Fee Navigator

    Health Service Code 54.21D

    With electrocautery or injection hemostasis for esophageal hemorrhage

    1. May only be claimed in addition to 01.14.
    2. Single benefit applies regardless of the number of sites or applications.
    Category:1 Major Procedure (pre-operative period: 0 days, post-operative period: 14 days)
    Base rate:$136.79

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$109.31
    LVPADDYesReplace Base100%

    Governing Rules: