A maximum of three hours may be claimed.
Category: | 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days) |
---|---|
Base rate: | $313.46 |
Type | Code | # of calls | Explicit | Action | Amount |
---|---|---|---|---|---|
BMI | BMIANE | Yes | Increase By | 25% | |
BMI | BMIANT | Yes | Increase By | 25% | |
BMI | BMIPRO | Yes | Increase By | 25% | |
ROLE | ANE | Yes | Replace Base | $149.85 | |
ROLE | ANEST | Yes | Replace Base | $18.70 | |
ROLE | SA | Yes | Replace Base | $148.42 | |
ROLE | SAQS | Yes | Replace Base | $51.10 | |
ROLE | SSST | Yes | Replace Base | $325.09 | |
ANU | ANU | 1 | For Each Call Pay Base At | 100% | |
ANU | ANU | 2 - 150 | For Each Call Increase By | $18.70 | |
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 | M30 | 1 | For Each Call Pay Base At | 100% | |
CALL | M30 | 2 - 6 | For Each Call Pay Base At | 100% | |
TRAY | MAJT | Increase By | $38.88 | ||
NBTR | NBTR | Yes | |||
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 |
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 |
The section on multiple procedures does not apply where the lesser or secondary procedure is:
16.09N | 16.09O | 16.09P | 16.3 A | 16.3 B | 16.43D |
16.43E | 16.49B | 16.49C | 16.49D | 16.49E | 16.49F |
16.49G | 17.08A | 17.39C | 17.5 D |
52.12 | 52.13 | 52.42 | 65.04C | 65.1 A |
90.00A | 90.01 | 90.02B | 90.02C | 90.03A | 90.03C |
90.04 | 90.05A | 90.06A | 90.06B | 90.07A | 90.07B |
90.09A | 90.09B | 90.09C | 90.2 A | 90.32A | 90.32B |
90.34A | 90.34B | 90.39A | 90.5 A | 90.5 B | 90.6 D |
92.32B | 92.32C | 92.32D | 92.40 | 92.41 | 92.44 |
92.45 | 92.46 | 92.8 A | 92.8 B | 92.8 C | 92.8 D |
93.01A | 93.01B | 93.02A | 93.02B | 93.05D | 93.05E |
93.06A | 93.09B | 93.09C | 93.09D | 93.09E | 93.09F |
93.09G | 93.09H | 93.11A | 93.12A | 93.12B | 93.12C |
93.13A | 93.14 | 93.16A | 93.18A | 93.18B | 93.21 |
93.22 | 93.23 | 93.24 | 93.25 | 93.26A | 93.39B |
93.39C | 93.41A | 93.44A | 93.45A | 93.45B | 93.45C |
93.45D | 93.45E | 93.45F | 93.45G | 93.45H | 93.45J |
93.45K | 93.47A | 93.47C | 93.49A | 93.49B |
93.49C | 93.59A | 93.6 A | 93.6 B | 93.69A | 93.69B |
93.69C | 93.71A | 93.71D | 93.8 A | 93.81A | 93.81B |
93.83B | 93.83C | 93.83D | 93.83E | 93.83F | 93.83G |
93.83H | 93.83I | 93.83N | 93.83O | 93.84A | 93.85A |
93.87A | 93.87E | 93.87J | 93.87K | 93.96B | 93.96C |
93.96D |
93.96E | 93.96F | 93.96G | 93.96H | 93.96I | 93.96J |
93.96K | 93.96L | 94.01B | 94.35A |
Group A
Group B
Group C
Group D
A major 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.
01.03 | 01.04A | 01.05A | 01.24A | 01.24B | 01.24BA |
01.24BB | 01.34 | 02.84A | 02.84B | 03.22B | 03.25 |
07.53B | 07.53D | 07.53E | 07.57A |
12.31 | 13.59C | 17.08A | 17.81A | 18.29F | 18.29FA |
21.42 | 21.69A | 22.13A | 22.13B | 22.13C | 22.5 A |
22.51A | 22.62A | 22.71 | 22.81 | 25.1 A | 25.29A |
25.39D |
32.01A | 32.81 | 33.02A | 33.22B | 34.0 A | 34.1 A |
34.89A | 37.82A | 38.89A | 39.21A | 39.62A | 39.83A |
39.83A |
50.4 A | 50.97A | 52.1 A | 52.11A | 52.13 | 56.93B |
60.24C | 61.01B | 61.03 | 61.29B | 61.37A | 61.39B |
66.91A |
70.1 | 70.5 A | 72.91 | 75.64 | 79.23A | 79.29E |
82.81A | 82.91A | 83.7 A | 87.3 | 87.55A | 89.37A |
89.37B | 89.41A | 89.41B | 89.42A |
93.39B | 93.39C | 95.02A | 95.09A | 95.81A | 97.11B |
97.83A | 97.89B | 98.04A | 98.6 A | 98.6 B | 98.12A |
98.12B | 98.12C | 98.12H | 98.12J | 98.12M | 98.12N |
98.12Q | 98.12R | 98.12T | 98.14A | 98.22A | 98.22B |
98.71D | 98.81A | 98.96A | 98.96B | 98.96C | 98.96D |
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:
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%.
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%.
Benefits for additional trays may not exceed the benefit listed for one major tray.
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