Fee Navigator®

    Health Service Code 67.86

    Retrograde pyelogram

    1. Includes cystoscopy.
    2. Only one call may be claimed whether unilateral or bilateral.
    Category:M+ Designated Minor Procedure
    Base rate:$136.90

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    ROLEANEYesReplace Base$110.53
    ROLEANESTYesReplace Base$18.39
    VANEL30ANIncrease By$108.34
    VANEL30ATIncrease By$108.34
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    UGAUGAYesReplace Base$134.85
    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: