Fee Navigator®

    Health Service Code 13.99H

    Critical care of severely ill or injured patient in a hospital emergency department requiring major treatment intervention(s), per 15 minutes

    1. May only be claimed when a patient presents with a serious condition requiring at least a two hour stay in the active treatment portion of the emergency department or care results in hospitalization. The two hour period criterion does not apply in cases where the patient dies after having been seen.
    2. Time may be claimed on a cumulative basis per day (defined as 0001 to 2400), and may include time spent with the patient, review of patient history including diagnostics, review of patient prescriptions and other activities the physician does in relation to the patient's care on the same date of service.
    3. Time spent providing services compensated elsewhere in the Schedule, e.g., family conferences and procedures, may not be included in time claimed for HSC 13.99H.
    4. Major treatment intervention is defined as a medical intervention which prevents or treats a condition that may result in significant morbidity.
    Category:V Visit
    Base rate:$58.61

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLM151 - 16For Each Call Pay Base At100%
    LMTSDSCHYesIncrease Base By

    Governing Rules:

    • 2.3.2

      Cumulative time is calculated by adding the total time spent delivering patient care as identified in the description of the HSC, over the course of the day (GR 1.19) and dividing the total time by the time units specified in the HSC to determine the appropriate number of calls. When the remainder of the time calculation equals less than half of one call, an additional call may not be claimed. Separate encounters may only be claimed when a special call for attendance has been made on the patient's behalf.

    • 5.1.5

      HSCs 13.99H and 13.99HA may not be claimed in association with another visit HSC. Time units may be claimed on a cumulative basis.