Fee Navigator®

    Health Service Code 98.11F

    Functional area, over 64 total square cms

    Category:14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
    Base rate:$668.93

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    BMIBMI2ANYesIncrease By25%
    ROLEANEYesReplace Base$218.88
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    ROLE2ANESYesReplace Base$22.07
    VANEL30ANIncrease By$108.34
    VANEL30AT2Increase By$108.34
    2ANU2ANU1For Each Call Pay Base At100%
    2ANU2ANU2 - 150For Each Call Increase By$22.07
    SAUSAU1For Each Call Pay Base At100%
    SAUSAU2 - 33For Each Call Increase By$37.04
    SAQUSAQU1 - 36For Each Call Pay Base At100%
    RECOCMPRSCYesIncrease Base To125%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70
    LMTSL44ANEYesIncrease Base By$108.34
    LVPLVP75YesReduce Base To75%

    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.

      CategoryPre-operativePost-operative
      10 - Days14 - Days
      37 - Days7 - Days
      47 - Days14 - Days
      614 - Days14 - Days
      1430 - Days14 - Days
      150 - Days7 - Days
    • 7.1.1 FUNCTIONAL AREA

      Functional area includes the following anatomical areas: Head, face, neck, shoulder, axilla, elbow, wrist, hand, groin, perineum, hip, knee, ankle, foot, and includes coverage of exposed vital structures (bone, tendon, major vessel, nerve). Paired structures would be claimed as two separate areas, e.g., right and left wrist would be claimed as two separate areas.

    • 18.1

      The Body Mass Index (BMI) modifier may be claimed for selected procedures, obstetrical services, anesthesia, second qualified surgeon and surgical assistant services provided in any location when the following criteria are met:

      1. An adult patient has a body mass index of 40 or more.
      2. A patient under 18 years of age who is above the 97th percentile for BMI on an approved pediatric growth curve.
      3. The following HSCs are only eligible for the BMI modifier when the service is provided under general, spinal, epidural anesthetic or regional nerve block performed in an operating room, day surgery or surgical suite: 98.11A, 98.11B, 98.11C, 98.11D, 98.11E, 98.11F, 98.22A, 98.22B.