Fee Navigator®

    Health Service Code 01.24BB

    Flexible proctosigmoidoscopy for screening of patients who are considered to be of average risk for colon cancer

    1. HSCs 57.13A, 57.21A, 57.21B, 57.21C, and 58.99D may be claimed in addition.
    2. Benefit includes biopsies.
    3. Benefit includes the removal of diminutive polyps that are 5mm or less in size.
    4. Average risk is defined as an individual who is asymptomatic and aged 50 to 74 years.
    5. May be claimed once every 5 years.
    Category:M+ Designated Minor Procedure
    Base rate:$79.48

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$110.16
    ROLEANESTYesReplace Base$18.55
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.55
    UGAUGAYesReplace Base$134.85
    TRAYMAJTIncrease By$38.78
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules: