Governing Rules:

• 6.6.2

  If a procedure designated "+" is performed in a physician's office, both the procedural benefit and the appropriate office visit benefit for that day may be claimed, but if a consultation benefit pursuant to GR 6.6.4 has been claimed, a visit benefit will not be payable for the day on which the procedure is performed.

• 6.6.3

  If a procedure designated "+" is performed in a place other than a physician's office, either a procedural benefit or a visit benefit, but not both, may be claimed for that day.

• 6.6.4

  If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.

• 6.7.1

  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.

• 14.2 MINOR TRAY SERVICE

  A minor tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.

  07.53C	07.56A	07.57B	10.16A	11.23A	12.01
  12.21	13.53B	13.59E	13.59F	13.59H	13.59J
  13.59K	13.59L	13.59N	13.99BB 16.89B	16.89C
  16.89D	17.71A	17.71B	18.29E	19.81

  21.31A	21.41	21.32D	21.69C	23.99D	24.91
  30.19A	32.96A	32.96B	33.01A	33.03A	33.21A
  33.22A	33.61A	35.0 A	37.81	37.91A	38.0 A
  39.91B

  43.0 B

  50.98A

  51.92A

  53.81B

  61.01A	67.93	70.5 B	71.95	73.91	78.7 A
  79.22

  80.83B	81.8	93.91A	93.91B	94.01B	94.04
  95.03	95.93	95.94A	95.94B	95.96A	97.81
  97.89A	98.01A	98.03A	98.03B	98.03C	98.03E
  98.04B	98.04C	98.12K	98.12S

• 14.3 MULTIPLE TRAY SERVICE

  If multiple procedures listed under GRs 14.1 and 14.2 are performed during the same encounter in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services, the following applies:

• 14.3.1

  For the same anatomical area (example - 3 moles removed from the face), only one tray may be claimed except when the condition relates to suspected cancer or infection, in which case, if required, additional tray(s) may be claimed at 50%.

• 14.3.2

  For different anatomical areas, the tray for the initial procedure may be claimed at 100% and if required, the tray for each additional procedure may be claimed at 50%.

• 14.3.3

  Benefits for additional trays may not exceed the benefit listed for one major tray.