Fee Navigator®

    Health Service Code 18.29E

    Paravertebral block

    NOTE:
    1. When claimed for a diagnostic branch block of a spinal facet joint, one call may be claimed for each individual joint blocked. For example, L4/5 and L5/S1 on the right is two calls. L4/5 and L5/S1 bilaterally is four joints; therefore four calls.
    2. Up to three calls may be claimed per side when nerves for that number of joints are blocked, for a maximum of six calls.
    3. The first joint (cervical, thoracic, or lumbar) for Diagnostic medial branch block(s) requires two needle placements, each additional contiguous joint requires one additional needle placement.
    4. Branch blocks of a spinal facet joint may only be claimed for diagnostic procedures, not for therapeutic use.
    5. May not be used in place of HSCs 16.89B, 16.89C, or 16.89D for facet joint injections when the limits for HSC 16.89 have otherwise been reached.
    6. Fluoroscopy HSC (X107A) may only be submitted for the first call.
    Category:M+ Designated Minor Procedure
    Base rate:$107.03

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 6For Each Call Pay Base At50%
    TRAYMINTIncrease By$13.14
    NBTRNBTRYes
    SURCEVYesIncrease By$48.82
    SURCNTAMYesIncrease By$117.12
    SURCNTPMYesIncrease By$117.12
    SURCWKYesIncrease By$48.82
    LVPLVP75YesReduce Base To75%

    Governing Rules:

    • 6.6.2

      If a procedure designated "+" is performed in a physician's office, both the procedural benefit and the appropriate office visit benefit for that day may be claimed, but if a consultation benefit pursuant to GR 6.6.4 has been claimed, a visit benefit will not be payable for the day on which the procedure is performed.

    • 6.6.3

      If a procedure designated "+" is performed in a place other than a physician's office, either a procedural benefit or a visit benefit, but not both, may be claimed for that day.

    • 6.6.4

      If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.

    • 6.7.1

      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.

    • 14.2 MINOR TRAY SERVICE

      A minor tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.

    • 14.3 MULTIPLE TRAY SERVICE

      If multiple procedures listed under GRs 14.1 and 14.2 are performed during the same encounter in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services, the following applies:

    • 14.3.1

      For the same anatomical area (example - 3 moles removed from the face), only one tray may be claimed except when the condition relates to suspected cancer or infection, in which case, if required, additional tray(s) may be claimed at 50%.

    • 14.3.2

      For different anatomical areas, the tray for the initial procedure may be claimed at 100% and if required, the tray for each additional procedure may be claimed at 50%.

    • 14.3.3

      Benefits for additional trays may not exceed the benefit listed for one major tray.