Fee Navigator®

    Health Service Code 71.96A

    Extra-corporeal Shock Wave Lithotripsy (ESWL)

    That for upper urinary tract calculi

    1. Only one benefit may be claimed regardless of the number of calculi treated on one side.
    2. Physician in continuous attendance.
    3. Includes injection of dye contrast material.
    4. Includes injection of sedation when required.
    5. Repeat within 42 days, refer to Price List.
    6. Cystoscopy and retrograde pyelography performed at the same encounter may be claimed.
    7. Bilateral calculi may be claimed for the second side, refer to Price List.
    Category:3 Major Procedure (pre-operative period: 7 days, post-operative period: 7 days)
    Base rate:$346.66

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANTYesIncrease By25%
    REPTOPSTYesReplace Base100%
    REPTREPTYesReplace Base$173.35
    ROLEANESTYesReplace Base$18.70
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.70
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At75%
    SURCEVYesIncrease By$48.82
    SURCNTAMYesIncrease By$117.12
    SURCNTPMYesIncrease By$117.12
    SURCWKYesIncrease By$48.82
    LVPLVP75YesReduce Base To75%

    Governing Rules: