Governing Rules:

• 6.6.2

  If a procedure designated "+" is performed in a physician's office, both the procedural benefit and the appropriate office visit benefit for that day may be claimed, but if a consultation benefit pursuant to GR 6.6.4 has been claimed, a visit benefit will not be payable for the day on which the procedure is performed.

• 6.6.3

  If a procedure designated "+" is performed in a place other than a physician's office, either a procedural benefit or a visit benefit, but not both, may be claimed for that day.

• 6.6.4

  If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.

• 6.7.1

  If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.

• 6.8.4

  Where a procedure is performed under general anesthesia, the following applies:

  1. If the procedure is the only procedure performed at that time, a benefit of $134.85 may be claimed.
  2. If another procedure is also performed at the same encounter and the listed benefit payable in respect of it under the Schedule is greater than $134.85 the physician is entitled to receive that listed benefit plus a percentage of the listed benefit for the lesser procedure(s) calculated in accordance with this Schedule. The $134.85 minimum benefit does not apply to the lesser procedures.
  3. If multiple procedures are performed at the same encounter and the listed benefit payable in respect of each of them under the Schedule is less than $134.85, the physician is entitled to receive a benefit of $134.85 in respect of the greater procedure plus a benefit in respect of each of the lesser procedures that is a percentage of the listed benefit and calculated in accordance with this schedule. The $134.85 minimum benefit does not apply to the lesser procedures.
  4. If multiple procedures are performed at the same encounter and only one of them appears under GR 6.8.4 (e), the physician is entitled to receive a benefit of $134.85 in respect of that procedure plus a benefit in respect of the other procedures that is a percentage of the listed benefit and calculated in accordance with this schedule.

  1. GR 6.8.4 applies to the following HSCs:

     01.01A	01.01B	01.03	01.09	01.24A	01.24B
     01.24BA	01.24BB	02.84B	03.22A	03.22B	03.25
     07.29A	07.57A

     10.23	10.25	11.71A	11.81A	12.01	12.21
     12.24	12.31	13.59L	13.59N	13.59O	13.99BB
     14.09A	17.39E	17.81A	19.81

     21.41	21.42	21.69A	21.69C	22.13B	22.13C
     22.5 A	22.81	24.22A	24.5	25.1 A	26.91A
     28.8 A

     30.19A	30.19B	30.9 A	32.01A	32.1	32.21A
     32.23A	32.39A	33.22A	33.22B	33.51A	33.51B
     33.61A	34.0 A	34.1 A	34.89A	35.0 A	37.81
     37.82A	38.0 A	38.89A	39.21A	39.62A	39.83A

     40.5	40.92A	43.95A	45.81A	45.83	45.84A
     46.04B	46.09B	46.09C	46.84A	49.0	49.82B
     49.83A

     50.4 A	50.94D	50.94E	50.94F	50.97A	51.43
     51.53A	52.1 A	53.81B	53.83A	54.92D	58.99F

     60.82C	61.01A	61.29B	61.37A	61.39B	62.81A
     64.95A	66.82A	67.81	67.86	67.96A	68.1
     68.32B	69.13D	69.29A	69.83A	69.83B

     70.1	70.2 A	70.2 B	70.2 H	70.4 F
     70.5 A	72.91	74.82A	76.91A	78.7 A	79.29E

     80.83B	80.85B	81.8	81.96	82.12A	82.12B
     82.12C	82.14D	82.81A	82.91A	83.7 A	87.6
     87.72A	87.82	87.89A	87.89B	87.91	87.92
     88.92	89.59A

     91.01H	91.01J	91.02A	91.03A	91.03B	91.05E
     91.05H	91.06D	91.06E	91.07A	91.08B	91.70A
     91.70B	91.71	91.73A	91.73B	91.77B	91.77C
     91.78A	91.78B	92.70	92.71	92.72	92.74
     92.75	92.76	92.78C	93.91A	93.91B	94.04
     95.02A	95.03	95.81A	95.93	95.96A

     97.81	97.96	98.03A	98.04A	98.12A	98.12B
     98.12C	98.12E	98.12G	98.12H	98.12J	98.12K
     98.12M	98.12N	98.12Q	98.12R	98.22A	98.49A
     98.6 A	98.6 C	98.81A	98.93A	98.93B	98.96A
     98.96B	98.96C	98.96D	98.98B

• 14.1

  A major tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.

  01.03	01.04A	01.05A	01.24A	01.24B	01.24BA
  01.24BB	01.34	02.84A	02.84B	03.22B	03.25
  07.53B	07.53D	07.53E	07.57A

  12.31

  13.59C

  17.08A

  17.81A

  21.42	21.69A	22.13A	22.13B	22.13C	22.5 A
  22.51A	22.62A	22.71	22.81	25.1 A	25.29A
  25.39D

  32.01A	32.81	33.02A	33.22B	34.0 A	34.1 A
  34.89A	37.82A	38.89A	39.21A	39.62A	39.83A
  39.83A

  40.92A 46.91

  50.4 A

  50.97A

  52.1 A

  52.11A

  52.13

  56.93B

  60.24C	61.01B	61.03	61.29B	61.37A	61.39B
  66.91A

  70.1

  70.5 A

  72.91

  75.64

  79.23A

  79.29E

  82.81A	82.91A	83.7 A	87.3	87.55A	89.37A
  89.37B	89.41A	89.41B	89.42A

  93.39B	93.39C	95.02A	95.09A	95.81A	97.11B
  97.83A	97.89B	98.04A	98.6 A	98.6 B	98.12A
  98.12B	98.12C	98.12H	98.12J	98.12M	98.12N
  98.12Q	98.12R	98.12T	98.14A	98.22A	98.22B
  98.81A	98.96A	98.96B	98.96C	98.96D

• 14.3 MULTIPLE TRAY SERVICE

  If multiple procedures listed under GRs 14.1 and 14.2 are performed during the same encounter in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services, the following applies:

• 14.3.1

  For the same anatomical area (example - 3 moles removed from the face), only one tray may be claimed except when the condition relates to suspected cancer or infection, in which case, if required, additional tray(s) may be claimed at 50%.

• 14.3.2

  For different anatomical areas, the tray for the initial procedure may be claimed at 100% and if required, the tray for each additional procedure may be claimed at 50%.

• 14.3.3

  Benefits for additional trays may not exceed the benefit listed for one major tray.

• 15.10

  The unscheduled service benefit (modifier SURC) may not be claimed for:

• 15.10.6

  Services included in the following list unless supporting information detailing unusual circumstances satisfactory to the Minister is provided.

  03.21A	03.22A	03.22B	03.25	03.29A	07.29B
  07.51A	07.51C	07.54A	07.56A	13.42A	13.53A
  13.57A	13.59A	13.59B	13.59H	13.59J	17.81A

  21.69A	22.13B	22.13C	22.71	22.81	23.99D
  24.91	26.91A	29.91	30.19A	30.81A	32.1
  32.81	33.21A	33.22B	33.51A	37.82A	37.82B
  38.89A	39.21A	39.62A	39.83A

  40.92A	41.29A	50.97A	51.92A	52.1 A	52.11A
  52.11B	52.12	52.13

  60.82C	61.29B	61.39B	69.83A	69.83B	73.2 A
  75.83A	76.1 A	79.22	79.23A	79.29E

  81.91A	82.81A	82.91A	83.2 B	83.7 A	87.99B
  95.81A	95.94A	95.94B	97.11A	98.12A	98.12B
  98.12C	98.12J	98.12K	98.12L	98.12M	98.12N
  98.12Q	98.12R	98.12T	98.8 A	98.81A	98.81B
  98.99AA