May not be claimed if vasectomy is subsequent to a previous reversal. If a repeat procedure is required due to a previously failed attempt, supporting documentation must be provided.
Category: | 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days) |
---|---|
Base rate: | $184.30 |
If a patient previously had an insured vasectomy followed by a reversal, the second vasectomy is not considered to be an insured service and should be billed to the patient.
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 | $112.39 | |
ROLE | ANEST | Yes | Replace Base | $18.70 | |
ANU | ANU | 1 | For Each Call Pay Base At | 100% | |
ANU | ANU | 2 - 150 | For Each Call Increase By | $18.70 | |
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 | |
LVP | LVP75 | Yes | Reduce Base To | 75% |
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 may not be claimed for procedures that do not routinely require the services of a surgical assistant or a 2nd surgeon for a 2nd surgical team, unless supporting information detailing unusual circumstances satisfactory to the Minister is provided. Such procedures include but are not limited to the following list:
01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
01.12B | 01.14 | 01.16B | 01.16C | 01.22 | 01.22A |
01.22B | 01.22C | 01.24A | 01.24B | 01.24BA | 01.24BB |
01.32 | 01.34 | 02.84A | 02.84B |
06.35A | 06.35B | 06.39A | 06.39B | 07.09A | 07.27A |
07.27B | 07.29A | 07.29B | 07.51A | 07.51C | 07.53A |
07.53B | 07.53C | 07.53D | 07.53E | 07.54A | 07.56A |
07.57A | 07.57B | 09.01A | 09.01B | 09.01C | 09.01F |
09.05A | 09.06A | 09.07C | 09.11A | 09.12A | 09.26A |
09.49A |
15.93A | 15.93B | 15.93C | 15.94A | 15.99A | 16.2 B |
16.81A | 16.83A | 16.83B | 16.83C | 16.89A | 16.92A |
17.03A | 17.08D | 17.08E | 17.08K | 17.1 A | 17.39E |
17.71A | 17.81A | 17.89A | 18.29A | 18.29B | 19.81 |
40.0 | 40.1 A | 40.5 | 40.92A | 41.29A | 41.29B |
42.09A | 42.09B | 43.1 B | 43.81 | 43.82 | 43.95A |
43.96A | 43.96B | 43.96C | 43.96D | 43.96E | 44.01 |
44.22A | 45.81A | 45.83 | 45.84A | 45.88A |
52.1 A | 52.85A | 53.42A | 53.81A | 53.81B | 53.83A |
54.21B | 54.21C | 54.21D | 54.21E | 54.89A | 54.89B |
54.89D | 54.89E | 54.89F | 54.91A | 54.92A | 54.92B |
54.92C | 54.92D | 54.92E | 55.41A | 55.41B | 56.34A |
56.93B | 57.21A | 57.92A | 58.99B |
70.1 | 70.2 A | 70.2 B | 70.2 H | 70.4 F | 70.4 G |
70.5 A | 70.5 B | 71.8 | 71.95 | 71.96A | 72.1 C |
72.91 | 73.2 A | 73.91 | 74.82A | 75.64 | 75.83A |
76.0 | 76.1 A | 76.89A | 76.91A | 78.7 A | 79.22 |
79.23A | 79.29C | 79.29E |
80.81 | 80.83B | 80.85A | 80.85B | 81.01D | 81.09 |
81.8 | 81.91A | 81.96 | 82.12A | 82.12B | 82.12C |
82.81A | 82.91A | 83.09A | 83.2 B | 83.7 A | 84.21D |
85.5 A | 87.3 | 87.53A | 87.54A | 87.54B | 87.55A |
87.6 | 87.99A | 87.99AA | 88.02A | 88.92 | 89.98A |
91.00A | 91.01A | 91.01B | 91.01H | 91.01J | 91.02A |
91.02C | 91.02D | 91.03A | 91.03B | 91.04A | 91.04B |
91.05A | 91.06B | 91.06D | 91.06E | 91.07A | 91.08B |
91.08J | 91.12A | 91.13A | 91.72 | 91.73A | 91.73B |
91.77C | 91.78B | 91.78C |
92.70 | 92.71 | 92.72 | 92.74 | 92.75 | 92.76 |
92.78A | 92.78B | 92.78C | 93.91A | 93.91B | 95.03 |
95.81A | 95.93 | 95.96A | 96.01A | 96.01B | 96.02A |
96.02B | 96.11A | 97.81 | 97.83A | 97.89A | 97.89B |
97.96 |
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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