I
CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES
II
OPERATIONS ON THE NERVOUS SYSTEM
III
OPERATIONS ON THE ENDOCRINE SYSTEM
IV
OPERATIONS ON THE EYES
V
OPERATIONS ON THE EARS
VI
OPERATIONS ON THE NOSE, MOUTH,AND PHARYNX
VII
OPERATIONS ON THE RESPIRATORY SYSTEM
VIII
OPERATIONS ON THE CARDIOVASCULAR SYSTEM
IX
OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEMS
X
OPERATIONS ON THE DIGESTIVE SYSTEM AND ABDOMINAL REGION
- 54
  OPERATIONS ON ESOPHAGUS
- 55
  INCISION AND EXCISION OF STOMACH
- 56
  OTHER OPERATIONS ON STOMACH
- 57
  INCISION, EXCISION AND ANASTOMOSIS OF INTESTINE
- 58
  OTHER OPERATIONS ON INTESTINE
- 59
  OPERATIONS ON APPENDIX
- 60
  OPERATIONS ON RECTUM AND PERIRECTAL TISSUE
  No additional benefits for sigmoidoscopy
- 61
  OPERATIONS ON ANUS
  NOTE: No additional payment for sigmoidoscopy
- 62
  OPERATIONS ON LIVER
- 63
  OPERATIONS ON GALLBLADDER AND BILIARY TRACT
- 64
  OPERATIONS ON PANCREAS
  - 64.0
    Pancreatotomy
  - 64.4
    Partial pancreatectomy
  - 64.6
    Radical pancreaticoduodenectomy
  - 64.7
    Anastomosis of pancreas (duct)
  - 64.8
    Transplant of pancreas
  - 64.9
    Other operations on pancreas
  - 65.1
    Repair of inguinofemoral hernia with graft or prosthesis (unilateral)
  - 65.4
    Repair of umbilical hernia
  - 65.6
    Repair of other hernia of anterior abdominal wall with graft or prosthesis
    - 65.61
      Repair of incisional hernia with graft or prosthesis
      - 65.61A
        Repair of incisional hernia including mesh, if used
        NOTE: 1. Refer to Price List for benefit when performed in conjunction with other abdominal procedures. 2. May not be claimed in conjunction with bowel obstruction HSCs 58.81A, 58.81B, or 58.81C. 3. A second call may only be claimed if a non-contiguous site requires repair. 4. HSC 66.4 A may not be claimed in addition. 5. Not for recurrent inguinal hernias.
  - 65.7
    Repair of diaphragmatic hernia (abdominal approach)
  - 65.8
    Repair of diaphragmatic hernia, thoracic approach
- 66
  OTHER OPERATIONS ON ABDOMINAL REGION
XI
OPERATIONS ON THE URINARY TRACT
XII
OPERATIONS ON THE MALE GENITAL ORGANS
XIII
OPERATIONS ON THE FEMALE GENITAL ORGANS
XIV
OBSTETRIC PROCEDURES
XV
OPERATIONS ON THE MUSCULOSKELETAL SYSTEM
XVI
OPERATIONS ON THE BREAST
XVII
OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE
XVIII
PROCEDURES NOT ELSEWHERE CLASSIFIED
LABORATORY AND PATHOLOGY
DIAGNOSTIC RADIOLOGY
NOTE: As stated in G.R. 11.1.1, claims for services in the Diagnostic Radiology section will not be payable unless the physician has been approved by the CPSA to provide those services.
THERAPEUTIC RADIOLOGY

Health Service Code 65.61A

Repair of incisional hernia including mesh, if used

NOTE:

Refer to Price List for benefit when performed in conjunction with other abdominal procedures.
May not be claimed in conjunction with bowel obstruction HSCs 58.81A, 58.81B, or 58.81C.
A second call may only be claimed if a non-contiguous site requires repair.
HSC 66.4 A may not be claimed in addition.
Not for recurrent inguinal hernias.

Category:	14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
Base rate:	$860.69

AMA billing tips:

HSCs 65.61A and 66.4 A may not be claimed together. The fee for 65.61A includes an amount for the lysis of adhesions.

Fee modifiers:

Type	Code	# of calls	Explicit	Action	Amount
BMI	BMIANE		Yes	Increase By	25%
BMI	BMIANT		Yes	Increase By	25%
BMI	BMIPRO		Yes	Increase By	25%
ROLE	ANE		Yes	Replace Base	$441.75
ROLE	ANEST		Yes	Replace Base	$18.70
ROLE	SA		Yes	Replace Base	$148.42
ROLE	SAQS		Yes	Replace Base	$51.10
ROLE	SSST		Yes	Replace Base	$325.09
VANE	L30AN			Increase By	$110.16
VANE	L30AT			Increase By	$110.16
ANEU	ANEU	1		For Each Call Pay Base At	100%
ANEU	ANEU	2 - 2		For Each Call Pay Base At	75%
ANU	ANU	1		For Each Call Pay Base At	100%
ANU	ANU	2 - 150		For Each Call Increase By	$18.70
SAU	SAU	1		For Each Call Pay Base At	100%
SAU	SAU	2 - 33		For Each Call Increase By	$37.13
SAQU	SAQU	1 - 36		For Each Call Pay Base At	100%
CALL	NBRSER	1		For Each Call Pay Base At	100%
CALL	NBRSER	2 - 2		For Each Call Pay Base At	75%
SURC	EV		Yes	Increase By	$48.82
SURC	NTAM		Yes	Increase By	$117.12
SURC	NTPM		Yes	Increase By	$117.12
SURC	WK		Yes	Increase By	$48.82
LMTS	L44ANE		Yes	Increase Base By	$110.16
LVP	ADD		Yes	Replace	$157.50
LVP	LVP75		Yes	Reduce Base To	75%

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.
Category Pre-operative Post-operative
1 0 - Days 14 - Days
3 7 - Days 7 - Days
4 7 - Days 14 - Days
6 14 - Days 14 - Days
14 30 - Days 14 - Days
15 0 - Days 7 - Days

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Health Service Codes

Health Service Code 65.61A

Repair of incisional hernia including mesh, if used

NOTE:

AMA billing tips:

Fee modifiers:

Governing Rules:

Category	Pre-operative	Post-operative
1	0 - Days	14 - Days
3	7 - Days	7 - Days
4	7 - Days	14 - Days
6	14 - Days	14 - Days
14	30 - Days	14 - Days
15	0 - Days	7 - Days

Fee Navigator®

Health Service Codes

Health Service Code 65.61A

Repair of incisional hernia including mesh, if used

NOTE:

AMA billing tips:

Fee modifiers:

Governing Rules:

Fee Navigator^®