Fee Navigator®

    Health Service Code 03.04O

    Follow-up care of patient with functioning renal transplant - first year

    1. May only be claimed 4 times per patient within the first 12 months following a renal transplant.
    2. Should the required number of visits for the patient exceed four in the first year following a renal transplant, subsequent visits may be submitted using the appropriate visit HSC.
    3. May only be claimed by physicians with GNSG or NEPH skill codes.
    Category:V Visit
    Base rate:$100.36

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLGNSGReplace Base$100.36
    SKLLNEPHReplace Base$315.61

    Governing Rules:

    • 4.6.1

      Comprehensive visits and/or comprehensive/major consultations may only be claimed once every 365 days per patient by the same physician. Comprehensive visit and consultation services are defined as HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08B, 03.08BZ, 03.08C, 03.08CV, 03.08F, 03.08H, 03.08K, 08.11A, 08.11C, 08.19A, 08.19AZ, 08.19AA, and 08.19CX.

      HSC 03.09B is defined as comprehensive and may not be billed more frequently than once every 180 days by the same physician.

      HSCs 03.04O and 03.04P are defined as comprehensive services and may not be

      billed more frequently than four times per year as indicated or within 180 days of a comprehensive service or consultation by the same physician.