| Category: | M+ Designated Minor Procedure |
|---|---|
| Base rate: | $107.30 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| 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% |
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 |
| 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 |
| F7 |
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.
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.
If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.
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.
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.
