Fee Navigator®

    Governing Rule: 6.11


    • 6.11.1

      For a compound fracture, closed or open reduction, 150% of the listed benefit may be claimed.

    • 6.11.2

      For an uncomplicated fracture without displacement, only 50% of the listed benefit may be claimed.

    • 6.11.3

      With the exception of facial fractures treated by closed reduction, multiple fractures, other than undisplaced fractures, may be claimed at the full benefit for each fracture treated by closed reduction, open reduction, continuous traction or extensive skeletal traction. This does not apply to anesthetic services; refer to GR 12.4.9.

    • 6.11.4


    • 6.11.5

      If an open operation is performed for the purpose of implanting an electrical stimulator, for conditions such as non-union of fractures, the appropriate HSC for open reduction of the fracture may be claimed.

    • 6.11.6

      With the exception of 90.09A, 90.09B and 90.09C, benefits for bone grafting or bone graft harvesting and fixation (90.00 through 90.08 series) may not be claimed in association with an open reduction of a fracture of the same bone.

    • 6.11.7

      Benefits for bone grafts include harvesting and fixation where indicated.

    • 6.11.8

      Osteotomy (all HSCs 89.2 and 89.3 series) may not be claimed in association with the following:

      1. bone grafting (all HSCs 90.00 to 90.08 series) when performed at the same encounter
      2. primary or revision arthroplasty when the osteotomy is of an adjacent bone.

      In these cases, only the greater benefit may be paid.

    • 6.11.9

      For open reduction and mini plate fixation of facial fractures, if a bone graft is required to fill a defect, 75% of HSC 98.79A may be claimed in addition to the benefit for the fracture.

    • 6.11.10

      For an open reduction of a periprosthetic fracture (a fracture involving bone around any prosthesis), of a long bone when no revision arthroplasty of the same long bone is performed, 150% of the benefit for open reduction and internal fixation of the bone involved may be claimed using modifier PROSTH.

    • 6.11.11

      Benefits for orthopedic services include the application of a cast when required and replacement of the cast within the 14 day post operative period.