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    Health Service Code 98.49D

    Non-functional split thickness skin graft over 100 total square cms

    NOTE:

    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.
    Additional notes:
    • 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:$492.33

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$323.24
    ROLEANESTYesReplace Base$18.39
    ROLESAYesReplace Base$148.05
    ROLESAQSYesReplace Base$50.97
    ROLESSSTYesReplace Base$280.58
    VANEL30ANIncrease By$108.34
    ANEUANEU1For Each Call Pay Base At100%
    ANEUANEU2 - 6For Each Call Pay Base At75%
    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%
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 6For Each Call Pay Base At75%
    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
    • 7.1.2 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.

      1. second and subsequent anatomical area(s) - 75% of the listed benefit.