51C | 07.53A |
07.53B | 07.53C | 07.53D | 07.53E | 07.54A | 07.56A |
07.57A | 07.57B | 09.01A | 09.01B | 09.01C | 09.01F |
09.05A | 09.06A | 09.07C | 09.11A | 09.12A | 09.26A |
09.49A |
15.93A | 15.93B | 15.93C | 15.94A | 15.99A | 16.2 B |
16.81A | 16.83A | 16.83B | 16.83C | 16.89A | 16.92A |
17.03A | 17.08D | 17.08E | 17.08K | 17.1 A | 17.39E |
17.71A | 17.81A | 17.89A | 18.29A | 18.29B | 19.81 |
40.0 | 40.1 A | 40.5 | 40.92A | 41.29A | 41.29B |
42.09A | 42.09B | 43.1 B | 43.81 | 43.82 | 43.95A |
43.96A | 43.96B | 43.96C | 43.96D | 43.96E | 44.01 |
44.22A | 45.81A | 45.83 | 45.84A | 45.88A |
52.1 A | 52.85A | 53.42A | 53.81A | 53.81B | 53.83A |
54.21B | 54.21C | 54.21D | 54.21E | 54.89A | 54.89B |
54.89D | 54.89E | 54.89F | 54.91A | 54.92A | 54.92B |
54.92C | 54.92D | 54.92E | 55.41A | 55.41B | 56.34A |
56.93B | 57.21A | 57.92A | 58.99B |
70.1 | 70.2 A | 70.2 B | 70.2 H | 70.4 F | 70.4 G |
70.5 A | 70.5 B | 71.8 | 71.95 | 71.96A | 72.1 C |
72.91 | 73.2 A | 73.91 | 74.82A | 75.64 | 75.83A |
76.0 | 76.1 A | 76.89A | 76.91A | 78.7 A | 79.22 |
79.23A | 79.29C | 79.29E |
80.81 | 80.83B | 80.85A | 80.85B | 81.01D | 81.09 |
81.8 | 81.91A | 81.96 | 82.12A | 82.12B | 82.12C |
82.81A | 82.91A | 83.09A | 83.2 B | 83.7 A | 84.21D |
85.5 A | 87.3 | 87.53A | 87.54A | 87.54B | 87.55A |
87.6 | 87.99A | 87.99AA | 88.02A | 88.92 | 89.98A |
91.00A | 91.01A | 91.01B | 91.01H | 91.01J | 91.02A |
91.02C | 91.02D | 91.03A | 91.03B | 91.04A | 91.04B |
91.05A | 91.06B | 91.06D | 91.06E | 91.07A | 91.08B |
91.08J | 91.12A | 91.13A | 91.72 | 91.73A | 91.73B |
91.77C | 91.78B | 91.78C |
92.70 | 92.71 | 92.72 | 92.74 | 92.75 | 92.76 |
92.78A | 92.78B | 92.78C | 93.91A | 93.91B | 95.03 |
95.81A | 95.93 | 95.96A | 96.01A | 96.01B | 96.02A |
96.02B | 96.11A | 97.81 | 97.83A | 97.89A | 97.89B |
97.96 |
The unscheduled service benefit (modifier SURC) may not be claimed for:
Services included in the following list unless supporting information detailing unusual circumstances satisfactory to the Minister is provided.
03.21A | 03.22A | 03.22B | 03.25 | 03.29A | 07.29B |
07.51A | 07.51C | 07.54A | 07.56A | 13.42A | 13.53A |
13.57A | 13.59A | 13.59B | 13.59H | 13.59J | 17.81A |
21.69A | 22.13B | 22.13C | 22.71 | 22.81 | 23.99D |
24.91 | 26.91A | 29.91 | 30.19A | 30.81A | 32.1 |
32.81 | 33.21A | 33.22B | 33.51A | 37.82A | 37.82B |
38.89A | 39.21A | 39.62A | 39.83A |
40.92A | 41.29A | 50.97A | 51.92A | 52.1 A | 52.11A |
52.11B | 52.12 | 52.13 |
60.82C | 61.29B | 61.39B | 69.83A | 69.83B | 73.2 A |
75.83A | 76.1 A | 79.22 | 79.23A | 79.29E |
81.91A | 82.81A | 82.91A | 83.2 B | 83.7 A | 87.99B |
95.81A | 95.94A | 95.94B | 97.11A | 98.12A | 98.12B |
98.12C | 98.12J | 98.12K | 98.12L | 98.12M | 98.12N |
98.12Q | 98.12R | 98.12T | 98.8 A | 98.81A | 98.81B |
98.99AA |
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