| Category: | M+ Designated Minor Procedure |
|---|---|
| Base rate: | $29.62 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| BMI | BMIANT | Yes | Increase By | 25% | |
| ROLE | ANEST | Yes | Replace Base | $18.70 | |
| ANU | ANU | 1 | For Each Call Pay Base At | 100% | |
| ANU | ANU | 2 - 150 | For Each Call Increase By | $18.70 | |
| CALL | NBRSER | 1 | For Each Call Pay Base At | 100% | |
| CALL | NBRSER | 2 - 2 | For Each Call Pay Base At | 75% | |
| LVP | LVP75 | Yes | Reduce Base To | 75% |
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
| 01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
| 01.12A | 01.12B | 01.14 | 01.16A | 01.16B | 01.16C |
| 01.22 | 01.22A | 01.22B | 01.22C | 01.24A | 01.24B |
| 01.24BA | 01.24BB | 01.32 | 01.34 | 02.82A | 02.84A |
| 02.84B |
| 10.04 | 10.08A | 10.33B | 13.99CC 13.99GA* | 14.49A | |
| 14.82 | 14.85B | 14.88A | 14.88B | 15.94A | 16.83A |
| 16.83B | 16.83C | 16.89A | 16.92B | 17.81B | 19.81 |
| 22.81 | 24.89A | 24.89B | 28.8 A | 28.81A | 29.0 A |
| 30.81A | 33.22B | 37.81 | 37.82A | 37.82B | 38.89A |
| 38.89B | 39.21A | 39.62A | 39.83A |
| 40.92A | 41.29A | 41.29B | 42.09B | 43.81 | 43.82 |
| 44.3 B | 45.81A | 45.83 | 45.84B | 45.86A | 46.5 A |
| 46.81A | 46.82 | 46.84A | 46.88A | 48.92A | 48.98A |
| 48.98B | 49.93A | 49.95A | 49.96A | 49.96B | 49.98B |
| 49.98C | 49.98D |
| 60.82C | 60.89A | 62.12A | 62.12B | 62.81A | 63.86A |
| 63.96B | 64.95A | 64.97A | 66.19A | 66.3 C | 66.83 |
| 66.89A | 66.89B | 66.89C | 67.81 | 67.86 | 67.87A |
| 67.89A | 68.95 | 69.83A | 69.83B | 72.91 | 72.92A |
| 74.82A | 75.83A | 76.89A | 78.7 A | 79.29E |
| F7 |
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.
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.
If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.
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.
Benefits may not be claimed for procedures that do not routinely require the services of a surgical assistant or a 2nd surgeon for a 2nd surgical team, unless supporting information detailing unusual circumstances satisfactory to the Minister is provided. Such procedures include but are not limited to the following list:
| 01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
| 01.12B | 01.14 | 01.16B | 01.16C | 01.22 | 01.22A |
| 01.22B | 01.22C | 01.24A | 01.24B | 01.24BA | 01.24BB |
| 01.32 | 01.34 | 02.84A | 02.84B |
| 06.35A | 06.35B | 06.39A | 06.39B | 07.09A | 07.27A |
| 07.27B | 07.29A | 07.29B | 07.51A | 07.51C | 07.53A |
| 07.53B | 07.53C | 07.53D | 07.53E | 07.54A | 07.56A |
| 07.57A | 07.57B | 09.01A | 09.01B | 09.01C | 09.01F |
| 09.05A | 09.06A | 09.07C | 09.11A | 09.12A | 09.26A |
| 09.49A |
| 15.93A | 15.93B | 15.93C | 15.94A | 15.99A | 16.2 B |
| 16.81A | 16.83A | 16.83B | 16.83C | 16.89A | 16.92A |
| 17.03A | 17.08D | 17.08E | 17.08K | 17.1 A | 17.39E |
| 17.71A | 17.81A | 17.89A | 18.29A | 18.29B | 19.81 |
| 40.0 | 40.1 A | 40.5 | 40.92A | 41.29A | 41.29B |
| 42.09A | 42.09B | 43.1 B | 43.81 | 43.82 | 43.95A |
| 43.96A | 43.96B | 43.96C | 43.96D | 43.96E | 44.01 |
| 44.22A | 45.81A | 45.83 | 45.84A | 45.88A |
| 52.1 A | 52.85A | 53.42A | 53.81A | 53.81B | 53.83A |
| 54.21B | 54.21C | 54.21D | 54.21E | 54.89A | 54.89B |
| 54.89D | 54.89E | 54.89F | 54.91A | 54.92A | 54.92B |
| 54.92C | 54.92D | 54.92E | 55.41A | 55.41B | 56.34A |
| 56.93B | 57.21A | 57.92A | 58.99B |
| 70.1 | 70.2 A | 70.2 B | 70.2 H | 70.4 F | 70.4 G |
| 70.5 A | 70.5 B | 71.8 | 71.95 | 71.96A | 72.1 C |
| 72.91 | 73.2 A | 73.91 | 74.82A | 75.64 | 75.83A |
| 76.0 | 76.1 A | 76.89A | 76.91A | 78.7 A | 79.22 |
| 79.23A | 79.29C | 79.29E |
| 80.81 | 80.83B | 80.85A | 80.85B | 81.01D | 81.09 |
| 81.8 | 81.91A | 81.96 | 82.12A | 82.12B | 82.12C |
| 82.81A | 82.91A | 83.09A | 83.2 B | 83.7 A | 84.21D |
| 85.5 A | 87.3 | 87.53A | 87.54A | 87.54B | 87.55A |
| 87.6 | 87.99A | 87.99AA | 88.02A | 88.92 | 89.98A |
| 91.00A | 91.01A | 91.01B | 91.01H | 91.01J | 91.02A |
| 91.02C | 91.02D | 91.03A | 91.03B | 91.04A | 91.04B |
| 91.05A | 91.06B | 91.06D | 91.06E | 91.07A | 91.08B |
| 91.08J | 91.12A | 91.13A | 91.72 | 91.73A | 91.73B |
| 91.77C | 91.78B | 91.78C |
| 92.70 | 92.71 | 92.72 | 92.74 | 92.75 | 92.76 |
| 92.78A | 92.78B | 92.78C | 93.91A | 93.91B | 95.03 |
| 95.81A | 95.93 | 95.96A | 96.01A | 96.01B | 96.02A |
| 96.02B | 96.11A | 97.81 | 97.83A | 97.89A | 97.89B |
| 97.96 |
The unscheduled service benefit (modifier SURC) may not be claimed for:
Services included in the following list unless supporting information detailing unusual circumstances satisfactory to the Minister is provided.
| 03.21A | 03.22A | 03.22B | 03.25 | 03.29A | 07.29B |
| 07.51A | 07.51C | 07.54A | 07.56A | 13.42A | 13.53A |
| 13.57A | 13.59A | 13.59B | 13.59H | 13.59J | 17.81A |
| 21.69A | 22.13B | 22.13C | 22.71 | 22.81 | 23.99D |
| 24.91 | 26.91A | 29.91 | 30.19A | 30.81A | 32.1 |
| 32.81 | 33.21A | 33.22B | 33.51A | 37.82A | 37.82B |
| 38.89A | 39.21A | 39.62A | 39.83A |
| 40.92A | 41.29A | 50.97A | 51.92A | 52.1 A | 52.11A |
| 52.11B | 52.12 | 52.13 |
| 60.82C | 61.29B | 61.39B | 69.83A | 69.83B | 73.2 A |
| 75.83A | 76.1 A | 79.22 | 79.23A | 79.29E |
| 81.91A | 82.81A | 82.91A | 83.2 B | 83.7 A | 87.99B |
| 95.81A | 95.94A | 95.94B | 97.11A | 98.12A | 98.12B |
| 98.12C | 98.12J | 98.12K | 98.12L | 98.12M | 98.12N |
| 98.12Q | 98.12R | 98.12T | 98.8 A | 98.81A | 98.81B |
| 98.99AA |
