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.