Fee Navigator®

    Health Service Code 57.21A

    Polypectomy of large intestine, additional benefit

    1. May only be claimed for the removal of polyps that are greater than 5mm in size.
    2. May only be claimed with HSCs 01.16B, 01.16C, 01.22, 01.22A, 01.22B, 01.22C, 01.24B, 01.24BA and 01.24BB and when the removal of a colonic mucosal lesion is performed using a polypectomy snare (with or without electrocautery)or a hot biopsy forceps.
    3. May be claimed in addition to HSC 57.21C if polyps are removed from different sites.
    4. May not be claimed when a regular biopsy forceps is used to remove a diminutive polyp without electrocautery, even if multiple passes are required.
    5. Benefit includes placement of clips at the time of polypectomy.
    6. Each additional polyp may be claimed at the rate specified on the Price List; a maximum benefit of six calls applies.
    Category:4 Major Procedure (pre-operative period: 7 days, post-operative period: 14 days)
    Base rate:$85.49

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$111.05
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 6For Each Call Increase By$64.12

    Governing Rules: