I
CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES
II
OPERATIONS ON THE NERVOUS SYSTEM
III
OPERATIONS ON THE ENDOCRINE SYSTEM
IV
OPERATIONS ON THE EYES
V
OPERATIONS ON THE EARS
VI
OPERATIONS ON THE NOSE, MOUTH,AND PHARYNX
VII
OPERATIONS ON THE RESPIRATORY SYSTEM
VIII
OPERATIONS ON THE CARDIOVASCULAR SYSTEM
IX
OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEMS
X
OPERATIONS ON THE DIGESTIVE SYSTEM AND ABDOMINAL REGION
XI
OPERATIONS ON THE URINARY TRACT
XII
OPERATIONS ON THE MALE GENITAL ORGANS
XIII
OPERATIONS ON THE FEMALE GENITAL ORGANS
XIV
OBSTETRIC PROCEDURES
XV
OPERATIONS ON THE MUSCULOSKELETAL SYSTEM
XVI
OPERATIONS ON THE BREAST
XVII
OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE
- 98
  OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE
  - 98.0
    Incision of skin and subcutaneous tissue
  - 98.1
    Excision of skin and subcutaneous tissue
    - 98.11
      Debridement of wound or infected tissue
      NOTE: Only one of HSCs 98.11A to 98.11F may be claimed per functional or non-functional anatomical area as defined in GRs 7.1.1 and 7.1.2 with the exception of paired structures which may be claimed as two.
    - 98.12
      Local excision or destruction of lesion or tissue of skin and subcutaneous tissue
    - Warts or Keratoses
      NOTE: 1. Items 98.12J, 98.12K and 98.12L may only be claimed for the following: genital warts; plantar warts; precancerous skin lesions, e.g., actinic keratoses; seborrhoeic keratoses which are irritated and treatment is medically required; warts in immuno-deficient patients or immuno-suppressed patients; or molluscum contagiosum. 2. The treatment of common warts or keratoses is an uninsured service.
      - 98.12J
        Removal or excision, first lesion
        NOTE: 1. May be claimed in addition to a visit or a consultation. 2. A maximum of four calls may be claimed.
      - 98.12K
        Removal by fulguration, first lesion
        NOTE: A maximum of six calls may be claimed.
      - 98.12L
        Non-surgical treatment (cryotherapy, chemotherapy), warts or keratoses
        NOTE: May be claimed in addition to a visit or consultation.
      - 98.12M
        Removal of pigmented benign nevus, excluding face
      - 98.12N
        Removal of pigmented benign nevus of the face
      - 98.12P
        Removal of complicated naevi
      - Multiple dysplastic or localized carcinomatous lesions of the skin
      - Condylomata acuminata
    - 98.13
      Radical excision of skin lesion
    - 98.14
      Excision of pilonidal sinus or cyst
  - 98.2
    Suture of skin and subcutaneous tissue
  - 98.4
    Free skin graft
  - 98.5
    Flap or pedicle graft
    NOTE: 1. Functional areas includes the following anatomical areas: Head, neck, axillae, elbow, wrist, hand, groin, perineum, hip, knee, ankle, foot and includes coverage of exposed vital structures (bone, tendon, major vessel, nerve) 2. Flaps (HSCs 98.53,98.5A,98.51A,98.51B) for functional areas are designated by FNCAR modifier, add 50% to total benefit. 3. Flap size 5-10 cms or double Z-plasty designated by 2ZPL modifier, add 25% to benefit. 4. Flap size greater than 10 cms or triple Z-plasty designated by 3ZPL modifier, add 50% to benefit. 5. Composite tissue resection (includes bone) designated by CMPRSC modifier, add 25% to benefit. 6. Only one modifier (CMPRSC, FNCAR, 2ZPL, 3ZPL) may be claimed per flap.
  - 98.6
    Plastic operations on lip and external mouth
  - 98.7
    Other repair and reconstruction of skin and subcutaneous tissue
  - 98.8
    Invasive diagnostic procedures on skin and subcutaneous tissue
  - 98.9
    Other operations on skin and subcutaneous tissue
XVIII
PROCEDURES NOT ELSEWHERE CLASSIFIED
LABORATORY AND PATHOLOGY
DIAGNOSTIC RADIOLOGY
NOTE: As stated in G.R. 11.1.1, claims for services in the Diagnostic Radiology section will not be payable unless the physician has been approved by the CPSA to provide those services.
THERAPEUTIC RADIOLOGY

Health Service Code 98.12K

Removal by fulguration, first lesion

NOTE:

A maximum of six calls may be claimed.

Additional notes:

Listed under - Warts or Keratoses:
1. Items 98.12J, 98.12K and 98.12L may only be claimed for the following: genital warts; plantar warts; precancerous skin lesions, e.g., actinic keratoses; seborrhoeic keratoses which are irritated and treatment is medically required; warts in immuno-deficient patients or immuno-suppressed patients; or molluscum contagiosum.
2. The treatment of common warts or keratoses is an uninsured service.

Category:	M Minor Procedure
Base rate:	$24.85

Fee modifiers:

Type	Code	# of calls	Explicit	Action	Amount
BMI	BMIANE		Yes	Increase By	25%
BMI	BMIANT		Yes	Increase By	25%
ROLE	ANE		Yes	Replace Base	$112.39
ROLE	ANEST		Yes	Replace Base	$18.70
ANU	ANU	1		For Each Call Pay Base At	100%
ANU	ANU	2 - 150		For Each Call Increase By	$18.70
UGA	UGA		Yes	Replace Base	$134.85
CALL	NBRSER	1		For Each Call Pay Base At	100%
CALL	NBRSER	2 - 5		For Each Call Increase By	$6.57
CALL	NBRSER	6 - 6		For Each Call Increase By	$3.35
CALL	NBRSER			To a Maximum Of	$54.48
TRAY	MINT			Increase By	$13.14
NBTR	NBTR		Yes
LVP	LVP75		Yes	Reduce Base To	75%

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.

6.8.4

Where a procedure is performed under general anesthesia, the following applies:

If the procedure is the only procedure performed at that time, a benefit of $134.85 may be claimed.
If another procedure is also performed at the same encounter and the listed benefit payable in respect of it under the Schedule is greater than $134.85 the physician is entitled to receive that listed benefit plus a percentage of the listed benefit for the lesser procedure(s) calculated in accordance with this Schedule. The $134.85 minimum benefit does not apply to the lesser procedures.
If multiple procedures are performed at the same encounter and the listed benefit payable in respect of each of them under the Schedule is less than $134.85, the physician is entitled to receive a benefit of $134.85 in respect of the greater procedure plus a benefit in respect of each of the lesser procedures that is a percentage of the listed benefit and calculated in accordance with this schedule. The $134.85 minimum benefit does not apply to the lesser procedures.
If multiple procedures are performed at the same encounter and only one of them appears under GR 6.8.4 (e), the physician is entitled to receive a benefit of $134.85 in respect of that procedure plus a benefit in respect of the other procedures that is a percentage of the listed benefit and calculated in accordance with this schedule.

GR 6.8.4 applies to the following HSCs:

01.01A	01.01B	01.03	01.09	01.24A	01.24B
01.24BA	01.24BB	02.84B	03.22A	03.22B	03.25
07.29A	07.57A

10.23	10.25	11.71A	11.81A	12.01	12.21
12.24	12.31	13.59L	13.59N	13.59O	13.99BB
14.09A	17.39E	17.81A	19.81

21.41	21.42	21.69A	21.69C	22.13B	22.13C
22.5 A	22.81	24.22A	24.5	25.1 A	26.91A
28.8 A

30.19A	30.19B	30.9 A	32.01A	32.1	32.21A
32.23A	32.39A	33.22A	33.22B	33.51A	33.51B
33.61A	34.0 A	34.1 A	34.89A	35.0 A	37.81
37.82A	38.0 A	38.89A	39.21A	39.62A	39.83A

