Fee Navigator

    Health Service Code 03.07A

    Minor consultation

    NOTE:

    May not be claimed in addition to a surgical assist (SA, SAQS, SSOS) for the same patient by the same physician.

    Category:V Visit
    Base rate:$40.52

    AMA billing tips:

    • 03.07A may only be claimed when all of the following criteria have been met:

      • •Patient is examined by referring provider (full list G.R. 4.4.1)
      • •Referring provider specifically requests (verbal or written)opinion and or advice of consultant
      • • Consultant performs:
      1. history (limited to presenting problem and
      2. physical (relative to their speciality)
      3. may order lab or diagnostics.
      4. discusses treatment and advice with the patient and in some cases the referring provider
      5. provides referring with written report about recommendations, treatment, opinion.

      Consultations may NOT be claimed for transfer of care or pre operative assessments.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLANESReplace Base$58.48
    SKLLANPAReplace Base$81.68
    SKLLCARDReplace Base$115.03
    SKLLCLIMReplace Base$111.27
    SKLLCMSPReplace Base$111.27
    SKLLCRCMReplace Base$73.77
    SKLLCRSGReplace Base$57.75
    SKLLCTSGReplace Base$57.75
    SKLLDERMReplace Base$40.52
    SKLLE/MReplace Base$120.19
    SKLLEMSPReplace Base$60.04
    SKLLFTERReplace Base$60.04
    SKLLGASTReplace Base$105.10
    SKLLGNSGReplace Base$63.39
    SKLLGPReplace Base$66.56
    SKLLHEMReplace Base$111.27
    SKLLHEPAReplace Base$81.68
    SKLLIDISReplace Base$149.97
    SKLLINMDReplace Base$111.27
    SKLLMDBIReplace Base$81.68
    SKLLMDGNReplace Base$120.24
    SKLLMDMIReplace Base$81.68
    SKLLMDONReplace Base$111.27
    SKLLNEPHReplace Base$112.22
    SKLLNEURReplace Base$98.93
    SKLLNPMReplace Base$120.24
    SKLLNUPAReplace Base$81.68
    SKLLNUSGReplace Base$74.95
    SKLLOBGYReplace Base$61.70
    SKLLOCMDReplace Base$111.27
    SKLLOPHTReplace Base$84.92
    SKLLORTHReplace Base$67.39
    SKLLOTOLReplace Base$56.16
    SKLLPATHReplace Base$81.68
    SKLLPDGEReplace Base$120.24
    SKLLPDNRReplace Base$120.24
    SKLLPDSGReplace Base$120.24
    SKLLPEDReplace Base$120.24
    SKLLPEDCReplace Base$120.24
    SKLLPEDNReplace Base$120.24
    SKLLPHMDReplace Base$100.24
    SKLLPLASReplace Base$51.82
    SKLLRHEUReplace Base$89.57
    SKLLRSMDReplace Base$95.38
    SKLLTHORReplace Base$56.90
    SKLLUROLReplace Base$68.45
    SKLLVSSGReplace Base$100.35
    CARECMXV15YesIncrease Base By$15.70
    CARECMXV20YesIncrease Base By$15.70
    CARECMXV30YesIncrease Base By$31.43
    CARECMXV35YesIncrease Base By$31.43
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    CMPXCMGP1 - 10YesFor Each Call Increase By$18.48
    TELETELESYesIncrease Base To120%

    Governing Rules: