Medical
Procedure List As Of 14 March 2025
I
CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES
II
OPERATIONS ON THE NERVOUS SYSTEM
III
OPERATIONS ON THE ENDOCRINE SYSTEM
IV
OPERATIONS ON THE EYES
V
OPERATIONS ON THE EARS
VI
OPERATIONS ON THE NOSE, MOUTH,AND PHARYNX
VII
OPERATIONS ON THE RESPIRATORY SYSTEM
VIII
OPERATIONS ON THE CARDIOVASCULAR SYSTEM
IX
OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEMS
X
OPERATIONS ON THE DIGESTIVE SYSTEM AND ABDOMINAL REGION
- 54
  OPERATIONS ON ESOPHAGUS
- 55
  INCISION AND EXCISION OF STOMACH
- 56
  OTHER OPERATIONS ON STOMACH
- 57
  INCISION, EXCISION AND ANASTOMOSIS OF INTESTINE
- 58
  OTHER OPERATIONS ON INTESTINE
- 59
  OPERATIONS ON APPENDIX
- 60
  OPERATIONS ON RECTUM AND PERIRECTAL TISSUE
  No additional benefits for sigmoidoscopy
- 61
  OPERATIONS ON ANUS
  NOTE: No additional payment for sigmoidoscopy
- 62
  OPERATIONS ON LIVER
- 63
  OPERATIONS ON GALLBLADDER AND BILIARY TRACT
  - 63.0
    Cholecystotomy and cholecystostomy
  - 63.1
    Cholecystectomy
  - 63.2
    Anastomosis of gallbladder or bile duct
  - 63.4
    Other incision of bile duct
  - 63.6
    Repair of bile ducts
  - 63.8
    Other operations on biliary ducts and operations on sphincter of Oddi
    - 63.86
      Endoscopic sphincterotomy and papillotomy
      - 63.86A
        Billary sphincteroplasty, dilation of the ampulla of Vater
        NOTE: May only be claimed in addition to 64.97A.
    - 63.87
      Endoscopic insertion of nasobiliary drainage tube
      NOTE: 1. May not be claimed in association with 63.88. 2. May only be claimed in addition to 64.97A.
    - 63.88
      Endoscopic pancreatic stent placement or insertion of stent into bile duct, additional benefit
      NOTE: 1. May not be claimed in addition to HSC 63.87. 2. May only be claimed in addition to HSC 64.97A.
    - 63.89
      Other operations on sphincter of Oddi
  - 63.9
    Other operations on biliary tract
- 64
  OPERATIONS ON PANCREAS
- 66
  OTHER OPERATIONS ON ABDOMINAL REGION
XI
OPERATIONS ON THE URINARY TRACT
XII
OPERATIONS ON THE MALE GENITAL ORGANS
XV
OPERATIONS ON THE MUSCULOSKELETAL SYSTEM
XVI
OPERATIONS ON THE BREAST
XVII
OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE
XVIII
PROCEDURES NOT ELSEWHERE CLASSIFIED
LABORATORY AND PATHOLOGY
DIAGNOSTIC RADIOLOGY
NOTE: 1. As stated in G.R. 11.1.1, claims for services in the Diagnostic Radiology section will not be payable unless the physician has been approved by the CPSA to provide those services. 2. An additional 30% of the benefit applies to patients 12 years of age and younger, for some diagnostic radiology HSCs. Refer to Price List.
THERAPEUTIC RADIOLOGY

Health Service Code 63.86A

Billary sphincteroplasty, dilation of the ampulla of Vater

NOTE:

May only be claimed in addition to 64.97A.

Category:	14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
Base rate:	$113.99

Fee modifiers:

Type	Code	Explicit	Action	Amount
BMI	BMIANE	Yes	Increase By	25%
BMI	BMIPRO	Yes	Increase By	25%
ROLE	ANE	Yes	Replace Base	$89.35
VANE	ADDA		Replace	$100.25
LVP	ADD	Yes	Replace Base	100%

Governing Rules:

4.4.8 CLAIMS REQUIRING REFERRING PRACTITIONER NUMBER

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

03.01O*	03.01LJ* 03.01LK* 03.01LL* 03.03D*	03.03F*
03.03FA*	03.03FT* 03.03FV* 03.03FZ* 03.04Q*	03.05B*
03.07A*	03.07AZ* 03.07B*	03.07C*	03.08A*	03.08AZ*
03.08B*	03.08BZ* 03.08C*	03.08CV* 03.08F*	03.08H*
03.08K*	03.08L*	03.08M*

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

6.8.1
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.
1. a consultation benefit may be claimed up to and including the day of surgery.
2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
4. Deleted
5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.
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

03.09A*	03.09B*	03.12A	03.16A	03.16B	03.16C
03.16D	03.19C	03.19D	03.21A	03.22A	03.22B
03.22C	03.26	03.29A	03.37A	03.37B	03.38A
03.38B	03.38C	03.38D	03.38E	03.38F	03.38G
03.38H	03.38K	03.38M	03.38N	03.38P	03.38R
03.38S	03.38T	03.38X	03.41A	03.41B	03.41C
03.41D	03.44A	03.45A	03.45B	03.52A	03.52B
03.52C	03.52D	03.52E	03.52F	03.55A	03.55B

07.09A	07.09B	08.19A*	08.19AZ* 08.19B*	08.19C*
08.19AA*	08.19BB* 08.19CC* 08.19CX*	09.01A	09.01B
09.01C	09.01E	09.02B	09.02E	09.05A	09.05B
09.06A	09.07C	09.11A	09.11B	09.11C	09.12A
09.12B	09.13C	09.13D	09.13E	09.13F	09.13G
09.13H	09.23A	09.23B	09.24B	09.26A	09.26D
09.41A	09.41B	09.43A	09.43B	09.43C	09.43D
09.43E	09.46A	09.49A

50.81A	50.81B	50.81C	50.81D	50.81E	50.82A
50.82B	50.83A	50.84A	50.84B	50.84C	50.87A
50.87B	50.87C	50.88A	50.89A	50.89B	50.89C
50.89D	50.89E	50.91B	50.95A	50.95B	50.98A
52.1 A	52.11A	52.12	52.13	52.85A	53.81A
53.81B	53.83A	54.89A	54.89B	54.89D	54.89E
54.89F	57.92A

80.81	80.83B	80.85A	80.85B	82.12A	82.81A
82.91A	83.7 A	87.53A	87.53B	87.54A	87.55A
89.59A	89.59B	89.59G	89.98A	92.70	92.71
92.72	92.74	92.75	92.76	92.78A	92.78B
92.78C	92.8 A	92.8 B	95.81A	97.11A	97.11B
97.81	97.82A	97.83A	97.89A	97.89B	98.12A
98.12B	98.8 A	98.81A	98.81B	98.89A	98.89B
98.89C	98.89D	98.89E	98.89F	98.89G	98.89H

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Health Service Codes

Health Service Code 63.86A

Billary sphincteroplasty, dilation of the ampulla of Vater

NOTE:

Fee modifiers:

Governing Rules:

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

Fee Navigator®

Health Service Codes

Health Service Code 63.86A

Billary sphincteroplasty, dilation of the ampulla of Vater

NOTE:

Fee modifiers:

Governing Rules:

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