40.5	40.92A	43.95A	45.81A	45.83	45.84A
46.04B	46.09B	46.09C	46.84A	49.0	49.82B
49.83A

50.4 A	50.94D	50.94E	50.94F	50.97A	51.43
51.53A	52.1 A	53.81B	53.83A	54.92D	58.99F

60.82C	61.01A	61.29B	61.37A	61.39B	62.81A
64.95A	66.82A	67.81	67.86	67.96A	68.1
68.32B	69.13D	69.29A	69.83A	69.83B

70.1	70.2 A	70.2 B	70.2 H	70.4 F
70.5 A	72.91	74.82A	76.91A	78.7 A	79.29E

80.83B	80.85B	81.8	81.96	82.12A	82.12B
82.12C	82.14D	82.81A	82.91A	83.7 A	87.6
87.72A	87.82	87.89A	87.89B	87.91	87.92
88.92	89.59A

97.81	97.96	98.03A	98.04A	98.12A	98.12B
98.12C	98.12E	98.12G	98.12H	98.12J	98.12K
98.12M	98.12N	98.12Q	98.12R	98.22A	98.49A
98.6 A	98.6 C	98.81A	98.93A	98.93B	98.96A
98.96B	98.96C	98.96D	98.98B

13.3

Benefits may not be claimed for procedures that do not routinely require the services of a surgical assistant or a 2nd surgeon for a 2nd surgical team, unless supporting information detailing unusual circumstances satisfactory to the Minister is provided. Such procedures include but are not limited to the following list:

01.01A	01.01B	01.03	01.04A	01.05A	01.09
01.12B	01.14	01.16B	01.16C	01.22	01.22A
01.22B	01.22C	01.24A	01.24B	01.24BA	01.24BB
01.32	01.34	02.84A	02.84B

06.35A	06.35B	06.39A	06.39B	07.09A	07.27A
07.27B	07.29A	07.29B	07.51A	07.51C	07.53A
07.53B	07.53C	07.53D	07.53E	07.54A	07.56A
07.57A	07.57B	09.01A	09.01B	09.01C	09.01F
09.05A	09.06A	09.07C	09.11A	09.12A	09.26A
09.49A

15.93A	15.93B	15.93C	15.94A	15.99A	16.2 B
16.81A	16.83A	16.83B	16.83C	16.89A	16.92A
17.03A	17.08D	17.08E	17.08K	17.1 A	17.39E
17.71A	17.81A	17.89A	18.29A	18.29B	19.81

40.0	40.1 A	40.5	40.92A	41.29A	41.29B
42.09A	42.09B	43.1 B	43.81	43.82	43.95A
43.96A	43.96B	43.96C	43.96D	43.96E	44.01
44.22A	45.81A	45.83	45.84A	45.88A

52.1 A	52.85A	53.42A	53.81A	53.81B	53.83A
54.21B	54.21C	54.21D	54.21E	54.89A	54.89B
54.89D	54.89E	54.89F	54.91A	54.92A	54.92B
54.92C	54.92D	54.92E	55.41A	55.41B	56.34A
56.93B	57.21A	57.92A	58.99B

70.1	70.2 A	70.2 B	70.2 H	70.4 F	70.4 G
70.5 A	70.5 B	71.8	71.95	71.96A	72.1 C
72.91	73.2 A	73.91	74.82A	75.64	75.83A
76.0	76.1 A	76.89A	76.91A	78.7 A	79.22
79.23A	79.29C	79.29E

80.81	80.83B	80.85A	80.85B	81.01D	81.09
81.8	81.91A	81.96	82.12A	82.12B	82.12C
82.81A	82.91A	83.09A	83.2 B	83.7 A	84.21D
85.5 A	87.3	87.53A	87.54A	87.54B	87.55A
87.6	87.99A	87.99AA	88.02A	88.92	89.98A

91.00A	91.01A	91.01B	91.01H	91.01J	91.02A
91.02C	91.02D	91.03A	91.03B	91.04A	91.04B
91.05A	91.06B	91.06D	91.06E	91.07A	91.08B
91.08J	91.12A	91.13A	91.72	91.73A	91.73B
91.77C	91.78B	91.78C

92.70	92.71	92.72	92.74	92.75	92.76
92.78A	92.78B	92.78C	93.91A	93.91B	95.03
95.81A	95.93	95.96A	96.01A	96.01B	96.02A
96.02B	96.11A	97.81	97.83A	97.89A	97.89B
97.96

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 18.29EA 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

