| Common terms: |
|
|---|---|
| Category: | M Minor Procedure |
| Base rate: | $68.37 |
No modifiers.
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 |
| 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 |
Benefits for non-invasive diagnostic procedures including HSCs in Section E (Laboratory and Pathology) and X (Diagnostic Radiology) performed for a hospital inpatient, registered outpatient or AACC or UCC patient are not payable under the Schedule. Payment for these services is the responsibility of the hospital/Regional Health Authority. This applies to both the technical and professional components. Such procedures include but are not limited to the following list.
| 03.12A | 03.16A | 03.16B | 03.19C | 03.19D | 03.37A |
| 03.37B | 03.38A | 03.38B | 03.38C | 03.38D | 03.38E |
| 03.38F | 03.38G | 03.38H | 03.38K | 03.38M | 03.38N |
| 03.38P | 03.38Q | 03.38R | 03.38S | 03.38T | 03.38X |
| 03.39A | 03.39B | 03.41A | 03.41B | 03.41C | 03.41D |
| 13.99CC | 24.89A | 32.81 | 49.98T | 50.98A |
| 95.94C | 98.8 A | 98.89A | 98.89B | 98.89C | 98.89D |
| 98.89E | 98.89F | 98.89H | 98.92E | 98.99F |
| F7 |
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.
Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08H and 09.04:
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.
Benefits may not be claimed for procedures that do not routinely require the services of a surgical assistant or a 2nd surgeon for a 2nd surgical team, unless supporting information detailing unusual circumstances satisfactory to the Minister is provided. Such procedures include but are not limited to the following list:
| 01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
| 01.12B | 01.14 | 01.16B | 01.16C | 01.22 | 01.22A |
| 01.22B | 01.22C | 01.24A | 01.24B | 01.24BA | 01.24BB |
| 01.32 | 01.34 | 02.84A | 02.84B |
| 06.35A | 06.35B | 06.39A | 06.39B | 07.09A | 07.27A |
| 07.27B | 07.29A | 07.29B | 07.51A | 07.51C | 07.53A |
| 07.53B | 07.53C | 07.53D | 07.53E | 07.54A | 07.56A |
| 07.57A | 07.57B | 09.01A | 09.01B | 09.01C | 09.01F |
| 09.05A | 09.06A | 09.07C | 09.11A | 09.12A | 09.26A |
| 09.49A |
| 15.93A | 15.93B | 15.93C | 15.94A | 15.99A | 16.2 B |
| 16.81A | 16.83A | 16.83B | 16.83C | 16.89A | 16.92A |
| 17.03A | 17.08D | 17.08E | 17.08K | 17.1 A | 17.39E |
| 17.71A | 17.81A | 17.89A | 18.29A | 18.29B | 19.81 |
| 40.0 | 40.1 A | 40.5 | 40.92A | 41.29A | 41.29B |
| 42.09A | 42.09B | 43.1 B | 43.81 | 43.82 | 43.95A |
| 43.96A | 43.96B | 43.96C | 43.96D | 43.96E | 44.01 |
| 44.22A | 45.81A | 45.83 | 45.84A | 45.88A |
| 52.1 A | 52.85A | 53.42A | 53.81A | 53.81B | 53.83A |
| 54.21B | 54.21C | 54.21D | 54.21E | 54.89A | 54.89B |
| 54.89D | 54.89E | 54.89F | 54.91A | 54.92A | 54.92B |
| 54.92C | 54.92D | 54.92E | 55.41A | 55.41B | 56.34A |
| 56.93B | 57.21A | 57.92A | 58.99B |
| 70.1 | 70.2 A | 70.2 B | 70.2 H | 70.4 F | 70.4 G |
| 70.5 A | 70.5 B | 71.8 | 71.95 | 71.96A | 72.1 C |
| 72.91 | 73.2 A | 73.91 | 74.82A | 75.64 | 75.83A |
| 76.0 | 76.1 A | 76.89A | 76.91A | 78.7 A | 79.22 |
| 79.23A | 79.29C | 79.29E |
| 80.81 | 80.83B | 80.85A | 80.85B | 81.01D | 81.09 |
| 81.8 | 81.91A | 81.96 | 82.12A | 82.12B | 82.12C |
| 82.81A | 82.91A | 83.09A | 83.2 B | 83.7 A | 84.21D |
| 85.5 A | 87.3 | 87.53A | 87.54A | 87.54B | 87.55A |
| 87.6 | 87.99A | 87.99AA | 88.02A | 88.92 | 89.98A |
| 91.00A | 91.01A | 91.01B | 91.01H | 91.01J | 91.02A |
| 91.02C | 91.02D | 91.03A | 91.03B | 91.04A | 91.04B |
| 91.05A | 91.06B | 91.06D | 91.06E | 91.07A | 91.08B |
| 91.08J | 91.12A | 91.13A | 91.72 | 91.73A | 91.73B |
| 91.77C | 91.78B | 91.78C |
| 92.70 | 92.71 | 92.72 | 92.74 | 92.75 | 92.76 |
| 92.78A | 92.78B | 92.78C | 93.91A | 93.91B | 95.03 |
| 95.81A | 95.93 | 95.96A | 96.01A | 96.01B | 96.02A |
| 96.02B | 96.11A | 97.81 | 97.83A | 97.89A | 97.89B |
| 97.96 |
