Fee Navigator

    Health Service Code 67.87A

    Percutaneous injection of contrast media into renal pelvis under CT or ultrasound guidance for antegrade pyelography

    Category:M Minor Procedure
    Base rate:$134.88

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    ROLEANEYesReplace Base$109.21
    ROLEANESTYesReplace Base$18.39
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP75YesReduce Base To75%

    Governing Rules: