Governing Rules:

• 6.1

  If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.

• 6.2

  If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.

• 6.7.1

  If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.

• 14.2 MINOR TRAY SERVICE

  A minor tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.

  07.53C	07.56A	07.57B	10.16A	11.23A	12.01
  12.21	13.53B	13.59E	13.59F	13.59H	13.59J
  13.59K	13.59L	13.59N	13.99BB 16.89B	16.89C
  16.89D	17.71A	17.71B	18.29E	19.81

  21.31A	21.41	21.32D	21.69C	23.99D	24.91
  30.19A	32.96A	32.96B	33.01A	33.03A	33.21A
  33.22A	33.61A	35.0 A	37.81	37.91A	38.0 A
  39.91B

  43.0 B

  50.98A

  51.92A

  53.81B

  61.01A	67.93	70.5 B	71.95	73.91	78.7 A
  79.22

  80.83B	81.8	93.91A	93.91B	94.01B	94.04
  95.03	95.93	95.94A	95.94B	95.96A	97.81
  97.89A	98.01A	98.03A	98.03B	98.03C	98.03E
  98.04B	98.04C	98.12K	98.12S

• 14.3 MULTIPLE TRAY SERVICE

  If multiple procedures listed under GRs 14.1 and 14.2 are performed during the same encounter in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services, the following applies:

• 14.3.1

  For the same anatomical area (example - 3 moles removed from the face), only one tray may be claimed except when the condition relates to suspected cancer or infection, in which case, if required, additional tray(s) may be claimed at 50%.

• 14.3.2

  For different anatomical areas, the tray for the initial procedure may be claimed at 100% and if required, the tray for each additional procedure may be claimed at 50%.

• 14.3.3

  Benefits for additional trays may not exceed the benefit listed for one major tray.

• 15.10

  The unscheduled service benefit (modifier SURC) may not be claimed for:

• 15.10.6

  Services included in the following list unless supporting information detailing unusual circumstances satisfactory to the Minister is provided.

  03.21A	03.22A	03.22B	03.25	03.29A	07.29B
  07.51A	07.51C	07.54A	07.56A	13.42A	13.53A
  13.57A	13.59A	13.59B	13.59H	13.59J	17.81A

  21.69A	22.13B	22.13C	22.71	22.81	23.99D
  24.91	26.91A	29.91	30.19A	30.81A	32.1
  32.81	33.21A	33.22B	33.51A	37.82A	37.82B
  38.89A	39.21A	39.62A	39.83A

  40.92A	41.29A	50.97A	51.92A	52.1 A	52.11A
  52.11B	52.12	52.13

  60.82C	61.29B	61.39B	69.83A	69.83B	73.2 A
  75.83A	76.1 A	79.22	79.23A	79.29E

  81.91A	82.81A	82.91A	83.2 B	83.7 A	87.99B
  95.81A	95.94A	95.94B	97.11A	98.12A	98.12B
  98.12C	98.12J	98.12K	98.12L	98.12M	98.12N
  98.12Q	98.12R	98.12T	98.8 A	98.81A	98.81B
  98.99AA