| Category: | 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days) |
|---|---|
| Base rate: | $261.43 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| BMI | BMIANE | Yes | Increase By | 25% | |
| BMI | BMIANT | Yes | Increase By | 25% | |
| BMI | BMIPRO | Yes | Increase By | 25% | |
| AGE | L30 | Increase Base To | 150% | ||
| ROLE | ANE | Yes | Replace Base | $149.85 | |
| ROLE | ANEST | Yes | Replace Base | $18.70 | |
| ROLE | SA | Yes | Replace Base | $148.42 | |
| ROLE | SAQS | Yes | Replace Base | $51.10 | |
| ROLE | SSST | Yes | Replace Base | $325.09 | |
| VANE | L30AN | Increase By | $110.16 | ||
| VANE | L30AT | Increase By | $110.16 | ||
| ANU | ANU | 1 | For Each Call Pay Base At | 100% | |
| ANU | ANU | 2 - 150 | For Each Call Increase By | $18.70 | |
| SAU | SAU | 1 | For Each Call Pay Base At | 100% | |
| SAU | SAU | 2 - 33 | For Each Call Increase By | $37.13 | |
| SAQU | SAQU | 1 - 36 | For Each Call Pay Base At | 100% | |
| SURC | EV | Yes | Increase By | $48.82 | |
| SURC | NTAM | Yes | Increase By | $117.12 | |
| SURC | NTPM | Yes | Increase By | $117.12 | |
| SURC | WK | Yes | Increase By | $48.82 | |
| LMTS | L44 | Yes | Increase Base To | 150% | |
| LMTS | L44ANE | Yes | Increase Base By | $110.16 | |
| LVP | ADD | Yes | Replace Base | 100% |
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 |
HSCs with a designated category code of 1 and 15 include related post-operative services and those with a designated category code of 3, 4, 6 and 14 include both related pre-operative and post-operative services.
The following chart gives the pre-operative and post-operative periods.
| Category | Pre-operative | Post-operative |
| 1 | 0 - Days | 14 - Days |
| 3 | 7 - Days | 7 - Days |
| 4 | 7 - Days | 14 - Days |
| 6 | 14 - Days | 14 - Days |
| 14 | 30 - Days | 14 - Days |
| 15 | 0 - Days | 7 - Days |
