Age modifier required, refer to Price List.
| Category: | 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days) |
|---|---|
| Base rate: | $1831.63 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| BMI | BMIANE | Yes | Increase By | 25% | |
| BMI | BMIPRO | Yes | Increase By | 25% | |
| BMI | BMI2AN | Yes | Increase By | 25% | |
| AGE | G2 | Replace Base | $943.25 | ||
| ROLE | ANE | Yes | Replace Base | $941.63 | |
| ROLE | SA | Yes | Replace Base | $148.42 | |
| ROLE | SAQS | Yes | Replace Base | $51.10 | |
| ROLE | SSCVT | Yes | Replace Base | $312.56 | |
| ROLE | SSST | Yes | Replace Base | $325.09 | |
| ROLE | 2ANES | Yes | Replace Base | $22.44 | |
| VANE | AGEG2 | Replace Base | $521.59 | ||
| 2ANU | 2ANU | 1 | For Each Call Pay Base At | 100% | |
| 2ANU | 2ANU | 2 - 150 | For Each Call Increase By | $22.44 | |
| SAU | SAU | 1 | For Each Call Pay Base At | 100% | |
| SAU | SAU | 2 - 37 | For Each Call Increase By | $37.13 | |
| SAQU | SAQU | 1 - 36 | For Each Call Pay Base At | 100% | |
| REDO | COMPLT | Yes | Increase Base To | 150% | |
| REDO | PART | Yes | Increase Base To | 125% | |
| REDO | REDO1 | Yes | Increase Base To | 175% | |
| REDO | REDO2 | Yes | Increase Base To | 225% | |
| REDO | REDO3 | Yes | Increase Base To | 275% | |
| REDO | REDO4 | Yes | Increase Base To | 325% | |
| REDO | REDO5 | Yes | Increase Base To | 375% | |
| 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 | |
| LVP | LVP75 | Yes | Reduce Base To | 75% |
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 |
Benefits that may be claimed for redos for one of the following HSCs vary depending on how many redos have been performed in the past, (whether partly or wholly), through that incision. The first redo may be claimed at 175% of the listed benefit, the second at 225%, the third at 275%, the fourth at 325%, and the fifth at 375%.
| 50.04A | 50.05A | 50.14 | 50.15A | 50.24A | 50.24B |
| 50.34A | 50.34B | 50.34D | 50.34K | 50.34L | 50.75B |
| 50.75C | 51.21A | 51.21B | 51.21C | 51.3 C |
