Fee Navigator®

    Health Service Code 09.04

    Eye examination under anesthesia

    NOTE:

    May not be claimed when topical anesthesia only is used.

    Category:M+ Designated Minor Procedure
    Base rate:$287.65

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    ROLEANEYesReplace Base$110.53
    ROLEANESTYesReplace Base$18.39
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70

    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.

    • 6.9.8

      Unless otherwise stated in the schedule, if a surgical procedure and related diagnostic procedure are performed by the same physician, utilizing the same anesthetic, only the greater benefit may be claimed.

    • 9.1.1

      The following examinations are included in the complete examination (03.04A, 03.08A, 03.08H, 09.04) and may not be claimed in addition:

      • Measurement of vision
      • Refractive error
      • Extra-ocular muscle balance
      • 03.12A Intra-ocular pressure measurement
      • 09.01A Biomicroscopy (slit lamp examination)
      • Retinal examination
    • 9.1.2

      Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.04A, 03.08A, 03.08H and 09.04:

      • 09.01B Gonioscopy
      • 09.01C Orthoptic analysis, interpretation
      • 09.01E Orthoptic analysis, technical (may include Hess screen)
      • 09.02B Anterior chamber depth measurement
      • 09.02E Amblyopia evaluation for patients nine years of age or younger
      • 09.05A Full threshold perimetric examination, technical
      • 09.05B Full threshold perimetric examination, interpretation
      • 09.06A Color vision test, interpretation and technical
      • 09.11A Bilateral specular microscopy for corneal graft patients only - technical
      • 09.11B Bilateral specular microscopy for corneal graft patients only - interpretation
      • 09.11C Potential acuity measurement (PAM)
      • 09.12A Intravenous fluorescein angiography (IVFA), interpretation
      • 09.12B Intravenous fluorescein angiography (IVFA), technical
      • 09.13E Optical coherence tomography (OCT), interpretation
      • 09.13F Optical coherence tomography (OCT), technical
      • 09.26A Diurnal tension curve
      • 09.26D Bilateral corneal pachymetry
      • 21.31A Diagnostic irrigation of nasolacrimal duct, office procedure, per eye
      • 24.89B Diagnostic conjunctival scraping
      • 25.81A Diagnostic corneal scraping