Fee Navigator®

    Health Service Code 82.64A

    Vaginal vault suspension, additional benefit

    1. May only be claimed in addition to HSCs 81.99A, 81.99C, 82.41A, 82.42A and 82.69B.
    2. An additional benefit of 100% may be claimed for a repeat by using modifier REPT.
    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$264.53

    AMA billing tips:

    • Proactive tip - in order to receive payment of 82.64A at the 100% additional benefit rate, you must submit the claim with text noting the acceptable procedure that was claimed in addition. If you claimed 82.64A in addition to an accepted procedure and the payment is reduced (LVP75), you can resubmit the claim with text noting that the service was billed in addition to HSC x, an acceptable procedure, and should be paid at 100%. Please note that adding text to claims will cause delays in payment as the claim will require manual adjudication. Alberta Health is aware of this problem and will work towards a solution.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    REPTREPTYesIncrease Base To200%
    ROLEANEYesReplace Base$104.73

    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.

      10 - Days14 - Days
      37 - Days7 - Days
      47 - Days14 - Days
      614 - Days14 - Days
      1430 - Days14 - Days
      150 - Days7 - Days