Fee Navigator

    Health Service Code 54.21D

    With electrocautery or injection hemostasis for esophageal hemorrhage

    NOTE:
    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
    VANEADDAReplace$109.31
    LVPADDYesReplace Base100%

    Governing Rules: