Fee Navigator®

    Health Service Code 16.09F

    Laminectomy with microsurgical exploration of spinal cord

    For syringomyelia and shunting

    NOTE:

    Instrumentation may be claimed in addition.

    Additional notes:
    • Listed under 16 - OPERATIONS ON SPINAL CORD AND SPINAL CANAL STRUCTURES:

      The listed benefits are payable irrespective of the number of vertebrae involved if one incision utilized, unless otherwise stated.

    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$2007.68

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$939.49
    ROLEANESTYesReplace Base$18.39
    ROLEMSRGNYesReplace Base$441.69
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    VANEL30ANIncrease By$108.34
    VANEL30ATIncrease By$108.34
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    SAUSAU1For Each Call Pay Base At100%
    SAUSAU2 - 33For Each Call Increase By$37.04
    2MNU2MNU1 - 7For Each Call Pay Base At100%
    2MNU2MNUTo a Maximum Of$3091.83
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LMTSL44ANEYesIncrease Base By$108.34
    LVPLVP75YesReduce Base To75%

    Governing Rules:

    • 6.8.1

      HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.

      1. a consultation benefit may be claimed up to and including the day of surgery.
      2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
      3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
      4. Deleted
      5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.

      The following chart gives the pre-operative and post-operative periods.

      CategoryPre-operativePost-operative
      10 - Days14 - Days
      37 - Days7 - Days
      47 - Days14 - Days
      614 - Days14 - Days
      1430 - Days14 - Days
      150 - Days7 - Days