| Category: | V Visit |
|---|---|
| Base rate: | $39.49 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| SKLL | ANES | Replace Base | $59.95 | ||
| SKLL | ANPA | Replace Base | $87.79 | ||
| SKLL | CARD | Replace Base | $115.12 | ||
| SKLL | CLIM | Replace Base | $158.29 | ||
| SKLL | CMSP | Replace Base | $158.29 | ||
| SKLL | CRCM | Replace Base | $74.21 | ||
| SKLL | CRSG | Replace Base | $58.16 | ||
| SKLL | CTSG | Replace Base | $58.16 | ||
| SKLL | DERM | Replace Base | $40.80 | ||
| SKLL | E/M | Replace Base | $117.07 | ||
| SKLL | EMSP | Replace Base | $42.89 | ||
| SKLL | FTER | Replace Base | $42.89 | ||
| SKLL | GAST | Replace Base | $105.10 | ||
| SKLL | GNSG | Replace Base | $63.76 | ||
| SKLL | GP | Replace Base | $39.49 | ||
| SKLL | HEM | Replace Base | $158.29 | ||
| SKLL | HEPA | Replace Base | $87.79 | ||
| SKLL | IDIS | Replace Base | $149.97 | ||
| SKLL | INMD | Replace Base | $158.29 | ||
| SKLL | MDBI | Replace Base | $87.79 | ||
| SKLL | MDGN | Replace Base | $163.62 | ||
| SKLL | MDMI | Replace Base | $87.79 | ||
| SKLL | MDON | Replace Base | $158.29 | ||
| SKLL | NEPH | Replace Base | $140.61 | ||
| SKLL | NEUR | Replace Base | $98.93 | ||
| SKLL | NPM | Replace Base | $163.62 | ||
| SKLL | NUPA | Replace Base | $87.79 | ||
| SKLL | NUSG | Replace Base | $73.65 | ||
| SKLL | OBGY | Replace Base | $63.90 | ||
| SKLL | OCMD | Replace Base | $158.29 | ||
| SKLL | OPHT | Replace Base | $85.42 | ||
| SKLL | ORTH | Replace Base | $65.93 | ||
| SKLL | OTOL | Replace Base | $58.87 | ||
| SKLL | PATH | Replace Base | $87.79 | ||
| SKLL | PDGE | Replace Base | $163.62 | ||
| SKLL | PDNR | Replace Base | $163.62 | ||
| SKLL | PDSG | Replace Base | $163.62 | ||
| SKLL | PED | Replace Base | $163.62 | ||
| SKLL | PEDC | Replace Base | $163.62 | ||
| SKLL | PEDN | Replace Base | $163.62 | ||
| SKLL | PHMD | Replace Base | $100.24 | ||
| SKLL | PLAS | Replace Base | $83.04 | ||
| SKLL | RHEU | Replace Base | $94.22 | ||
| SKLL | ROSP | Replace Base | $39.49 | ||
| SKLL | RSMD | Replace Base | $95.38 | ||
| SKLL | THOR | Replace Base | $57.51 | ||
| SKLL | UROL | Replace Base | $60.67 | ||
| SKLL | VSSG | Replace Base | $80.28 | ||
| CARE | CMXV15 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV20 | Yes | Increase Base By | $15.74 | |
| CARE | CMXV30 | Yes | Increase Base By | $31.51 | |
| CARE | CMXV35 | Yes | Increase Base By | $31.51 | |
| 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 | |
| CMPX | CMGP | 1 - 10 | Yes | For Each Call Increase By | $19.19 |
| TELE | TELES | Yes | Increase Base To | 120% |
"Active Practice" is defined as a physician that has fulfilled both of the following criteria in the previous 12 months:
Repeat consultations may not be claimed unless a further request has been initiated by and received from the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner for another consultation. A repeat consultation may not be claimed if initiated by the consultant.
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 |
| 03.01O* | 03.01LJ* 03.01LK* 03.01LL* 03.03D* | 03.03F* | ||
| 03.03FA* | 03.03FT* 03.03FV* 03.03FZ* 03.04Q* | 03.05B* | ||
| 03.07A* | 03.07AZ* *03.07B | 03.07C* | 03.08A* | 03.08AZ* |
| 03.08B* | 03.08BZ* 03.08C* | 03.08CV* 03.08F* | 03.08H* | |
| 03.08K* | 03.08L* | 03.08M* |
| 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 |
When the care of the patient remains with the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, physical therapist or nurse practitioner and the nature of the illness makes further intermittent visits by the consultant advisable, they may not be claimed as repeat consultations.
Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.02A, 03.03A, 03.03AZ, 03.07A, 03.07AZ, and 03.07B:
When done independently on a separate day or as a repeat, not more than three interpretations and three technical services from the list in GR 9.1.3 may be claimed.
The unscheduled service benefit (modifier SURC) may be claimed for the services outlined in GRs 15.9.1 through 15.9.3.
selected "V" category code services:
