Refer to notes following 07.53J.
| Common terms: |
|
|---|---|
| Category: | M Minor Procedure |
| Base rate: | $49.37 |
A half slab cast may be claimed as 07.53H when performed on an upper limb only.
| 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 | |
| SURC | EV | Yes | Increase By | $48.82 | |
| SURC | NTAM | Yes | Increase By | $117.12 | |
| SURC | NTPM | Yes | Increase By | $117.12 | |
| SURC | WK | Yes | Increase By | $48.82 | |
| 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 for orthopedic services include the application of a cast when required and replacement of the cast within the 14 day post operative period.
