Schedule of Benefits for Professional Fees 2019 Vascular Procedures CONSULTATION PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

Claimable by vascular surgeon assisting in ALIF 647012 Co-surgery benefit for vascular surgeon who assists in ALIF spinal surgery (I.P.) Yes Independent procedure spinal surgery procedure €1,002.45 €684.00 €759.53 €543.00

ANASTOMOSIS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

820 Arteriovenous anastomosis in arm No €563.75 €183.00 €337.23 €117.00

1453 Arteriovenous anastomosis, open by basilic vein transposition No Possible co-payment please check Table of Cover €972.73 €518.00 €497.13 €290.00

1465 Splenorenal anastomosis No Possible co-payment please check Table of Cover €989.13 €455.00 €635.50 €225.00

ANEURYSMS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or 1401 without patch graft; for ruptured aneurysm, abdominal aorta No Possible co-payment please check Table of Cover €2,670.13 €1,422.00 €1,371.45 €802.00

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or 1402 without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, No Possible co-payment please check Table of Cover €3,124.20 €1,662.00 €1,603.10 €935.00 coeliac, renal)

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with 1403 or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, No Possible co-payment please check Table of Cover €2,809.53 €1,496.00 €1,438.08 €843.00 hypogastric external)

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, using aorto-aortic tube 1404 prosthesis No Possible co-payment please check Table of Cover €1,438.08 €765.00 €868.18 €507.00

1409 Aorta bi-iliac bypass for atherosclerosis or aneurysm; endovascular (using prosthesis) (I.P.) No Independent Procedure €2,244.75 €728.00 €1,128.53 €283.00

1416 Thrombin injection into groin for pseudoaneurysm (including ultrasound guidance) No €254.20 €135.00 €182.45 €108.00

1427 Supra-renal aneurysm repair No Possible co-payment please check Table of Cover €2,416.95 €728.00 €1,216.68 €283.00

1428 Repair of supra-renal aortic aneurysm rupture No Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00

1436 Repair of ruptured iliac artery aneurysm No Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00

1461 Repair of subclavian aneurysm No Possible co-payment please check Table of Cover €1,089.58 €364.00 €746.20 €254.00

1474 Repair of femoral artery aneurysm No Possible co-payment please check Table of Cover €1,089.58 €455.00 €547.35 €196.00 BYPASS PROCEDURES PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1432 Aorto bi-iliac bypass for atherosclerosis or aneurysm (I.P.) No Independent Procedure Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00

1433 Aorto-femoral or bifemoral bypass for atherosclerosis or aneurysm (I.P.) No Independent Procedure Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00

1443 Obturator bypass from aorta or iliac to profunda or distal femoral bypass No Possible co-payment please check Table of Cover €1,686.13 €455.00 €806.68 €196.00

1446 Aortic exclusion by axillo-femoral bypass No Possible co-payment please check Table of Cover €1,410.40 €455.00 €713.40 €196.00

1449 Vertebral artery bypass or repair No Possible co-payment please check Table of Cover €1,410.40 €670.00 €735.95 €196.00

1456 Carotid subclavian bypass No Possible co-payment please check Table of Cover €1,410.40 €364.00 €735.95 €254.00

1457 Subclavian subclavian bypass No Possible co-payment please check Table of Cover €1,199.25 €364.00 €536.08 €196.00

1459 Subclavian to branchial bypass or endarterectomy No Possible co-payment please check Table of Cover €1,199.25 €364.00 €730.83 €254.00

1463 Repair or bypass of brachial to radial or ulnar vessel, any method including harvesting of graft material No Possible co-payment please check Table of Cover €1,410.40 €455.00 €713.40 €196.00

1467 Femoral to popliteal bypass, above knee vein No Possible co-payment please check Table of Cover €1,399.13 €455.00 €718.53 €196.00

1468 Femoral to popliteal bypass, above knee synthetic No Possible co-payment please check Table of Cover €1,282.28 €455.00 €658.05 €196.00

1469 Femoral to popliteal bypass, below knee vein No Possible co-payment please check Table of Cover €1,526.23 €455.00 €767.73 €196.00

1471 Femoral to popliteal bypass, below knee synthetic No Possible co-payment please check Table of Cover €1,305.85 €455.00 €658.05 €196.00

Femoral tibial artery bypass, including tibial-peroneal and peroneal artery bypass, or other distal 1478 vessels No Possible co-payment please check Table of Cover €1,847.05 €728.00 €928.65 €283.00

1479 Popliteal aneurysm artery repair or bypass No Possible co-payment please check Table of Cover €1,199.25 €455.00 €602.70 €196.00

1481 Femorofemoral bypass No Possible co-payment please check Table of Cover €1,305.85 €455.00 €658.05 €196.00

EMBOLUS / THROMBUS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1280 Common femoral artery embolectomy No Possible co-payment please check Table of Cover €597.58 €273.00 €382.33 €136.00

1306 Transcatheter embolisation, extremity, arteriovenous malformation (AVM) (I.P.) No Independent Procedure Possible co-payment please check Table of Cover €591.43 €273.00 €382.33 €136.00

1307 Transcatheter removal of intravascular thrombus or foreign body No Possible co-payment please check Table of Cover €591.43 €273.00 €387.45 €136.00

Transcatheter therapy, infusion for thrombolysis other than coronary, including necessary local 1308 anaesthesia, all lesser order selective catheterisation used in the approach and any necessary pre No Side Room €502.25 €267.00 €260.35 €151.00 and post-injection care

1430 Iliac or femoral veins - removal of thrombus No €492.00 €227.00 €260.35 €88.00

1437 Endarterectomy of iliac vessels alone No Possible co-payment please check Table of Cover €1,305.85 €728.00 €824.10 €283.00

1439 Renal artery anastomosis, endarterectomy or re-implantation or bypass No Possible co-payment please check Table of Cover €1,686.13 €728.00 €850.75 €283.00 EMBOLUS / THROMBUS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1441 Embolectomy of visceral branches, superior mesenteric or renal arteries No Possible co-payment please check Table of Cover €1,199.25 €364.00 €519.68 €136.00

Endarterectomy of internal/ external common carotid artery with or without patch graft, with or 1447 without shunt No Possible co-payment please check Table of Cover €2,178.13 €728.00 €1,094.70 €283.00

1462 Brachial embolectomy No Possible co-payment please check Table of Cover €652.93 €364.00 €382.33 €136.00

1476 Popliteal artery embolectomy No Possible co-payment please check Table of Cover €984.00 €455.00 €525.83 €196.00

1477 Tibial artery embolectomy No Possible co-payment please check Table of Cover €1,199.25 €455.00 €602.70 €196.00

ENDARTERECTOMY PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1434 Endarterectomy of abdominal aorta and iliac vessels No Possible co-payment please check Table of Cover €1,526.23 €728.00 €835.38 €283.00

1472 Profundaplasty with or without patch or endarterectomy No Possible co-payment please check Table of Cover €984.00 €455.00 €492.00 €196.00

1473 Common femoral artery endarterectomy No Possible co-payment please check Table of Cover €757.48 €273.00 €382.33 €136.00

ENDOVASCULAR PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1419 Transluminal dilation of iliac vessels with or without stent or graft No Possible co-payment please check Table of Cover €679.58 €363.00 €348.50 €202.00

1421 Transluminal dilation with or without stent of carotid vessels No Possible co-payment please check Table of Cover €707.25 €377.00 €358.75 €211.00

1422 Transluminal dilation with or without stent or graft of femoral vessels No Possible co-payment please check Table of Cover €707.25 €377.00 €358.75 €211.00

1423 Transluminal dilation with stent of distal vessels No Possible co-payment please check Table of Cover €707.25 €377.00 €358.75 €211.00

1424 Transluminal dilation of distal vessels No Possible co-payment please check Table of Cover €525.83 €281.00 €265.48 €156.00 VARICOSE VEINS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

Independent 1408 Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed (I.P.) No Procedure, Day Care €630.38 €335.00 €376.18 €190.00

Endovenous radiofrequency ablation therapy of incompetent veins, extremity, inclusive of all imaging 1411 guidance and monitoring, percutaneous; one leg No Day Care €535.92 €287.00 €267.96 €152.00

Endovenous radiofrequency ablation therapy of incompetent veins, extremity, inclusive of all imaging 1412 guidance and monitoring, percutaneous; both legs No Day Care €635.50 €339.00 €325.95 €191.00

The treatment of spider/ thread veins and 1413 Endovenous laser ablation therapy of incompetent veins, extremity, inclusive of all imaging guidance No Day Care telangiectasia are specifically excluded €535.92 €287.00 €267.96 €152.00 and monitoring, percutaneous; one leg from benefit

The treatment of spider/ thread veins and 1414 Endovenous laser ablation therapy of incompetent veins, extremity, inclusive of all imaging guidance No Day Care telangiectasia are specifically excluded €635.50 €339.00 €325.95 €191.00 and monitoring, percutaneous; both legs from benefit

1435 Inferior vena cava ligation/ clipping, with or without thrombus No Possible co-payment please check Table of Cover €796.43 €364.00 €397.70 €136.00

The treatment of spider/ thread veins and 1455 Sclerosing operation on varicose vein(s), one leg (I.P.) No Independent telangiectasia are specifically excluded from €99.43 €46.00 Procedure, Side Room benefit

The treatment of spider/ thread veins and 1460 Sclerosing operation on varicose veins, both legs (I.P.) No Independent telangiectasia are specifically excluded €148.63 €69.00 Procedure, Side Room from benefit

1490 Varicose veins, exploration and removal of thrombus, unilateral No €492.00 €227.00 €254.20 €69.00

Flush ligation of long saphenous vein at sapheno-femoral junction with or without complete stripping; 1493 multiple incisions with avulsion and ligation of varicose veins in one leg No Day Care €541.20 €287.00 €270.60 €152.00

Flush ligation of long saphenous vein at sapheno-femoral junction in both groins with or without 1494 complete stripping; multiple incisions with avulsion and ligation of varicose veins in both legs No Day Care €635.50 €339.00 €325.95 €191.00

1495 Varicose veins, exploration and removal of thrombus, bilateral No €591.43 €273.00 €314.68 €88.00

Documentation must be provided in order to Flush ligation of long saphenous vein at sapheno-femoral junction in the groin with or without support incompetence of the short saphenous 1496 complete stripping plus ligation of the short saphenous vein at the sapheno-popliteal junction with or No Day Care vein - the Doppler scan report must therefore €558.63 €298.00 €281.88 €162.00 without complete stripping; multiple incisions with avulsion and ligation of varicose veins in one leg be attached to the claim form

Documentation must be provided in order to Flush ligation of long saphenous vein at sapheno-femoral junction in the groin with or without support incompetence of the short saphenous 1497 complete stripping plus ligation of the short saphenous vein at the sapheno-popliteal junction with or No Day Care vein - the Doppler scan report must therefore €685.73 €366.00 €348.50 €203.00 without complete stripping; multiple incisions with avulsion and ligation of varicose veins in both legs be attached to the claim form

Flush ligation of long saphenous vein at sapheno-femoral junction with or without complete stripping; 1498 multiple incisions with avulsion and ligation of varicose veins in the other leg No Day Care €541.20 €287.00 €275.73 €162.00

Flush ligation of short saphenous vein at sapheno-popliteal junction behind the knee with or without 1499 complete stripping; multiple incisions in calf with avulsion and ligation of varicose veins; one leg No Day Care €541.20 €287.00 €270.60 €152.00

1500 Venous pressure and blood volume studies No Diagnostic €88.15 €46.00 VARICOSE VEINS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

Flush ligation of short saphenous veins at sapheno-popliteal junctions behind both knees with or 1501 without complete stripping; multiple incisions in both calves with avulsion and ligation of varicose veins No 1 Night Only €635.50 €339.00 €325.95 €191.00 in both legs

Independent 1502 Ligation of single varicose vein in thigh or calf (I.P.) No Procedure, Side Room €148.63 €79.00 €169.13 €90.00

Independent 1503 Ligation of multiple varicose veins one or both legs (I.P.) No Procedure, Day Care €370.03 €196.00 €254.20 €147.00

Independent 1526 Stab avulsion of varicose vein(s), one leg (I.P.) No Procedure, Side Room €99.43 €52.00 €169.13 €90.00

Independent 1527 Stab avulsion of varicose vein(s), both legs (I.P.) No Procedure, Side Room €148.63 €79.00 €169.13 €90.00

VESSEL REPAIR PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1429 Tube graft repair of abdominal aorta No Possible co-payment please check Table of Cover €2244.75 728.00 1128.53 283.00

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or 1431 without patch graft; with or without the involvement of other vessels; for other vessels not specified in No Independent Procedure Possible co-payment please check Table of Cover €2416.95 728.00 1216.68 283.00 the above codes (I.P.)

1438 Visceral artery repair, re-anastomosis or endarterectomy No Possible co-payment please check Table of Cover €1,686.13 €728.00 €850.75 €283.00

1444 Repair of abdominal aortic trauma No Possible co-payment please check Table of Cover €1,199.25 €455.00 €619.10 €196.00

1451 Open repair of subclavian artery No Possible co-payment please check Table of Cover €1,199.25 €455.00 €608.85 €196.00

1458 Thoracotomy with repair of vessels of arch of aorta No Possible co-payment please check Table of Cover €1,686.13 €728.00 €874.33 €283.00

1464 Repair of trauma to brachial artery with endarterectomy patch or bypass No Possible co-payment please check Table of Cover €1,199.25 €568.00 €602.70 €196.00

1482 Repair of femoral or popliteal vessels due to trauma No Possible co-payment please check Table of Cover €1,410.40 €455.00 €713.40 €196.00

OTHER VASCULAR PROCEDURES PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1250 Arterial biopsy (temporal artery, biopsy, bilateral under local anaesthetic) No Diagnostic, Side Room €182.45 €91.00 €169.13 €69.00

1290 Ligation of major vessels No Possible co-payment please check Table of Cover €492.00 €227.00 €314.68 €69.00 OTHER VASCULAR PROCEDURES PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE

1305 Renal stenosis, repair of No Possible co-payment please check Table of Cover €989.13 €455.00 €525.83 €225.00

1442 Removal of infected aortic prosthesis No Possible co-payment please check Table of Cover €2178.13 €935.00 €1,067.03 €390.00

1450 Portosystemic shunt No Possible co-payment please check Table of Cover €1,305.85 €500.00 €735.95 €225.00

Creation of arteriovenous fistula by other than direct arteriovenous anastomosis; autogenous or non- 1452 autogenous graft No Possible co-payment please check Table of Cover €757.48 €405.00 €387.45 €228.00

1454 Translocation of common carotid to subclavian artery No Possible co-payment please check Table of Cover €1,410.40 €364.00 €735.95 €196.00

Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery 1466 or other distal vessels (payable in full with code for main procedure) No Payable in full with code for main procedure €216.28 €119.00 €169.13 €90.00

Irish Life Health, P.O. Box 764, Togher, Cork 1890 717 717 www.irishlifehealth.ie

Irish Life Health dac is regulated by the Central Bank of Ireland. Terms and Conditions apply. Registered in Ireland No. 376607. Registered Office: Irish Life Centre, Lower Abbey Street, Dublin 1 Q83-3-0519