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    Health Service Code 57.21C

    Removal of sessile polyp, additional benefit

    NOTE:
    1. May only be claimed for polyps greater than 2 cms in size requiring submucosal injection and piecemeal resection.
    2. May only be claimed in addition to HSCs 01.22, 01.22A, 01.22B, 01.22C, 01.24B, 01.24BA and 01.24BB.
    3. May be claimed in addition to HSC 57.21A if polyps are removed from different sites.
    4. May not be claimed for pedunculated polyps.
    5. Benefit includes placement of clips at the time of polypectomy.
    6. A maximum of two calls applies.
    Category:4 Major Procedure (pre-operative period: 7 days, post-operative period: 14 days)
    Base rate:$175.00

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$145.74
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At100%

    Governing Rules:

    • 6.8.1

      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.

      1. a consultation benefit may be claimed up to and including the day of surgery.
      2. pre-operative hospital care may be claimed by the physician who performs the surgery if information is submitted to show that conservative treatment was attempted before surgery was performed.
      3. benefits may be claimed as applicable for complications occurring during or following post-operative time periods.
      4. Deleted
      5. HSC 03.04R may be claimed in the pre-operative time frame when all conditions in the notes have been met.

      The following chart gives the pre-operative and post-operative periods.

      CategoryPre-operativePost-operative
      10 - Days14 - Days
      37 - Days7 - Days
      47 - Days14 - Days
      614 - Days14 - Days
      1430 - Days14 - Days
      150 - Days7 - Days