Fee Navigator®

    Health Service Code 45.5 A

    Lung transplant

    With recipient pneumonectomy

    NOTE:
    1. May be claimed with HSC 49.5 A.
    2. When performed as a bilateral procedure and/or when claimed in addition to HSC 49.5A, the procedural benefit may be claimed at 100% for both lungs. This does not apply to the anesthetic rate.
    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$4938.44

    AMA billing tips:

    • For donor harvesting claims following the date of death:

      1. Submit the claim using the date of death as the PHN becomes invalid following the date of death.
      2. Add text to the claim that states the date that the harvesting occurred.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    BMIBMI2ANYesIncrease By25%
    AGEL30Increase Base To150%
    ROLEANEYesReplace Base$1389.47
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSCVTYesReplace Base$310.38
    ROLESSSTYesReplace Base$280.58
    ROLE2ANESYesReplace Base$22.07
    VANEL30ANIncrease By$108.34
    VANEL30AT2Increase By$108.34
    ANEUANEU1For Each Call Pay Base At100%
    ANEUANEU2 - 2For Each Call Pay Base At75%
    2ANU2ANU1For Each Call Pay Base At100%
    2ANU2ANU2 - 150For Each Call Increase By$22.07
    SAUSAU1For Each Call Pay Base At100%
    SAUSAU2 - 37For Each Call Increase By$37.04
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At100%
    REDOCOMPLTYesIncrease Base To150%
    REDOPARTYesIncrease Base To125%
    REDOREDO1YesIncrease Base To175%
    REDOREDO2YesIncrease Base To225%
    REDOREDO3YesIncrease Base To275%
    REDOREDO4YesIncrease Base To325%
    REDOREDO5YesIncrease Base To375%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LMTSL44YesIncrease Base To150%
    LMTSL44ANEYesIncrease Base By$108.34
    LVPLVP75YesReduce Base To75%

    Governing Rules: