Fee Navigator

    Health Service Code 83.9 A

    Operations on the adnexa, any method

    XIV OBSTETRIC PROCEDURES

    NOTE:
    1. May be claimed with HSCs 71.7 A, 82.7 A and 81.99A.
    2. May not be claimed in association with a hysterectomy for the removal of fallopian tubes alone.
    3. May not be claimed for sterilization.
    4. When performed as a second or subsequent procedure through the same incision, the procedural rate should be claimed at 50% using modifier LVP50. Anesthetic claims using ANE for second and subsequent procedures should use the LVP75 modifier.
    Common terms:
    • BSO
    • Oophorectomy
    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$373.30

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$165.79
    ROLEANESTYesReplace Base$18.39
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    ANEUANEU1For Each Call Pay Base At100%
    ANEUANEU2 - 2For Each Call Pay Base At75%
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    SAUSAU1For Each Call Pay Base At100%
    SAUSAU2 - 33For Each Call Increase By$37.04
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At75%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    INCSDIFFYesIncrease Base By
    LVPLVP50YesReduce Base To50%
    LVPLVP75YesReduce Base To75%

    Governing Rules: