Category: | 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days) |
---|---|
Base rate: | $784.29 |
Type | Code | # of calls | Explicit | Action | Amount |
---|---|---|---|---|---|
BMI | BMIANE | Yes | Increase By | 25% | |
BMI | BMIPRO | Yes | Increase By | 25% | |
BMI | BMI2AN | Yes | Increase By | 25% | |
AGE | L30 | Increase Base To | 150% | ||
ROLE | ANE | Yes | Replace Base | $360.18 | |
ROLE | SA | Yes | Replace Base | $148.42 | |
ROLE | SAQS | Yes | Replace Base | $51.10 | |
ROLE | SSCVT | Yes | Replace Base | $312.56 | |
ROLE | SSST | Yes | Replace Base | $325.09 | |
ROLE | 2ANES | Yes | Replace Base | $22.44 | |
VANE | L30AN | Increase By | $110.16 | ||
VANE | L30AT2 | Increase By | $110.16 | ||
ANEU | ANEU | 1 | For Each Call Pay Base At | 100% | |
ANEU | ANEU | 2 - 4 | For Each Call Increase By | $81.81 | |
2ANU | 2ANU | 1 | For Each Call Pay Base At | 100% | |
2ANU | 2ANU | 2 - 150 | For Each Call Increase By | $22.44 | |
SAU | SAU | 1 | For Each Call Pay Base At | 100% | |
SAU | SAU | 2 - 33 | For Each Call Increase By | $37.13 | |
SAQU | SAQU | 1 - 36 | For Each Call Pay Base At | 100% | |
CALL | NBRSER | 1 | For Each Call Pay Base At | 100% | |
CALL | NBRSER | 2 - 4 | For Each Call Increase By | $116.74 | |
REDO | COMPLT | Yes | Increase Base To | 150% | |
REDO | PART | Yes | Increase Base To | 125% | |
REDO | REDO1 | Yes | Increase Base To | 175% | |
REDO | REDO2 | Yes | Increase Base To | 225% | |
REDO | REDO3 | Yes | Increase Base To | 275% | |
REDO | REDO4 | Yes | Increase Base To | 325% | |
REDO | REDO5 | Yes | Increase Base To | 375% | |
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 | |
LMTS | L44 | Yes | Increase Base To | 150% | |
LMTS | L44ANE | Yes | Increase Base By | $110.16 | |
LVP | LVP75 | Yes | Reduce Base To | 75% |
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
01.12A | 01.12B | 01.14 | 01.16A | 01.16B | 01.16C |
01.22 | 01.22A | 01.22B | 01.22C | 01.24A | 01.24B |
01.24BA | 01.24BB | 01.32 | 01.34 | 02.82A | 02.84A |
02.84B |
10.04 | 10.08A | 10.33B | 13.99CC 13.99GA* | 14.49A | |
14.82 | 14.85B | 14.88A | 14.88B | 15.94A | 16.83A |
16.83B | 16.83C | 16.89A | 16.92B | 17.81B | 19.81 |
22.81 | 24.89A | 24.89B | 28.8 A | 28.81A | 29.0 A |
30.81A | 33.22B | 37.81 | 37.82A | 37.82B | 38.89A |
38.89B | 39.21A | 39.62A | 39.83A |
40.92A | 41.29A | 41.29B | 42.09B | 43.81 | 43.82 |
44.3 B | 45.81A | 45.83 | 45.84B | 45.86A | 46.5 A |
46.81A | 46.82 | 46.84A | 46.88A | 48.92A | 48.98A |
48.98B | 49.93A | 49.95A | 49.96A | 49.96B | 49.98B |
49.98C | 49.98D |
60.82C | 60.89A | 62.12A | 62.12B | 62.81A | 63.86A |
63.96B | 64.95A | 64.97A | 66.19A | 66.3 C | 66.83 |
66.89A | 66.89B | 66.89C | 67.81 | 67.86 | 67.87A |
67.89A | 68.95 | 69.83A | 69.83B | 72.91 | 72.92A |
74.82A | 75.83A | 76.89A | 78.7 A | 79.29E |
F7 |
HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.
The following chart gives the pre-operative and post-operative periods.
Category | Pre-operative | Post-operative |
1 | 0 - Days | 14 - Days |
3 | 7 - Days | 7 - Days |
4 | 7 - Days | 14 - Days |
6 | 14 - Days | 14 - Days |
14 | 30 - Days | 14 - Days |
15 | 0 - Days | 7 - Days |
Benefits that may be claimed for redos for one of the following HSCs vary depending on how many redos have been performed in the past, (whether partly or wholly), through that incision. The first redo may be claimed at 175% of the listed benefit, the second at 225%, the third at 275%, the fourth at 325%, and the fifth at 375%.
50.04A | 50.05A | 50.14 | 50.15A | 50.24A | 50.24B |
50.34A | 50.34B | 50.34D | 50.34K | 50.34L | 50.75B |
50.75C | 51.21A | 51.21B | 51.21C | 51.3 C |
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