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Home , Amoebic liver abscess, Eosinophilic cellulitis, Myoma, Peptic ulcer disease

List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee P91.3 Neonatal cerebral irritability ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 P91.4 Neonatal cerebral depression ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 P91.6 Hypoxic ischaemic encephalopathy of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400

P91.8 Other specified disturbances of cerebral status of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400

P91.9 Disturbance of cerebral status of newborn, unspecified ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 Peritonsillar abscess; Abscess of tonsil; Peritonsillar J36 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 ; Quinsy Other diseases of ; Abscess of larynx; Cellulitis of larynx; Disease NOS of larynx; Necrosis of larynx; J38.7 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Pachyderma of larynx; Perichondritis of larynx; of larynx Retropharyngeal and parapharyngeal abscess; J39.0 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Peripharyngeal abscess Other abscess of pharynx; Cellulitis of pharynx; J39.1 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Nasopharyngeal abscess Other diseases of pharynx; of pharynx or nasopharynx; J39.2 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Oedema of pharynx or nasopharynx J85.1 Abscess of lung with ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000

J85.2 Abscess of lung without pneumonia; Abscess of lung NOS ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000

J85.3 Abscess of mediastinum ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 J86.0 Pyothorax with fistula ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Pyothorax without fistula; Abscess of pleura; Abscess of J86.9 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 thorax; Empyema; Pyopneumothorax A00.0 due to 01, biovar cholerae 6,000 1,800 4,200 A00.1 Cholera due to Vibrio cholerae 01, biovar eltor ACUTE GASTROENTERITIS 6,000 1,800 4,200 A00.9 Cholera, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200 due to ; Group A shigellosis A03.0 ACUTE GASTROENTERITIS 6,000 1,800 4,200 [Shiga-Kruse ] A03.1 Shigellosis due to ;Group B shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.2 Shigellosis due to ; Group C shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.3 Shigellosis due to ; Group D shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.8 Other shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.9 Shigellosis, unspecified; ; NOS ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.0 Enteropathogenic infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.1 Enterotoxigenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.2 Enteroinvasive Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.3 Enterohaemorrhagic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.4 Other intestinal Escherichia coli infections ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.5 ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.6 Enteritis due to ACUTE GASTROENTERITIS 6,000 1,800 4,200 due to Clostridium difficile; Foodborne A04.7 intoxication by Clostridium difficile; Pseudomembranous ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.8 Other specified bacterial intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200 Bacterial intestinal infection, unspecified. Bacterial enteritis A04.9 ACUTE GASTROENTERITIS 6,000 1,800 4,200 NOS A05.0 Foodborne staphylococcal intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200 Foodborne Clostridium perfringens [Clostridium welchii] A05.2 intoxication. Enteritis necroticans. ACUTE GASTROENTERITIS 6,000 1,800 4,200 Pig-bel A05.3 Foodborne intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200 A05.4 Foodborne Bacillus cereus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200 A05.8 Other specified bacterial foodborne intoxications ACUTE GASTROENTERITIS 6,000 1,800 4,200 A05.9 Bacterial foodborne intoxication, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200 A07.0 Balantidiasis; Balantidial dysentery ACUTE GASTROENTERITIS 6,000 1,800 4,200 A07.1 Giardiasis [lambliasis] ACUTE GASTROENTERITIS 6,000 1,800 4,200 A07.2 Cryptosporidiosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Isosporiasis; Infection due to Isospora belli and Isospora A07.3 ACUTE GASTROENTERITIS 6,000 1,800 4,200 hominis; Intestinal coccidiosis; Isosporosis Other specified protozoal intestinal diseases; Intestinal A07.8 ACUTE GASTROENTERITIS 6,000 1,800 4,200 trichomoniasis; Sarcocystosis; Sarcosporidiosis Protozoal intestinal disease, unspecified;Flagellate A07.9 diarrhoea; Protozoal colitis; Protozoal diarrhoea; Protozoal ACUTE GASTROENTERITIS 6,000 1,800 4,200 dysentery A08.0 Rotaviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Acute gastroenteropathy due to Norovirus; Noroviral A08.1 ACUTE GASTROENTERITIS 6,000 1,800 4,200 enteritis; Small round structured virus enteritis A08.2 Adenoviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A08.3 Other viral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200

Viral intestinal infection, unspecified; Viral enteritis NOS; A08.4 ACUTE GASTROENTERITIS 6,000 1,800 4,200 Viral gastroenteritis NOS; Viral gastroenteropathy NOS

A08.5 Other specified intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200

Page 1 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Infectious Infectious diarrhea with no dehydration A09.0 ACUTE GASTROENTERITIS 6,000 1,800 4,200 Other and unspecified gastroenteritis and colitis of infectious origin

Gastroenteritis and colitis of unspecified origin; Neonatal A09.9 ACUTE GASTROENTERITIS 6,000 1,800 4,200 diarrhoea NOS

K52.0 Gastroenteritis and colitis due to radiation ACUTE GASTROENTERITIS 6,000 1,800 4,200 K52.1 Toxic gastroenteritis and colitis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Allergic and dietetic gastroenteritis and colitis; Food K52.2 ACUTE GASTROENTERITIS 6,000 1,800 4,200 hypersensitivity gastroenteritis or colitis Other specified noninfective gastroenteritis and colitis; K52.8 ACUTE GASTROENTERITIS 6,000 1,800 4,200 Eosinophilic or gastroenteritis

Noninfective gastroenteritis and colitis, unspecified; Diarrhoea specified as noninfective, or NOS in countries where the conditions can be presumed to be of noninfectious origin; Enteritis specified as noninfective, or NOS in countries where the conditions can be presumed to be of noninfectious origin; specified as noninfective, K52.9 ACUTE GASTROENTERITIS 6,000 1,800 4,200 or NOS in countries where the conditions can be presumed to be noninfectious origin; Jejunitis specified as noninfective, or NOS in countries where the conditions can be presumed to be noninfectious origin; Sigmoiditis pecified as noninfective, or NOS in countries where the conditions can be presumed to be noninfectious origin

K58.0 with diarrhoea ACUTE GASTROENTERITIS 6,000 1,800 4,200

Acute renal failure with tubular necrosis; Tubular necrosis N17.0 ACUTE RENAL FAILURE 19,300 5,790 13,510 NOS; Acute Tubular necrosis ; Renal Tubular necrosis

Acute renal failure with acute cortical necrosis; Cortical N17.1 necrosis NOS; Acute Cortical necrosis ; Renal Cortical ACUTE RENAL FAILURE 19,300 5,790 13,510 necrosis Acute renal failure with medullary necrosis; Medullary N17.2 papillary necrosis, NOS; Acute medullary papillary necrosis; ACUTE RENAL FAILURE 19,300 5,790 13,510 Renal medullary papillary necrosis N17.8 Other acute renal failure ACUTE RENAL FAILURE 19,300 5,790 13,510 N17.9 Acute renal failure, unspecified; ACUTE RENAL FAILURE 19,300 5,790 13,510

Renal failure following abortion and ectopic and molar O08.4 pregnancy; Oliguria Acute renal failure; Oliguria renal ACUTE RENAL FAILURE 19,300 5,790 13,510 shutdown; Oliguria renal tubular necrosis; Oliguria Uraemia

Adult respiratory distress syndrome; Adult hyaline J80 ADULT RESPIRATORY DISTRESS SYNDROME 32,000 9,600 22,400 membrane disease T78.1 Other adverse food reactions, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340

T78.3 Angioneurotic oedema; Giant urticaria; Quinke's oedema ALLERGIC REACTIONS 6,200 1,860 4,340

Allergy, unspecified; Allergic reaction NOS; Hypersensitivity T78.4 ALLERGIC REACTIONS 6,200 1,860 4,340 NOS; Idiosyncracy NOS T78.8 Other adverse effects, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340 T78.9 Adverse effect, unspecified ALLERGIC REACTIONS 6,200 1,860 4,340

Unspecified adverse effect of drug or medicament; Adverse effect of correct drug or medicament properly administered; Allergic reactiion to correct drug or T88.7 medicament properly administered; Hypersensitivity to ALLERGIC REACTIONS 6,200 1,860 4,340 correct drug or medicament properly administered; Idiosyncracy to correct drug or medicament properly administered; Drug: hypersensitivity NOS; reaction NOS

A06.4+ K77.0* Amoebic abscess; Hepatic AMOEBIASIS, HEPATIC 10,000 3,000 7,000 Acute amoebic dysentery; Acute amoebiasis; Intestinal A06.0 AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 amoebiasis NOS A06.1 Chronic intestinal amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.2 Amoebic nondysenteric colitis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.3 Amoeboma of intestine; Amoeboma NOS AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.7 AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 Amoebic infection of other sites A06.8 AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 Amoebic ; Amoebic balanitis (N51.2*) E85.8 Other amyloidosis; Localized amyloidosis AMYLOIDOSIS 11,100 3,330 7,770 T78.0 Anaphylactic shock due to adverse food reaction ANAPHYLACTIC SHOCK 7,600 2,280 5,320 Anaphylactic shock, unspecified; Allergic shock NOS; T78.2 ANAPHYLACTIC SHOCK 7,600 2,280 5,320 Anaphylactic reaction NOS; NOS Anaphylactic shock due to adverse effect of correct drug or T88.6 ANAPHYLACTIC SHOCK 7,600 2,280 5,320 medicament properly administered anaemia secondary to blood loss (chronic); D50.0 10,000 3,000 7,000 Posthaemorrhagic anaemia (chronic)

Page 2 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Sideropenic ; Kelly-Paterson syndrome; Plummer- D50.1 ANEMIA 10,000 3,000 7,000 Vinson syndrome D50.8 Other iron deficiency anaemias ANEMIA 10,000 3,000 7,000 D50.9 Iron deficiency anaemia, unspecified ANEMIA 10,000 3,000 7,000 Vitamin B12 deficiency anaemia due to intrinsic factor deficiency; Addison Anaemia; Biermer Anaemia; D51.0 Congenital Pernicious Anaemia; Congenital intrinsic factor ANEMIA 10,000 3,000 7,000 deficiency Pernicious anemia D51.8 Other vitamin B12 deficiency anaemias ANEMIA 10,000 3,000 7,000 D51.9 Vitamin B12 deficiency anaemia, unspecified ANEMIA 10,000 3,000 7,000 Drug-induced folate deficiency anaemia D52.1 Use additional external code (Chapter XX), if desired ANEMIA 10,000 3,000 7,000 to identify drug Folate deficiency anaemia, unspecified; Folic deficiency D52.9 ANEMIA 10,000 3,000 7,000 anaemia NOS Protein deficiency anaemia; Amino-acid deficiency D53.0 ANEMIA 10,000 3,000 7,000 anaemia; Orotaciduric anaemia Other megaloblastic anaemias, not elsewhere classified; D53.1 ANEMIA 10,000 3,000 7,000 Megaloblastic anaemia NOS D53.2 Scorbutic anaemia ANEMIA 10,000 3,000 7,000 Other specified nutritional anaemias; Anaemia associated with deficiency of copper; Anaemia associated with D53.8 ANEMIA 10,000 3,000 7,000 deficiency of molybdenum; Anaemia associated with deficiency of zinc

D53.9 Nutritional anaemia, unspecified; Simple chronic anaemia ANEMIA 10,000 3,000 7,000

Anaemia due to glucose-6-phosphate dehydrogenase D55.0 [G6PD] deficiency; Favism; ANEMIA 10,000 3,000 7,000 G6PD deficiency anaemia Anaemia due to other disorders of glutathione metabolism; Anaemia due to enzyme deficiencies, except G6PD, related D55.1 to the hexose monophosphate [HMP] shunt pathway; ANEMIA 10,000 3,000 7,000 Anaemia due to haemolytic nonspherocytic hereditary, type I Anaemia due to disorders of glycolytic enzymes; Haemolytic nonspherocytic hereditary Anaemia, type II; D55.2 Hexokinase deficiency Anaemia; Pyruvate kinase [PK] ANEMIA 10,000 3,000 7,000 deficiency Anaemia; Triose-phosphate isomerase deficiency Anaemia D55.8 Other anaemias due to enzyme disorders ANEMIA 10,000 3,000 7,000 D55.9 Anaemia due to enzyme disorder, unspecified ANEMIA 10,000 3,000 7,000 Thalassaemia, unspecified Mediterranean anaemia; Mediterranean anaemia with D56.9 other haemoglobinopathy; Thalassaemia minor with other ANEMIA 10,000 3,000 7,000 haemoglobinopathy; Thalassaemia mixed with other haemoglobinopathy; D57.0 Sickle-cell anaemia with crisis; Hb-SS disease with crisis ANEMIA 10,000 3,000 7,000 Sickle-cell anaemia without crisis; Sickle-cell anaemia NOS; D57.1 ANEMIA 10,000 3,000 7,000 Sickle-cell disease NOS ; Sickle-cell disorder NOS

D57.3 Sickle-cell trait; Hb-S trait ; Heterozygous Haemoglobin S ANEMIA 10,000 3,000 7,000

D57.8 Other sickle-cell disorders ANEMIA 10,000 3,000 7,000 Hereditary spherocytosis; Acholuric (familial) ; D58.0 Congenital (spherocytic) haemolytic icterus; Minkowski- ANEMIA 10,000 3,000 7,000 Chauffard syndrome Hereditary elliptocytosis; Congenital Elliptocytosis; D58.1 ANEMIA 10,000 3,000 7,000 Congenital Ovalocytosis; Hereditary Ovalocytosis

Other haemoglobinopathies; Abnormal haemoglobin NOS; Congenital Heinz body anaemia; Hb-C Disease; Hb-C D58.2 ANEMIA 10,000 3,000 7,000 Disease; Hb-D Disease; Hb-E Disease; Haemoglobinopathy NOS; Unstable haemoglobin haemolytic disease

Other specified hereditary haemolytic anaemias; D58.8 ANEMIA 10,000 3,000 7,000 Stomatocytosis Hereditary haemolytic anaemia, unspecified; Acquired D58.9 ANEMIA 10,000 3,000 7,000 haemolytic anaemia D59.0 Drug-induced autoimmune haemolytic anaemia ANEMIA 10,000 3,000 7,000

Other autoimmune haemolytic anaemias; Autoimmune haemolytic disease, cold type; (Autoimmune haemolytic disease, warm type; Chronic cold haemagglutinin disease; D59.1 ANEMIA 10,000 3,000 7,000 Cold agglutinin disease; Cold agglutinin haemoglobinuria; Secondary symptomatic Haemolytic anaemia, cold type; Secondary symptomatic Haemolytic anaemia, warm type;

Page 3 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Drug-induced nonautoimmune haemolytic anaemia; Drug- D59.2 ANEMIA 10,000 3,000 7,000 induced enzyme deficiency anaemia Other nonautoimmune haemolytic anaemias; Mechanical D59.4 Haemolytic anaemia; Microangiopathic Haemolytic ANEMIA 10,000 3,000 7,000 anaemia; Toxic Haemolytic anaemia Paroxysmal nocturnal haemoglobinuria [Marchiafava- D59.5 ANEMIA 10,000 3,000 7,000 Micheli]

Haemoglobinuria due to haemolysis from other external D59.6 causes; Haemoglobinuria from exertion; Haemoglobinuria ANEMIA 10,000 3,000 7,000 march; Haemoglobinuria paroxysmal cold

D59.8 Other acquired haemolytic anaemias ANEMIA 10,000 3,000 7,000 Acquired haemolytic anaemia, unspecified; Chronic D59.9 ANEMIA 10,000 3,000 7,000 Idiopathic haemolytic anaemia D60.1 Transient acquired pure red cell aplasia ANEMIA 10,000 3,000 7,000 Constitutional aplastic anaemia; Congenital Pure red cell Aplasia; Pure red cell Aplasia of infants; Primary Pure red D61.0 cell Aplasia; Blackfan-Diamond syndrome; Familial ANEMIA 10,000 3,000 7,000 hypoplastic anaemia; Fanconi's anaemia; Pancytopenia with malformations D61.1 Drug-induced aplastic anaemia ANEMIA 10,000 3,000 7,000 D61.2 Aplastic anaemia due to other external agents ANEMIA 10,000 3,000 7,000 D61.3 Idiopathic aplastic anaemia ANEMIA 10,000 3,000 7,000 D61.8 Other specified aplastic anaemias ANEMIA 10,000 3,000 7,000 Aplastic anaemia, unspecified; Hypoplastic anaemia NOS; D61.9 ANEMIA 10,000 3,000 7,000 Medullary hypoplasia; Panmyelophthisis D62 Acute posthaemorrhagic anaemia ANEMIA 10,000 3,000 7,000 D63.0* Anaemia in neoplastic disease ANEMIA 10,000 3,000 7,000 D63.8* Anaemia in other chronic diseases classified elsewhere ANEMIA 10,000 3,000 7,000 Hereditary sideroblastic anaemia; Sex-linked hypochromic D64.0 ANEMIA 10,000 3,000 7,000 sideroblastic anaemia D64.1 Secondary sideroblastic anaemia due to disease ANEMIA 10,000 3,000 7,000

D64.2 Secondary sideroblastic anaemia due to drugs and toxins ANEMIA 10,000 3,000 7,000

Other sideroblastic anaemias; Sideroblastic anaemia NOS; D64.3 ANEMIA 10,000 3,000 7,000 pyridoxine-responsive NEC Sideroblastic anaemia

Other specified anaemias; Infantile pseudoleukaemia; D64.8 ANEMIA 10,000 3,000 7,000 Leukoerythroblastic anaemia Anaemia, unspecified D64.9 ANEMIA 10,000 3,000 7,000 Severe anemia M00.16 Pneumococcal arthritis and polyarthritis, Lower leg ARTHRITIS INFECTIOUS 9,700 2,910 6,790

M00.19 Pneumococcal arthritis and polyarthritis, Site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790

Other streptococcal arthritis and polyarthritis, Site M00.29 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 unspecified Arthritis and polyarthritis due to other specified bacterial M00.82 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 agents upper arm Pyogenic arthritis, unspecified; Infective arthritis NOS M00.90 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 multiple sites Pyogenic arthritis, unspecified; Infective arthritis NOS M00.91 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 shoulder region Pyogenic arthritis, unspecified; Infective arthritis NOS M00.93 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 forearm Pyogenic arthritis, unspecified; Infective arthritis NOS M00.94 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 hand Pyogenic arthritis, unspecified; Infective arthritis NOS M00.95 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 pelvic region and thigh Pyogenic arthritis, unspecified; Infective arthritis NOS M00.96 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 lower leg Pyogenic arthritis, unspecified; Infective arthritis NOS M00.97 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 ankle and foot Pyogenic arthritis, unspecified; Infective arthritis NOS M00.98 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 other sites Pyogenic arthritis, unspecified; Infective arthritis NOS M00.99 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 site unspecified M02.39 Reiter's disease, site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790 M06.19 Adult-onset Still's disease, site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790 Juvenile arthritis with systemic onset; Still's disease NOS M08.29 ARTHRITIS INFECTIOUS 9,700 2,910 6,790 site unspecified M02.99 Reactive arthropathy, unspecified, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Seropositive rheumatoid arthritis, unspecified, site M05.99 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 unspecified M06.01 Seronegative rheumatoid arthritis, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.09 Seronegative rheumatoid arthritis, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.36 Rheumatoid nodule, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.45 Inflammatory polyarthropathy, pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Page 4 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M06.49 Inflammatory polyarthropathy, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.81 Other specified rheumatoid arthritis, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.86 Other specified rheumatoid arthritis, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.87 Other specified rheumatoid arthritis, ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.89 Other specified rheumatoid arthritis, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.90 Rheumatoid arthritis, unspecified, multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.91 Rheumatoid arthritis, unspecified, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.93 Rheumatoid arthritis, unspecified, forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.94 Rheumatoid arthritis, unspecified, hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M06.95 Rheumatoid arthritis, unspecified, pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M06.96 Rheumatoid arthritis, unspecified, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.97 Rheumatoid arthritis, unspecified, ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.98 Rheumatoid arthritis, unspecified, other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M06.99 Rheumatoid arthritis, unspecified, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis M08.06 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 with or without rheumatoid factor lower leg

Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis M08.07 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 with or without rheumatoid factor ankle and foot

Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis M08.09 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 with or without rheumatoid factor site unspecified

M08.19 Juvenile ankylosing spondylitis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M08.86 Other juvenile arthritis lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M08.89 Other juvenile arthritis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M08.91 Juvenile arthritis, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M08.96 Juvenile arthritis, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M08.99 Juvenile arthritis, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M10.00 Idiopathic gout; Gouty bursitis; Primary gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Idiopathic gout; Gouty bursitis; Primary gout; M10.01 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Urate tophus of heart shoulder region Idiopathic gout; Gouty bursitis; Primary gout; M10.02 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Urate tophus of heart upper arm M10.03 Idiopathic gout; Gouty bursitis; Primary gout forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Idiopathic gout; Gouty bursitis; Primary gout; M10.04 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Urate tophus of heart hand Idiopathic gout; Gouty bursitis; Primary gout;Urate tophus M10.05 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 of heart pelvic region and thigh

M10.06 Idiopathic gout; Gouty bursitis; Primary gout lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Idiopathic gout; Gouty bursitis; Primary gout; M10.07 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Urate tophus of heart ankle and foot Idiopathic gout; Gouty bursitis; Primary gout; M10.08 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Urate tophus of heart other sites Idiopathic gout; Gouty bursitis; Primary gout; M10.09 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Urate tophus of heart site unspecified M10.10 Lead-induced gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.29 Drug-induced gout site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M10.30 Gout due to impairment of renal function multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M10.36 Gout due to impairment of renal function lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M10.39 Gout due to impairment of renal function site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M10.40 Other secondary gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.49 Other secondary gout site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.90 Gout, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.91 Gout, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.92 Gout, unspecified upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.93 Gout, unspecified forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.94 Gout, unspecified hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.96 Gout, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.97 Gout, unspecified ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.98 Gout, unspecified other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M10.99 Gout, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M11.89 Other specified crystal arthropathies site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M11.90 Crystal arthropathy, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M11.99 Crystal arthropathy, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.26 Villonodular synovitis (pigmented) lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.39 Palindromic rheumatism site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.50 Traumatic arthropathy multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.52 Traumatic arthropathy upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.53 Traumatic arthropathy forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.54 Traumatic arthropathy hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.55 Traumatic arthropathy pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.56 Traumatic arthropathy lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Page 5 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M12.57 Traumatic arthropathy ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.58 Traumatic arthropathy other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M12.59 Traumatic arthropathy site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Other specific arthropathies, not elsewhere classified; M12.86 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Transient arthropathy lower leg Other specific arthropathies, not elsewhere classified; M12.89 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Transient arthropathy site unspecified M13.00 Polyarthritis, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.01 Polyarthritis, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.02 Polyarthritis, unspecified upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.06 Polyarthritis, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.09 Polyarthritis, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.13 Monoarthritis, not elsewhere classified forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.16 Monoarthritis, not elsewhere classified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.17 Monoarthritis, not elsewhere classified ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.18 Monoarthritis, not elsewhere classified other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.80 Other specified arthritis; Allergic arthritis multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.81 Other specified arthritis; Allergic arthritis shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Other specified arthritis; Allergic arthritis pelvic region and M13.85 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 thigh M13.86 Other specified arthritis; Allergic arthritis lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.87 Other specified arthritis; Allergic arthritis ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.88 Other specified arthritis; Allergic arthritis other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.89 Other specified arthritis; Allergic arthritis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.90 Arthritis, unspecified; Arthropathy NOS multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.91 Arthritis, unspecified; Arthropathy NOS shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.92 Arthritis, unspecified; Arthropathy NOS upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.93 Arthritis, unspecified; Arthropathy NOS forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.94 Arthritis, unspecified; Arthropathy NOS hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 Arthritis, unspecified; Arthropathy NOS pelvic region and M13.95 ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 thigh M13.96 Arthritis, unspecified; Arthropathy NOS lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.97 Arthritis, unspecified; Arthropathy NOS ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900 M13.98 Arthritis, unspecified; Arthropathy NOS other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

M13.99 Arthritis, unspecified; Arthropathy NOS site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900

Chikungunya virus disease; Chikungunya (haemorrhagic) A92.0 ARTHROPOD BORNE VIRAL 8,100 2,430 5,670 fever A92.1 O'nyong-nyong fever ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670

Venezuelan equine fever; Venezuelan equine encephalitis; A92.2 ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670 Venezuelan encephalomyelitis virus disease

A92.8 Other specified -borne viral ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670 A93.1 Sandfly fever; Pappataci fever; Phlebotomus fever ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670

Other specified arthropod-borne viral fevers; Piry virus A93.8 disease; Severe fever with thrombocytopenia syndrome ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670 [SFTS]; Vesicular stomatitis virus disease [Indiana fever]

Unspecified arthropod-borne viral fever; Unspecified arthropod-borne viral fever; Arboviral fever NOS; Arbovirus A94 ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670 infection NOS Acute hemorrhagic fever M15.0 Primary generalized (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900 M15.2 Bouchard's nodes (with arthropathy) ARTHROSIS 7,000 2,100 4,900

M15.3 Secondary multiple arthrosis; Post-traumatic polyarthrosis ARTHROSIS 7,000 2,100 4,900

M15.4 Erosive (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900 M15.8 Other polyarthrosis ARTHROSIS 7,000 2,100 4,900

M15.9 Polyarthrosis, unspecified; Generalized osteoarthritis NOS ARTHROSIS 7,000 2,100 4,900

M16.0 Primary coxarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900 Other primary coxarthrosis; Primary coxarthrosis NOS; M16.1 ARTHROSIS 7,000 2,100 4,900 Primary coxarthrosis unilateral M16.2 Coxarthrosis resulting from dysplasia, bilateral ARTHROSIS 7,000 2,100 4,900 Other dysplastic coxarthrosis; Dysplastic coxarthrosis NOS; M16.3 ARTHROSIS 7,000 2,100 4,900 Dysplastic coxarthrosis unilateral M16.9 Coxarthrosis, unspecified ARTHROSIS 7,000 2,100 4,900 M17.0 Primary gonarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900 Other primary gonarthrosis; Primary gonarthrosis NOS; M17.1 ARTHROSIS 7,000 2,100 4,900 Primary gonarthrosis unilateral M17.2 Post-traumatic gonarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900

Page 6 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Other post-traumatic gonarthrosis; Post-traumatic M17.3 ARTHROSIS 7,000 2,100 4,900 gonarthrosis NOS; Post-traumatic gonarthrosis unilateral

Other secondary gonarthrosis; Secondary gonarthrosis M17.5 ARTHROSIS 7,000 2,100 4,900 NOS; Secondary gonarthrosis unilateral M17.9 Gonarthrosis, unspecified ARTHROSIS 7,000 2,100 4,900

M18.0 Primary arthrosis of first carpometacarpal joints, bilateral ARTHROSIS 7,000 2,100 4,900