03.16A	03.21A	03.22A	03.22B	03.22C	03.26
03.29A	03.37A	03.38A	03.38B	03.38C	03.38D
03.38E	03.38F	03.38G	03.38H	03.38K	03.38M
03.38N	03.38P	03.38Q	03.38R	03.38S	03.38T
03.38X	03.41A	03.44A	03.45A	03.45B	03.52A
03.52C	03.55A	03.56A	03.63

10.04	10.08A	10.16A	10.23	10.25	10.33A
10.33B	10.35	10.55A	10.56A	11.02	11.02A
11.81A	12.01	12.03	12.05	12.12A	12.12B
12.13A	12.21	12.23	12.24	12.31	13.4 A
13.42A	13.53A	13.55A	13.57A	13.59A	13.59B
13.59C	13.59D	13.72A	13.99A	13.99AA	13.99B
13.99BB	13.99C	13.99D	14.3 B	14.85B

20.55B	21.31B	21.32B	21.32D	21.41	21.42
21.69A	22.13A	22.13B	22.13C	22.39A	22.5 A
22.5 B	22.62A	22.71	22.81	23.99A	23.99C
23.99D	24.22A	24.5	24.89A	24.89B	24.91
25.1 A	25.29A	25.81A	27.4 A	27.5 A	27.7 A
27.7 C	27.73A	28.1 A	28.4 A	28.5 A	29.91

46.04A	46.04B	46.09B	46.09C	46.84A	46.88A
46.91	47.02B	47.03A	48.92A	48.98A	48.98B
49.0	49.61B	49.7 D	49.7 N	49.73A	49.81
49.82A	49.82B	49.83A	49.84	49.85	49.86
49.93A	49.95A	49.96A	49.96B	49.98B	49.98C
49.98D	49.98P	49.98Q	49.98R	49.98S	49.98T
49.98U

50.4 A	50.6 B	50.71C	50.75E	50.79A	50.81A
50.81B	50.81C	50.81D	50.81E	50.82A	50.82B
50.83A	50.84A	50.84B	50.84C	50.87A	50.87B
50.87C	50.88A	50.89A	50.89B	50.89C	50.89D
50.89E	50.91B	50.91D	50.91E	50.93A	50.94D
50.94E	50.94F	50.95A	50.95B	50.96	50.97A
50.98A	50.99A	50.99D	51.52A	51.53B	51.59B
51.65A	51.65B	51.92A	51.92B	51.99A	51.99B

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Health Service Codes

Health Service Code 98.12K

Removal by fulguration, first lesion

NOTE:

Additional notes:

Fee modifiers:

Governing Rules:

30.19A	30.19B	30.81A	30.9 A	32.01A	32.1
32.31	32.81	33.01A	33.02A	33.03A	33.21A
33.22A	33.22B	33.4 C	33.51A	33.51B	33.61A
33.76A	33.76B	33.76C	33.76D	33.76E	33.76F
33.76G	34.0 A	34.1 A	34.54A	34.89A	35.0 A
37.81	37.82A	37.82B	38.0 A	38.89A	38.89B
39.21A	39.62A	39.83A

60.82C	60.89A	61.01A	61.03	61.29B	61.37A
61.39B	62.81A	62.82A	63.96B	63.99A	63.99B
63.99C	64.95A	64.97A	66.83	66.89B	66.89C
66.91B	66.91C	66.98A	67.02	67.81	67.83
67.86	67.87A	67.89A	67.93	67.96A	68.0 A
68.95	68.99A	68.99B	69.11	69.13D	69.29A
69.29B	69.29C	69.83A	69.83B	69.94

98.03A	98.03C	98.03E	98.04A	98.04B	98.12A
98.12B	98.12C	98.12G	98.12J	98.12K	98.12L
98.12M	98.12N	98.12Q	98.12R	98.12S	98.12T
98.12U	98.13A	98.22A	98.22B	98.6 A	98.8 A
98.81A	98.81B	98.89A	98.89B	98.89C	98.89D
98.89E	98.89F	98.89G	98.92C	98.93A	98.93B
98.96A	98.96B	98.96C	98.96D	98.98B	98.99AA

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

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Health Service Codes

Health Service Code 98.12K

Removal by fulguration, first lesion

NOTE:

Additional notes:

Fee modifiers:

Governing Rules:

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