Includes the technical and professional components.
| Category: | M Minor Procedure |
|---|---|
| Base rate: | $127.84 |
| 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 | |
| TRAY | MAJT | Increase By | $38.88 | ||
| NBTR | NBTR | Yes | |||
| LVP | LVP75 | Yes | Reduce Base To | 75% |
If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.
If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.
Benefits for non-invasive diagnostic procedures including HSCs in Section E (Laboratory and Pathology) and X (Diagnostic Radiology) performed for a hospital inpatient, registered outpatient or AACC or UCC patient are not payable under the Schedule. Payment for these services is the responsibility of the hospital/Regional Health Authority. This applies to both the technical and professional components. Such procedures include but are not limited to the following list.
| 03.12A | 03.16A | 03.16B | 03.19C | 03.19D | 03.37A |
| 03.37B | 03.38A | 03.38B | 03.38C | 03.38D | 03.38E |
| 03.38F | 03.38G | 03.38H | 03.38K | 03.38M | 03.38N |
| 03.38P | 03.38Q | 03.38R | 03.38S | 03.38T | 03.38X |
| 03.39A | 03.39B | 03.41A | 03.41B | 03.41C | 03.41D |
| 13.99CC | 24.89A | 32.81 | 49.98T | 50.98A |
| 95.94C | 98.8 A | 98.89A | 98.89B | 98.89C | 98.89D |
| 98.89E | 98.89F | 98.89H | 98.92E | 98.99F |
| F7 |
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 |
A major 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.
| 01.03 | 01.04A | 01.05A | 01.24A | 01.24B | 01.24BA |
| 01.24BB | 01.34 | 02.84A | 02.84B | 03.22B | 03.25 |
| 07.53B | 07.53D | 07.53E | 07.57A |
| 12.31 | 13.59C | 17.08A | 17.81A | 18.29F | 18.29FA |
| 21.42 | 21.69A | 22.13A | 22.13B | 22.13C | 22.5 A |
| 22.51A | 22.62A | 22.71 | 22.81 | 25.1 A | 25.29A |
| 25.39D |
| 32.01A | 32.81 | 33.02A | 33.22B | 34.0 A | 34.1 A |
| 34.89A | 37.82A | 38.89A | 39.21A | 39.62A | 39.83A |
| 39.83A |
| 50.4 A | 50.97A | 52.1 A | 52.11A | 52.13 | 56.93B |
| 60.24C | 61.01B | 61.03 | 61.29B | 61.37A | 61.39B |
| 66.91A |
| 70.1 | 70.5 A | 72.91 | 75.64 | 79.23A | 79.29E |
| 82.81A | 82.91A | 83.7 A | 87.3 | 87.55A | 89.37A |
| 89.37B | 89.41A | 89.41B | 89.42A |
| 93.39B | 93.39C | 95.02A | 95.09A | 95.81A | 97.11B |
| 97.83A | 97.89B | 98.04A | 98.6 A | 98.6 B | 98.12A |
| 98.12B | 98.12C | 98.12H | 98.12J | 98.12M | 98.12N |
| 98.12Q | 98.12R | 98.12T | 98.14A | 98.22A | 98.22B |
| 98.71D | 98.81A | 98.96A | 98.96B | 98.96C | 98.96D |
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:
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%.
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%.
Benefits for additional trays may not exceed the benefit listed for one major tray.
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 |