M18.9 Arthrosis of first carpometacarpal joint, unspecified ARTHROSIS 7,000 2,100 4,900 Primary arthrosis of other joints; Primary arthrosis M19.00 ARTHROSIS 7,000 2,100 4,900 NOSmultiple sites Primary arthrosis of other joints; Primary arthrosis M19.02 ARTHROSIS 7,000 2,100 4,900 NOSupper arm Primary arthrosis of other joints; Primary arthrosis M19.05 ARTHROSIS 7,000 2,100 4,900 NOSpelvic region and thigh Primary arthrosis of other joints; Primary arthrosis M19.06 ARTHROSIS 7,000 2,100 4,900 NOSlower leg Primary arthrosis of other joints; Primary arthrosis M19.08 ARTHROSIS 7,000 2,100 4,900 NOSother sites Primary arthrosis of other joints; Primary arthrosis NOSsite M19.09 ARTHROSIS 7,000 2,100 4,900 unspecified Post-traumatic arthrosis of other joints; Post-traumatic M19.10 ARTHROSIS 7,000 2,100 4,900 arthrosis NOS multiple sites Post-traumatic arthrosis of other joints; Post-traumatic M19.11 ARTHROSIS 7,000 2,100 4,900 arthrosis NOS shoulder region Post-traumatic arthrosis of other joints; Post-traumatic M19.12 ARTHROSIS 7,000 2,100 4,900 arthrosis NOS upper arm Post-traumatic arthrosis of other joints; Post-traumatic M19.19 ARTHROSIS 7,000 2,100 4,900 arthrosis NOS site unspecified Other secondary arthrosis; Secondary arthrosis NOS M19.21 ARTHROSIS 7,000 2,100 4,900 shoulder region Other secondary arthrosis; Secondary arthrosis NOS site M19.29 ARTHROSIS 7,000 2,100 4,900 unspecified M19.81 Other specified arthrosis shoulder region ARTHROSIS 7,000 2,100 4,900 M19.86 Other specified arthrosis lower leg ARTHROSIS 7,000 2,100 4,900 M19.87 Other specified arthrosis ankle and foot ARTHROSIS 7,000 2,100 4,900 M19.88 Other specified arthrosis other sites ARTHROSIS 7,000 2,100 4,900 M19.89 Other specified arthrosis site unspecified ARTHROSIS 7,000 2,100 4,900 M19.90 Arthrosis, unspecified multiple sites ARTHROSIS 7,000 2,100 4,900 M19.91 Arthrosis, unspecified shoulder region ARTHROSIS 7,000 2,100 4,900 M19.92 Arthrosis, unspecified upper arm ARTHROSIS 7,000 2,100 4,900 M19.93 Arthrosis, unspecified forearm ARTHROSIS 7,000 2,100 4,900 M19.94 Arthrosis, unspecified hand ARTHROSIS 7,000 2,100 4,900 M19.95 Arthrosis, unspecified pelvic region and thigh ARTHROSIS 7,000 2,100 4,900 M19.96 Arthrosis, unspecified lower leg ARTHROSIS 7,000 2,100 4,900 M19.97 Arthrosis, unspecified ankle and foot ARTHROSIS 7,000 2,100 4,900 M19.98 Arthrosis, unspecified other sites ARTHROSIS 7,000 2,100 4,900 Arthrosis, unspecified site unspecified M19.99 ARTHROSIS 7,000 2,100 4,900 Osteoarthritis Predominantly allergic asthma; Allergic bronchitis NOS; Allergic rhinitis with asthma; Atopic asthma; Extrinsic J45.00 ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300 allergic asthma; Hay fever with asthma; in Acute Exacerbation Nonallergic asthma; Idiosyncratic asthma; Intrinsic J45.10 ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300 nonallergic asthma, in Acute Exacerbation J45.80 Mixed asthma, in Acute Exacerbation ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300 J45.90 Bronchial Asthma in Acute Exacerbation ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300 J46 Status asthmaticus; Acute severe asthma ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300 Pulmonary collapse; Atelectasis; Collapse of lung; Brock's J98.1 ATELECTASIS 13,800 4,140 9,660 syndrome Panniculitis affecting regions of neck and back occipito- M54.01 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 atlanto-axial region Panniculitis affecting regions of neck and back lumbar M54.06 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 region Panniculitis affecting regions of neck and back sacral and M54.08 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 sacrococcygeal region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.10 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS Multiple sites in spine Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.11 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS occipito-atlanto-axial region

Page 7 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.12 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS cervical region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.14 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS thoracic region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.15 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS thoracolumbar region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.16 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS lumbar region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.17 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS lumbosacral region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.18 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS sacral and sacrococcygeal region Radiculopathy; Brachial Neuritis or radiculitis NOS; Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic M54.19 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Neuritis or radiculitis NOS ; Radiculitis NOS site unspecified M54.2 Cervicalgia BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.20 Cervicalgia Multiple sites in spine BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.22 Cervicalgia cervical region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.26 Cervicalgia lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.3 Sciatica BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.30 Sciatica Multiple sites in spine BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.31 Sciatica occipito-atlanto-axial region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.35 Sciatica thoracolumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.36 Sciatica lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.37 Sciatica lumbosacral region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.38 Sciatica sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.39 Sciatica site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.4 Lumbago with sciatica BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.41 Lumbago with sciatica occipito-atlanto-axial region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.44 Lumbago with sciatica thoracic region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.46 Lumbago with sciatica lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

M54.48 Lumbago with sciatica sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

M54.49 Lumbago with sciatica site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

M54.5 ; Loin pain; Low back strain; Lumbago NOS BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

Low back pain; Loin pain; Low back strain; Lumbago NOS M54.50 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Multiple sites in spine Low back pain; Loin pain; Low back strain; Lumbago NOS M54.51 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 occipito-atlanto-axial region Low back pain; Loin pain; Low back strain; Lumbago NOS M54.52 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 cervical region M54.84 Other dorsalgia thoracic region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 M54.88 Other dorsalgia sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 Dorsalgia, unspecified; Backache NOS occipito-atlanto-axial M54.91 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 region Dorsalgia, unspecified; Backache NOS cervicothoracic M54.93 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 region M54.96 Dorsalgia, unspecified; Backache NOS lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

M54.97 Dorsalgia, unspecified; Backache NOS lumbosacral region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

Dorsalgia, unspecified; Backache NOS sacral and M54.98 BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480 sacrococcygeal region M54.99 Dorsalgia, unspecified; Backache NOS site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480

N31.0 Uninhibited neuropathic bladder, not elsewhere classified BLADDER DYSFUNCTION 9,000 2,700 6,300

N31.1 Reflex neuropathic bladder, not elsewhere classified BLADDER DYSFUNCTION 9,000 2,700 6,300 Flaccid neuropathic bladder, not elsewhere classified; Atonic Motor Neuropathic bladder; Sensory Atonic Motor N31.2 BLADDER DYSFUNCTION 9,000 2,700 6,300 Neuropathic bladder; Autonomous Neuropathic bladder ; Nonreflex Neuropathic bladder N31.8 Other neuromuscular dysfunction of bladder BLADDER DYSFUNCTION 9,000 2,700 6,300 Neuromuscular dysfunction of bladder, unspecified; N31.9 BLADDER DYSFUNCTION 9,000 2,700 6,300 Neurogenic bladder dysfunction NOS

Page 8 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee N32.9 Bladder disorder, unspecified BLADDER DYSFUNCTION 9,000 2,700 6,300 N39.3 incontinence BLADDER DYSFUNCTION 9,000 2,700 6,300 Other specified urinary incontinence; Overflow N39.4 BLADDER DYSFUNCTION 9,000 2,700 6,300 incontinence, Reflex incontinence, Urge incontinence R32 Unspecified urinary incontinence; Enuresis NOS BLADDER DYSFUNCTION 9,000 2,700 6,300 Botulism; Classical foodborne intoxication due to A05.1 BOTULISM 4,800 1,440 3,360 Clostridium botulinum Compression of brain; [compression, Herniation] of brain G93.5 BRAIN HERNIATION 22,400 6,720 15,680 (stem)

Inflammatory disorders of breast; Acute abscess of non puerperal areola; Acute abscess nonpuerperal breast; Chronic abscess of nonpuerperal areola; Chronic abscess of N61 nonpuerperal breast; Carbuncle of breast; Acute mastitis BREAST INFECTIONS 7,900 2,370 5,530 nonpuerperal, NOS; Acute mastitis nonpuerperal, infective; subacute mastitis nonpuerperal, NOS; subacute mastitis nonpuerpural, infective

Infection of nipple associated with childbirth; Gestational O91.0 BREAST INFECTIONS 7,900 2,370 5,530 abscess of nipple; Puerperal abscess of nipple

Abscess of breast associated with childbirth; Mammary abscess gestational or puerperal; Purulent mastitis O91.1 BREAST INFECTIONS 7,900 2,370 5,530 gestational or puerperal; Subareolar abscess gestational or puerperal Nonpurulent mastitis associated with childbirth; Lymphangitis of breast gestational or puerperal; Mastitis O91.2 NOS gestational or puerperal; Interstitial mastitis BREAST INFECTIONS 7,900 2,370 5,530 gestational or puerperal; Parenchymatous mastitis gestational or puerperal O92.0 Retracted nipple associated with childbirth BREAST INFECTIONS 7,900 2,370 5,530 Cracked nipple associated with childbirth; Fissure of nipple, O92.1 BREAST INFECTIONS 7,900 2,370 5,530 gestational or puerperal C50.0 Malignant of Nipple and areola, breast BREAST 11,800 3,540 8,260 C50.1 Malignant neoplasm of Central portion of breast BREAST MALIGNANCY 11,800 3,540 8,260 C50.2 Malignant neoplasm of Upper-inner quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260 C50.3 Malignant neoplasm of Lower-inner quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260

C50.4 Malignant neoplasm of Upper-outer quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260

C50.6 Malignant neoplasm of Axillary tail of breast BREAST MALIGNANCY 11,800 3,540 8,260 C50.8 Malignant neoplasm of Overlapping lesion of breast BREAST MALIGNANCY 11,800 3,540 8,260 C50.9 Malignant neoplasm of Breast, unspecified BREAST MALIGNANCY 11,800 3,540 8,260 L10.0 Pemphigus vulgaris BULLOUS DISORDERS 12,000 3,600 8,400 L10.1 Pemphigus vegetans BULLOUS DISORDERS 12,000 3,600 8,400 L10.2 Pemphigus foliaceus BULLOUS DISORDERS 12,000 3,600 8,400 L10.4 Pemphigus erythematosus; Senear-Usher syndrome BULLOUS DISORDERS 12,000 3,600 8,400 L10.8 Other pemphigus BULLOUS DISORDERS 12,000 3,600 8,400 L10.9 Pemphigus, unspecified BULLOUS DISORDERS 12,000 3,600 8,400 L11.0 Acquired keratosis follicularis BULLOUS DISORDERS 12,000 3,600 8,400 L11.1 Transient acantholytic dermatosis [Grover] BULLOUS DISORDERS 12,000 3,600 8,400 L11.9 Acantholytic disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400 L12.0 Bullous pemphigoid BULLOUS DISORDERS 12,000 3,600 8,400 Cicatricial pemphigoid; Benign mucous membrane L12.1 BULLOUS DISORDERS 12,000 3,600 8,400 pemphigoid Chronic bullous disease of childhood; Juvenile dermatitis L12.2 BULLOUS DISORDERS 12,000 3,600 8,400 herpetiformis L12.3 Acquired epidermolysis bullosa BULLOUS DISORDERS 12,000 3,600 8,400 L12.8 Other pemphigoid BULLOUS DISORDERS 12,000 3,600 8,400 L13.0 Dermatitis herpetiformis; Duhring's disease BULLOUS DISORDERS 12,000 3,600 8,400

L13.1 Subcorneal pustular dermatitis; Sneddon-Wilkinson disease BULLOUS DISORDERS 12,000 3,600 8,400

L13.9 Bullous disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400 T20.4 Corrosion of unspecified degree of head and neck A 8,500 2,550 5,950 T21.0 Burn of unspecified degree of trunk BURN A 8,500 2,550 5,950 T21.2 Burn of second degree of trunk BURN A 8,500 2,550 5,950 T21.5 Corrosion of first degree of trunk BURN A 8,500 2,550 5,950 T21.6 Corrosion of second degree of trunk BURN A 8,500 2,550 5,950 Burn of second degree of shoulder and upper limb, except T22.2 BURN A 8,500 2,550 5,950 wrist and hand Corrosion of first degree of shoulder and upper limb, T22.5 BURN A 8,500 2,550 5,950 except wrist and hand Corrosion of second degree of shoulder and upper limb, T22.6 BURN A 8,500 2,550 5,950 except wrist and hand T23.2 Burn of second degree of wrist and hand BURN A 8,500 2,550 5,950 T23.4 Corrosion of unspecified degree of wrist and hand BURN A 8,500 2,550 5,950 Burn of second degree of hip and lower limb, except ankle T24.2 BURN A 8,500 2,550 5,950 and foot

Page 9 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Corrosion of first degree of hip and lower limb, except T24.5 BURN A 8,500 2,550 5,950 ankle and foot Corrosion of second degree of hip and lower limb, except T24.6 BURN A 8,500 2,550 5,950 ankle and foot T25.2 Burn of second degree of ankle and foot BURN A 8,500 2,550 5,950 T25.5 Corrosion of first degree of ankle and foot BURN A 8,500 2,550 5,950 T26.0 Burn of eyelid and periocular area BURN A 8,500 2,550 5,950 T26.4 Burn of eye and adnexa, part unspecified BURN A 8,500 2,550 5,950 T26.9 Corrosion of eye and adnexa, part unspecified BURN A 8,500 2,550 5,950 T27.3 Burn of respiratory tract, part unspecified BURN A 8,500 2,550 5,950 T27.7 Corrosion of respiratory tract, part unspecified BURN A 8,500 2,550 5,950 T28.9 Corrosion of other and unspecified internal organs BURN A 8,500 2,550 5,950 of multiple regions, no more than first-degree burns T29.1 BURN A 8,500 2,550 5,950 mentioned Burn of unspecified body region, unspecified degree; Burn T30.0 BURN A 8,500 2,550 5,950 NOS Burn of second degree, body region unspecified; Secodn- T30.2 BURN A 8,500 2,550 5,950 degree burn NOS Burn of third degree, body region unspecified; Third-degree T30.3 BURN A 8,500 2,550 5,950 burn NOS Corrosion of unspecified body region, unspecified degree; T30.4 BURN A 8,500 2,550 5,950 Corrosion NOS Corrosion of first degree, body region unspecified; First- T30.5 BURN A 8,500 2,550 5,950 degree corrosion NOS Corrosion of second degree, body region unspecified; T30.6 BURN A 8,500 2,550 5,950 Second-degree corrosion NOS Corrosion of third degree, body region unspecified; Thrid- T30.7 BURN A 8,500 2,550 5,950 degree corrosion NOS T31.0 Burns involving less than 10% of body surface BURN A 8,500 2,550 5,950 T31.1 Burns involving 10-19% of body surface BURN A 8,500 2,550 5,950 T32.0 Corrosions involving less than 10% of body surface BURN A 8,500 2,550 5,950 T32.1 Corrosions involving 10-19% of body surface BURN A 8,500 2,550 5,950 T34.1 Frostbite with tissue necrosis of neck BURN A 8,500 2,550 5,950 Superficial frostbite involving multiple body regions; T35.0 BURN A 8,500 2,550 5,950 Multiple superficial frosbite NOS Frostbite with tissue necrosis involving multiple body T35.1 BURN A 8,500 2,550 5,950 regions; Multiple frosbite with tissue necrosis NOS T20.2 Burn of second degree of head and neck BURN B 10,600 3,180 7,420 T20.3 Burn of third degree of head and neck BURN B 10,600 3,180 7,420 T20.6 Corrosion of second degree of head and neck BURN B 10,600 3,180 7,420 Burn of third degree of shoulder and upper limb, except T22.3 BURN B 10,600 3,180 7,420 wrist and hand T23.3 Burn of third degree of wrist and hand BURN B 10,600 3,180 7,420 T23.6 Corrosion of second degree of wrist and hand BURN B 10,600 3,180 7,420 T23.7 Corrosion of third degree of wrist and hand BURN B 10,600 3,180 7,420 Burn of third degree of hip and lower limb, except ankle T24.3 BURN B 10,600 3,180 7,420 and foot Corrosion of third degree of hip and lower limb, except T24.7 BURN B 10,600 3,180 7,420 ankle and foot T25.3 Burn of third degree of ankle and foot BURN B 10,600 3,180 7,420 T26.1 Burn of cornea and conjunctival sac BURN B 10,600 3,180 7,420 T26.2 Burn with resulting rupture and destruction of eyeball BURN B 10,600 3,180 7,420 T26.3 Burn of other parts of eye and adnexa BURN B 10,600 3,180 7,420 T26.6 Corrosion of cornea and conjunctival sac BURN B 10,600 3,180 7,420 T27.0 Burn of larynx and trachea BURN B 10,600 3,180 7,420 T27.2 Burn of other parts of respiratory tract; Thoracic cavity BURN B 10,600 3,180 7,420 T28.0 Burn of mouth and pharynx BURN B 10,600 3,180 7,420 T28.1 Burn of oesophagus BURN B 10,600 3,180 7,420 T28.2 Burn of other parts of alimentary tract BURN B 10,600 3,180 7,420 T28.3 Burn of internal genitourinary organs BURN B 10,600 3,180 7,420 T28.5 Corrosion of mouth and pharynx BURN B 10,600 3,180 7,420 T28.6 Corrosion of oesophagus BURN B 10,600 3,180 7,420 T28.7 Corrosion of other parts of alimentary tract BURN B 10,600 3,180 7,420 T28.8 Corrosion of internal genitourinary organs BURN B 10,600 3,180 7,420 Burns of multiple regions, no more than second-degree T29.2 BURN B 10,600 3,180 7,420 burns mentioned Burns of multiple regions, at least one burn of third degree T29.3 BURN B 10,600 3,180 7,420 mentioned Corrosions of multiple regions, no more than second- T29.6 BURN B 10,600 3,180 7,420 degree corrosions mentioned T31.2 Burns involving 20-29% of body surface BURN B 10,600 3,180 7,420 T31.3 Burns involving 30-39% of body surface BURN B 10,600 3,180 7,420 T31.4 Burns involving 40-49% of body surface BURN B 10,600 3,180 7,420 T31.5 Burns involving 50-59% of body surface BURN B 10,600 3,180 7,420 T32.2 Corrosions involving 20-29% of body surface BURN B 10,600 3,180 7,420 T32.3 Corrosions involving 30-39% of body surface BURN B 10,600 3,180 7,420 T32.4 Corrosions involving 40-49% of body surface BURN B 10,600 3,180 7,420

Page 10 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Frostbite with tissue necrosis of other and unspecified T34.9 sites; Frosbite with tissue necrosis NOS; Frosbite with tissue BURN B 10,600 3,180 7,420 of leg NOS; Frosbite with tissue necrosis of trunk NOS

T21.3 Burn of third degree of trunk BURN C 16,100 4,830 11,270 T31.6 Burns involving 60-69% of body surface BURN C 16,100 4,830 11,270 T31.7 Burns involving 70-79% of body surface BURN C 16,100 4,830 11,270 T31.8 Burns involving 80-89% of body surface BURN C 16,100 4,830 11,270 T31.9 Burns involving 90% or more of body surface BURN C 16,100 4,830 11,270 T32.9 Corrosions involving 90% or more of body surface BURN C 16,100 4,830 11,270 I47.0 Re-entry ventricular arrhythmia CARDIAC ARRHYTHMIA 12,200 3,660 8,540 Supraventricular tachycardia; Atrial Paroxysmal tachycardia; Atrioventricular [AV] Paroxysmal tachycardia; I47.1 CARDIAC ARRHYTHMIA 12,200 3,660 8,540 Junctional Paroxysmal tachycardia; Nodal Paroxysmal tachycardia I47.2 Ventricular tachycardia CARDIAC ARRHYTHMIA 12,200 3,660 8,540 Paroxysmal tachycardia, unspecified; Bouveret (-Hoffmann) I47.9 CARDIAC ARRHYTHMIA 12,200 3,660 8,540 syndrome I48 Atrial fibrillation and flutter CARDIAC ARRHYTHMIA 12,200 3,660 8,540 I49.0 Ventricular fibrillation and flutter CARDIAC ARRHYTHMIA 12,200 3,660 8,540

I49.1 Atrial premature depolarization; Atrial premature beats CARDIAC ARRHYTHMIA 12,200 3,660 8,540

I49.2 Junctional premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540 I49.3 Ventricular premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540 Other and unspecified premature depolarization; Ectopic I49.4 beats; Extrasystoles; Extrasystolic arrhythmias; Premature CARDIAC ARRHYTHMIA 12,200 3,660 8,540 beats NOS; Premature contractions

I49.5 Sick sinus syndrome; Tachycardia-bradycardia syndrome CARDIAC ARRHYTHMIA 12,200 3,660 8,540

Other specified cardiac arrhythmias; Brugada syndrome; I49.8 CARDIAC ARRHYTHMIA 12,200 3,660 8,540 Long QT syndrome; coronary sinus rhythm disorder; ectopic rhythm disorder; nodal rhythm disorder

I49.9 Cardiac arrhythmia, unspecified; Cardiac arrhythmia NOS CARDIAC ARRHYTHMIA 12,200 3,660 8,540

I42.0 Dilated cardiomyopathy; Congestive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380 Obstructive hypertrophic cardiomyopathy; Hypertrophic I42.1 CARDIOMYOPATHY 13,400 4,020 9,380 subaortic stenosis Other hypertrophic cardiomyopathy; Nonobstructive I42.2 CARDIOMYOPATHY 13,400 4,020 9,380 hypertrophic cardiomyopathy

Endomyocardial (eosinophilic) disease; Endomyocardial I42.3 CARDIOMYOPATHY 13,400 4,020 9,380 (tropical) fibrosis; Löffler's endocarditis

I42.4 Endocardial fibroelastosis; Congenital cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380 I42.5 Other restrictive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380 I42.6 Alcoholic cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380

I42.7 Cardio myopathy due to drugs and other external agents CARDIOMYOPATHY 13,400 4,020 9,380

I42.8 Other cardiomyopathies CARDIOMYOPATHY 13,400 4,020 9,380 Cardio myopathy, unspecified; Primary cardiomyopathy I42.9 CARDIOMYOPATHY 13,400 4,020 9,380 NOS; Secondary cardiomyopathy NOS CARDIOVASCULAR COMPLICATIONS IN THE P29.0 Neonatal cardiac failure 22,700 6,810 15,890 NEWBORN CARDIOVASCULAR COMPLICATIONS IN THE P29.1 Neonatal cardiac dysrhythmia 22,700 6,810 15,890 NEWBORN CARDIOVASCULAR COMPLICATIONS IN THE P29.2 Neonatal hypertension 22,700 6,810 15,890 NEWBORN CARDIOVASCULAR COMPLICATIONS IN THE P29.4 Transient myocardial ischaemia of newborn 22,700 6,810 15,890 NEWBORN Other cardiovascular disorders originating in the perinatal CARDIOVASCULAR COMPLICATIONS IN THE P29.8 22,700 6,810 15,890 period NEWBORN Cauda equina syndrome; Neurogenic bladder due to cauda G83.4 equina syndrome CAUDA EQUINA SYNDROME 8,800 2,640 6,160 Excludes: cord bladder NOS (G95.8) A46 Erysipelas CELLULITIS 9,600 2,880 6,720

A48.0 Gas gangrene; Clostridial cellulitis; Clostridial myonecrosis CELLULITIS 9,600 2,880 6,720

Cellulitis of finger and toe; Infection of nail; Onychia; L03.0 CELLULITIS 9,600 2,880 6,720 Paronychia; Perionychia Cellulitis of other parts of limb, Axilla; Cellulitis of L03.1 CELLULITIS 9,600 2,880 6,720 Hip;Cellulitis of Shoulder L03.2 Cellulitis of face CELLULITIS 9,600 2,880 6,720 Cellulitis of trunk;Cellulitis of Abdominal wall;Cellulitis of L03.3 Back [any part]; Cellulitis of Chest wall;Cellulitis of CELLULITIS 9,600 2,880 6,720 Groin;Cellulitis of Perineum;Cellulitis of Umbilicus Cellulitis of other sites; Cellulitis of Head [any part, except L03.8 CELLULITIS 9,600 2,880 6,720 face];Cellulitis of Scalp

Page 11 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee L03.9 Cellulitis, unspecified CELLULITIS 9,600 2,880 6,720 L98.3 Eosinophilic cellulitis [Wells] CELLULITIS 9,600 2,880 6,720 Spastic cerebral palsy; Congenital spastic paralysis G80.0 CEREBRAL PALSY 9,500 2,850 6,650 (cerebral); Spastic tetraplegic cerebral palsy G80.1 Spastic diplegia; Spastic cerebral palsy NOS CEREBRAL PALSY 9,500 2,850 6,650 Infantile hemiplegia G80.2 CEREBRAL PALSY 9,500 2,850 6,650 Spastic hemiplegic cerebral palsy Dyskinetic cerebral palsy; Athetoid cerebral palsy; Dystonic G80.3 CEREBRAL PALSY 9,500 2,850 6,650 cerebral palsy G80.4 Ataxic cerebral palsy CEREBRAL PALSY 9,500 2,850 6,650 Other infantile cerebral palsy; Mixed cerebral palsy G80.8 CEREBRAL PALSY 9,500 2,850 6,650 syndromes

G80.9 Infantile cerebral palsy, unspecified; Cerebral palsy NOS CEREBRAL PALSY 9,500 2,850 6,650

Primary biliary ; Chronic nonsupparative K74.3 CHOLANGITIS 13,200 3,960 9,240 destructive cholangitis Calculus of with cholangitis; Any condition listed in K80.3 CHOLANGITIS 13,200 3,960 9,240 K80.5 with cholangitis Calculus of gallbladder with acute ; Any K80.0 condition listed in K80.2 with acute cholecystitis CHOLECYSTITIS 11,300 3,390 7,910 Acute cholecystitis with cholelithiasis Calculus of gallbladder with other cholecystitis; Any K80.1 condition listed in K80.2 with chronic cholecystitis; CHOLECYSTITIS 11,300 3,390 7,910 Cholecystitis with cholelithiasis NOS Calculus of bile duct with cholecystitis; Any condition listed K80.4 CHOLECYSTITIS 11,300 3,390 7,910 in K80.5 with cholecystitis (with cholangitis)

Acute cholecystitis; Abscess of gallbladder without calculus; Angiocholecystitis without calculus; Acute emphysematous cholecystitis without calculus; Gangrenous cholecystitis K81.0 CHOLECYSTITIS 11,300 3,390 7,910 without calculus; Supparative cholecystitis without calculus; Empyema of gallbladder without calculus; Gangrene of gallbladder without calculus

K81.1 Chronic cholecystitis CHOLECYSTITIS 11,300 3,390 7,910 K81.8 Other cholecystitis CHOLECYSTITIS 11,300 3,390 7,910 Q90.0 Trisomy 21, meiotic nondisjunction CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q90.2 Trisomy 21, translocation CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q90.9 Down's syndrome, unspecified; Trisomy 21 NOS CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q91.0 Trisomy 18, meiotic nondisjunction CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q91.2 Trisomy 18, translocation CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q91.3 Edwards' syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q91.7 Patau's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q92.9 Trisomy and partial trisomy of autosomes, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Whole chromosome monosomy, mosaicism (mitotic Q93.1 CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 nondisjunction) Q93.2 Chromosome replaced with ring or dicentric CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Deletion of short arm of chromosome 5; Cri-du-chat Q93.4 CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 syndrome Other deletions of part of a chromosome; Angelman Q93.5 CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 syndrome Q93.7 Deletions with other complex rearrangements CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q93.9 Deletion from autosomes, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890

Q95.9 Balanced rearrangement and structural marker, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890

Q96.9 Turner's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Sex chromosome abnormality, female phenotype, Q97.9 CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 unspecified Q98.4 Klinefelter's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q99.2 Fragile X chromosome; Fragile X syndrome CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 Q99.8 Other specified chromosome abnormalities CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890 N18.0 End stage renal disease CHRONIC KIDNEY DISEASE N/A N/A N/A Chronic kidney disease, stage 5 Chronic uraemia End stage kidney disease: • in allograft failure • NOS • on dialysis • without dialysis or transplant N18.5 CHRONIC KIDNEY DISEASE 14,500 4,350 10,150 Renal retinitis+(H32.8*) Uraemic: • apoplexia+(I68.8*) • dementia+(F02.8*) • neuropathy+(G63.8*) • paralysis+(G99.8*) • +(I32.8*) N18.8 Other chronic renal failure CHRONIC KIDNEY DISEASE N/A N/A N/A

Page 12 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Chronic renal failure N18.9 CHRONIC KIDNEY DISEASE 14,500 4,350 10,150 Chronic kidney disease, unspecified Unspecified renal failure N19 Unspecified kidney failure CHRONIC KIDNEY DISEASE 14,500 4,350 10,150 Renal insufficiency NOS

Chronic obstructive/ asthmatic/ emphysematous J44.0 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540 pulmonary disease with acute lower respiratory infection

Chronic obstructive/ asthmatic/ emphysematous J44.1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540 pulmonary disease with acute exacerbation, unspecified

Chronic asthmatic (obstructive) bronchitis NOS; Chronic J44.8 emphysematous bronchitis NOS; Chronic obstructive CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540 bronchitis NOS Chronic obstructive pulmonary disease, unspecified; J44.9 Chronic obstructive airway disease NOS; Chronic CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540 obstructive lung disease NOS Cleft hard palate, bilateral; Bilateral fissure of hard palate; Q35.0 CLEFT LIP AND PALATE 7,800 2,340 5,460 Bilateral palatoschisis of hard palate Q35.1 Cleft hard palate CLEFT LIP AND PALATE 7,800 2,340 5,460 Q35.3 Cleft soft palate CLEFT LIP AND PALATE 7,800 2,340 5,460 Q35.5 Cleft hard palate with cleft soft palate CLEFT LIP AND PALATE 7,800 2,340 5,460 Q35.7 Cleft uvula CLEFT LIP AND PALATE 7,800 2,340 5,460 Q35.8 Cleft palate, unspecified, bilateral CLEFT LIP AND PALATE 7,800 2,340 5,460 Q35.9 Cleft palate, unspecified CLEFT LIP AND PALATE 7,800 2,340 5,460 Q36.0 Cleft lip, bilateral CLEFT LIP AND PALATE 7,800 2,340 5,460 Q36.1 Cleft lip, median CLEFT LIP AND PALATE 7,800 2,340 5,460 Q36.9 Cleft lip, unilateral; Cleft lip NOS CLEFT LIP AND PALATE 7,800 2,340 5,460 Q37.0 Cleft hard palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460 Cleft hard palate with unilateral cleft lip; Cleft hard palate Q37.1 CLEFT LIP AND PALATE 7,800 2,340 5,460 with cleft lip NOS Q37.2 Cleft soft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460 Cleft soft palate with unilateral cleft lip; Cleft soft palate Q37.3 CLEFT LIP AND PALATE 7,800 2,340 5,460 with cleft lip NOS Q37.4 Cleft hard and soft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460 Cleft hard and soft palate with unilateral cleft lip; Cleft hard Q37.5 CLEFT LIP AND PALATE 7,800 2,340 5,460 and soft palate with cleft lip NOS Q37.8 Unspecified cleft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460 Unspecified cleft palate with unilateral cleft lip; Cleft palate Q37.9 CLEFT LIP AND PALATE 7,800 2,340 5,460 with cleft lip NOS F01.0 Vascular dementia of acute onset COGNITIVE DYSFUNCTION 8,200 2,460 5,740 R41.0 Disorientation, unspecified; Confusion NOS COGNITIVE DYSFUNCTION 8,200 2,460 5,740 R41.3 Other amnesia; Amnesia NOS COGNITIVE DYSFUNCTION 8,200 2,460 5,740 Senility; Old age without mention of psychosis; Senescence R54 without mention of psychosis; Senile asthenia; Senile COGNITIVE DYSFUNCTION 8,200 2,460 5,740 debility COMPLICATIONS OF BENIGN OF D34 Benign neoplasm of thyroid gland 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF D35.0 Benign neoplasm of Adrenal gland 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF D35.1 Benign neoplasm of Parathyroid gland 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF D35.2 Benign neoplasm of Pituitary gland 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF D35.3 Benign neoplasm of Craniopharyngeal duct 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF D35.4 Benign neoplasm of Pineal gland 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF D35.9 Benign neoplasm of Endocrine gland, unspecified 12,000 3,600 8,400 ENDOCRINE GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.0 Benign neoplasm of Scapula and long bones of upper limb 10,500 3,150 7,350 BONES COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.1 Benign neoplasm of Short bones of upper limb 10,500 3,150 7,350 BONES COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.2 Benign neoplasm ofLong bones of lower limb 10,500 3,150 7,350 BONES COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.3 Benign neoplasm of Short bones of lower limb 10,500 3,150 7,350 BONES Benign neoplasm of Bones of skull and face; Benign COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.4 neoplasm of Superior Maxilla; Benign neoplasm of Orbital 10,500 3,150 7,350 BONES bone COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.5 Benign neoplasm of Lower jaw bone 10,500 3,150 7,350 BONES COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.6 Benign neoplasm of Vertebral column 10,500 3,150 7,350 BONES COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.7 Benign neoplasm of Ribs, sternum and clavicle 10,500 3,150 7,350 BONES

Page 13 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.8 Benign neoplasm of Pelvic bones, sacrum and coccyx 10,500 3,150 7,350 BONES Benign neoplasm of Bone and articular cartilage, COMPLICATIONS OF BENIGN NEOPLASMS OF THE D16.9 10,500 3,150 7,350 unspecified BONES Benign neoplasm of Caecum;Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.0 8,700 2,610 6,090 Ileocaecal valve DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.1 Benign neoplasm of 8,700 2,610 6,090 DIGESTIVE SYSTEM

Benign neoplasm of Transverse colon; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.3 8,700 2,610 6,090 Hepatic flexure; Benign neoplasm of Splenic flexure DIGESTIVE SYSTEM

COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.4 Benign neoplasm of Descending colon 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.5 Benign neoplasm of Sigmoid colon 8,700 2,610 6,090 DIGESTIVE SYSTEM Benign neoplasm of Colon, unspecified; Adenomatosis of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.6 colon; Benign neoplasm of NOS; Hereditary 8,700 2,610 6,090 DIGESTIVE SYSTEM Polyposis of colon Benign neoplasm of Rectosigmoid junction; Adenomatosis COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.7 of colon; Benign neoplasm of Large intestine NOS; 8,700 2,610 6,090 DIGESTIVE SYSTEM Hereditary Polyposis of colon COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.8 Benign neoplasm of 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D12.9 Benign neoplasm of Anus and 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.0 Benign neoplasm of Oesophagus 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.1 Benign neoplasm of 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.2 Benign neoplasm of 8,700 2,610 6,090 DIGESTIVE SYSTEM Benign neoplasm of Other and unspecified parts of small COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.3 8,700 2,610 6,090 intestine DIGESTIVE SYSTEM Benign neoplasm of Liver; Benign neoplasm of Intrahepatic COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.4 8,700 2,610 6,090 bile ducts DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.5 Benign neoplasm of Extrahepatic bile ducts 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.6 Benign neoplasm of 8,700 2,610 6,090 DIGESTIVE SYSTEM Benign neoplasm of Endocrine pancreas; Benign neoplasm COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.7 of Islet cell tumour; Benign neoplasm of Islets of 8,700 2,610 6,090 DIGESTIVE SYSTEM Langerhans

Benign neoplasm of Ill-defined sites within the digestive COMPLICATIONS OF BENIGN NEOPLASMS OF THE D13.9 system; Benign neoplasm of Digestive system NOS; Benign 8,700 2,610 6,090 DIGESTIVE SYSTEM neoplasm of Intestine NOS; Benign neoplasm of Spleen

COMPLICATIONS OF BENIGN NEOPLASMS OF THE D17.5 Benign lipomatous neoplasm of intra-abdominal organs 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D17.6 Benign lipomatous neoplasm of spermatic cord 8,700 2,610 6,090 DIGESTIVE SYSTEM Benign lipomatous neoplasm of other sites; Benign COMPLICATIONS OF BENIGN NEOPLASMS OF THE D17.7 lipomatous neoplasm of ; Benign lipomatous 8,700 2,610 6,090 DIGESTIVE SYSTEM neoplasm of Retroperitoneum COMPLICATIONS OF BENIGN NEOPLASMS OF THE D20.0 Benign neoplasm of of of Retroperitoneum 8,700 2,610 6,090 DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D20.1 Benign neoplasm of of soft tissue of Peritoneum 8,700 2,610 6,090 DIGESTIVE SYSTEM Benign neoplasm of Connective and other soft tissue of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D21.4 8,700 2,610 6,090 abdomen DIGESTIVE SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D25.0 Submucous of uterus 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D25.1 Intramural leiomyoma of uterus 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D25.2 Subserosal leiomyoma of uterus 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D25.9 Leiomyoma of uterus, unspecified 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D26.0 Other Benign neoplasm of Cervix uteri 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D26.1 Other Benign neoplasm of Corpus uteri 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D26.7 Other Benign neoplasm of Other parts of uterus 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D26.9 Other Benign neoplasm of Uterus, unspecified 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D27 Benign neoplasm of ovary 9,600 2,880 6,720 FEMALE GENITAL TRACT

Page 14 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee COMPLICATIONS OF BENIGN NEOPLASMS OF THE D28.0 Benign neoplasm of Vulva 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D28.1 Benign neoplasm of Vagina 9,600 2,880 6,720 FEMALE GENITAL TRACT Benign neoplasm of Uterine tubes and ligaments; Benign neoplasm of Fallopian Tubes; Benign neoplasm of Uterine COMPLICATIONS OF BENIGN NEOPLASMS OF THE D28.2 9,600 2,880 6,720 Broad Ligament; Benign neoplasm of Uterine round FEMALE GENITAL TRACT ligament COMPLICATIONS OF BENIGN NEOPLASMS OF THE D28.7 Benign neoplasm of Other specified female genital organs 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D28.9 Benign neoplasm of Female genital organ, unspecified 9,600 2,880 6,720 FEMALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D29.0 Benign neoplasm of Penis 7,700 2,310 5,390 MALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D29.1 Benign neoplasm of Prostate 7,700 2,310 5,390 MALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D29.2 Benign neoplasm of Testis 7,700 2,310 5,390 MALE GENITAL TRACT Benign neoplasm of Scrotum; Benign neoplasm of Skin of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D29.4 7,700 2,310 5,390 scrotum MALE GENITAL TRACT COMPLICATIONS OF BENIGN NEOPLASMS OF THE D32.0 Benign neoplasm of Cerebral meninges 14,800 4,440 10,360 NERVOUS SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D32.1 Benign neoplasm of Spinal meninges 14,800 4,440 10,360 NERVOUS SYSTEM Benign neoplasm of Meninges, unspecified; Meningioma COMPLICATIONS OF BENIGN NEOPLASMS OF THE D32.9 14,800 4,440 10,360 NOS NERVOUS SYSTEM Benign neoplasm of Brain, supratentorial; Benign neoplasm of Cerebral ventricle; Benign neoplasm of Cerebrum; COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.0 Benign neoplasm of Frontal lobe; Benign neoplasm of 14,800 4,440 10,360 NERVOUS SYSTEM Occipital lobe; Benign neoplasm of Parietal lobe; Benign neoplasm of Temporal lobe Benign neoplasm of Brain, infratentorial; Benign neoplasm COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.1 of Brain stem; Benign neoplasm of Cerebellum; Benign 14,800 4,440 10,360 NERVOUS SYSTEM neoplasm of Fourth ventricle COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.2 Benign neoplasm of Brain, unspecified 14,800 4,440 10,360 NERVOUS SYSTEM Benign neoplasm of Cranial nerves; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.3 14,800 4,440 10,360 Olfactory bulb NERVOUS SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.4 Benign neoplasm of Spinal cord 14,800 4,440 10,360 NERVOUS SYSTEM Benign neoplasm of Other specified parts of central COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.7 14,800 4,440 10,360 nervous system NERVOUS SYSTEM Benign neoplasm of Central nervous system, unspecified; COMPLICATIONS OF BENIGN NEOPLASMS OF THE D33.9 14,800 4,440 10,360 Central Nervous system NOS NERVOUS SYSTEM Benign neoplasm of Peripheral nerves and autonomic COMPLICATIONS OF BENIGN NEOPLASMS OF THE D36.1 14,800 4,440 10,360 nervous system NERVOUS SYSTEM Benign neoplasm of Lip; Benign neoplasm of frenulum of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D10.0 Lip; Benign neoplasm of Inner aspect of lip; Benign ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 neoplasm of Mucosa of Lip; Vermilion border of Lip GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE Benign neoplasm of Tongue;Benign neoplasm of Lingual D10.1 ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 tonsil GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE Benign neoplasm of Other and unspecified parts of mouth; D10.3 ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 Benign neoplasm of Minor salivary gland NOS GLANDS Benign neoplasm of Nasopharynx; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE D10.6 Pharyngeal tonsil; Benign neoplasm of Posterior margin of ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 septum and choanae GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE D10.7 Benign neoplasm of Hypopharynx ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE D10.9 Benign neoplasm of Pharynx, unspecified ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE D11.0 Benign neoplasm of Parotid gland ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE Benign neoplasm of Other major salivary glands; sublingual; D11.7 ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 submandibular GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE D11.9 Benign neoplasm of Major salivary gland, unspecified ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE Benign neoplasm of Larynx; Benign neoplasm of D14.1 ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 suprahyoid portion of Epiglottis GLANDS

Page 15 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee COMPLICATIONS OF BENIGN NEOPLASMS OF THE D14.2 Benign neoplasm of Trachea ORAL CAVITY, PHARYNX, LARYNX, SALIVARY 9,500 2,850 6,650 GLANDS COMPLICATIONS OF BENIGN NEOPLASMS OF THE D30.0 Benign neoplasm of Kidney 8,300 2,490 5,810 URINARY SYSTEM COMPLICATIONS OF BENIGN NEOPLASMS OF THE D30.1 Benign neoplasm of Renal pelvis 8,300 2,490 5,810 URINARY SYSTEM Benign neoplasm of Bladder; Benign neoplasm of Urethral COMPLICATIONS OF BENIGN NEOPLASMS OF THE D30.3 orifice of bladder; Benign neoplasm of ureteric orifice of 8,300 2,490 5,810 URINARY SYSTEM bladder COMPLICATIONS OF BENIGN NEOPLASMS OF THE D30.4 Benign neoplasm of Urethra 8,300 2,490 5,810 URINARY SYSTEM Benign neoplasm of Urinary organ, unspecified; Benign COMPLICATIONS OF BENIGN NEOPLASMS OF THE D30.9 8,300 2,490 5,810 neoplasm of Urinary system NOS URINARY SYSTEM Cardiac septal defect, acquired; Acquired atrial septal I51.0 defect old; Acquired auricular septal defect old ; Acquired COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 ventricular septal defect old I51.1 Rupture of chordae tendineae, not elsewhere classified COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 I51.2 Rupture of papillary muscle, not elsewhere classified COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 Intra cardiac thrombosis, not elsewhere classified; Old I51.3 Apical thrombosis; Old Atrial thrombosis; Old Auricular COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 thrombosis; Old Venticular thrombosis Myocarditis, unspecified; Myocardial fibrosis; Myocarditis I51.4 COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 NOS; Chronic interstitial myocarditis Myocardial degeneration; Fatty Degeneration of heart or I51.5 myocardium fatty; Senile Degeneration of heart or COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 myocardium; Myocardial disease Other ill-defined heart diseases; Acute carditis; Chronic I51.8 COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080 Carditis; Acute pancarditis; Chronic pancarditis COMPLICATIONS OF HEMANGIOMA AND D18.0 Haemangioma, any site; Angioma NOS 9,000 2,700 6,300 LYMPHANGIOMA COMPLICATIONS OF HEMANGIOMA AND D18.1 Lymphangioma, any site 9,000 2,700 6,300 LYMPHANGIOMA COMPLICATIONS OF INTRATHORACIC BENIGN D14.3 Benign neoplasm of Bronchus and lung 10,100 3,030 7,070 NEOPLASMS COMPLICATIONS OF INTRATHORACIC BENIGN D14.4 Benign neoplasm of Respiratory system, unspecified 10,100 3,030 7,070 NEOPLASMS COMPLICATIONS OF INTRATHORACIC BENIGN D15.0 Benign neoplasm of Thymus 10,100 3,030 7,070 NEOPLASMS COMPLICATIONS OF INTRATHORACIC BENIGN D15.1 Benign neoplasm of Heart 10,100 3,030 7,070 NEOPLASMS COMPLICATIONS OF INTRATHORACIC BENIGN D15.2 Benign neoplasm of Mediastinum 10,100 3,030 7,070 NEOPLASMS COMPLICATIONS OF INTRATHORACIC BENIGN D15.9 Benign neoplasm of Intrathoracic organ, unspecified 10,100 3,030 7,070 NEOPLASMS COMPLICATIONS OF INTRATHORACIC BENIGN D17.4 Benign lipomatous neoplasm of intrathoracic organs 10,100 3,030 7,070 NEOPLASMS Benign neoplasm of Connective and other soft tissue of thorax; Benign neoplasm of Connective and other soft COMPLICATIONS OF INTRATHORACIC BENIGN D21.3 tissue of Axilla; Benign neoplasm of Connective and other 10,100 3,030 7,070 NEOPLASMS soft tissue of Diaphragm; Benign neoplasm of Connective and other soft tissue of Great vessels COMPLICATIONS OF SEXUALLY TRANSMITTED A52.1 Late Symptomatic neurosyphilis; Tabes dorsalis 5,500 1,650 3,850 DISEASES

Neurosyphilis, unspecified; Syphilitic Gumma of central COMPLICATIONS OF SEXUALLY TRANSMITTED A52.3 nervous system NOS; Late Syphilis of central nervous 5,500 1,650 3,850 DISEASES system NOS; Syphiloma of central nervous system NOS

COMPLICATIONS OF SEXUALLY TRANSMITTED A52.7 Other symptomatic late syphilis 5,500 1,650 3,850 DISEASES Latent syphilis, unspecified as early or late; Latent syphilis COMPLICATIONS OF SEXUALLY TRANSMITTED A53.0 5,500 1,650 3,850 NOS; Positive serological reaction for syphilis DISEASES Gonococcal infection of lower genitourinary tract with COMPLICATIONS OF SEXUALLY TRANSMITTED A54.1 periurethral and accessory gland abscess; Gonococcal 5,500 1,650 3,850 DISEASES Bartholin's gland abscess Gonococcal Pelviperitonitis and other gonococcal COMPLICATIONS OF SEXUALLY TRANSMITTED A54.2 5,500 1,650 3,850 genitourinary infections DISEASES Other gonococcal infections: COMPLICATIONS OF SEXUALLY TRANSMITTED A54.8 5,500 1,650 3,850 Gonococcal septicaemia; Gonococcal skin lesions DISEASES Chlamydial lymphogranuloma (venereum); Climatic or COMPLICATIONS OF SEXUALLY TRANSMITTED A55 tropical bubo ; Durand-Nicolas-Favre disease; Esthiomene; 5,500 1,650 3,850 DISEASES Lymphogranuloma inguinale Chlamydial infection of pelviperitoneum and other COMPLICATIONS OF SEXUALLY TRANSMITTED A56.1 5,500 1,650 3,850 genitourinary organs; DISEASES COMPLICATIONS OF SEXUALLY TRANSMITTED A59 Trichomoniasis 5,500 1,650 3,850 DISEASES T79.0 Air embolism (traumatic) COMPLICATIONS OF TRAUMA 9,300 2,790 6,510

Page 16 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee T79.1 Fat embolism (traumatic) COMPLICATIONS OF TRAUMA 9,300 2,790 6,510 T79.2 Traumatic secondary and recurrent haemorrhage COMPLICATIONS OF TRAUMA 9,300 2,790 6,510

T79.3 Post-traumatic wound infection, not elsewhere classified COMPLICATIONS OF TRAUMA 9,300 2,790 6,510

Traumatic shock; immediate shock following injury; T79.4 COMPLICATIONS OF TRAUMA 9,300 2,790 6,510 Delayed shock following injury Traumatic anuria; Crush syndrome; Renal failure following T79.5 COMPLICATIONS OF TRAUMA 9,300 2,790 6,510 crushing Traumatic ischaemia of muscle; Compartment syndrome; T79.6 COMPLICATIONS OF TRAUMA 9,300 2,790 6,510 Volkmann's ischaemic contracture T79.7 Traumatic subcutaneous emphysema COMPLICATIONS OF TRAUMA 9,300 2,790 6,510 T79.8 Other early complications of trauma COMPLICATIONS OF TRAUMA 9,300 2,790 6,510

Congenital adrenogenital disorders associated with enzyme E25.0 deficiency; Congenital adrenal hyperplasia; 21-Hydroxylase CONGENITAL ANDROGENITAL DISORDER 7,800 2,340 5,460 deficiency; Salt-losing congenital adrenal hyperplasia

P61.2 Anaemia of prematurity CONGENITAL ANEMIA 15,200 4,560 10,640 P61.3 Congenital anaemia from fetal blood loss CONGENITAL ANEMIA 15,200 4,560 10,640 Other congenital anaemias, not elsewhere classified; P61.4 CONGENITAL ANEMIA 15,200 4,560 10,640 Congenital anaemia NOS Congenital dyserythropoietic anaemia; Congenital D64.4 CONGENITAL BLOOD DISORDERS 4,000 1,200 2,800 Dyshaematopoietic anaemia D74.0 Congenital methaemoglobinaemia CONGENITAL BLOOD DISORDERS 4,000 1,200 2,800 Q80.2 Lamellar ichthyosis; Collodion baby CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q80.9 Congenital ichthyosis, unspecified CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q81.2 Epidermolysis bullosa dystrophica CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q81.8 Other epidermolysis bullosa CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q81.9 Epidermolysis bullosa, unspecified CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q82.0 Hereditary lymphoedema CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q82.2 ; Urticaria pigmentosa CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q82.3 Incontinentia pigmenti CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Q82.4 Ectodermal dysplasia (anhidrotic) CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Other specified congenital malformations of skin; Abnormal palmar creases; Accessory skin tags; Benign familial Q82.8 pemphigus [Hailey-Hailey]; Cutis laxa (hyperelastica); CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Dermatoglyphic anomalies; Inherited keratosis palmaris et plantaris; Keratosis follicula Other specified congenital malformations of integument; Q84.8 CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260 Aplasia cutis congenita CONGENITAL DISORDERS OF THE FEMALE GENITAL Q50.1 Developmental ovarian cyst 9,300 2,790 6,510 TRACT

Other congenital malformations of ovary; Accessory ovary; CONGENITAL DISORDERS OF THE FEMALE GENITAL Q50.3 9,300 2,790 6,510 Congenital malformation of ovary NOS; Ovarian streak TRACT

CONGENITAL DISORDERS OF THE FEMALE GENITAL Q50.4 Embryonic cyst of fallopian tube; Fimbrial cyst 9,300 2,790 6,510 TRACT Embryonic cyst of broad ligament; Cyst epoophoron; CONGENITAL DISORDERS OF THE FEMALE GENITAL Q50.5 9,300 2,790 6,510 Gartner's duct Cyst; Parovarian Cyst TRACT

Other congenital malformations of fallopian tube and broad ligament; Absence of fallopian tube or broad CONGENITAL DISORDERS OF THE FEMALE GENITAL Q50.6 ligament; Accessory of fallopian tube or broad ligament; 9,300 2,790 6,510 TRACT Atresia of fallopian tube or broad ligament; Congenital malformation of fallopian tube or broad ligament NOS

Agenesis and aplasia of uterus; Congenital absence of CONGENITAL DISORDERS OF THE FEMALE GENITAL Q51.0 9,300 2,790 6,510 uterus TRACT CONGENITAL DISORDERS OF THE FEMALE GENITAL Q51.9 Congenital malformation of uterus and cervix, unspecified 9,300 2,790 6,510 TRACT CONGENITAL DISORDERS OF THE Q65.6 Unstable hip; Dislocatable hip; Subluxatable hip 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM CONGENITAL DISORDERS OF THE Q67.3 Plagiocephaly 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM Other congenital deformities of skull, face and jaw; Depressions in skull; Deviation of nasal septum, congenital; CONGENITAL DISORDERS OF THE Q67.4 5,300 1,590 3,710 Hemifacial atrophy or hypertrophy; Squashed or bent nose, MUSCULOSKELETAL SYSTEM congenital CONGENITAL DISORDERS OF THE Q67.6 Pectus excavatum; Congenital funnel chest 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM CONGENITAL DISORDERS OF THE Q67.7 Pectus carinatum; Congenital pigeon chest 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM Congenital deformity of sternocleidomastoid muscle; Congenital, sternomastoid torticollis; Contracture of CONGENITAL DISORDERS OF THE Q68.0 5,300 1,590 3,710 sternocleidomastoid muscle; Sternomastoid tumour, MUSCULOSKELETAL SYSTEM congenital Congenital scoliosis due to congenital bony malformation; CONGENITAL DISORDERS OF THE Q76.3 Hemivertebra fusion or failure of segmentation with 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM scoliosis

Page 17 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee CONGENITAL DISORDERS OF THE Q78.0 Osteogenesis imperfecta; Fragilitas ossium 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM CONGENITAL DISORDERS OF THE Q78.2 Osteopetrosis; Albers-Schönberg syndrome 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM CONGENITAL DISORDERS OF THE Q78.8 Other specified osteochondrodysplasias; Osteopoikilosis 5,300 1,590 3,710 MUSCULOSKELETAL SYSTEM Osteochondrodysplasia, unspecified; Chondrodystrophy CONGENITAL DISORDERS OF THE Q78.9 5,300 1,590 3,710 NOS; Osteodystrophy NOS MUSCULOSKELETAL SYSTEM Other congenital malformation syndromes with other CONGENITAL DISORDERS OF THE Q87.5 5,300 1,590 3,710 skeletal changes MUSCULOSKELETAL SYSTEM Atresia of oesophagus without fistula; Atresia of Q39.0 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 oesophagus NOS

Atresia of oesophagus with tracheo-oesophageal fistula; Q39.1 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Atresia of oesophagus with broncho-oesophageal fistula

Congenital tracheo-oesophageal fistula without atresia; Q39.2 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Congenital tracheo-oesophageal fistula NOS Q39.6 Diverticulum of oesophagus; Oesophageal pouch CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q39.9 Congenital malformation of oesophagus, unspecified CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Congenital hypertrophic ; Congenital or infantile constriction of ; Congenital or infantile Q40.0 hypertrophy of pylorus; Congenital or infantile spasm of CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 pylorus; Congenital or infantile stenosis of pylorus; Congenital or infantile stricture of pylorus Congenital hiatus ; Displacement of cardia through Q40.1 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 oesophageal hiatus

Other specified congenital malformations of stomach; Congenital displacement of stomach; Congenital Q40.2 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 diverticulum of stomach; Congenital hourglass stomach; Duplication of stomach; Megalogastria; Microgastria

Congenital malformation of upper alimentary tract, Q40.9 unspecified; Congenital anomaly NOS of upper alimentary CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 tract; Congenital deformity NOS of upper alimentary tract

Q41.0 Congenital absence, atresia and stenosis of duodenum CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Congenital absence, atresia and stenosis of ; Apple Q41.1 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 peel syndrome; Imperforate jejunum Q41.2 Congenital absence, atresia and stenosis of CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Congenital absence, atresia and stenosis of , Q41.9 part unspecified; Congenital absence, atresia and stenosis CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 of intestine NOS Congenital absence, atresia and stenosis of rectum with Q42.0 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 fistula Congenital absence, atresia and stenosis of rectum without Q42.1 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 fistula; Imperforate rectum

Q42.2 Congenital absence, atresia and stenosis of anus with fistula CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910

Congenital absence, atresia and stenosis of anus without Q42.3 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 fistula; Imperforate anus Congenital absence, atresia and stenosis of large intestine, Q42.9 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 part unspecified Meckel's diverticulum; Persistent omphalomesenteric duct; Q43.0 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Persistent vitelline duct Hirschsprung's disease; Aganglionosis; Congenital Q43.1 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 (aganglionic) Other congenital functional disorders of colon; Congenital Q43.2 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 dilatation of colon Congenital malformations of intestinal fixation; Congenital anomalous omental adhesions [bands] ; Congenital peritoneal adhesions [bands]; Jackson's membrane; Q43.3 Malrotation of colon; Failure of rotation of caecum and CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 colon; Incomplete rotation of caecum and colon; Insufficient rotation of caecum and colon; Universal mesentery Q43.4 Duplication of intestine CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q43.5 Ectopic anus CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q43.6 Congenital fistula of rectum and anus CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q43.7 Persistent cloaca; Cloaca NOS CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Other specified congenital malformations of intestine; Congenital ; Congenital , colon; Congenital diverticulum, intestine; Dolichocolon; Q43.8 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Megaloappendix; Megaloduodenum; Microcolon; Transposition of appendix; Transposition of colon; Transposition of intestine Q43.9 Congenital malformation of intestine, unspecified CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910

Page 18 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Agenesis, aplasia and hypoplasia of gallbladder; Congenital Q44.0 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 absence of gallbladder

Other congenital malformations of gallbladder; Congenital Q44.1 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 malformation of gallbladder NOS; Intrahepatic gallbladder

Q44.2 Atresia of bile ducts CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q44.3 Congenital stenosis and stricture of bile ducts CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q44.4 Choledochal cyst CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910

Other congenital malformations of bile ducts; Accessory Q44.5 hepatic duct; Congenital malformation of bile duct NOS; CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Biliary duct Duplication; Cystic duct Duplication

Q44.6 Cystic disease of liver; Fibrocystic disease of liver CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910

Other congenital malformations of liver; Accessory liver; Q44.7 Alagille's syndrome; Congenital absence of liver; Congenital CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 hepatomegaly; Congenital malformation of liver NOS

Agenesis, aplasia and hypoplasia of pancreas; Congenital Q45.0 CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 absence of pancreas Other specified congenital malformations of digestive system; Absence of alimentary tract NOS, complete; Q45.8 Absence of alimentary tract NOS, partial; Duplication of CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 digestive organs NOS; Malposition, congenital of digestive organs NOS

Congenital malformation of digestive system, unspecified; Q45.9 Congenital anomaly NOS of digestive system ; Congenital CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 deformity NOS of digestive system

Q79.0 Congenital CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Other congenital malformations of diaphragm; Absence of Q79.1 diaphragm; Congenital malformation of diaphragm NOS; CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Eventration of diaphragm Q79.2 Exomphalos; Omphalocele CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q79.3 Gastroschisis CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q79.4 Prune belly syndrome CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q79.5 Other congenital malformations of abdominal wall CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910 Q20.0 Common arterial trunk; Persistent truncus arteriosus CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q20.1 Double outlet right ventricle; Taussig-Bing syndrome CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q20.2 Double outlet left ventricle CONGENITAL HEART DISEASES 11,600 3,480 8,120 Discordant ventriculoarterial connection; Q20.3 Dextrotransposition of aorta; Transposition of great vessels CONGENITAL HEART DISEASES 11,600 3,480 8,120 (complete) Double inlet ventricle; Common ventricle; Cor triloculare Q20.4 CONGENITAL HEART DISEASES 11,600 3,480 8,120 biatriatum; Single ventricle

Discordant atrioventricular connection; Corrected Q20.5 CONGENITAL HEART DISEASES 11,600 3,480 8,120 transposition; Laevotransposition; Ventricular inversion

Congenital malformation of cardiac chambers and Q20.9 CONGENITAL HEART DISEASES 11,600 3,480 8,120 connections, unspecified Q21.0 Ventricular septal defect CONGENITAL HEART DISEASES 11,600 3,480 8,120 Atrial septal defect; Coronary sinus defect; Patent or Q21.1 persistent foramen ovale; Patent or persistent ostium CONGENITAL HEART DISEASES 11,600 3,480 8,120 secundum defect (type II); Sinus venosus defect Atrioventricular septal defect; Common atrioventricular Q21.2 canal; Endocardial cushion defect; Ostium primum atrial CONGENITAL HEART DISEASES 11,600 3,480 8,120 septal defect (type I) Tetralogy of Fallot; Ventricular septal defect with Q21.3 pulmonary stenosis or atresia, dextroposition of aorta and CONGENITAL HEART DISEASES 11,600 3,480 8,120 hypertrophy of right ventricle. Aortopulmonary septal defect; Aortic septal defect; Q21.4 CONGENITAL HEART DISEASES 11,600 3,480 8,120 Aortopulmonary window Other congenital malformations of cardiac septa; Q21.8 CONGENITAL HEART DISEASES 11,600 3,480 8,120 Eisenmenger's defect; Pentalogy of Fallot Congenital malformation of cardiac septum, unspecified; Q21.9 CONGENITAL HEART DISEASES 11,600 3,480 8,120 Septal (heart) defect NOS Q22.0 Pulmonary valve atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q22.1 Congenital pulmonary valve stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120 Congenital pulmonary valve insufficiency; Congenital Q22.2 CONGENITAL HEART DISEASES 11,600 3,480 8,120 pulmonary valve regurgitation Q22.4 Congenital tricuspid stenosis; Tricuspid atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q22.5 Ebstein's anomaly CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q22.6 Hypoplastic right heart syndrome CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q22.8 Other congenital malformations of tricuspid valve CONGENITAL HEART DISEASES 11,600 3,480 8,120 Congenital stenosis of aortic valve; Congenital aortic Q23.0 CONGENITAL HEART DISEASES 11,600 3,480 8,120 atresia; Congenital aortic stenosis Congenital insufficiency of aortic valve; Bicuspid aortic Q23.1 CONGENITAL HEART DISEASES 11,600 3,480 8,120 valve; Congenital aortic insufficiency

Page 19 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Q23.2 Congenital mitral stenosis; Congenital mitral atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q23.3 Congenital mitral insufficiency CONGENITAL HEART DISEASES 11,600 3,480 8,120 Hypoplastic left heart syndrome; Atresia, or marked hypoplasia of aortic orifice or valve, with hypoplasia of Q23.4 ascending aorta and defective development of left ventricle CONGENITAL HEART DISEASES 11,600 3,480 8,120 (with mitral valve stenosis or atresia).

Q23.8 Other congenital malformations of aortic and mitral valves CONGENITAL HEART DISEASES 11,600 3,480 8,120

Congenital malformation of aortic and mitral valves, Q23.9 CONGENITAL HEART DISEASES 11,600 3,480 8,120 unspecified Q24.0 Dextrocardia CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q24.2 Cor triatriatum CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q24.3 Pulmonary infundibular stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q24.4 Congenital subaortic stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120 Malformation of coronary vessels; Congenital coronary Q24.5 CONGENITAL HEART DISEASES 11,600 3,480 8,120 (artery) aneurysm Q24.6 Congenital heart block CONGENITAL HEART DISEASES 11,600 3,480 8,120

Other specified congenital malformations of heart; Congenital diverticulum of left ventricle; Congenital Q24.8 CONGENITAL HEART DISEASES 11,600 3,480 8,120 malformation of myocardium; Congenital malformation of pericardium; Malposition of heart; Uhl's disease

Congenital malformation of heart, unspecified; Congenital Q24.9 CONGENITAL HEART DISEASES 11,600 3,480 8,120 anomaly NOS of heart; Congenital disease NOS of heart

Patent ductus arteriosus; Patent ductus Botallo; Persistent Q25.0 CONGENITAL HEART DISEASES 11,600 3,480 8,120 ductus arteriosus Coarctation of aorta; Preductal coarctation of aorta; Q25.1 CONGENITAL HEART DISEASES 11,600 3,480 8,120 Postductal coarctation of aorta Q25.2 Atresia of aorta CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q25.3 Stenosis of aorta; Supravalvular aortic stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120 Other congenital malformations of aorta; Absence of aorta; Aplasia of aorta; Congenital aneurysm of aorta; Congenital dilatation of aorta; Aneurysm of sinus of valsalva (rupture); Q25.4 CONGENITAL HEART DISEASES 11,600 3,480 8,120 Double aortic arch [vascular ring or aorta]; Hypoplasia of aorta; Persistent convolutions of aortic arch; Persistent right aortic arch Q25.5 Atresia of pulmonary artery CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q25.6 Stenosis of pulmonary artery CONGENITAL HEART DISEASES 11,600 3,480 8,120 Other congenital malformations of pulmonary artery; aberrant pulmonary artery; agenesis of pulmonary artery; Q25.7 aneurysm, congenital of pulmonary artery; anomaly of CONGENITAL HEART DISEASES 11,600 3,480 8,120 pulmonary artery; hypoplasia of pulmonary artery; pulmonary arteriovenous aneurysm Q25.8 Other congenital malformations of great arteries CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q25.9 Congenital malformation of great arteries, unspecified CONGENITAL HEART DISEASES 11,600 3,480 8,120 Congenital stenosis of vena cava; Congenital stenosis of Q26.0 inferior vena cava; Congenital stenosis of superior vena CONGENITAL HEART DISEASES 11,600 3,480 8,120 cava Q26.2 Total anomalous pulmonary venous connection CONGENITAL HEART DISEASES 11,600 3,480 8,120 Q26.4 Anomalous pulmonary venous connection, unspecified CONGENITAL HEART DISEASES 11,600 3,480 8,120

Other congenital malformations of great veins; Absence of inferior vena cava ; Absence of superior vena cava ; Azygos Q26.8 CONGENITAL HEART DISEASES 11,600 3,480 8,120 continuation of inferior vena cava; Persistent left posterior cardinal vein; Scimitar syndrome

Congenital malformation of great vein, unspecified; Q26.9 Anomaly of inferior vena cava NOS; Anomaly of superior CONGENITAL HEART DISEASES 11,600 3,480 8,120 vena cava NOS Congenital iodine-deficiency syndrome, neurological type; E00.0 CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930 Endemic cretinism, neurological type Congenital hypothyroidism with diffuse goitre; Nontoxic E03.0 congenital Goitre NOS; Nontoxic ongenital CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930 parenchymatous Goitre Congenital hypothyroidism without goitre; Aplasia of E03.1 thyroid (with myxoedema); Congenital atrophy of thyroid; CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930 Congenital hypothyroidism NOS Anencephaly; Acephaly; Acrania; Amyelencephaly; CONGENITAL MALFORMATIONS OF THE Q00.0 13,000 3,900 9,100 Hemicephaly; Hemicephaly BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q01.0 Frontal encephalocele 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q01.1 Nasofrontal encephalocele 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q01.2 Occipital encephalocele 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM

Page 20 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee CONGENITAL MALFORMATIONS OF THE Q01.8 Encephalocele of other sites 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q02 Microcephaly; Hydromicrocephaly; Micrencephalon 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Malformations of aqueduct of Sylvius; Anomaly of CONGENITAL MALFORMATIONS OF THE Q03.0 aqueduct of sylvius; Obstruction, congenital of aqueduct of 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM sylvius; Stenosis of aqueduct of sylvius Atresia of foramina of Magendie and Luschka; Dandy- CONGENITAL MALFORMATIONS OF THE Q03.1 13,000 3,900 9,100 Walker syndrome BRAIN/NERVOUS SYSTEM Congenital malformations of corpus callosum; Agenesis of CONGENITAL MALFORMATIONS OF THE Q04.0 13,000 3,900 9,100 corpus callosum BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q04.2 Holoprosencephaly 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM

Other reduction deformities of brain; Absence of part of brain; Agenesis of part of brain; Aplasia of part of brain; CONGENITAL MALFORMATIONS OF THE Q04.3 13,000 3,900 9,100 Hypoplasia of part of brain ; Agyria; Hydranencephaly; BRAIN/NERVOUS SYSTEM Lissencephaly; Microgyria; Pachygyria

CONGENITAL MALFORMATIONS OF THE Q04.4 Septo-optic dysplasia 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q04.6 Congenital cerebral ; Porencephaly; Schizencephaly 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Other specified congenital malformations of brain; CONGENITAL MALFORMATIONS OF THE Q04.8 13,000 3,900 9,100 Macrogyria BRAIN/NERVOUS SYSTEM

Congenital malformation of brain, unspecified; Congenital anomaly NOS of brain; Congenital deformity NOS of brain; CONGENITAL MALFORMATIONS OF THE Q04.9 13,000 3,900 9,100 Congenital disease of lesion NOS of brain; Congenital BRAIN/NERVOUS SYSTEM multiple anomalis NOS of brain

Thoracic spina bifida with hydrocephalus; Dorsal spina CONGENITAL MALFORMATIONS OF THE Q05.1 bifida with hydrocephalus; Thoracolumbar spina bifida with 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM hydrocephalus Lumbar spina bifida with hydrocephalus; Lumbosacral spina CONGENITAL MALFORMATIONS OF THE Q05.2 13,000 3,900 9,100 bifida with hydrocephalus BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q05.4 Unspecified spina bifida with hydrocephalus 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Thoracic spina bifida without hydrocephalus; Dorsal NOS CONGENITAL MALFORMATIONS OF THE Q05.6 13,000 3,900 9,100 spina bifida; Thoracolumbar NOS spina bifida BRAIN/NERVOUS SYSTEM Lumbar spina bifida without hydrocephalus; Lumbosacral CONGENITAL MALFORMATIONS OF THE Q05.7 13,000 3,900 9,100 spina bifida NOS BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q05.8 Sacral spina bifida without hydrocephalus 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q05.9 Spina bifida, unspecified 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q06.0 Amyelia 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q06.2 Diastematomyelia 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q06.4 Hydromyelia; Hydrorachis 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q06.8 Other specified congenital malformations of spinal cord 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM

Congenital malformation of spinal cord, unspecified; Congenital anomaly NOS of spinal cord or meninges; CONGENITAL MALFORMATIONS OF THE Q06.9 13,000 3,900 9,100 Congenital deformity NOS of spinal cord or meninges; BRAIN/NERVOUS SYSTEM Congenital disease or lesion NOS of spinal cord or meninges

CONGENITAL MALFORMATIONS OF THE Q07.0 Arnold-Chiari syndrome 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Congenital malformation of nervous system, unspecified; Congenital anomaly NOS of nervous system; Congenital CONGENITAL MALFORMATIONS OF THE Q07.9 13,000 3,900 9,100 deformity NOS of nervous system; Congenital disease or BRAIN/NERVOUS SYSTEM lesion NOS of nervous system CONGENITAL MALFORMATIONS OF THE Q74.3 Arthrogryposis multiplex congenita 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Craniosynostosis; Acrocephaly; ]Imperfect fusion of skull; CONGENITAL MALFORMATIONS OF THE Q75.0 13,000 3,900 9,100 Oxycephaly; Trigonocephaly BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q75.1 Craniofacial dysostosis; Crouzon's disease 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM CONGENITAL MALFORMATIONS OF THE Q75.2 Hypertelorism 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Mandibulofacial dysostosis; Franceschetti Syndrome; CONGENITAL MALFORMATIONS OF THE Q75.4 13,000 3,900 9,100 Treacher Collins Syndrome BRAIN/NERVOUS SYSTEM Other specified congenital malformations of skull and face CONGENITAL MALFORMATIONS OF THE Q75.8 bones; Absence of skull bone, congenital; Congenital 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM deformity of forehead; Platybasia

Page 21 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Congenital malformation of skull and face bones, CONGENITAL MALFORMATIONS OF THE Q75.9 unspecified; Congenital anomaly of face bones NOS; 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM Congenital anomaly of skull NOS CONGENITAL MALFORMATIONS OF THE Q76.0 Spina bifida occulta 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM

Other congenital malformations of spine, not associated with scoliosis; Congenital absence of vertebra unspecified or not associated with scoliosis; Congenital fusion of spine unspecified or not associated with scoliosis; Congenital kyphosis unspecified or not associated with scoliosis; Congenital lordosis unspecified or not associated with scoliosis; Congenital malformation of lumbosacral joint CONGENITAL MALFORMATIONS OF THE Q76.4 unspecified or not associated with scoliosis; Congenital 13,000 3,900 9,100 BRAIN/NERVOUS SYSTEM malformation of lumbosacral region unspecified or not associated with scoliosis; Hemivertebra unspecified or not associated with scoliosis; Malformation of spine unspecified or not associated with scoliosis; Platyspondylisis unspecified or not associated with scoliosis; Supernumerary vertebra unspecified or nor associated with scoliosis

CONGENITAL MALFORMATIONS OF THE LOWER Q32.0 Congenital tracheomalacia 21,700 6,510 15,190 RESPIRATORY TRACT

Other congenital malformations of bronchus; Absence of bronchus; Agenesis of bronchus; Atresia of bronchus; CONGENITAL MALFORMATIONS OF THE LOWER Q32.4 21,700 6,510 15,190 Congenital malformation NOS of bronchus; Diverticulum of RESPIRATORY TRACT bronchus; Congenital malformations of lung] of bronchus

Congenital cystic lung; Congenital honeycomb lung; CONGENITAL MALFORMATIONS OF THE LOWER Q33.0 Congenital cystic lung disease; Congenital polycystic lung 21,700 6,510 15,190 RESPIRATORY TRACT disease CONGENITAL MALFORMATIONS OF THE LOWER Q33.2 Sequestration of lung 21,700 6,510 15,190 RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE LOWER Q33.3 Agenesis of lung; Absence of lung, lobe 21,700 6,510 15,190 RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE LOWER Q33.4 Congenital bronchiectasis 21,700 6,510 15,190 RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE LOWER Q33.6 Hypoplasia and dysplasia of lung 21,700 6,510 15,190 RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE LOWER Q34.1 Congenital cyst of mediastinum 21,700 6,510 15,190 RESPIRATORY TRACT Other specified congenital malformations of respiratory CONGENITAL MALFORMATIONS OF THE LOWER Q34.8 21,700 6,510 15,190 system; Atresia of nasopharynx RESPIRATORY TRACT Congenital malformation of respiratory system, CONGENITAL MALFORMATIONS OF THE LOWER Q34.9 unspecified; Congenital absence of respiratory organ ; 21,700 6,510 15,190 RESPIRATORY TRACT Congenital anomaly NOS of respiratory organ Choanal atresia; Absence of anterior nares; Absence of CONGENITAL MALFORMATIONS OF THE NOSE, Q30.0 posterior nares; congenital stenosis of anterior nares; 11,000 3,300 7,700 UPPER RESPIRATORY TRACT Congenital stenosis of posterior nares Agenesis and underdevelopment of nose; Congenital CONGENITAL MALFORMATIONS OF THE NOSE, Q30.1 11,000 3,300 7,700 absence of nose UPPER RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE NOSE, Q30.2 Fissured, notched and cleft nose 11,000 3,300 7,700 UPPER RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE NOSE, Q31.3 Laryngocele 11,000 3,300 7,700 UPPER RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE NOSE, Q31.5 Congenital laryngomalacia 11,000 3,300 7,700 UPPER RESPIRATORY TRACT

Other congenital malformations of larynx; Absence of cricoid cartilage, epiglottis, glottis, larynx or thyroid cartilage; Agenesis of cricoid cartilage, epiglottis, glottis, CONGENITAL MALFORMATIONS OF THE NOSE, Q31.8 larynx or thyroid cartilage; Atresia of cricoid cartilage, 11,000 3,300 7,700 UPPER RESPIRATORY TRACT epiglottis, glottis, larynx or thyroid cartilage; Cleft thyroid cartilage; Congenital stenosis of larynx NEC; Fissure of epiglottis; Posterior cleft of cricoid cartilage

CONGENITAL MALFORMATIONS OF THE NOSE, Q31.9 Congenital malformation of larynx, unspecified 11,000 3,300 7,700 UPPER RESPIRATORY TRACT CONGENITAL MALFORMATIONS OF THE ORAL Q38.2 Macroglossia 4,000 1,200 2,800 CAVITY Congenital malformations of palate, not elsewhere CONGENITAL MALFORMATIONS OF THE ORAL Q38.5 classified; Absence of uvula; Congenital malformation of 4,000 1,200 2,800 CAVITY palate NOS; High arched palate Other congenital malformations of mouth; Congenital CONGENITAL MALFORMATIONS OF THE ORAL Q38.6 4,000 1,200 2,800 malformation of mouth NOS CAVITY Other congenital malformations of pharynx; Congenital CONGENITAL MALFORMATIONS OF THE ORAL Q38.8 4,000 1,200 2,800 malformation of pharynx NOS CAVITY Q12.2 Coloboma of lens CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010

Page 22 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Q12.4 Spherophakia CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 Other congenital corneal malformations; Congenital Q13.4 malformation of cornea NOS; CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 Microcornea; Peter's anomaly Congenital malformation of vitreous humour; Congenital Q14.0 CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 vitreous opacity Congenital malformation of retina; Congenital retinal Q14.1 CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 aneurysm Congenital malformation of posterior segment of eye, Q14.9 CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 unspecified

Congenital glaucoma; Buphthalmos; Glaucoma of newborn; Hydrophthalmos; Keratoglobus, congenital, with glaucoma; Q15.0 CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 Macrocornea with glaucoma; Macrophthalmos in congenital glaucoma; Megalocornea with glaucoma

Q15.8 Other specified congenital malformations of eye CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010

Congenital malformation of eye, unspecified; Congenital Q15.9 CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010 anomaly NOS of eye; Congenital deformity NOS of eye

P96.0 Congenital renal failure; Uraemia of newborn CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q60.0 Renal agenesis, unilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q60.1 Renal agenesis, bilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q60.2 Renal agenesis, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q60.3 Renal hypoplasia, unilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q60.5 Renal hypoplasia, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q60.6 Potter's syndrome CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Congenital single renal cyst; Congenital cyst of kidney; Q61.0 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Single cyst of kidney Polycystic kidney, autosomal recessive; Polycystic kidney, Q61.1 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 infantile type Polycystic kidney, autosomal dominant; Polycystic kidney, Q61.2 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 adult type Q61.3 Polycystic kidney, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q61.4 Renal dysplasia CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q61.5 Medullary cystic kidney; Sponge kidney NOS CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Other cystic kidney diseases; Fibrocystic kidney; Fibrocystic Q61.8 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 renal degeneration or disease Cystic kidney disease, unspecified; Meckel-Gruber Q61.9 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 syndrome Q62.0 Congenital hydronephrosis CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q62.7 Congenital vesico-uretero-renal reflux CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q63.0 Accessory kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Q63.1 Lobulated, fused and horseshoe kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Ectopic kidney; Congenital displaced kidney; Malrotation of Q63.2 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 kidney Q63.3 Hyperplastic and giant kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Other specified congenital malformations of kidney; Q63.8 CONGENITAL RENAL DISORDERS 9,100 2,730 6,370 Congenital renal calculi Early cutaneous congenital syphilis: , Early mucocutaneous congenital syphilis, Early visceral congenital syphilis; Early congenital syphilitic laryngitis; Early congenital syphilitic A50.0 oculopathy; Early congenital syphilitic CONGENITAL SYPHILIS 12,800 3,840 8,960 osteochondropathy; Early congenital syphilitic pharyngitis; Early congenital syphilitic pneumonia; Early congenital syphilitic rhinitis Early congenital syphilis, unspecified; Congenital syphilis A50.2 CONGENITAL SYPHILIS 12,800 3,840 8,960 NOS less than two years after birth.

Late congenital neurosyphilis [juvenile neurosyphilis]; A50.4 Dementia paralytica juvenilis; Juvenile general paresis ; CONGENITAL SYPHILIS 12,800 3,840 8,960 Juvenile tabes dorsalis; Juvenile taboparetic neurosyphilis

Other late congenital syphilis, symptomatic; Syphilitic A50.5 CONGENITAL SYPHILIS 12,800 3,840 8,960 A50.9 Congenital syphilis, unspecified CONGENITAL SYPHILIS 12,800 3,840 8,960 Atresia and stenosis of ureter; Congenital occlusion of ureter; Congenital occlusion of ureteropelvic junction; Q62.1 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 Congenital occlusion of ureterovesical orifice; Impervious ureter

Q62.2 Congenital megaloureter; Congenital dilatation of ureter CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370

Other obstructive defects of renal pelvis and ureter; Q62.3 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 Congenital ureterocele

Q62.5 Duplication of ureter; Accessory of ureter, Double of ureter CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370

Page 23 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Malposition of ureter; Deviation of ureter or ureteric orifice; Displacement of ureter or ureteric orifice; Ectopic of Q62.6 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 ureter or ureteric orifice; Implantation, anomalous of ureter or ureteric orifice Exstrophy of urinary bladder; Ectopia vesicae; Extroversion Q64.1 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 of bladder Q64.2 Congenital posterior urethral valves CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370

Other atresia and stenosis of urethra and bladder neck; Congenital bladder neck obstruction; Congenital stricture of Q64.3 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 urethra; Congenital stricture of urinary meatus; Congenital stricture of vesicourethral orifice; Impervious urethra

Malformation of urachus; Cyst of urachus; Patent urachus; Q64.4 CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 Prolapse of urachus

Other congenital malformations of bladder and urethra; Accessory bladder; Accessory urethra; Congenital hernia of bladder; Congenital malformation of bladder or urethra Q64.7 NOS; Congenital prolapse of bladder (mucosa); Congenital CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 prolapse of urethra; Congenital prolapse of urinary meatus; Congenital prolapse of urethrorectal fistula; Double urethra; Double urinary meatus

Q64.8 Other specified congenital malformations of urinary system CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370

Congenital malformation of urinary system, unspecified; Q64.9 Congenital anomaly NOS of urinary system; Congenital CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370 deformity NOS of urinary system Q27.1 Congenital renal artery stenosis CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 Peripheral arteriovenous malformation; Arteriovenous Q27.3 CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 aneurysm Other specified congenital malformations of peripheral vascular system; Aberrant subclavian artery; Absence of Q27.8 artery or vein NEC; Atresia of artery or vein NEC; Congenital CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 aneurysm (peripheral); Congenital stricture, artery; Congenital varix Congenital malformation of peripheral vascular system, Q27.9 CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 unspecified; Anomaly of artery or vein NOS Arteriovenous malformation of precerebral vessels; Q28.0 Congenital arteriovenous precerebral aneurysm CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 (nonruptured) Other malformations of precerebral vessels; Congenital Q28.1 malformation of precerebral vessels NOS; Congenital CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 precerebral aneurysm (nonruptured)

Arteriovenous malformation of cerebral vessels; Q28.2 Arteriovenous malformation of brain NOS; CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 Congenital arteriovenous cerebral aneurysm (nonruptured)

Other malformations of cerebral vessels; Congenital Q28.3 cerebral aneurysm, nonruptured; Congenital malformation CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400 of cerebral vessels NOS M30.0 Polyarteritis nodosa DISEASES 13,800 4,140 9,660 Polyarteritis with lung involvement [Churg-Strauss]; Allergic M30.1 CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 granulomatous angiitis M30.2 Juvenile polyarteritis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M30.3 Mucocutaneous lymph node syndrome [Kawasaki] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 Other conditions related to polyarteritis nodosa; M30.8 CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 Polyangiitis overlap syndrome M31.0 Hypersensitivity angiitis; Goodpasture's syndrome CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 Thrombotic microangiopathy; Thrombotic M31.1 CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 thrombocytopenic purpura M31.2 Lethal midline granuloma CONNECTIVE TISSUE DISEASES N/A N/A N/A Wegener's granulomatosis; Necrotizing respiratory M31.3 CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 granulomatosis M31.4 Aortic arch syndrome [Takayasu] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M31.6 Other giant cell arteritis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 Other specified necrotizing vasculopathies; M31.8 CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 Hypocomplementaemic M31.9 Necrotizing vasculopathy, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M33.0 Juvenile dermatomyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M33.1 Other dermatomyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M33.2 Polymyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M33.9 Dermatopolymyositis, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M34.0 Progressive systemic sclerosis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 CR(E)ST syndrome; Combination of calcinosis, Raynaud's M34.1 phenomenon, (o)esophageal dysfunction, CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 sclerodactyly, telangiectasia M34.2 Systemic sclerosis induced by drugs and chemicals CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660

Page 24 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M34.9 Systemic sclerosis, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M35.0 Sicca syndrome [SJÖGREN] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660

M35.1 Other overlap syndromes; Mixed connective tissue disease CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660

M35.2 Behçet's disease CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M35.3 Polymyalgia rheumatica CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 M35.4 Diffuse (eosinophilic) fasciitis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660

M35.8 Other specified systemic involvement of connective tissue CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660

Systemic involvement of connective tissue, unspecified; M35.9 Systemic NOS; Collagen (vascular) CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660 disease NOS Trigeminal neuralgia; Syndrome of paroxysmal facial pain; G50.0 CRANIAL NERVE DISORDER 7,400 2,220 5,180 Tic douloureux G50.8 Other disorders of trigeminal nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180 G51.0 Bell's palsy; Facial palsy CRANIAL NERVE DISORDER 7,400 2,220 5,180 G51.1 Geniculate ganglionitis CRANIAL NERVE DISORDER 7,400 2,220 5,180 G51.3 Clonic hemifacial spasm CRANIAL NERVE DISORDER 7,400 2,220 5,180 G51.4 Facial myokymia CRANIAL NERVE DISORDER 7,400 2,220 5,180 G51.8 Other disorders of facial nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180 G51.9 Disorder of facial nerve, unspecified CRANIAL NERVE DISORDER 7,400 2,220 5,180

G52.0 Disorders of olfactory nerve; Disorder of 1st cranial nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180

Disorders of glossopharyngeal nerve; Disorder of 9th G52.1 CRANIAL NERVE DISORDER 7,400 2,220 5,180 cranial nerve; Glossopharyngeal neuralgia Disorders of vagus nerve; Disorder of pneumogastric [10th] G52.2 CRANIAL NERVE DISORDER 7,400 2,220 5,180 nerve

G52.7 Disorders of multiple cranial nerves; Polyneuritis cranialis CRANIAL NERVE DISORDER 7,400 2,220 5,180

G52.8 Disorders of other specified cranial nerves CRANIAL NERVE DISORDER 7,400 2,220 5,180 Optic neuritis; Optic neuropathy, except ischaemic; Optic H46 CRANIAL NERVE DISORDER 7,400 2,220 5,180 papillitis; Retrobulbar neuritis NOS Disorders of optic nerve, not elsewhere classified; H47.0 Compression of optic nerve; Haemorrhage in optic nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180 sheath; Ischaemic optic neuropathy Acute obstructive laryngitis [croup]; Obstructive laryngitis J05.0 CROUP 8,200 2,460 5,740 NOS

Pituitary-dependent Cushing's disease; Overproduction of E24.0 CUSHING'S SYNDROME 9,500 2,850 6,650 pituitary ACTH; Pituitary-dependent hyperadrenocorticism

E24.1 Nelson's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650 E24.2 Drug-induced Cushing's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650 E24.3 Ectopic ACTH syndrome CUSHING'S SYNDROME 9,500 2,850 6,650 E24.8 Other Cushing's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650 E24.9 Cushing's syndrome, unspecified CUSHING'S SYNDROME 9,500 2,850 6,650 E84.0 Cystic fibrosis with pulmonary manifestations CYSTIC FIBROSIS 7,300 2,190 5,110 E84.1 Cystic fibrosis with intestinal manifestations CYSTIC FIBROSIS 7,300 2,190 5,110 Cystic fibrosis with other manifestations; Cystic fibrosis with E84.8 CYSTIC FIBROSIS 7,300 2,190 5,110 combined manifestations E84.9 Cystic fibrosis, unspecified CYSTIC FIBROSIS 7,300 2,190 5,110 DEGENERATIVE DISEASES OF CENTRAL NERVOUS G30.0 Alzheimer's disease with early onset 10,000 3,000 7,000 SYSTEM DEGENERATIVE DISEASES OF CENTRAL NERVOUS G30.1 Alzheimer's disease with late onset 10,000 3,000 7,000 SYSTEM DEGENERATIVE DISEASES OF CENTRAL NERVOUS G30.8 Other Alzheimer's disease 10,000 3,000 7,000 SYSTEM DEGENERATIVE DISEASES OF CENTRAL NERVOUS G30.9+F00.9* Dementia in alzheimer's disease, unspecified 10,000 3,000 7,000 SYSTEM Circumscribed brain atrophy; Pick's disease; Progressive DEGENERATIVE DISEASES OF CENTRAL NERVOUS G31.0 10,000 3,000 7,000 isolated aphasia SYSTEM DEGENERATIVE DISEASES OF CENTRAL NERVOUS G31.1 Senile degeneration of brain, not elsewhere classified 10,000 3,000 7,000 SYSTEM

Degeneration of nervous system due to ; Alcoholic cerebellar ataxia; Alcoholic cerebellar degeneration; DEGENERATIVE DISEASES OF CENTRAL NERVOUS G31.2 10,000 3,000 7,000 Alcoholic cerebral degeneration; Alcoholic encephalopathy; SYSTEM Dysfunction of autonomic nervous system due to alcohol

Other specified degenerative diseases of nervous system; Grey-matter degeneration [Alpers]; Lewy body (ies) DEGENERATIVE DISEASES OF CENTRAL NERVOUS G31.8 10,000 3,000 7,000 dementia; Lewy body (ies) disease; Subacute necrotizing SYSTEM encephalopathy [Leigh] Other specified degenerative disorders of nervous system DEGENERATIVE DISEASES OF CENTRAL NERVOUS G32.8* 10,000 3,000 7,000 in diseases classified elsewhere SYSTEM

Multiple sclerosis; Multiple sclerosis NOS; Multiple DEMYELINATING DISEASE OF CENTRAL NERVOUS G35 sclerosis of brain stem; Multiple sclerosis of cord; Multiple 11,600 3,480 8,120 SYSTEM sclerosis, disseminated; Multiple sclerosis, generalized

Page 25 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Neuromyelitis optica [Devic]; Demyelination in optic DEMYELINATING DISEASE OF CENTRAL NERVOUS G36.0 11,600 3,480 8,120 neuritis SYSTEM Acute and subacute haemorrhagic leukoencephalitis DEMYELINATING DISEASE OF CENTRAL NERVOUS G36.1 11,600 3,480 8,120 [Hurst] SYSTEM DEMYELINATING DISEASE OF CENTRAL NERVOUS G36.8 Other specified acute disseminated demyelination 11,600 3,480 8,120 SYSTEM DEMYELINATING DISEASE OF CENTRAL NERVOUS G36.9 Acute disseminated demyelination, unspecified 11,600 3,480 8,120 SYSTEM DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.0 Diffuse sclerosis; Periaxial encephalitis; Schilder's disease 11,600 3,480 8,120 SYSTEM DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.1 Central demyelination of corpus callosum 11,600 3,480 8,120 SYSTEM DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.2 Central pontine myelinolysis 11,600 3,480 8,120 SYSTEM Acute transverse myelitis in demyelinating disease of DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.3 11,600 3,480 8,120 central nervous system; Acute transverse myelitis NOS SYSTEM DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.4 Subacute necrotizing myelitis 11,600 3,480 8,120 SYSTEM Other specified demyelinating diseases of central nervous DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.8 11,600 3,480 8,120 system SYSTEM Demyelinating disease of central nervous system, DEMYELINATING DISEASE OF CENTRAL NERVOUS G37.9 unspecified 11,600 3,480 8,120 SYSTEM Brain sclerosis Dengue without warning signs: Dengue fever (DF) Dengue A97.0 haemorrhagic fever Grades 1 and 2; Dengue haemorrhagic DENGUE FEVER 10,000 3,000 7,000 fever without warning signs Dengue with warning sings; Dengue haemorrhagic fever A97.1 DENGUE FEVER 10,000 3,000 7,000 with warning signs Severe Dengue; Severe Dengue fever; Severe Dengue A97.2 DENGUE, SEVERE 16,000 4,800 11,200 haemorrhagic fever E23.2 Diabetes insipidus DIABETES INSIPIDUS 10,100 3,030 7,070 N25.1 Nephrogenic diabetes insipidus DIABETES INSIPIDUS 10,100 3,030 7,070

Insulin-dependent diabetes mellitus with coma; Brittle diabetes (mellitus) with coma; Juvenile-onset diabetes E10.0 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 (mellitus) withcoma ; Ketosis-prone diabetes (mellitus) with coma; Type I diabetes (mellitus) with coma;

Insulin-dependent diabetes mellitus with acididosis/ ketoacidosis without mention of coma; Diabetic acididosis E10.1 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 without mention of coma; Diabetic ketoacidosis without mention of coma;

Non-insulin-dependent diabetes mellitus with coma; Nonobese diabetes (mellitus) With coma ; Obese diabetes mellitus With coma ; Adult-onset diabetes mellitus With E11.0 coma ; Maturity-onset diabetes mellitus With coma ; DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 Nonketotic diabetes mellitus With coma; Stable diabetes mellitus with coma; Type II diabetes mellitus with coma; Non-insulin-dependent diabetes of the young

Non-insulin-dependent diabetes mellitus with ketoacidosis without mention of coma; ; Nonobese diabetes (mellitus) With ketoacidosis without mention of coma; Obese diabetes mellitus With ketoacidosis without mention of coma; Adult-onset diabetes mellitus without mention of E11.1 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 coma; Maturity-onset diabetes mellitus without mention of coma; Nonketotic diabetes mellitus without mention of coma; Stable diabetes mellitus without mention of coma; Type II diabetes mellitus without mention of coma; Non- insulin-dependent diabetes of the young

Malnutrition-related diabetes mellitus with coma; Insulin- dependent malnutrition-related diabetes mellitus with E12.0 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 coma ; Non-insulin-dependent malnutrition-related diabetes mellitus with coma E13.0 Other specified diabetes mellitus with coma DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 Other specified diabetes mellitus with acididosis/ E13.1 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 ketoacidosis without mention of coma E14.0 Unspecified diabetes mellitus; diabetes NOS with coma DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 Unspecified diabetes mellitus; diabetes NOS with E14.1 DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060 acididosis/ ketoacidosis without mention of coma Insulin-dependent diabetes mellitus with Diabetic DIABETES MELLITUS WITH COMPLICATIONS E10.5 12,600 3,780 8,820 gangrene/ ulcer OTHER THAN COMA AND KETOSIS Insulin-dependent diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS E10.6 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS Insulin-dependent diabetes mellitus with multiple DIABETES MELLITUS WITH COMPLICATIONS E10.7 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS

Page 26 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Insulin-dependent diabetes mellitus with unspecified DIABETES MELLITUS WITH COMPLICATIONS E10.8 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS

Non-insulin-dependent diabetes mellitus with Diabetic gangrene/ ulcer; Nonobese diabetes (mellitus) with Diabetic gangrene/ ulcer; Obese diabetes mellitus with Diabetic gangrene/ ulcer; Adult-onset diabetes mellitus with Diabetic gangrene/ ulcer; Maturity -onset diabetes DIABETES MELLITUS WITH COMPLICATIONS E11.5 12,600 3,780 8,820 mellitus with Diabetic gangrene/ulcer; Nonketotic diabetes OTHER THAN COMA AND KETOSIS mellitus with Diabetic gangrene/ulcer; Stable diabetes mellitus with diabetic gangrene/ulcer; Type II diabetes mellitus with diabetic gangrene/ulcer; Non-insulin- dependent diabetes of the young

Non-insulin-dependent diabetes mellitus with other DIABETES MELLITUS WITH COMPLICATIONS E11.6 12,600 3,780 8,820 specified complications OTHER THAN COMA AND KETOSIS Non-insulin-dependent diabetes mellitus with multiple complications ; Nonobese diabetes (mellitus) With DIABETES MELLITUS WITH COMPLICATIONS E11.7 multiple complications ; Obese diabetes mellitus With 12,600 3,780 8,820 OTHER THAN COMA AND KETOSIS multiple complications ; Adult-onset diabetes mellitus With multiple complications ; Matur Malnutrition-related diabetes mellitus with Diabetic gangrene/ ulcer; Insulin-dependent malnutrition-related DIABETES MELLITUS WITH COMPLICATIONS E12.5 diabetes mellitus with Diabetic gangrene/ ulcer; Non- 12,600 3,780 8,820 OTHER THAN COMA AND KETOSIS insulin-dependent malnutrition-related diabetes mellitus with Diabetic gangrene/ ulcer Malnutrition-related diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS E12.6 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS

Malnutrition-related diabetes mellitus with unspecified complications; Insulin-dependent malnutrition-related DIABETES MELLITUS WITH COMPLICATIONS E12.8 diabetes mellitus with unspecified complications; Non- 12,600 3,780 8,820 OTHER THAN COMA AND KETOSIS insulin-dependent malnutrition-related diabetes mellitus with unspecified complications

Other specified diabetes mellitus with Diabetic gangrene/ DIABETES MELLITUS WITH COMPLICATIONS E13.5 12,600 3,780 8,820 ulcer OTHER THAN COMA AND KETOSIS Other specified diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS E13.6 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS Unspecified diabetes mellitus; diabetes NOS with Diabetic DIABETES MELLITUS WITH COMPLICATIONS E14.5 12,600 3,780 8,820 gangrene/ ulcer OTHER THAN COMA AND KETOSIS Unspecified diabetes mellitus with other specified DIABETES MELLITUS WITH COMPLICATIONS E14.6 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS Unspecified diabetes mellitus; diabetes NOS with multiple DIABETES MELLITUS WITH COMPLICATIONS E14.7 12,600 3,780 8,820 complications OTHER THAN COMA AND KETOSIS Pharyngeal diphtheria; Diphtheritic membranous angina; A36.0 DIPHTHERIA 8,700 2,610 6,090 Tonsillar diphtheria A36.3 Cutaneous diphtheria DIPHTHERIA 8,700 2,610 6,090 A36.9 Diphtheria, unspecified DIPHTHERIA 8,700 2,610 6,090 Agranulocytosis; Agranulocytic angina; Infantile genetic agranulocytosis; Kostmann's disease; Neutropenia NOS; Congenital Neutropenia; Cyclic DISEASES OF BLOOD AND BLOOD FORMING D70 12,100 3,630 8,470 Neutropenia; Drug-induced Neutropenia; Periodic ORGANS Neutropenia; Primary Splenic Neutropenia; Toxic Neutropenia; Neutropenic splenomegaly Functional disorders of polymorphonuclear ; Cell membrane receptor complex [CR3] defect; Chronic DISEASES OF BLOOD AND BLOOD FORMING D71 (childhood) granulomatous disease; 12,100 3,630 8,470 ORGANS Congenital dysphagocytosis; Progressive septic granulomatosis; Other disorders of white blood cells

Genetic anomalies of leukocytes; Alder Granulation Anomaly or Syndrome; Alder Granulocyte Anomaly or Syndrome; May-Hegglin Granulation Anomaly or DISEASES OF BLOOD AND BLOOD FORMING D72.0 Syndrome; May-Hegglin Granulocyte Anomaly or 12,100 3,630 8,470 ORGANS Syndrome; Pelger-Huët Granulocyte Anomaly or Syndrome; Hereditary leukocytic: hypersegmentation,; hyposegmentation ; Hereditary leukomelanopathy

Other specified disorders of white blood cells; Lymphocytic Leukaemoid reaction; Monocytic Leukaemoid reaction; DISEASES OF BLOOD AND BLOOD FORMING D72.8 Myelocytic Leukaemoid reaction; Leukocytosis; 12,100 3,630 8,470 ORGANS Symptomatic Lymphocytosis; Lymphopenia; Symptomatic Monocytosis;Plasmacytosis

DISEASES OF BLOOD AND BLOOD FORMING D73.2 Chronic congestive splenomegaly 12,100 3,630 8,470 ORGANS DISEASES OF BLOOD AND BLOOD FORMING D73.3 Abscess of spleen 12,100 3,630 8,470 ORGANS

Page 27 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee DISEASES OF BLOOD AND BLOOD FORMING D73.4 Cyst of spleen 12,100 3,630 8,470 ORGANS Infarction of spleen; Nontraumatic Splenic rupture; Torsion DISEASES OF BLOOD AND BLOOD FORMING D73.5 12,100 3,630 8,470 of spleen ORGANS Other diseases of spleen; Fibrosis of spleen NOS; DISEASES OF BLOOD AND BLOOD FORMING D73.8 12,100 3,630 8,470 Perisplenitis; Splenitis NOS ORGANS DISEASES OF BLOOD AND BLOOD FORMING D74.9 Methaemoglobinaemia, unspecified 12,100 3,630 8,470 ORGANS Familial erythrocytosis; Benign Polycythaemia; Familial DISEASES OF BLOOD AND BLOOD FORMING D75.0 12,100 3,630 8,470 Polycythaemia ORGANS Secondary polycythaemia; Acquired Polycythaemia due to erythropoietin; Acquired Polycythaemia due to fall in plasma volume; Acquired Polycythaemia due to high DISEASES OF BLOOD AND BLOOD FORMING D75.1 12,100 3,630 8,470 altitude; Acquired Polycythaemia due to stress; Emotional ORGANS Polycythaemia; Hypoxaemic Polycythaemia; nephrogenous Polycythaemia; relative Polycythaemia DISEASES OF BLOOD AND BLOOD FORMING D75.2 Essential thrombocytosis 12,100 3,630 8,470 ORGANS DISEASES OF BLOOD AND BLOOD FORMING D75.8 Other specified diseases of blood and blood-forming organs 12,100 3,630 8,470 ORGANS DISEASES OF BLOOD AND BLOOD FORMING D76.0 Langerhans' cell histiocytosis, not elsewhere classified 12,100 3,630 8,470 ORGANS Haemophagocytic lymphohistiocytosis; Eosinophilic DISEASES OF BLOOD AND BLOOD FORMING D76.1 granuloma; Hand-Schüller-Christian disease; Chronic 12,100 3,630 8,470 ORGANS Histiocytosis X DISEASES OF BLOOD AND BLOOD FORMING D76.2 Haemophagocytic syndrome, infection-associated 12,100 3,630 8,470 ORGANS Other histiocytosis syndromes; Reticulohistiocytoma (giant- DISEASES OF BLOOD AND BLOOD FORMING D76.3 cell); Sinus histiocytosis with massive lymphadenopathy; 12,100 3,630 8,470 ORGANS Xanthogranuloma Oesophagitis; Abscess of oesophagus; Oesophagitis NOS; K20 DISEASES OF 8,300 2,490 5,810 Chemical oesophagitis; oesophagitis K22.0 Achalasia of cardia; Achalasia NOS; Cardiospasm DISEASES OF ESOPHAGUS 8,300 2,490 5,810

Ulcer of oesophagus; Erosion of oesophagus; Ulcer of oesophagus NOS; Ulcer of oesophagus due to ingestion of K22.1 chemicals; Ulcer of oesophagus due to ingestion of drugs DISEASES OF ESOPHAGUS 8,300 2,490 5,810 and medicaments; Fungal ulcer of oesophagus; Peptic ulcer of oesophagus; Ulcerative oesophagitis

Oesophageal obstruction; Oesophageal web (acquired); K22.2 Compression of oesophagus; Constriction of oesophagus; DISEASES OF ESOPHAGUS 8,300 2,490 5,810 Stenosis of oesophagus; Stricture of oesophagus

K22.3 Perforation of oesophagus; Rupture of oesophagus DISEASES OF ESOPHAGUS 8,300 2,490 5,810 Dyskinesia of oesophagus; Corksrew oesophagus; Diffuse K22.4 DISEASES OF ESOPHAGUS 8,300 2,490 5,810 oesophageal spasm; Spasm of oesophagus Gastro-oesophageal laceration-haemorrhage syndrome; K22.6 DISEASES OF ESOPHAGUS 8,300 2,490 5,810 Mallory-Weiss syndrome

K22.7 Barrett's esophagus; Barret's disease; Barett's syndrome DISEASES OF ESOPHAGUS 8,300 2,490 5,810

Other specified diseases of oesophagus; Haemorrhage of K22.8 DISEASES OF ESOPHAGUS 8,300 2,490 5,810 oesophagus NOS K22.9 Disease of oesophagus, unspecified DISEASES OF ESOPHAGUS 8,300 2,490 5,810 Cellulitis of external ear; Cellulitis of auricle; Cellulitis of H60.1 DISEASES OF EXTERNAL EAR 9,000 2,700 6,300 external auditory canal H60.2 Malignant otitis externa DISEASES OF EXTERNAL EAR 9,000 2,700 6,300 Other infective otitis externa; diffuse Otitis externa ; H60.3 DISEASES OF EXTERNAL EAR 9,000 2,700 6,300 Haemorrhagic Otitis externa ; Swimmer's ear Cholesteatoma of external ear; Keratosis obturans of H60.4 DISEASES OF EXTERNAL EAR 9,000 2,700 6,300 external ear (canal) H83.0 Labyrinthitis DISEASES OF INNER EAR 6,200 1,860 4,340 H83.8 Other specified diseases of inner ear DISEASES OF INNER EAR 6,200 1,860 4,340 Obstruction of Eustachian tube; Compression of H68.1 Eustachian tube; Stenosis of Eustachian tube; Stricture of DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 Eustachian tube H69.9 Eustachian tube disorder, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 Acute mastoiditis; Abscess of mastoid; Empyema of H70.0 DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 mastoid

H70.1 Chronic mastoiditis; Caries of mastoid; Fistula of mastoid DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280

Petrositis; Acute of petrous bone; Chronic H70.2 DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 inflammation of petrous bone H70.8 Other mastoiditis and related conditions DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 H70.9 Mastoiditis, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280

Page 28 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Cholesteatoma of middle ear; Cholesteatoma tympani; Perforation of tympanic membrane; Persistent post- H71 DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 traumatic perforation of ear drum; Postinflammatory perforation of ear drum H73.0 Acute myringitis; Acute tympanitis; Bullous myringitis DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 H73.1 Chronic myringitis; Chronic tympanitis DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 H73.8 Other specified disorders of tympanic membrane DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 H73.9 Disorder of tympanic membrane, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 H74.8 Other specified disorders of middle ear and mastoid DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 H74.9 Disorder of middle ear and mastoid, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280 Developmental odontogenic cysts; Dentigerous cyst; DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K09.0 Eruption Cyst; Follicular cyst; Gingival cyst; Lateral 8,300 2,490 5,810 AND JAW periodontal cyst; Primordial cyst; Keratocyst

Developmental (nonodontogenic) cysts of oral region; Cyst DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K09.1 of globulomaxillary; Cyst of incisive canal; Cyst of median 8,300 2,490 5,810 AND JAW palatal; Cyst of nasopalatine; Cyst of palatine papilla

Other cysts of jaw; Cyst of jaw NOS; Aneurysmal cyst of DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K09.2 8,300 2,490 5,810 jaw; Haemorrhagic cyst of jaw; Traumatic cyst of jaw AND JAW

Other cysts of oral region, not elsewhere classified; Dermoid cyst of mouth; Epidermoid cyst of mouth; DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K09.8 8,300 2,490 5,810 Lymphoepithelial cyst of mouth; Epstein's pearl; AND JAW Nasoalveolar cyst; Nasolabial cyst DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K09.9 Cyst of oral region, unspecified 8,300 2,490 5,810 AND JAW Developmental disorders of jaws; Latent bone cyst of jaw; DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K10.0 8,300 2,490 5,810 Stafne's cyst; Torus mandibularis; Torus palatinus AND JAW DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K10.1 Giant cell granuloma, central; Giant cell granuloma NOS 8,300 2,490 5,810 AND JAW

Inflammatory conditions of jaws; Acute osteitis of jaw; Chronic osteitis of jaw; Supparative osteitis of jaw; Acute neonatal osteomyelitis of jaw; Chronic neonatal osteomyelitis of jaw; Supparative neonatal osteomyelitis of DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K10.2 8,300 2,490 5,810 jaw; Acute osteoradionecrosis of jaw; chronic AND JAW osteoradionecrosis of jaw; Suppurative osteoradionecrosis of jaw; Acute periostitis of jaw; Chronic periortitis of jaw; Suppurative periortitis of jaw; Sequestrum, of jaw bone

DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K10.3 Alveolitis of jaws; Alveolar osteitis; Dry socket 8,300 2,490 5,810 AND JAW Other specified diseases of jaws; Cherubism of jaw; DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K10.8 Exostosis of jaw; Fibrous dysplasia of jaw; Unilateral 8,300 2,490 5,810 AND JAW condylar hyperplasia; Unilateral condylar hypoplasia DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.2 Sialoadenitis 8,300 2,490 5,810 AND JAW DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.3 Abscess of salivary gland 8,300 2,490 5,810 AND JAW DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.4 Fistula of salivary gland 8,300 2,490 5,810 AND JAW Sialolithiasis; Calculus of salivary gland or duct; Stone of DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.5 8,300 2,490 5,810 salivary gland or duct AND JAW Mucocele of salivary gland; Mucous extravasation cyst of DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.6 salivary gland; Mucous retention cyst of salivary gland; 8,300 2,490 5,810 AND JAW Ranula Other diseases of salivary glands; Benign lymphoepithelial lesion of salivary gland; Mikulicz' disease; Necrotizing DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.8 8,300 2,490 5,810 sialometaplasia; Sialectasia; Stenosis of salivary duct; AND JAW Stricture of salivary duct DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K11.9 Disease of salivary gland, unspecified; Sialoadenopathy NOS 8,300 2,490 5,810 AND JAW Cellulitis and abscess of mouth; Cellulitis of floor of mouth; DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K12.2 8,300 2,490 5,810 Submandibular abscess AND JAW Granuloma and granuloma-like lesions of oral mucosa; Eosinophilic granuloma of oral mucosa; Granuloma DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K13.4 8,300 2,490 5,810 pyogenicum of oral mucosa; Verrucous xanthoma of oral AND JAW mucosa Other and unspecified lesions of oral mucosa; Focal oral DISEASES OF ORAL CAVITY, SALIVARY GLANDS, K13.7 8,300 2,490 5,810 mucinosis AND JAW

K31.1 Adult hypertrophic pyloric stenosis; Pyloric stenosis NOS DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620

K31.2 Hourglass stricture and stenosis of stomach DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 K31.3 Pylorospasm, not elsewhere classified DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 K31.4 Gastric diverticulum DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 Obstruction of duodenum; Constriction of duodenum; K31.5 Stenosis of duodenum; Stricture of duodenum; Chronic DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 duodenal

Page 29 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Fistula of stomach and duodenum; Gastrocolic fistula; K31.6 DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 Gastrojejunocolic fistula K31.7 of stomach and duodenum DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 Other specified diseases of stomach and duodenum; K31.8 ; ; Hourglass contraction of DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620 stomach DISEASES OF THE GALLBLADDER AND BILIARY K74.4 Secondary biliary cirrhosis 9,800 2,940 6,860 TRACT DISEASES OF THE GALLBLADDER AND BILIARY K74.5 Biliary cirrhosis, unspecified 9,800 2,940 6,860 TRACT

Calculus of gallbladder without cholecystitis; Cholecystolithiasis unspecified or without cholecystitis; Cholelithiasis unspecified or without cholecystitis; DISEASES OF THE GALLBLADDER AND BILIARY K80.2 Recurrent colic of gallbladder unspecified or without 9,800 2,940 6,860 TRACT cholecystitis; Impacted of cystic duct unspecified or without cholecystitis; impacted gallstone of gallbladder unspecified or without cholecystitis

Calculus of bile duct without cholangitis or cholecystitis; Choledocholithiasis unspecified or without cholangitis or cholecystitis; Impacted gallstone of bile duct NOS unspecified or without cholangitis or cholecystitis; Impacted gallstone of common duct unspecified or without DISEASES OF THE GALLBLADDER AND BILIARY K80.5 9,800 2,940 6,860 cholangitis or cholecystitis; Impacted gallstone of hepatic TRACT duct unspecified or without cholangitis or cholecystitis; Hepatic cholelithiasis unspecified or without cholangitisor cholecystitis; Hepatic recurrent colic unspecified or without cholangitis or cholecystitis

DISEASES OF THE GALLBLADDER AND BILIARY K80.8 Other cholelithiasis 9,800 2,940 6,860 TRACT Obstruction of gallbladder; Occlusion of cystic duct of gallbladder without calculus; Stenosis of cystic duct or DISEASES OF THE GALLBLADDER AND BILIARY K82.0 9,800 2,940 6,860 gallbladder without calculus; Stricture of cystic duct or TRACT gallbladder without calculus DISEASES OF THE GALLBLADDER AND BILIARY K82.1 Hydrops of gallbladder; Mucocele of gallbladder 9,800 2,940 6,860 TRACT Perforation of gallbladder; Rupture of cystic duct or DISEASES OF THE GALLBLADDER AND BILIARY K82.2 9,800 2,940 6,860 gallbladder TRACT Fistula of gallbladder; Cholecystocolic fistula; DISEASES OF THE GALLBLADDER AND BILIARY K82.3 9,800 2,940 6,860 Cholecystoduodenal fistula TRACT DISEASES OF THE GALLBLADDER AND BILIARY K82.4 Cholesterolosis of gallbladder; Strawberry gallbladder 9,800 2,940 6,860 TRACT Other specified diseases of gallbladder; Adhesions of cystic duct or gallbladder; Atrophy of cystic duct or gallbladder; Cyst of cystic duct or gallbladder; Dyskinesia of cystic duct DISEASES OF THE GALLBLADDER AND BILIARY K82.8 9,800 2,940 6,860 or gallbladder; Hypertrophy of cystic duct or gallbladder; TRACT Nonfunctioning of cystic duct or gallbladder; Ulcer of cystic duct or gallbladder Cholangitis; Cholangitis NOS; ; Primary cholangitis; Recurrent cholangitis; Sclerosing DISEASES OF THE GALLBLADDER AND BILIARY K83.0 9,800 2,940 6,860 cholangitis; Secondary cholangitis; Stenosing cholangitis; TRACT Suppurative cholangitis Obstruction of bile duct; Occlusion of bile duct without DISEASES OF THE GALLBLADDER AND BILIARY K83.1 calculus; Stenosis of bile duct without calculus; Stricture of 9,800 2,940 6,860 TRACT bile duct without calculus DISEASES OF THE GALLBLADDER AND BILIARY K83.3 Fistula of bile duct; Choledochoduodenal fistula 9,800 2,940 6,860 TRACT DISEASES OF THE GALLBLADDER AND BILIARY K83.4 Spasm of sphincter of Oddi 9,800 2,940 6,860 TRACT DISEASES OF THE GALLBLADDER AND BILIARY K83.5 Biliary cyst 9,800 2,940 6,860 TRACT Other specified diseases of ; Adhesions of bile DISEASES OF THE GALLBLADDER AND BILIARY K83.8 duct; Atrophy of bile duct; Hypertrophy of bile duct; Ulcer 9,800 2,940 6,860 TRACT of bile duct

Acute ; Abscess of pancreas; Acute necrosis of pancreas; Infective necrosis of pancreas; Pancreatitis NOS; K85 DISEASES OF THE PANCREAS 12,600 3,780 8,820 Acute recurrent pancreatitis; Haemorrhagic pancreatitis; Subacute pancreatitis; Supparative pancreatitis

K85.0 Idiopathic DISEASES OF THE PANCREAS 12,600 3,780 8,820 K85.1 Biliary acute pancreatitis; Gallstone pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820 K85.2 Alcohol-induced acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820 K85.8 Other acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820

K85.9 Acute pancreatitis, unspecified; Other diseases of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820

K86.0 Alcohol-induced DISEASES OF THE PANCREAS 12,600 3,780 8,820

Page 30 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other chronic pancreatitis; Chronic pancreatitis NOS; K86.1 Infectious chronic pancreatitis; Recurrent chronic DISEASES OF THE PANCREAS 12,600 3,780 8,820 pancreatitis; Relapsing chronic pancreatitis K86.2 Cyst of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820 K86.3 Pseudocyst of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820

Other specified diseases of pancreas; Atrophy of pancreas; Calculus of pancreas; Cirrhosis of pancreas; Fibrosis of K86.8 DISEASES OF THE PANCREAS 12,600 3,780 8,820 pancreas; Pancreatic infantilism; Pancreatic necrosis NOS; Aseptic pancreatic necrosis; Fat necrosis of pancreas

Other specified diseases of pulmonary vessels; Rupture of I28.8 pulmonary vessel; Stenosis of pulmonary vessel; Stricture DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 of pulmonary vessel Dissection of aorta [anypart]; Dissecting aneurysm of aorta I71.0 DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 (ruptured) [any part] Aortic aneurysm of unspecified site without mention of I71.9 rupture; Aneurysm of aorta; Dilatation of aorta; Hyaline DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 necrosis of aorta Embolism and thrombosis of abdominal aorta; Aortic I74.0 DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 bifurcation syndrome; Leriche's syndrome Embolism and thrombosis of other and unspecified parts of I74.1 DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 aorta

I74.2 Embolism and thrombosis of arteries of upper extremities DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170

I74.3 Embolism and thrombosis of arteries of lower extremities DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170

Embolism and thrombosis of arteries of extremities, I74.4 DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 unspecified; Peripheral arterial embolism I74.5 Embolism and thrombosis of iliac artery DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 I74.8 Embolism and thrombosis of other arteries DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 I74.9 Embolism and thrombosis of unspecified artery DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 I77.4 Coeliac artery compression syndrome DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 I77.6 Arteritis, unspecified; Aortitis NOS; Endarteritis NOS DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 I77.8 Other specified disorders of arteries and arterioles DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 I85.0 Oesophageal varices with bleeding DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 Compression of vein; Stricture of vein; Inferior Vena cava I87.1 DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170 syndrome; Superior vena cava syndrome Disseminated chorioretinal inflammation; Disseminated H30.1 chorioretinitis; Disseminated choroiditis; Disseminated DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220 retinitis; Disseminated retinochoroiditis H30.8 Other chorioretinal ; Harada's disease DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220 Choroidal haemorrhage and rupture; Choroidal H31.3 DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220 haemorrhage NOS; Choroidal haemorrhage expulsive

M80.0 Postmenopausal osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530

M80.1 Postoophorectomy osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530

Postsurgical osteoporosis with pathological M80.3 DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 fracture M81.0 Postmenopausal osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.08 Postmenopausal osteoporosis Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.1 Postoophorectomy osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.4 Drug-induced osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.40 Drug-induced osteoporosis Multiple site DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.55 Idiopathic osteoporosis Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.58 Idiopathic osteoporosis Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.6 Localized osteoporosis [Lequesne] DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.8 Other osteoporosis; Senile osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 Other osteoporosis; Senile osteoporosis Other, head, M81.88 DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 neck,ribs,skull,trunk,vertebral column

M81.89 Other osteoporosis; Senile osteoporosis Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530

M81.9 Osteoporosis, unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.95 Osteoporosis, Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M81.98 Osteoporosis, Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 Adult osteomalacia due to malabsorption; Postsurgical M83.2 DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 malabsorption osteomalacia in adults M83.4 Aluminium bone disease DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M83.8 Other adult osteomalacia DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M83.87 Other adult osteomalacia Ankle and foot DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M83.89 Other adult osteomalacia Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M83.9 Adult osteomalacia, unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M83.99 Adult osteomalacia, unspecified Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.0 Fibrous dysplasia (monostotic) DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.1 Skeletal fluorosis Multiple site DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.2 Hyperostosis of skull DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.5 Aneurysmal bone cyst DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530

Page 31 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M85.55 Aneurysmal bone cyst Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.6 Other cyst of bone DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.63 Other cyst of bone Forearm DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 M85.65 Other cyst of bone Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 Other specified disorders of bone density and structure; M85.8 DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 Hyperostosis of bones, except skull Other specified disorders of bone density and structure; M85.88 DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 Hyperostosis of bones, except skull Other M89.38 Hypertrophy of bone Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530 Other sphingolipidosis; Fabry(-Anderson) Disease; Gaucher Disease; Krabbe Disease; Niemann-Pick Disease; Faber's E75.2 DISORDER OF LIPID STORAGE 8,100 2,430 5,670 syndrome; Metachromatic leukodystrophy; Sulfatase deficiency Neuronal ceroid lipofuscinosis; Batten Disease; E75.4 Bielschowsky-Jansky Disease; Kufs Disease; pielmeyer-Vogt DISORDER OF LIPID STORAGE 8,100 2,430 5,670 Disease Other lipid storage disorders; Cerebrotendinous E75.5 cholesterosis [van Bogaert-Scherer-Epstein]; Wolman's DISORDER OF LIPID STORAGE 8,100 2,430 5,670 disease E75.6 Lipid storage disorder, unspecified DISORDER OF LIPID STORAGE 8,100 2,430 5,670 N95.0 Postmenopausal bleeding DISORDERS ASSOCIATED WITH MENOPAUSE 6,000 1,800 4,200 Primary hyperaldosteronism; Conn's syndrome; E26.0 Primary aldosteronism due to adrenal hyperplasia DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 (bilateral) E26.1 Secondary hyperaldosteronism DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 E26.8 Other hyperaldosteronism; Bartter's syndrome DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 Hyperaldosteronism, unspecified; Other disorders of E26.9 DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 adrenal gland Primary adrenocortical insufficiency; Addison's disease; E27.1 DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 Autoimmune adrenalitis E27.2 Addisonian crisis; Adrenal crisis; Adrenocortical crisis DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 E27.3 Drug-induced adrenocortical insufficiency DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 Other and unspecified adrenocortical insufficiency; Adrenal E27.4 haemorrhage; Adrenal infarction; DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 Adrenocortical insufficiency NOS; Hypoaldosteronism Other specified disorders of adrenal gland; Abnormality of E27.8 DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930 cortisol-binding globulin E70.0 Classical phenylketonuria DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 E70.1 Other hyperphenylalaninaemias DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420

Disorders of tyrosine metabolism; Alkaptonuria; E70.2 DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 Hypertyrosinaemia; Ochronosis; Tyrosinaemia; Tyrosinosis

Albinism; OcularAlbinism; Oculocutaneous Albinism E70.3 Chediak(-Steinbrinck)-Higashi Syndrome; Cross Syndrome; DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 Hermansky-Pudlak Syndrome Other disorders of aromatic amino-acid metabolism; E70.8 Disorders of histidine metabolism; Disorders of tryptophan DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 metabolism E71.0 Maple-syrup-urine disease DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 Other disorders of branched-chain amino-acid metabolism; Hyperleucine-isoleucinaemia; Hypervalinaemia; Isovaleric E71.1 DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 acidaemia; Methylmalonic acidaemia; Propionic acidaemia Disorders of fatty-acid metabolism; Adrenoleukodystrophy E71.3 [Addison-Schilder]; Muscle carnitine palmityltransferase DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 deficiency Disorders of amino-acid transport; Cystinosis; Cystinuria; E72.0 Fanconi(-de Toni)(-Debré) syndrome; Hartnup's disease; DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 Lowe's syndrome Disorders of cycle metabolism; Argininaemia; E72.2 Argininosuccinic aciduria; Citrullinaemia; DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 Hyperammonaemia Disorders of lysine and hydroxylysine metabolism / Glutaric E72.3 DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 aciduria; Hydroxylysinaemia; Hyperlysinaemia Disorders of glycine metabolism; Hyperhydroxyprolinaemia; Hyperprolinaemia (type I) , E72.5 DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420 Hyperprolinaemia type II; Non-ketotic hyperglycinaemia; Sarcosinaemia E73.0 Congenital lactase deficiency DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060

Glycogen storage disease; Cardiac glycogenosis; Andersen Disease; Cori Disease; Forbes Disease; Hers Disease; E74.0 DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060 McArdle Disease; Pompe Disease; Tauri Disease; von Gierke Disease; Liver phosphorylase deficiency

Disorders of fructose metabolism; Essential fructosuria; E74.1 Fructose-1,6-diphosphatase deficiency; Hereditary fructose DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060 intolerance

Page 32 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Disorders of galactose metabolism; Galactokinase E74.2 DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060 deficiency; Galactosaemia Other disorders of intestinal carbohydrate absorption; E74.3 DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060 Glucose-galactose malabsorption; Sucrase deficiency Other specified disorders of carbohydrate E74.8 metabolism/Essential pentosuria; Oxalosis; Oxaluria; Renal DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060 glycosuria E77.8 Other disorders of glycoprotein metabolism DISORDERS OF GLYCOPROTEIN METABOLISM 10,600 3,180 7,420 Mucopolysaccharidosis, type I; Hurler Syndrome; Hurler- DISORDERS OF GLYCOSAMINOGLYCAN E76.0 10,900 3,270 7,630 Scheie Syndrome; Scheie Syndrome METABOLISM DISORDERS OF GLYCOSAMINOGLYCAN E76.1 Mucopolysaccharidosis, type II; Hunter's syndrome 10,900 3,270 7,630 METABOLISM

Other mucopolysaccharidoses; ß-Glucuronidase deficiency; Mucopolysaccharidosis, type III; Mucopolysaccharidosis IV, Mucopolysaccharidosis VI, Mucopolysaccharidosis VII; DISORDERS OF GLYCOSAMINOGLYCAN E76.2 Mild Maroteaux-Lamy Syndrome; Severe Maroteaux-Lamy 10,900 3,270 7,630 METABOLISM Syndrome; Morquio-like Syndrome; Morquio-classic syndrome; Sanfilippo type B syndrome; Sanfilippo type C syndrome; Sanfilippo type D syndrome

DISORDERS OF GLYCOSAMINOGLYCAN E76.3 Mucopolysaccharidosis, unspecified 10,900 3,270 7,630 METABOLISM DISORDERS OF GLYCOSAMINOGLYCAN E76.8 Other disorders of glucosaminoglycan metabolism 10,900 3,270 7,630 METABOLISM

Pure hypercholesterolaemia; Familial hypercholesterolaemia; Fredrickson's E78.0 hyperlipoproteinaemia, type Iia; DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620 Hyperbetalipoproteinaemia; Hyperlipidaemia, group A; Low- density-lipoprotein-type [LDL] hyperlipoproteinaemia

Pure hyperglyceridaemia; Endogenous hyperglyceridaemia; Fredrickson's hyperlipoproteinaemia, type IV; E78.1 Hyperlipidaemia, group B; Hyperprebetalipoproteinaemia'; DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620 Very-low-density-lipoprotein-type [VLDL] hyperlipoproteinaemia

Mixed hyperlipidaemia; Broad- or floating- betalipoproteinaemia; Fredrickson's hyperlipoproteinaemia, type IIb; Fredrickson's E78.2 hyperlipoproteinaemia type III; Hyperbetalipoproteinaemia DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620 with prebetalipoproteinaemia; Hypercholesterolaemia with endogenous hyperglyceridaemia; Hyperlipidaemia, group C; Tubero-eruptive xanthoma; Xanthoma tuberosum

Hyperchylomicronaemia; Fredrickson's hyperlipoproteinaemia, type I; Fredrickson's E78.3 DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620 hyperlipoproteinaemia, type V; Hyperlipidaemia, group D; Mixed hyperglyceridaemia

E78.4 Other hyperlipidaemia; Familial combined hyperlipidaemia DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620

Lipoprotein deficiency; Abetalipoproteinaemia; High-density lipoprotein deficiency; E78.6 Hypoalphalipoproteinaemia; Familial DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620 Hypobetalipoproteinaemia; Lecithin cholesterol acyltransferase deficiency; Tangier disease E78.8 Other disorders of lipoprotein metabolism DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620 Disorders of copper metabolism; Menkes' kinky hair E83.0 DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110 disease; Menkes' steely hair disease; Wilson's disease E83.1 Disorders of iron metabolism; Haemochromatosis DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110

E83.2 Disorders of zinc metabolism; Acrodermatitis enteropathica DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110

Disorders of phosphorus metabolism; Acid phosphatase deficiency; Familial hypophosphataemia; E83.3 DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110 Hypophosphatasia; Vitamin-D-resistant osteomalacia; Vitamin-D-resistant rickets Disorders of magnesium metabolism; Hypermagnesaemia; E83.4 DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110 Hypomagnesaemia Disorders of calcium metabolism; Familial hypocalciuric E83.5 DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110 hypercalcaemia; Idiopathic hypercalciuria E83.8 Other disorders of mineral metabolism DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110 Acute inflammation of orbit; Abscess of orbit;Cellulitis of H05.0 orbit; Osteomyelitis of orbit; Periostitis of orbit, Tenonitis of DISORDERS OF ORBIT 9,500 2,850 6,650 orbit Exophthalmic conditions; Displacement of globe (lateral) H05.2 DISORDERS OF ORBIT 9,500 2,850 6,650 NOS; Haemorrhage of orbit; Oedema of orbit

Page 33 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Hereditary erythropoietic porphyria; Congenital DISORDERS OF PORPHYRIN AND BILIRUBIN E80.0 9,800 2,940 6,860 erythropoietic porphyria; Erythropoietic protoporphyria METABOLISM

Other porphyria; Hereditary coproporphyria DISORDERS OF PORPHYRIN AND BILIRUBIN E80.2 9,800 2,940 6,860 Porphyria NOS; Acute intermittent (hepatic) Porphyria METABOLISM DISORDERS OF PORPHYRIN AND BILIRUBIN E80.4 Gilbert's syndrome 9,800 2,940 6,860 METABOLISM DISORDERS OF PORPHYRIN AND BILIRUBIN E80.5 Crigler-Najjar syndrome 9,800 2,940 6,860 METABOLISM Other disorders of bilirubin metabolism; Dubin-Johnson DISORDERS OF PORPHYRIN AND BILIRUBIN E80.6 9,800 2,940 6,860 syndrome; Rotor's syndrome METABOLISM Other disorders of purine and pyrimidine metabolism; DISORDERS OF PURINE AND PYRIMIDINE E79.8 7,000 2,100 4,900 Hereditary xanthinuria METABOLISM E20.0 Idiopathic hypoparathyroidism DISORDERS OF THE PARATHYROID 9,300 2,790 6,510 E20.8 Other hypoparathyroidism DISORDERS OF THE PARATHYROID 9,300 2,790 6,510 E20.9 Hypoparathyroidism, unspecified; Parathyroid tetany DISORDERS OF THE PARATHYROID 9,300 2,790 6,510 Primary ; Hyperplasia of parathyroid; E21.0 Osteitis fibrosa cystica generalisata [von Recklinghausen's DISORDERS OF THE PARATHYROID 9,300 2,790 6,510 disease of bone] E21.4 Other specified disorders of parathyroid gland DISORDERS OF THE PARATHYROID 9,300 2,790 6,510 E21.5 Disorder of parathyroid gland, unspecified DISORDERS OF THE PARATHYROID 9,300 2,790 6,510 Syndrome of inappropriate secretion of antidiuretic E22.2 DISORDERS OF THE PITUITARY GLAND 11,800 3,540 8,260 hormone

Hypopituitarism; Fertile eunuch syndrome; Hypogonadotropic hypogonadism; Idiopathic growth hormone deficiency; Isolated deficiency of gonadotropin; Isolated deficiency of growth hormone; Isolated deficiency E23.0 of pituitary hormone; Kallmann's syndrome; Loraine-Levi DISORDERS OF THE PITUITARY GLAND 11,800 3,540 8,260 short stature; Necrosis of pituitary gland(postpartum); Panhypopituitarism; Pituitary cachexia; Pituitary insufficiency NOS; Pituitary short stature; Sheehan's syndrome; Simmond's disease

H43.0 Vitreous prolapse DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280 H43.1 Vitreous haemorrhage DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280 Purulent endophthalmitis; Panophthalmitis; Vitreous H44.0 DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280 abscess Other endophthalmitis; Parasitic endophthalmitis NOS; H44.1 DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280 Sympathetic uveitis Degenerated conditions of globe; Absolute glaucoma; H44.5 DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280 Atrophy of globe; Phthisis bulbi Disseminated intravascular coagulation [defibrination syndrome]; Acquired Afibrinogenaemia; Consumption D65 coagulopathy; Diffuse or disseminated intravascular DISSEMINATED INTRAVASCULAR COAGULATION 32,000 9,600 22,400 coagulation [DIC] ; Acquired Fibrinolytic haemorrhage; Fibrinolytic Purpura; Purpura fulminans; Disseminated intravascular coagulation of fetus and P60 DISSEMINATED INTRAVASCULAR COAGULATION 32,000 9,600 22,400 newborn; Defibrination syndrome of fetus or newborn M42.1 Adult osteochondrosis of spine DORSOPATHIES 7,600 2,280 5,320 M43.02 Spondylolysis cervical region DORSOPATHIES 7,600 2,280 5,320 M43.03 Spondylolysis cervicothoracic region DORSOPATHIES 7,600 2,280 5,320 M43.04 Spondylolysis thoracic region DORSOPATHIES 7,600 2,280 5,320 M43.06 Spondylolysis lumbar region DORSOPATHIES 7,600 2,280 5,320 M43.07 Spondylolysis lumbosacral region DORSOPATHIES 7,600 2,280 5,320 M43.09 Spondylolysis site unspecified DORSOPATHIES 7,600 2,280 5,320 M43.10 Spondylolisthesis Multiple sites in spine DORSOPATHIES 7,600 2,280 5,320 M43.12 Spondylolisthesis cervical region DORSOPATHIES 7,600 2,280 5,320 M43.15 Spondylolisthesis thoracolumbar region DORSOPATHIES 7,600 2,280 5,320 M43.16 Spondylolisthesis lumbar region DORSOPATHIES 7,600 2,280 5,320 M43.17 Spondylolisthesis lumbosacral region DORSOPATHIES 7,600 2,280 5,320 M43.18 Spondylolisthesis sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320 M43.19 Spondylolisthesis site unspecified DORSOPATHIES 7,600 2,280 5,320 Other fusion of spine; Ankylosis of spinal joint cervical M43.22 DORSOPATHIES 7,600 2,280 5,320 region Other fusion of spine; Ankylosis of spinal joint lumbar M43.26 DORSOPATHIES 7,600 2,280 5,320 region Other fusion of spine; Ankylosis of spinal joint lumbosacral M43.27 DORSOPATHIES 7,600 2,280 5,320 region Other fusion of spine; Ankylosis of spinal joint site M43.29 DORSOPATHIES 7,600 2,280 5,320 unspecified M43.42 Other recurrent atlantoaxial subluxation cervical region DORSOPATHIES 7,600 2,280 5,320

