Fee Navigator

    Health Service Code 25.39D

    Phototherapeutic keratectomy - for corneal scar, epithelial irregularity or amblyogenic refractive error

    NOTE:

    May not be claimed for routine refractive purposes.

    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$461.26

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANTYesIncrease By25%
    ROLEANESTYesReplace Base$18.39
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    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
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    TRAYMAJTIncrease By$38.78
    NBTRNBTRYes
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules: