Fee Navigator®

    Health Service Code 03.03DG

    Complex pediatric hospital visit per full 15 minutes

    1. May only be claimed for visits where the patient is complex and requires a minimum of 15 minutes on patient care management.
    2. May not be claimed on the same date of service as any visit service by the same physician.
    3. Time may be claimed on a cumulative basis.
    4. May only be claimed by pediatricians and pediatric subspecialties.
    Category:V Visit
    Base rate:$100.22

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151For Each Call Pay Base At100%
    CALLM152 - 10For Each Call Pay Base At70%

    Governing Rules:

    • 2.3.2

      Cumulative time is calculated by adding the total time spent delivering patient care as identified in the description of the HSC, over the course of the day (GR 1.19) and dividing the total time by the time units specified in the HSC to determine the appropriate number of calls. When the remainder of the time calculation equals less than half of one call, an additional call may not be claimed. Separate encounters may only be claimed when a special call for attendance has been made on the patient's behalf.

    • 4.10.3

      When the care of a patient is transferred to a second physician, the second physician may charge daily hospital care, starting at the rate allowed for the first to seventh day, only if the transfer was due to the onset of a significant new illness.

    • 4.12.1

      The benefit for care of a healthy newborn in hospital does not apply when the infant is ill. In these circumstances, the daily hospital visit HSCs apply.