NOTE: 1. Two Papanicolaou smears may be claimed per patient, per physician, per year (April 1 of one year to March 31 of the following year). Additional claims may be submitted with supporting information. 2. May be claimed in addition to a visit or consultation. 3. When clinically indicated, Papanicolaou smears may be claimed for those patients not meeting the age requirements. In those instances, text must be submitted explaining the specific circumstance. 4. May not be claimed at the same encounter as HSC 13.99BD or 13.99BE.

NOTE: 1. May be claimed with a visit or consultation. 2. May not be claimed at the same encounter as HSC 13.99BA or 13.99BD.

NOTE: 1. May only be claimed by vascular surgeons and by general surgeons with additional training in vascular surgery. 2. If performing arterial and venous assessments, a second call may be claimed.

NOTE: 1. May be claimed in addition to a visit or consultation at the same encounter. 2. May only be claimed in an emergency room, AACC or UCC.

NOTE: May only be claimed in addition to HSCs 01.22 and 01.24B.

NOTE: May only be claimed in addition to HSCs 01.14 or 64.97A.

NOTE: May only be claimed when the patient is seen while receiving hemodialysis. If the patient is seen when they are not receiving hemodialysis, the appropriate visit HSC should be claimed.

NOTE: 1. A benefit for central line placement or umbilical vein catheter, if required, may be claimed in addition. 2. May not be claimed for blood transfusion.

NOTE: 1. Benefit includes prescription, monitoring and ongoing manipulation of dialysis therapy. 2. May only be claimed by physicians working in a level II or level III ICU. 3. May only be claimed once per patient, per day regardless whether the same or different physician provides the service. 4. May be claimed in addition to other visits or services provided on the same day by the same physician.

NOTE: 1. May only be claimed by internal medicine specialists. 2. May be claimed for patients on either hemodialysis or peritoneal dialysis. 3. May not be claimed in addition to HSC 13.99B and 13.99D within the same calendar week unless documentation to support the claim is provided. 4. May be claimed once per patient within the same calendar week if not preceded by any visit except those outlined in Note 5. 5. HSC 03.03AR, 03.03DF and special callback benefits (HSCs 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may be claimed within the same calendar week for the same patient by the same physician. 6. The physician must be actively involved in the management of the patient's care in order to claim.

NOTE: 1. May only be claimed by nephrologists. 2. May not be claimed in addition to HSC 13.99B or 13.99D within the same calendar week. 3. May be claimed once per patient within the same calendar week if not preceded by any visit except those outlined in Note 4. 4. HSCs 03.03AR, 03.03DF and special callback benefits (HSCs 03.03KA, 03.03LA, 03.03MC, 03.03MD, 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may be claimed within the same calendar week for the same patient by the same physician. 5. Other HSCs (03.08A, 03.08AZ, 03.07B, 03.04A, 03.04AZ, 03.03A, 03.03AZ, 03.03F, 03.03FZ) may not be claimed in the same calendar week for the same patient by any nephrologist. Exceptions to this include consultation and visit HSCs that are related to assessment for kidney/kidney-pancreas transplantation, which may be claimed within the same calendar week by nephrologists with special interest or training in transplantation. For the exceptions, supporting text must be submitted. 6. The physician must be actively involved in the management of the patient's care in order to claim.

NOTE: 1. May only be claimed for patients on home TPN. 2. May not be claimed in addition to office visits within the same calendar week unless documentation to support the claim is provided. 3. May be claimed once per patient within the same calendar week if not preceded by any visit except those outlined in Note 4. 4. HSC 03.03AR , 03.03DF and special callback benefits (HSCs 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may be claimed within the same calendar week for the same patient by the same physician.