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    Health Service Code 91.09A

    Diaphyseal bone external fixation with possible metaphyseal fixation

    NOTE:

    This will include complex cases such as a severe tibial plateau fracture that can not be treated with internal fixation.

    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$527.41

    AMA billing tips:

    • 91.09A should NOT be used for wrist pinning; 91.09B should be used for closed reduction and pinning of distal radius metaphyseal fractures.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$184.21
    ROLEANESTYesReplace Base$18.39
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    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%
    UNDPUNDPYesReduce Base To50%
    CMPDCMPDYesIncrease Base To150%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LVPLVP50YesReduce Base To50%

    Governing Rules: