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.

• 15.10

  The unscheduled service benefit (modifier SURC) may not be claimed for:

• 15.10.6

  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