Fee Navigator®

    Health Service Code 56.99A

    Balloon dilatation of upper gastrointestinal stricture (stomach, duodenum or jejunum)

    1. May only be claimed in addition to 01.14.
    2. A repeat performed within 90 days is payable at 50%.
    Category:M Minor Procedure
    Base rate:$90.62

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    REPTREPTYesReduce Base To50%
    ROLEANEYesReplace Base$88.12
    LVPADDYesReplace Base100%

    Governing Rules:

    • 6.1

      If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.

    • 6.2

      If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.

    • 6.7.1

      If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.