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
  - 98.2
    Suture of skin and subcutaneous tissue
  - 98.4
    Free skin graft
    - 98.44
      Full thickness skin graft to other sites
      NOTE: Includes closure of donor defect. Dorsum of hand, palm of hand and web space of hand are considered separate sites.
    - 98.49
      Other free skin graft to other sites
      Non-functional areas split thickness skin grafts
      NOTE: 1. Refer to GRs 7.1.1 through 7.2.2. 2. Only one of HSCs 98.49A to 98.49G may be claimed per anatomical area as defined in GRs 7.1.1 and GR 7.1.2 with the exception of paired structures which may be claimed as two.
  - 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 98.49B

Non-functional split thickness skin graft over 32 and up to 64 total square cms

NOTE:

Refer to the notes following HSC 98.49D.

Additional notes:

Listed under 98.49D - Non-functional split thickness skin graft over 100 total square cms:
1. For grafts over 100 square cms, only one HSC 98.49D may be claimed per anatomical area.
2. Refer to GRs 7.1.1 through 7.2.2 for explanation of functional and non-functional areas.
3. Only one of HSCs 98.49A, 98.49B, 98.49C or 98.49D may be claimed per anatomical area unless it is for a paired structure.
4. If several grafts of less than 100 sq cms are performed in the same anatomical area, the maximum that may be claimed is one HSC 98.49D.
Listed under 98.49 - Other free skin graft to other sites - Non-functional areas split thickness skin grafts:
1. Refer to GRs 7.1.1 through 7.2.2.
2. Only one of HSCs 98.49A to 98.49G may be claimed per anatomical area as defined in GRs 7.1.1 and GR 7.1.2 with the exception of paired structures which may be claimed as two.

Category:	14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)
Base rate:	$167.12

Fee modifiers:

Type	Code	# of calls	Explicit	Action	Amount
BMI	BMIANE		Yes	Increase By	25%
BMI	BMIANT		Yes	Increase By	25%
BMI	BMIPRO		Yes	Increase By	25%
ROLE	ANE		Yes	Replace Base	$155.28
ROLE	ANEST		Yes	Replace Base	$18.70
ROLE	SA		Yes	Replace Base	$148.42
ROLE	SAQS		Yes	Replace Base	$51.10
ROLE	SSST		Yes	Replace Base	$325.09
VANE	L30AN			Increase By	$110.16
VANE	L30AT			Increase By	$110.16
ANEU	ANEU	1		For Each Call Pay Base At	100%
ANEU	ANEU	2 - 10		For Each Call Pay Base At	75%
ANU	ANU	1		For Each Call Pay Base At	100%
ANU	ANU	2 - 150		For Each Call Increase By	$18.70
SAU	SAU	1		For Each Call Pay Base At	100%
SAU	SAU	2 - 33		For Each Call Increase By	$37.13
SAQU	SAQU	1 - 36		For Each Call Pay Base At	100%
CALL	NBRSER	1		For Each Call Pay Base At	100%
CALL	NBRSER	2 - 10		For Each Call Pay Base At	75%
SURC	EV		Yes	Increase By	$48.82
SURC	NTAM		Yes	Increase By	$117.12
SURC	NTPM		Yes	Increase By	$117.12
SURC	WK		Yes	Increase By	$48.82
LMTS	L44ANE		Yes	Increase Base By	$110.16
LVP	LVP75		Yes	Reduce Base To	75%

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.
Category Pre-operative Post-operative
1 0 - Days 14 - Days
3 7 - Days 7 - Days
4 7 - Days 14 - Days
6 14 - Days 14 - Days
14 30 - Days 14 - Days
15 0 - Days 7 - Days
7.1.2 NON - FUNCTIONAL AREA
Non-functional area includes the following anatomical areas: Posterior trunk, anterior trunk, arm (above elbow), forearm (below elbow), thigh, leg (below knee). Paired structures would be claimed as two separate areas, e.g., right and left arm would be claimed as two separate areas.
7.2.1
When multiple grafts are applied within the same anatomical area, the total number of square centimetres per anatomical area should be claimed.
7.2.2
When grafts are applied to multiple anatomical areas, whether non-functional or functional, payment will be as follows:
1. first anatomical area - 100% of listed benefit.
2. second and subsequent anatomical area(s) - 75% of the listed benefit.

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Health Service Codes

Health Service Code 98.49B

Non-functional split thickness skin graft over 32 and up to 64 total square cms

NOTE:

Additional notes:

Fee modifiers:

Governing Rules:

Category	Pre-operative	Post-operative
1	0 - Days	14 - Days
3	7 - Days	7 - Days
4	7 - Days	14 - Days
6	14 - Days	14 - Days
14	30 - Days	14 - Days
15	0 - Days	7 - Days

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Health Service Codes

Health Service Code 98.49B

Non-functional split thickness skin graft over 32 and up to 64 total square cms

NOTE:

Additional notes:

Fee modifiers:

Governing Rules:

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