Fee Navigator

    Health Service Code 16.09N

    Intervertebral fusion, thoracic & lumbar spine only (anterior lumbar intervertebral fusion (ALIF), posterior lumbar intervertebral fusion (PLIF), or translateral lumbar intervertebral fusion (TLIF))

    NOTE:
    1. Instrumentation may be claimed in addition.
    2. Additional levels may be claimed at the rate specified on the Price List; a maximum benefit of five calls applies.
    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:$1318.53

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$460.54
    ROLEANESTYesReplace Base$18.39
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSOSYesReplace Base$281.29
    VANEL30ANIncrease By$108.34
    VANEL30ATIncrease By$108.34
    ANEUANEU1For Each Call Pay Base At100%
    ANEUANEU2 - 5For Each Call Increase By$204.48
    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
    SSOUSSOU1For Each Call Pay Base At100%
    SSOUSSOU2 - 33For Each Call Increase By$93.76
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 5For Each Call Increase By$263.69
    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: