Fee Navigator

    Health Service Code 61.63A

    Anal fistulotomy and other procedures for anal fistula

    NOTE:
    1. Benefit includes insertion of seton, fibrin glue injection, anal fistula plug insertion, ligation of intersphincteric fistula tract.
    2. Maximum of three calls may be claimed per encounter.
    3. Second and third calls may not be claimed unless treatment is performed on documented separate internal openings for each call at the same encounter.
    4. HSC 10.23 may not be claimed in addition.
    Additional notes:
    • Listed under 61 - OPERATIONS ON ANUS:

      No additional payment for sigmoidoscopy

    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$290.52

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$110.53
    ROLEANESTYesReplace Base$18.39
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    VANEL30ANIncrease By$108.34
    VANEL30ATIncrease By$108.34
    ANEUANEU1For Each Call Pay Base At100%
    ANEUANEU2 - 3For Each Call Pay Base At50%
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    SAUSAU1For Each Call Pay Base At100%
    SAUSAU2 - 37For Each Call Increase By$37.04
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 3For Each Call Pay Base At50%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LMTSL44ANEYesIncrease Base By$108.34
    LVPLVP75YesReduce Base To75%

    Governing Rules: