I
CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES
II
OPERATIONS ON THE NERVOUS 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
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
  - 98.5
    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
    - 98.8 A
      Skin test, e.g. tuberculin
    - 98.81
      Biopsy of skin and subcutaneous tissue
      - 98.81A
        Biopsy, skin
        NOTE: A maximum of three calls may be claimed.
      - 98.81B
        Punch biopsy
    - 98.89
      Other 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 98.81A

Biopsy, skin

NOTE:

A maximum of three calls may be claimed.

Category:	M+ Designated Minor Procedure
Base rate:	$37.52

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	$111.49
ROLE	ANEST		Yes	Replace Base	$18.55
VANE	L30AN			Increase By	$109.28
VANE	L30AT			Increase By	$109.28
ANEU	ANEU	1		For Each Call Pay Base At	100%
ANEU	ANEU	2 - 3		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	$18.55
UGA	UGA		Yes	Replace Base	$134.85
CALL	NBRSER	1		For Each Call Pay Base At	100%
CALL	NBRSER	2 - 3		For Each Call Pay Base At	75%
CALL	NBRSER			To a Maximum Of	$93.80
TRAY	MAJT			Increase By	$38.78
NBTR	NBTR		Yes
LMTS	L44ANE		Yes	Increase Base By	$109.28
LVP	LVP75		Yes	Reduce Base To	75%

Governing Rules:

4.4.8 CLAIMS REQUIRING REFERRING PRACTITIONER NUMBER

When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.

HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.

HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.

01.01A	01.01B	01.03	01.04A	01.05A	01.09
01.12A	01.12B	01.14	01.16A	01.16B	01.16C
01.22	01.22A	01.22B	01.22C	01.24A	01.24B
01.24BA	01.24BB	01.32	01.34	02.82A	02.84A
02.84B

03.01O*	03.01LJ* 03.01LK* 03.01LL* 03.03D*	03.03F*
03.03FA*	03.03FV* 03.03FZ* 03.04Q*	03.05B*	03.07A*
03.07AZ*	03.07B*	03.07C*	03.08A*	03.08AZ* 03.08B*
03.08BZ*	03.08C*	03.08CV* 03.08F*	03.08H*	03.08K*
03.08L*	03.08M*

10.04	10.08A	10.33B	13.99CC 13.99GA*	14.49A
14.82	14.85B	14.88A	14.88B	15.94A	16.83A
16.83B	16.83C	16.89A	16.92B	17.81B	19.81

22.81	24.89A	24.89B	28.8 A	28.81A	29.0 A
30.81A	33.22B	37.81	37.82A	37.82B	38.89A
38.89B	39.21A	39.62A	39.83A

40.92A	41.29A	41.29B	42.09B	43.81	43.82
44.3 B	45.81A	45.83	45.84B	45.86A	46.5 A
46.81A	46.82	46.84A	46.88A	48.92A	48.98A
48.98B	49.93A	49.95A	49.96A	49.96B	49.98B
49.98C	49.98D

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	50.95A	50.95B	50.98A
52.1 A	52.11A	52.12	52.13	52.85A	53.81A
53.81B	53.83A	54.89A	54.89B	54.89D	54.89E
54.89F	57.92A

60.82C	60.89A	62.12A	62.12B	62.81A	63.86A
63.96B	64.95A	64.97A	66.19A	66.3 C	66.83
66.89A	66.89B	66.89C	67.81	67.86	67.87A
67.89A	68.95	69.83A	69.83B	72.91	72.92A
74.82A	75.83A	76.89A	78.7 A	79.29E

6.6.2
If a procedure designated "+" is performed in a physician's office, both the procedural benefit and the appropriate office visit benefit for that day may be claimed, but if a consultation benefit pursuant to GR 6.6.4 has been claimed, a visit benefit will not be payable for the day on which the procedure is performed.
6.6.3
If a procedure designated "+" is performed in a place other than a physician's office, either a procedural benefit or a visit benefit, but not both, may be claimed for that day.
6.6.4
If a procedure designated "+" and a consultation are provided on the same day, both the procedural benefit and the appropriate consultation benefit are payable.
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

12.7
An additional benefit per case (modifiers L30AN, L30AT, L30AT2, L44ANE) may be claimed for anesthetic services provided to neonates and infants under 44 weeks of conceptual age. Refer to the Price List for the additional benefit amount.

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

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

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

14.1
A major 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.
01.03 01.04A 01.05A 01.24A 01.24B 01.24BA
01.24BB 01.34 02.84A 02.84B 03.22B 03.25
07.53B 07.53D 07.53E 07.57A
12.31 13.59C 17.08A 17.81A
21.42 21.69A 22.13A 22.13B 22.13C 22.5 A
22.51A 22.62A 22.71 22.81 25.1 A 25.29A
25.39D
32.01A 32.81 33.02A 33.22B 34.0 A 34.1 A
34.89A 37.82A 38.89A 39.21A 39.62A 39.83A
39.83A
40.92A 46.91
50.4 A 50.97A 52.1 A 52.11A 52.13 56.93B
60.24C 61.01B 61.03 61.29B 61.37A 61.39B
66.91A
70.1 70.5 A 72.91 75.64 79.23A 79.29E
82.81A 82.91A 83.7 A 87.3 87.55A 89.37A
89.37B 89.41A 89.41B 89.42A
93.39B 93.39C 95.02A 95.09A 95.81A 97.11B
97.83A 97.89B 98.04A 98.6 A 98.6 B 98.12A
98.12B 98.12C 98.12H 98.12J 98.12M 98.12N
98.12Q 98.12R 98.12T 98.14A 98.22A 98.22B
98.81A 98.96A 98.96B 98.96C 98.96D
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

03.09A*	03.09B*	03.12A	03.16A	03.16B	03.16C
03.16D	03.19C	03.19D	03.21A	03.22A	03.22B
03.22C	03.26	03.29A	03.37A	03.37B	03.38A
03.38B	03.38C	03.38D	03.38E	03.38F	03.38G
03.38H	03.38K	03.38M	03.38N	03.38P	03.38R
03.38S	03.38T	03.38X	03.41A	03.41B	03.41C
03.41D	03.44A	03.45A	03.45B	03.52A	03.52B
03.52C	03.52D	03.55A	03.55B	03.56A	03.56B

07.09A	07.09B	08.19A*	08.19AZ* 08.19B*	08.19C*
08.19AA*	08.19BB* 08.19CC* 08.19CX*	09.01A	09.01B
09.01C	09.01E	09.02B	09.02E	09.05A	09.05B
09.06A	09.07C	09.11A	09.11B	09.11C	09.12A
09.12B	09.13C	09.13D	09.13E	09.13F	09.13G
09.13H	09.23A	09.23B	09.24B	09.26A	09.26D
09.41A	09.41B	09.43A	09.43B	09.43C	09.43D
09.43E	09.46A	09.49A

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

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Health Service Codes

Health Service Code 98.81A

Biopsy, skin

NOTE:

Fee modifiers:

Governing Rules:

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

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

32.01A	32.81	33.02A	33.22B	34.0 A	34.1 A
34.89A	37.82A	38.89A	39.21A	39.62A	39.83A
39.83A

93.39B	93.39C	95.02A	95.09A	95.81A	97.11B
97.83A	97.89B	98.04A	98.6 A	98.6 B	98.12A
98.12B	98.12C	98.12H	98.12J	98.12M	98.12N
98.12Q	98.12R	98.12T	98.14A	98.22A	98.22B
98.81A	98.96A	98.96B	98.96C	98.96D

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Health Service Codes

Health Service Code 98.81A

Biopsy, skin

NOTE:

Fee modifiers:

Governing Rules:

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