M43.49 Other recurrent atlantoaxial subluxation site unspecified DORSOPATHIES 7,600 2,280 5,320

M43.60 Torticollis Multiple sites in spine DORSOPATHIES 7,600 2,280 5,320 M43.62 Torticollis cervical region DORSOPATHIES 7,600 2,280 5,320 M43.64 Torticollis thoracic region DORSOPATHIES 7,600 2,280 5,320 M43.66 Torticollis lumbar region DORSOPATHIES 7,600 2,280 5,320

Page 34 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M43.68 Torticollis sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320 M43.69 Torticollis site unspecified DORSOPATHIES 7,600 2,280 5,320 M43.8 Other specified deforming dorsopathies DORSOPATHIES 7,600 2,280 5,320 M43.82 Other specified deforming dorsopathies cervical region DORSOPATHIES 7,600 2,280 5,320 Other specified deforming dorsopathies thoracolumbar M43.85 DORSOPATHIES 7,600 2,280 5,320 region M43.86 Other specified deforming dorsopathies lumbar region DORSOPATHIES 7,600 2,280 5,320

M43.87 Other specified deforming dorsopathies lumbosacral region DORSOPATHIES 7,600 2,280 5,320

Other specified deforming dorsopathies sacral and M43.88 DORSOPATHIES 7,600 2,280 5,320 sacrococcygeal region

M43.89 Other specified deforming dorsopathies site unspecified DORSOPATHIES 7,600 2,280 5,320

Deforming dorsopathy, unspecified; Curvature of spine M43.9 DORSOPATHIES 7,600 2,280 5,320 NOS Deforming dorsopathy, unspecified; Curvature of spine M43.94 DORSOPATHIES 7,600 2,280 5,320 NOS thoracic region Deforming dorsopathy, unspecified; Curvature of spine M43.95 DORSOPATHIES 7,600 2,280 5,320 NOS thoracolumbar region Deforming dorsopathy, unspecified; Curvature of spine M43.96 DORSOPATHIES 7,600 2,280 5,320 NOS lumbar region Deforming dorsopathy, unspecified; Curvature of spine M43.97 DORSOPATHIES 7,600 2,280 5,320 NOS lumbosacral region Deforming dorsopathy, unspecified; Curvature of spine M43.99 DORSOPATHIES 7,600 2,280 5,320 NOS site unspecified Cervicocranial syndrome; Posterior cervical sympathetic M53.0 DORSOPATHIES 7,600 2,280 5,320 syndrome M53.1 Cervicobrachial syndrome DORSOPATHIES 7,600 2,280 5,320 M53.12 Cervicobrachial syndrome cervical region DORSOPATHIES 7,600 2,280 5,320 M53.19 Cervicobrachial syndrome site unspecified DORSOPATHIES 7,600 2,280 5,320 M53.2 Spinal instabilities DORSOPATHIES 7,600 2,280 5,320 M53.22 Spinal instabilities cervical region DORSOPATHIES 7,600 2,280 5,320 M53.24 Spinal instabilities thoracic region DORSOPATHIES 7,600 2,280 5,320 M53.26 Spinal instabilities lumbar region DORSOPATHIES 7,600 2,280 5,320 M53.27 Spinal instabilities lumbosacral region DORSOPATHIES 7,600 2,280 5,320 M53.28 Spinal instabilities sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320 M53.29 Spinal instabilities site unspecified DORSOPATHIES 7,600 2,280 5,320 M53.3 Coccygodynia DORSOPATHIES 7,600 2,280 5,320 M53.38 Coccygodynia sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320 M53.8 Other specified dorsopathies DORSOPATHIES 7,600 2,280 5,320 M53.86 Other specified dorsopathies lumbar region DORSOPATHIES 7,600 2,280 5,320 M53.87 Other specified dorsopathies lumbosacral region DORSOPATHIES 7,600 2,280 5,320 M53.89 Other specified dorsopathies site unspecified DORSOPATHIES 7,600 2,280 5,320 M53.9 Dorsopathy, unspecified DORSOPATHIES 7,600 2,280 5,320 M53.92 Dorsopathy, unspecified cervical region DORSOPATHIES 7,600 2,280 5,320 M53.95 Dorsopathy, unspecified thoracolumbar region DORSOPATHIES 7,600 2,280 5,320 M54 Dorsalgia DORSOPATHIES 7,600 2,280 5,320 Drowning and nonfatal submersion; Immersion; Swimmer's T75.1 DROWNING 7,100 2,130 4,970 cramp O00.0 Abdominal pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460 Tubal pregnancy; Fallopian pregnancy; Rupture of fallopian O00.1 ECTOPIC PREGNANCY 7,800 2,340 5,460 tube due to pregnancy; Tubal abortion O00.2 Ovarian pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460

Other ectopic pregnancy; Cervical pregnancy; Cornual O00.8 ECTOPIC PREGNANCY 7,800 2,340 5,460 pregnancy; Intraligamentous pregnancy; Mural pregnancy

O00.9 Ectopic pregnancy, unspecified ECTOPIC PREGNANCY 7,800 2,340 5,460 O36.7 Maternal care for viable fetus in abdominal pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460 Effects of lightning; Shock from lightning; Struck by T75.0 ELECTRICAL SHOCK 5,400 1,620 3,780 lightning NOS Effects of electric current; Electrocution; Shock from T75.4 ELECTRICAL SHOCK 5,400 1,620 3,780 electric current MacLeod's syndrome; Unilateral emphysema; Unilateral J43.0 EMPHYSEMA 11,400 3,420 7,980 transparency of lung J43.1 Panlobular emphysema; Panacinar emphysema EMPHYSEMA 11,400 3,420 7,980 J43.2 Centrilobular emphysema EMPHYSEMA 11,400 3,420 7,980 J43.8 Other emphysema EMPHYSEMA 11,400 3,420 7,980 Emphysema, unspecified; Lung emphysema NOS; Pulmonary emphysema NOS; Bullous lung emphysema; J43.9 Bullous pulmonary emphysema; Vesicular lung EMPHYSEMA 11,400 3,420 7,980 emphysema; Vesucular pulmonary emphysema; Emphysematous bleb J98.2 Interstitial emphysema; Mediastinal emphysema EMPHYSEMA 11,400 3,420 7,980 J98.3 Compensatory emphysema EMPHYSEMA 11,400 3,420 7,980 Human immunodeficiency virus [HIV] disease resulting in B22.0 encephalopathy; Human immunodeficiency virus [HIV] ENCEPHALOPATHY 22,200 6,660 15,540 dementia

Page 35 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee G92 Toxic encephalopathy ENCEPHALOPATHY 22,200 6,660 15,540 G93.1 Anoxic brain damage, not elsewhere classified ENCEPHALOPATHY 22,200 6,660 15,540 I67.4 Hypertensive encephalopathy ENCEPHALOPATHY 22,200 6,660 15,540 N80.0 Endometriosis of uterus; Adenomyosis ENDOMETRIOSIS 7,700 2,310 5,390 N80.1 Endometriosis of ovary ENDOMETRIOSIS 7,700 2,310 5,390 N80.2 Endometriosis of fallopian tube ENDOMETRIOSIS 7,700 2,310 5,390 N80.3 Endometriosis of pelvic peritoneum ENDOMETRIOSIS 7,700 2,310 5,390 N80.4 Endometriosis of rectovaginal septum and vagina ENDOMETRIOSIS 7,700 2,310 5,390 N80.5 Endometriosis of intestine ENDOMETRIOSIS 7,700 2,310 5,390 N80.8 Other endometriosis; Endometriosis of thorax ENDOMETRIOSIS 7,700 2,310 5,390 N80.9 Endometriosis, unspecified ENDOMETRIOSIS 7,700 2,310 5,390 J05.1 Acute epiglottitis; Epiglottitis NOS EPIGLOTTITIS 9,700 2,910 6,790

Localization-related focal idiopathic epilepsy and epileptic syndromes with seizures of localized onset; Localization- related partial idiopathic epilepsy and epileptic syndromes G40.0 EPILEPSY 7,800 2,340 5,460 with seizures of localized onset; Benign childhood epilepsy with centrotemporal EEG spikes;Childhood epilepsy with occipital EEG paroxysms

Localization-related focal symptomatic epilepsy and epileptic syndromes with simple partial seizures; Localization-related partial symptomatic epilepsy and G40.1 EPILEPSY 7,800 2,340 5,460 epileptic syndromes with simple partial seizures; Attacks without alteration of consciousness ; Simple partial seizures developing into secondarily generalized seizures

Localization-related focal symptomatic epilepsy and epileptic syndromes with complex partial seizures; Localization-related partial symptomatic epilepsy and G40.2 epileptic syndromes with complex partial seizures; Attacks EPILEPSY 7,800 2,340 5,460 with alteration of consciousness, often with automatisms. Complex partial seizures developing into secondarily generalized seizures

Generalized idiopathic epilepsy and epileptic syndromes; Benign myoclonic epilepsy in infancy; Benign familial neonatal convulsions; Childhood absence epilepsy [pyknolepsy]; Epilepsy with grand mal seizures on awakening; Juvenile absence epilepsy; Juvenile absence G40.3 EPILEPSY 7,800 2,340 5,460 epilepsy; Juvenile myoclonic epilepsy impulsive petit mal); Nonspecific atonic epileptic seizures; Nonspecific clonic epileptic seizures; Nonspecific myoclonic epileptic seizures; nonspecific tonic epileptic seizures; Nonspecific tonic-clonic epileptic seizures

Other generalized epilepsy and epileptic syndromes; Epilepsy with myoclonic absences; Epilepsy with myoclonic- G40.4 astatic seizures; Infantile spasms; Lennox-Gastaut EPILEPSY 7,800 2,340 5,460 syndrome; Salaam attacks; Symptomatic early myoclonic; Encephalopathy; West's syndrome

Special epileptic syndromes; Epilepsia partialis continua [Kozhevnikof]; Epileptic seizures related to alcohol; G40.5 Epileptic seizures related to drugs; Epileptic seizures related EPILEPSY 7,800 2,340 5,460 to hormonal changes; Epileptic seizures related to sleep deprivation; Epileptic seizures related to stress

G40.6 Grand mal seizures, unspecified (with or without petit mal) EPILEPSY 7,800 2,340 5,460

G40.7 Petit mal, unspecified, without grand mal seizures EPILEPSY 7,800 2,340 5,460

Other epilepsy; Epilepsies and epileptic syndromes G40.8 EPILEPSY 7,800 2,340 5,460 undetermined as to whether they are focal or generalized

Epilepsy, unspecified; Epileptic convulsions NOS; Epileptic G40.9 EPILEPSY 7,800 2,340 5,460 fits NOS; Epileptic seizures NOS

G21.0 Malignant neuroleptic syndrome EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G21.1 Other drug-induced secondary parkinsonism EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G21.8 Other secondary parkinsonism EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G21.9 Secondary parkinsonism, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

Hallervorden-Spatz disease; Pigmentary pallidal G23.0 EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810 degeneration Progressive supranuclear ophthalmoplegia [Steele- G23.1 EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810 Richardson-Olszewski]

Page 36 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other specified degenerative diseases of basal ganglia; G23.8 Calcification of basal ganglia; Neurogenic orthostatic EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810 hypotension [Shy-Drager}

G23.9 Degenerative disease of basal ganglia, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G24.0 Carcinomatous neuromyopathy in Drug-induced dystonia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G24.1 Idiopathic familial dystonia; Idiopathic dystonia NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G24.3 Spasmodic torticollis EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G24.4 Idiopathic orofacial dystonia; Orofacial dyskinesia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G24.8 Other dystonia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G24.9 Dystonia, unspecified; Dyskinesia NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G25.3 Myoclonus; Drug-induced myoclonus EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

G25.5 Other chorea; Chorea NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

Other specified extrapyramidal and movement disorders; G25.8 Akathisia (drug-induced) (treatment-induced) Restless legs EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810 syndrome; Stiff-man syndrome

G25.9 Extrapyramidal and movement disorder, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810

R56.0 Febrile convulsions FEBRILE SEIZURES 7,000 2,100 4,900 Other and unspecified convulsions; Fit NOS; Seizure R56.8 FEBRILE SEIZURES 7,000 2,100 4,900 (convulsive) NOS P92.1 Regurgitation and rumination in newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090 P92.2 Slow feeding of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090 P92.4 Overfeeding of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090 P92.8 Other feeding problems of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090 P92.9 Feeding problem of newborn, unspecified FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090 R50.9 Fever, unspecified; Hyperpyrexia NOS; Pyrexia NOS FEVER OF UNKNOWN ORIGIN 7,000 2,100 4,900 Hyperosmolality and hypernatraemia; Sodium [Na] excess; E87.0 FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 Sodium [Na] overload E87.1 Hypo-osmolality and hyponatraemia FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 Acidosis; Acidosis NOS; Lactic Acidosis; Metabolic Acidosis; E87.2 FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 Respiratory Acidosis Alkalosis; Alkalosis NOS; ; Respiratory E87.3 FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 Alkalosis E87.4 Mixed disorder of acid-base balance FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 Hyperkalaemia; Potassium [K] excess; Potassium [K] E87.5 FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 overload E87.6 Hypokalaemia; Potassium [K] deficiency FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 E87.7 Fluid overload FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 Other disorders of electrolyte and fluid balance, not elsewhere classified; Electrolyte imbalance NOS; E87.8 Hyperchloraemia; Hypochloraemia; Other metabolic FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950 disorders Electrolyte abnormality Fracture of thoracic vertebra; Fracture of thoracic spine S22.00 FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 NOS (closed) S22.10 Multiple fractures of thoracic spine (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.2 Fracture of sternum FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.20 Fracture of sternum (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.3 Fracture of rib FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.30 Fracture of rib (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.31 Fracture of rib (open) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.4 Multiple fractures of ribs FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.40 Multiple fractures of ribs (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.41 Multiple fractures of ribs (open) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.80 Fracture of other parts of bony thorax (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 S22.90 Fracture of bony thorax, part unspecified (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090 J85.0 Gangrene and necrosis of lung GANGRENE 13,200 3,960 9,240 ; Dermatitis gangrenosa; L88 GANGRENE 13,200 3,960 9,240 Phagedenic pyoderma R02 Gangrene, not elsewhere classified GANGRENE 13,200 3,960 9,240 Gastro-oesophageal reflux disease with oesophagitis; K21.0 GASTROESOPHAGEAL REFLUX DISEASE 6,100 1,830 4,270 Reflux oesophagitis Gastro-oesophageal reflux disease without oesophagitis; K21.9 GASTROESOPHAGEAL REFLUX DISEASE 6,100 1,830 4,270 Oesophageal reflux NOS GASTROINTESTINAL DISORDERS OF THE P76.0 Meconium plug syndrome 11,700 3,510 8,190 NEWBORN GASTROINTESTINAL DISORDERS OF THE P76.1 Transitory ileus of newborn 11,700 3,510 8,190 NEWBORN

Page 37 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee GASTROINTESTINAL DISORDERS OF THE P76.8 Other specified intestinal obstruction of newborn 11,700 3,510 8,190 NEWBORN GASTROINTESTINAL DISORDERS OF THE P76.9 Intestinal obstruction of newborn, unspecified 11,700 3,510 8,190 NEWBORN GASTROINTESTINAL DISORDERS OF THE P77 Necrotizing enterocolitis of fetus and newborn 11,700 3,510 8,190 NEWBORN GASTROINTESTINAL DISORDERS OF THE P78.0 Perinatal intestinal perforation; Meconium 11,700 3,510 8,190 NEWBORN Neonatal haematemesis and melaena due to swallowed GASTROINTESTINAL DISORDERS OF THE P78.2 11,700 3,510 8,190 maternal blood NEWBORN GASTROINTESTINAL DISORDERS OF THE P78.3 Noninfective neonatal diarrhoea 11,700 3,510 8,190 NEWBORN Other specified perinatal digestive system disorders; GASTROINTESTINAL DISORDERS OF THE P78.8 11,700 3,510 8,190 Congenital cirrhosis of liver; Peptic ulcer of newborn NEWBORN GASTROINTESTINAL DISORDERS OF THE P78.9 Perinatal digestive system disorder, unspecified 11,700 3,510 8,190 NEWBORN H40.0 Glaucoma suspect; Ocular hypertension GLAUCOMA 6,500 1,950 4,550 Primary open-angle glaucoma; primary capsular with pseudoexfoliation of lens glaucoma; Residual stage capsular with pseudoexfoliation of lens; Primary chronic simple H40.1 glaucoma; Residual stage chronic simple glaucoma; Primary GLAUCOMA 6,500 1,950 4,550 low-tension glaucoma; Residual low tension glaucoma; Primary pigmentary glaucoma; Residual pigmentary glaucoma Primary angle-closure glaucoma; Primary acute angle- closure glaucoma ; Acute residual stage angle-closure glaucoma ; Primary chronic angle-closure glaucoma ; H40.2 GLAUCOMA 6,500 1,950 4,550 Residual stage chronic angle-closure glaucoma; Primary intermittent angle-cloure glaucoma; Residual intermittent angle-closure glaucoma H40.3 Glaucoma secondary to eye trauma GLAUCOMA 6,500 1,950 4,550 H40.4 Glaucoma secondary to eye inflammation GLAUCOMA 6,500 1,950 4,550 H40.5 Glaucoma secondary to other eye disorders GLAUCOMA 6,500 1,950 4,550 H40.8 Other glaucoma GLAUCOMA 6,500 1,950 4,550 H40.9 Glaucoma, unspecified GLAUCOMA 6,500 1,950 4,550

Acute nephritic syndrome including Acute glomerular N00.0 disease, Acute glomerulonephritis, Acute nephritis, Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS, with Minor glomerular abnormality

Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.1 renal disease NOS, with Focal and segmental glomerular GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 lesions (with focal and segmental hyalinosis; focal and segmental sclerosis) & Focal glomerulonephritis

Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS with Diffuse membranous glomerulonephritis Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.3 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS with Diffuse mesangial proliferative glomerulonephritis Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.4 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS with Diffuse endocapillary proliferative glomerulonephritis

Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.5 renal disease NOS with Diffuse mesangiocapillary GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 glomerulonephritis (Membranoproliferative glomerulonephritis, types 1 and 3, or NOS)

Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.7 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS with Diffuse crescentic glomerulonephritis (Extracpillary glomerulonephritis) Acute nephritic syndrome including Acute glomerular disease, Acute glomerulonephritis, Acute nephritis, Acute N00.8 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS with Other (Proliferative glomerulonephritis NOS) Acute nephritic syndrome including Acute glomerular N00.9 disease, Acute glomerulonephritis, Acute nephritis, Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 renal disease NOS, Unspecified renal

Page 38 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Rapidly progressive nephritic syndrome; rapidly progressive N01.0 glomerular disease; rapidly progressive glomerulonephritis; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 rapidly progressive nephritis, Minor glomerular abnormality

Rapidly progressive nephritic syndrome; rapidly progressive glomerular disease; rapidly progressive glomerulonephritis; N01.1 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 rapidly progressive nephritis, Focal and segmental glomerular lesions Rapidly progressive nephritic syndrome; rapidly progressive glomerular disease; rapidly progressive glomerulonephritis; N01.3 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 rapidly progressive nephritis, Diffuse mesangial proliferative glomerulonephritis Rapidly progressive nephritic syndrome; rapidly progressive glomerular disease; rapidly progressive glomerulonephritis; N01.5 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 rapidly progressive nephritis, Diffuse mesangiocapillary glomerulonephritis

Rapidly progressive nephritic syndrome; rapidly progressive N01.8 glomerular disease; rapidly progressive glomerulonephritis; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 rapidly progressive nephritis, other

Rapidly progressive nephritic syndrome; rapidly progressive N01.9 glomerular disease; rapidly progressive glomerulonephritis; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 rapidly progressive nephritis, Unspecified

Recurrent and persistent haematuria including Benign familial Haematuria; Benign familial Haematuria of N02.0 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 childhood; Haematuria with morphological lesion specified with Minor glomerular abnormality Recurrent and persistent haematuria including Benign familial Haematuria; Benign familial Haematuria of N02.1 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 childhood; Haematuria with morphological lesion specified with Focal and segmental glomerular lesions Recurrent and persistent haematuria including Benign familial Haematuria; Benign familial Haematuria of N02.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 childhood; Haematuria with morphological lesion specified with Diffuse membranous glomerulonephritis

Recurrent and persistent haematuria including Benign familial Haematuria; Benign familial Haematuria of N02.5 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 childhood; Haematuria with morphological lesion specified with Diffuse mesangiocapillary glomerulonephritis

Recurrent and persistent haematuria including Benign familial Haematuria; Benign familial Haematuria of N02.8 childhood; Haematuria with morphological lesion specified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 with other (Proliferative glomerulonephritis NOS) IgA Nephropathy

Recurrent and persistent haematuria including Benign familial Haematuria; Benign familial Haematuria of N02.9 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 childhood; Haematuria with morphological lesion specified with Unspecified renal biopsy Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.0 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Minor glomerular abnormality Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.1 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Focal and segmental glomerular lesions Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, withDiffuse membranous glomerulonephritis Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.3 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Diffuse mesangial proliferative glomerulonephritis Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.4 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Diffuse endocapillary proliferative glomerulonephritis Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.5 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Diffuse mesangiocapillary glomerulonephritis

Page 39 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.7 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Diffuse crescentic glomerulonephritis Chronic nephritic syndrome including Chronic glomerular disease, Chronic glomerulonephritis, Chronic nephritis, N03.8 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Other (Proliferative glomerulonephritis NOS)

Chronic nephritic syndrome including Chronic glomerular N03.9 disease, Chronic glomerulonephritis, Chronic nephritis, GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 chronic renal disease NOS, with Unspecified renal biopsy

Nephrotic syndrome: Minor glomerular abnormality; N04.0 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Minimal change lesion Nephrotic syndrome: Focal and segmental glomerular N04.1 lesions; Focal and segmental hyalinosis; Focal and GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 segmental sclerosis; Focal glomerulonephritis Nephrotic syndrome: Diffuse membranous N04.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 glomerulonephritis Nephrotic syndrome: Diffuse mesangial proliferative N04.3 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 glomerulonephritis Nephrotic syndrome: Diffuse endocapillary proliferative N04.4 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 glomerulonephritis Nephrotic syndrome: Diffuse mesangiocapillary N04.5 glomerulonephritis; Membranoproliferative GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 glomerulonephritis, types 1 and 3, or NOS Nephrotic syndrome: Diffuse crescentic glomerulonephritis; N04.7 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Extracapillary glomerulonephritis

N04.8 Nephrotic syndrome: Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

N04.9 Nephrotic syndrome:Unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

Unspecified nephritic syndrome including Glomerular N05.0 disease, Glomerulonephritis, Nephritis NOS with Minor GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 glomerular abnormality, minimal change lesion Unspecified nephritic syndrome including Glomerular disease, Glomerulonephritis, Nephritis NOS with Focal and N05.1 segmental glomerular lesions (with focal and segmental GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 hyalinosis; focal and segmental sclerosis) & Focal glomerulonephritis Unspecified nephritic syndrome including Glomerular N05.2 disease, Glomerulonephritis, Nephritis NOS with Diffuse GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 membranous glomerulonephritis Unspecified nephritic syndrome including Glomerular N05.3 disease, Glomerulonephritis, Nephritis NOS with Diffuse GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 mesangial proliferative glomerulonephritis Unspecified nephritic syndrome including Glomerular N05.4 disease, Glomerulonephritis, Nephritis NOS with Diffuse GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 endocapillary proliferative glomerulonephritis Unspecified nephritic syndrome including Glomerular disease, Glomerulonephritis, Nephritis NOS with Diffuse N05.5 mesangiocapillary glomerulonephritis, GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Membranoproliferative glomerulonephritis, types 1 and 3, or NOS Unspecified nephritic syndrome including Glomerular disease, Glomerulonephritis, Nephritis NOS with Dense N05.6 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 deposit disease Membranoproliferative glomerulonephritis, type 2 Unspecified nephritic syndrome including Glomerular disease, Glomerulonephritis, Nephritis NOS with Diffuse N05.7 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 crescentic glomerulonephritis, Extracapillary glomerulonephritis

Unspecified nephritic syndrome including Glomerular N05.8 disease, Glomerulonephritis, Nephritis NOS with Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 (Proliferative glomerulonephritis NOS)

Unspecified nephritic syndrome including Glomerular N05.9 disease, Glomerulonephritis, Nephritis NOS with GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Unspecified renal biopsy Isolated proteinuria with specified morphological lesion N06.0 with morphological lesion specified with Minor glomerular GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 abnormality Isolated proteinuria with specified morphological lesion N06.8 with Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 (Proliferative glomerulonephritis NOS) Isolated proteinuria with specified morphological lesion N06.9 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 with Unspecified renal biopsy

Page 40 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Hereditary nephropathy, not elsewhere classified with N07.0 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Minor glomerular abnormality Hereditary nephropathy, not elsewhere classified with Focal and segmental glomerular lesions (with focal and N07.1 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 segmental hyalinosis; focal and segmental sclerosis) & Focal glomerulonephritis Hereditary nephropathy, not elsewhere classified with N07.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Diffuse membranous glomerulonephritis Hereditary nephropathy, not elsewhere classified with N07.3 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Diffuse mesangial proliferative glomerulonephritis Hereditary nephropathy, not elsewhere classified with Diffuse mesangiocapillary glomerulonephritis, N07.5 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Membranoproliferative glomerulonephritis, types 1 and 3, or NOS Hereditary nephropathy, not elsewhere classified with N07.9 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Unspecified renal biopsy Acute tubulo-interstitial nephritis; pyelonephritis; Acute N10 infectious interstitial nephritis; Acute pyelitis; Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 pyelonephritis Chronic tubulo-interstitial nephritis, unspecified; Chronic N11.9 interstitial nephritis NOS; Chronic pyelitis NOS; Chronic GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 pyelonephritis NOS Tubulo-interstitial nephritis, not specified as acute or N12 chronic; Interstitial nephritis NOS; Pyelitis NOS; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 Pyelonephritis NOS

N14.0 Analgesic nephropathy GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

Nephropathy induced by other drugs, medicaments and N14.1 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 biological substances Nephropathy induced by unspecified drug, medicament or N14.2 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 biological substance

N14.4 Toxic nephropathy, not elsewhere classified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

N15.0 Balkan nephropathy; Balkan endemic nephropathy GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

N15.8 Other specified renal tubulo-interstitial diseases GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

Renal tubulo-interstitial disease, unspecified; Infection of N15.9 GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000 kidney NOS

N39.1 Persistent proteinuria, unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

N39.2 Orthostatic proteinuria, unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000

Derangement of meniscus due to old tear or injury; Old M23.20 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 bucket-handle tear multiple sites Derangement of meniscus due to old tear or injury; Old M23.21 bucket-handle tear Anterior cruciate ligament or Anterior HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 horn of medial meniscus Derangement of meniscus due to old tear or injury; Old M23.22 bucket-handle tear Posterior cruciate ligament or Posterior HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 horn of medial meniscus

Derangement of meniscus due to old tear or injury; Old M23.25 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 bucket-handle tear Posterior horn of lateral meniscus

M23.46 Loose body in knee Other and unspecified lateral meniscus HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440

M23.5 Chronic instability of knee HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 Other internal derangements of knee; Laxity of ligament of M23.80 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 knee; Snapping knee multiple sites M23.9 Internal derangement of knee, unspecified HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 Internal derangement of knee, unspecified Anterior M23.91 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 cruciate ligament or Anterior horn of medial meniscus M24.08 Loose body in joint other sites HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.1 Other articular cartilage disorders HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 Disorder of ligament; Instability secondary to old ligament M24.2 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 injury; Ligamentous laxity NOS M24.4 Recurrent dislocation and subluxation of joint HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 Recurrent dislocation and subluxation of joint shoulder M24.41 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 region M24.50 Contracture of joint multiple sites HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.54 Contracture of joint hand HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.56 Contracture of joint lower leg HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.6 Ankylosis of joint HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.65 Ankylosis of joint pelvic region and thigh HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.66 Ankylosis of joint lower leg HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.69 Ankylosis of joint site unspecified HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 M24.7 Protrusio acetabuli HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440

Page 41 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other specific joint derangements, not elsewhere classified; M24.88 HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440 Irritable hip other sites G43.0 Migraine without aura [common migraine] HEADACHE SYNDROMES 5,500 1,650 3,850 Migraine with aura [classical migraine]; Migraine aura without headache; Migraine, basilar; Migraine equivalents; G43.1 Familial hemiplegic Migraine; Migraine with acute-onset HEADACHE SYNDROMES 5,500 1,650 3,850 aura; Migraine with prolonged aura; Migraine with typical aura G43.2 Status migrainosus HEADACHE SYNDROMES 5,500 1,650 3,850 G43.3 Complicated migraine HEADACHE SYNDROMES 5,500 1,650 3,850 Other migraine; Ophthalmoplegic migraine; Retinal G43.8 HEADACHE SYNDROMES 5,500 1,650 3,850 migraine G43.9 Migraine, unspecified HEADACHE SYNDROMES 5,500 1,650 3,850 Cluster headache syndrome; Chronic paroxysmal G44.0 hemicrania; Chronic cluster headache; Episodic Cluster HEADACHE SYNDROMES 5,500 1,650 3,850 headache Vascular headache, not elsewhere classified; Vascular G44.1 HEADACHE SYNDROMES 5,500 1,650 3,850 headache NOS

Tension-type headache; Chronic tension-type headache; G44.2 HEADACHE SYNDROMES 5,500 1,650 3,850 Episodic tension headache; Tension headache NOS

G44.3 Chronic post-traumatic headache HEADACHE SYNDROMES 5,500 1,650 3,850 G44.4 Drug-induced headache, not elsewhere classified HEADACHE SYNDROMES 5,500 1,650 3,850 G44.8 Other specified headache syndromes HEADACHE SYNDROMES 5,500 1,650 3,850 R51 Headache; Facial pain NOS HEADACHE SYNDROMES 5,500 1,650 3,850 Atrioventricular block, complete; Complete heart block I44.2 HEART CONDUCTION DISORDERS 12,300 3,690 8,610 NOS; Third-degree block Other and unspecified atrioventricular block; I44.3 HEART CONDUCTION DISORDERS 12,300 3,690 8,610 Atrioventricular block NOS I44.4 Left anterior fascicular block HEART CONDUCTION DISORDERS 12,300 3,690 8,610 Other specified heart blockl; Sinoatrial NOS; Sinoauricular I45.5 HEART CONDUCTION DISORDERS 12,300 3,690 8,610 block Pre-excitation syndrome; Anomalous atrioventicular excitation; Atrioventricular conduction, accelerated; I45.6 Atrioventicular conduction, accesory; Atrioventicular HEART CONDUCTION DISORDERS 12,300 3,690 8,610 conduction pre-excitation; Lown-Ganong-Levine syndrome; Wolff-Parkinson-White syndrome Other specified conduction disorder; Atrioventricular [AV] I45.8 HEART CONDUCTION DISORDERS 12,300 3,690 8,610 dissociation; Interference dissociation Heart conduction disorders, unspecified; Heart block NOS; I45.9 HEART CONDUCTION DISORDERS 12,300 3,690 8,610 Stokes-Adams syndrome Rheumatic heart disease, unspecified; Rheumatic carditis; I09.9 HEART FAILURE 15,700 4,710 10,990 Rheumatic heart failure Congestive heart failure; Congestive heart disease; Right I50.0 HEART FAILURE 15,700 4,710 10,990 venticular failure (secondary to left heart failure) Left ventricular failure; Acute oedema of lung with mention of heart disease NOS or heart failure; Acute pulmonary oedema with mention of heart disease NOS or heart failure; I50.1 HEART FAILURE 15,700 4,710 10,990 Cardiac asthma with mention of heart disease NOS or heart failure; Left heart failure with mention of heart disease NOS or heart failure Heart failure, unspecified; Cardiac, heart or myocardial I50.9 HEART FAILURE 15,700 4,710 10,990 failure NOS

Mitral (valve) insufficiency; Incompetence mitral valve NOS I34.0 or of specified cause, except rheumatic; Regurgitation HEART VALVE DISORDERS 8,400 2,520 5,880 mitral valve NOS or of specified cause, except rheumatic

I34.1 Mitral (valve) prolapse; Floppy mitral valve syndrome HEART VALVE DISORDERS 8,400 2,520 5,880 I34.2 Nonrheumatic mitral (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880 I34.8 Other nonrheumatic mitral heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880 I34.9 Nonrheumatic mitral valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880 I35.0 Aortic (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880

Aortic (valve) insufficiency; Incompetence Aortic valve NOS I35.1 or of specified cause, except rheumatic; Aortic valve HEART VALVE DISORDERS 8,400 2,520 5,880 regurgitation NOS or of specified cause, except rheumatic

I35.2 Aortic (valve) stenosis with insufficiency HEART VALVE DISORDERS 8,400 2,520 5,880 I35.8 Other aortic heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880 I35.9 Aortic valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880 I36.0 Nonrheumatic tricuspid (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880 Nonrheumatic tricuspid (valve) insufficiency; Incompetence tricuspid valve of specified cause, except rheumatic; I36.1 HEART VALVE DISORDERS 8,400 2,520 5,880 Tricuspid valve regurgitation of specified cause, except rheumatic I36.8 Other nonrheumatic tricuspid valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880 I36.9 Nonrheumatic tricuspid valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880 I37.0 Pulmonary valve stenosis HEART VALVE DISORDERS 8,400 2,520 5,880

Page 42 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Pulmonary valve insufficiency; Incompetence pulmonary valve NOS or specified cause, except rheumatic; Pulmonary I37.1 HEART VALVE DISORDERS 8,400 2,520 5,880 valve regurgitation NOS or of specified cause, except rheumatic I37.8 Other pulmonary heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880 I37.9 Pulmonary valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880 Heat stroke and sunstroke; Heat apoplexy; Heat pyrexia; T67.0 HEAT EXHAUSTION 6,500 1,950 4,550 Siriasis; Thermoplegia T67.1 Heat syncope; Heat collapse HEAT EXHAUSTION 6,500 1,950 4,550 T67.2 Heat cramp HEAT EXHAUSTION 6,500 1,950 4,550 Heat exhaustion, anhydrotic; Heat prostration due to water T67.3 HEAT EXHAUSTION 6,500 1,950 4,550 depletion Heat exhaustion due to salt depletion; Heat prostation due T67.4 HEAT EXHAUSTION 6,500 1,950 4,550 to salt (and water) depletion T67.5 Heat exhaustion, unspecified; Heat prostration NOS HEAT EXHAUSTION 6,500 1,950 4,550 T67.9 Effect of heat and light, unspecified HEAT EXHAUSTION 6,500 1,950 4,550 M25.00 Haemarthrosis multiple sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.01 Haemarthrosis shoulder region HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.05 Haemarthrosis pelvic region and thigh HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.06 Haemarthrosis lower leg HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.07 Haemarthrosis ankle and foot HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.08 Haemarthrosis other sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.09 Haemarthrosis site unspecified HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.38 Other instability of joint other sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.40 Effusion of joint multiple sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.41 Effusion of joint shoulder region HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.46 Effusion of joint lower leg HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 M25.47 Effusion of joint ankle and foot HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460 D59.3 Haemolytic-uraemic syndrome HEMOLYTIC UREMIC SYNDROME 20,200 6,060 14,140 Delayed or excessive haemorrhage following abortion and HEMORRHAGE IN PREGNANCY AND POST O08.1 ectopic and molar pregnancy; Afibrinogenaemia; 7,000 2,100 4,900 PARTUM PERIOD Defibrination syndrome; Intravascular coagulation Third-stage haemorrhage; Haemorrhage associated with HEMORRHAGE IN PREGNANCY AND POST O72.0 retained, trapped or adherent placenta; Retained placenta 7,000 2,100 4,900 PARTUM PERIOD NOS Other immediate postpartum haemorrhage; Haemorrhage HEMORRHAGE IN PREGNANCY AND POST O72.1 following delivery of placenta; Postpartum atomic 7,000 2,100 4,900 PARTUM PERIOD haemorrhage NOS Delayed and secondary postpartum haemorrhage; Haemorrhage associated with retained portions of placenta HEMORRHAGE IN PREGNANCY AND POST O72.2 7,000 2,100 4,900 or membranes; Retained products of concepcion NOS, PARTUM PERIOD following delivery Postpartum coagulation defects; Afibrinogenaemia HEMORRHAGE IN PREGNANCY AND POST O72.3 7,000 2,100 4,900 postpartum; Fibrinolysis postpartum PARTUM PERIOD Retained placenta without haemorrhage; Placenta accreta HEMORRHAGE IN PREGNANCY AND POST O73.0 7,000 2,100 4,900 without haemorrhage PARTUM PERIOD Retained portions of placenta and membranes without HEMORRHAGE IN PREGNANCY AND POST O73.1 haemorrhage; Retained products of conception following 7,000 2,100 4,900 PARTUM PERIOD delivery, without haemorrhage HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P50.0 Fetal blood loss from vasa praevia 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P50.1 Fetal blood loss from ruptured cord 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P50.2 Fetal blood loss from placenta 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P50.9 Fetal blood loss, unspecified; Fetal haemorrhage NOS 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P51.9 Umbilical haemorrhage of newborn, unspecified 7,800 2,340 5,460 THE NEWBORN Haemorrhagic disease of fetus and newborn; Vitamin K HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P53 7,800 2,340 5,460 deficiency of newborn THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.0 Neonatal haematemesis 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.2 Neonatal rectal haemorrhage 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.3 Other neonatal gastrointestinal haemorrhage 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.4 Neonatal adrenal haemorrhage 7,800 2,340 5,460 THE NEWBORN Neonatal cutaneous haemorrhage; Bruising in fetus or newborn; Ecchymoses in fetus or newborn; Petechiae in HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.5 7,800 2,340 5,460 fetus or newborn; Superficial haematomata in fetus or THE NEWBORN newborn HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.6 Neonatal vaginal haemorrhage; Pseudomenses 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.8 Other specified neonatal haemorrhages 7,800 2,340 5,460 THE NEWBORN

Page 43 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P54.9 Neonatal haemorrhage, unspecified 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P55.0 Rh isoimmunization of fetus and newborn 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P55.1 ABO isoimmunization of fetus and newborn 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P55.8 Other haemolytic diseases of fetus and newborn 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P55.9 Haemolytic disease of fetus and newborn, unspecified 7,800 2,340 5,460 THE NEWBORN Transient neonatal thrombocytopenia; neonatal thrombocytopenia due to exchange transfusion; Neonatal HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P61.0 thrombocytopenia due to idiophatic maternal 7,800 2,340 5,460 THE NEWBORN thrombocytopenia; Neonatal thrombocytopenia due to isoimmunization HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P61.1 Polycythaemia neonatorum 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P61.5 Transient neonatal neutropenia 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P61.6 Other transient neonatal disorders of coagulation 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P61.8 Other specified perinatal haematological disorders 7,800 2,340 5,460 THE NEWBORN HEMORRHAGIC AND HEMATOLOGIC DISEASES OF P61.9 Perinatal haematological disorder, unspecified 7,800 2,340 5,460 THE NEWBORN Hereditary factor VIII deficiency; Deficiency factor VIII (with D66 functional defect); Haemophilia NOS; Haemophilia A; HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Classical Haemophilia

Hereditary factor IX deficiency; Christmas disease; Factor IX D67 Deficiency (with functional defect); Plasma thromboplastin HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 component [PTC] Deficiency; Haemophilia B

Von Willebrand's disease; Angiohaemophilia; Factor VIII D68.0 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 deficiency with vascular defect; Vascular haemophilia

Hereditary factor XI deficiency; Haemophilia C Plasma D68.1 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 thromoplastin antecedent [PTA] deficiency

Hereditary deficiency of other clotting factors; Congenital afibrinogenaemia; AC globulin Deficiency; Proaccelerin Deficiency; Deficiency of factor I [fibrinogen]; Deficiency of factor II [prothrombin]; Deficiency of factor V [labile]; D68.2 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Deficiency of factor VII [stable]; Deficiency of factor X [Stuart-Prower]; Deficiency of XII [hageman]; XIII [fibrin- stabilizing]; Congenital dysfibrinogenaemia; Hypoproconvertinaemia; Owren's disease

Haemorrhagic disorder due to circulating ; Haemorrhage during long term use of anticoagulants; D68.3 Hyperheparinaemia; Increase in antithrombin; Increase in HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 anti-VIIIa; Increase in anti-Ixa; Increase in anti-Xa; Increase in anti-Xia Acquired coagulation factor deficiency; Deficiency of D68.4 coagulation factor due to ; Deficiency of HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 coagulation factor due to vitamin K deficiency Other specified coagulation defects; Presence of systemic D68.8 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 lupus erythematosus [SLE] inhibitor D68.9 Coagulation defect, unspecified HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Allergic purpura; Anaphylactoid Purpura; Henoch(- Schönlein) Purpura; Nonthrombocytopenic Purpura; D69.0 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Haemorrhagic Purpura; Idiopathic Purpura; Vascular Purpura; AllergicVasculitis Qualitative platelet defects; Bernard-Soulier [giant platelet] syndrome; Glanzmann's disease; Grey platelet syndrome; D69.1 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Haemorrhagic Thromboasthenia; Hereditary Thromboasthenia; Thrombocytopathy ; Other nonthrombocytopenic purpura; Purpura NOS; Senile D69.2 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Purpura; Simplex Purpura

D69.3 Idiopathic thrombocytopenic purpura; Evans' syndrome HEMORRHAGIC CONDITIONS 12,800 3,840 8,960

Other specified haemorrhagic conditions; Hereditary D69.8 HEMORRHAGIC CONDITIONS 12,800 3,840 8,960 Capillary fragility; Vascular pseudohaemophilia Alcoholic hepatic failure; Alcoholic hepatic failure NOS; Acute alcoholic hepatic failure; Chronic alcoholic hepatic K70.4 HEPATIC FAILURE 20,600 6,180 14,420 failure; Subacute alcoholic hepatic failure; Alcoholic hepatic failure with or without hepatic coma Acute and subacute hepatic failure K72.0 HEPATIC FAILURE 20,600 6,180 14,420 Acute

Page 44 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee K72.1 Chronic hepatic failure HEPATIC FAILURE 20,600 6,180 14,420 Hepatic failure, unspecified K72.9 HEPATIC FAILURE 20,600 6,180 14,420 Liver necrosis

O01.0 Classical hydatidiform mole; Complete hydatidiform mole HYDATIDIFORM MOLE 6,600 1,980 4,620

O01.1 Incomplete and partial hydatidiform mole HYDATIDIFORM MOLE 6,600 1,980 4,620 Hydatidiform mole, unspecified; Trophoblastic disease O01.9 HYDATIDIFORM MOLE 6,600 1,980 4,620 NOS; Vesicular mole NOS G91.0 Communicating hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110 G91.1 Obstructive hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110 G91.2 Normal-pressure hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110 G91.3 Post-traumatic hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110 G91.8 Other hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110 G91.9 Hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110 Q03.8 Other congenital hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110 Q03.9 Congenital hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110 P56.0 Hydrops fetalis due to isoimmunization HYDROPS FETALIS 7,400 2,220 5,180 Hydrops fetalis due to other and unspecified haemolytic P56.9 HYDROPS FETALIS 7,400 2,220 5,180 disease Hydrops fetalis not due to haemolytic disease; Hydrops P83.2 HYDROPS FETALIS 7,400 2,220 5,180 fetalis NOS I10.1 Hypertension, stage 2 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 Hypertension I10.9 Essential hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 Malignant hypertension Hypertensive heart disease with (congestive) heart failure; I11.0 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 Hypertensive heart failure Hypertensive heart disease without (congestive) heart I11.9 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 failure; Hypertensive heart disease NOS Hypertensive renal disease with renal failure; Hypertensive I12.0 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 renal failure Hypertensive renal disease without renal failure; I12.9 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 Hypertensive renal disease NOS Hypertensive heart and renal disease with (congestive) I13.0 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 heart failure I13.1 Hypertensive heart and renal disease with renal failure HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 Hypertensive heart and renal disease with both I13.2 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 (congestive) heart failure and renal failure I13.9 Hypertensive heart and renal disease, unspecified HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 I15.0 Renovascular hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 I15.1 Hypertension secondary to other renal disorders HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 I15.2 Hypertension secondary to endocrine disorders HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 I15.8 Other secondary hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 I15.9 Secondary hypertension, unspecified HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300 Thyrotoxicosis with diffuse goitre; Exophthalmic or toxic E05.0 HYPERTHYROIDISM 8,500 2,550 5,950 goitre NOS; Graves' disease; Toxic diffuse goitre Thyrotoxicosis with toxic single thyroid nodule; E05.1 HYPERTHYROIDISM 8,500 2,550 5,950 Thyrotoxicosis with toxic uninodular goitre Thyrotoxicosis with toxic multinodular goitre; Toxic nodular goitre NOS E05.2 HYPERTHYROIDISM 8,500 2,550 5,950 Thyroid nodules with hyperthyroidism Toxic thyroid nodules E05.3 Thyrotoxicosis from ectopic thyroid tissue HYPERTHYROIDISM 8,500 2,550 5,950 E05.4 Thyrotoxicosis factitia HYPERTHYROIDISM 8,500 2,550 5,950 E05.5 Thyroid crisis or storm HYPERTHYROIDISM 8,500 2,550 5,950 Other thyrotoxicosis; Overproduction of thyroid-stimulating E05.8 HYPERTHYROIDISM 8,500 2,550 5,950 hormone Thyrotoxicosis, unspecified; Hyperthyroidism NOS; E05.9 HYPERTHYROIDISM 8,500 2,550 5,950 Thyroiditis E01.0 Iodine-deficiency-related diffuse (endemic) goitre HYPOTHYROIDISM 8,100 2,430 5,670 Iodine-deficiency-related multinodular (endemic) goitre; E01.1 HYPOTHYROIDISM 8,100 2,430 5,670 Iodine-deficiency-related nodular goitre E01.2 Iodine-deficiency-related (endemic) goitre, unspecified HYPOTHYROIDISM 8,100 2,430 5,670

Other iodine-deficiency-related thyroid disorders and allied E01.8 HYPOTHYROIDISM 8,100 2,430 5,670 conditions; Acquired iodine-deficiency hypothyroidism NOS

E02 Subclinical iodine-deficiency hypothyroidism HYPOTHYROIDISM 8,100 2,430 5,670 Hypothyroidism due to medicaments and other exogenous E03.2 HYPOTHYROIDISM 8,100 2,430 5,670 substances E03.5 Myxoedema coma HYPOTHYROIDISM 8,100 2,430 5,670 E03.8 Other specified hypothyroidism HYPOTHYROIDISM 8,100 2,430 5,670 E03.9 Hypothyroidism, unspecified; HYPOTHYROIDISM 8,100 2,430 5,670 Hereditary hypogammaglobulinaemia; Autosomal recessive agammaglobulinaemia (Swiss type); X-linked D80.0 IMMUNODEFICIENCY 11,600 3,480 8,120 agammaglobulinaemia [Bruton] (with growth hormone deficiency) D80.2 Selective deficiency of immunoglobulin A [IgA] IMMUNODEFICIENCY 11,600 3,480 8,120

Page 45 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee D80.7 Transient hypogammaglobulinaemia of infancy IMMUNODEFICIENCY 11,600 3,480 8,120 Other immunodeficiencies with predominantly D80.8 IMMUNODEFICIENCY 11,600 3,480 8,120 defects; Kappa light chain deficiency Immunodeficiency with predominantly antibody defects, D80.9 IMMUNODEFICIENCY 11,600 3,480 8,120 unspecified Severe combined immunodeficiency [SCID] with low T- and D81.1 IMMUNODEFICIENCY 11,600 3,480 8,120 B-cell numbers Major histocompatibility complex class I deficiency; Bare D81.6 IMMUNODEFICIENCY 11,600 3,480 8,120 lymphocyte syndrome Combined immunodeficiency, unspecified; Severe D81.9 IMMUNODEFICIENCY 11,600 3,480 8,120 combined immunodeficiency disorder [SCID] NOS Wiskott-Aldrich syndrome; Immunodeficiency with D82.0 IMMUNODEFICIENCY 11,600 3,480 8,120 thrombocytopenia and eczema Di George's syndrome; Pharyngeal pouch syndrome; D82.1 Thymic alymphoplasia; Thymic aplasia or hypoplasia with IMMUNODEFICIENCY 11,600 3,480 8,120 immunodeficiency

Immunodeficiency following hereditary defective response D82.3 IMMUNODEFICIENCY 11,600 3,480 8,120 to Epstein-Barr virus; X-linked lymphoproliferative disease

D82.4 Hyperimmunoglobulin E [IgE] syndrome IMMUNODEFICIENCY 11,600 3,480 8,120 Immunodeficiency associated with major defect, D82.9 IMMUNODEFICIENCY 11,600 3,480 8,120 unspecified

Common variable immunodeficiency with predominant D83.0 IMMUNODEFICIENCY 11,600 3,480 8,120 abnormalities of B-cell numbers and function

Common variable immunodeficiency with predominant D83.1 IMMUNODEFICIENCY 11,600 3,480 8,120 immunoregulatory T-cell disorders D83.9 Common variable immunodeficiency, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120 D84.8 Other specified immunodeficiencies IMMUNODEFICIENCY 11,600 3,480 8,120 D84.9 Immunodeficiency, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120 D86.1 Sarcoidosis of lymph nodes IMMUNODEFICIENCY 11,600 3,480 8,120 Sarcoidosis of other and combined sites; Uveoparotid fever D86.8 IMMUNODEFICIENCY 11,600 3,480 8,120 [Heerfordt] D86.9 Sarcoidosis, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120 Polyclonal hypergammaglobulinaemia; Benign D89.0 hypergammaglobulinaemic purpura; Polyclonal IMMUNODEFICIENCY 11,600 3,480 8,120 gammopathy NOS

Cryoglobulinaemia; Essential Cryoglobulinaemia; Idiopathic Cryoglobulinaemia; Mixed Cryoglobulinaemia; Primary D89.1 IMMUNODEFICIENCY 11,600 3,480 8,120 Cryoglobulinaemia; Secondary Cryoglobulinaemia; Cryoglobulinaemic purpura; Cryoglobulinaemic vasculitis

D89.2 Hypergammaglobulinaemia, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120 Other specified disorders involving the immune D89.8 IMMUNODEFICIENCY 11,600 3,480 8,120 mechanism, not elsewhere classified Disorder involving the immune mechanism, unspecified; D89.9 IMMUNODEFICIENCY 11,600 3,480 8,120 Immune disease NOS Leukoplakia of penis; Balanitis xerotica obliterans; Kraurosis INFLAMMATION/INFECTION OF THE MALE N48.0 9,000 2,700 6,300 of penis GENITAL TRACT INFLAMMATION/INFECTION OF THE MALE N48.1 Balanoposthitis; Balanitis 9,000 2,700 6,300 GENITAL TRACT

Other inflammatory disorders of penis; Abscess of corpus cavernosum and penis; Boil of corpus cavernosum and INFLAMMATION/INFECTION OF THE MALE N48.2 penis; Carbuncle of corpus cavernosum and penis; Cellulitis 9,000 2,700 6,300 GENITAL TRACT of corpus cavernosum and penis; Cavernitis (penis) of corpus cavernosum and penis

INFLAMMATION/INFECTION OF THE MALE N48.5 Ulcer of penis 9,000 2,700 6,300 GENITAL TRACT Induratio penis plastica; Peyronie's disease; Plastic INFLAMMATION/INFECTION OF THE MALE N48.6 9,000 2,700 6,300 induration of penis GENITAL TRACT INFLAMMATION/INFECTION OF THE MALE N49.0 Inflammatory disorders of seminal vesicle; Vesiculitis NOS 9,000 2,700 6,300 GENITAL TRACT Inflammatory disorders of spermatic cord, tunica vaginalis INFLAMMATION/INFECTION OF THE MALE N49.1 9,000 2,700 6,300 and vas deferens; Vasitis GENITAL TRACT INFLAMMATION/INFECTION OF THE MALE N49.2 Inflammatory disorders of scrotum 9,000 2,700 6,300 GENITAL TRACT Inflammatory disorders of other specified male genital INFLAMMATION/INFECTION OF THE MALE N49.8 organs; Inflammation of multiple sites in male genital 9,000 2,700 6,300 GENITAL TRACT organs Inflammatory disorder of unspecified male genital organ; Abscess of unspecified male genital organ; Boil of INFLAMMATION/INFECTION OF THE MALE N49.9 unspecified male genital organ; Carbuncle of unspecified 9,000 2,700 6,300 GENITAL TRACT male genital organ; Cellulitis of unspecified male genital organ

Page 46 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Crohn's disease of small intestine; Crohn's disease [regional enteritis] of duodenum; Crohn's disease [regional enteritis] K50.0 INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 of ileum; Crohn's disease [regional enteritis] of jejunum; Regional ileitis; Terminal ileitis

Crohn's disease of large intestine; Granulomatous colitis; Regional colitis; Crohn's disease [regional enteritis] of K50.1 INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 colon; Crohn's disease [regional enteritis] of large bowel; Crohn's disease [regional enteritis] of rectum

Other Crohn's disease; Crohn's disease of both small and K50.8 INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 large intestine Crohn's disease [regional enteritis], unspecified; Crohn's K50.9 disease NOS; Regional enteritis NOS; Granulomatous INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 enteritis NOS K51.0 Ulcerative (chronic) enterocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 K51.1 Ulcerative (chronic) ileocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 K51.2 Ulcerative (chronic) INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 K51.3 Ulcerative (chronic) rectosigmoiditis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 K51.5 Mucosal INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 K51.8 Other INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 K51.9 Ulcerative colitis, unspecified; Ulcerative enteritis NOS INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370 Acute disseminated encephalitis; Postimmunization INFLAMMATORY DISEASE OF THE CENTRAL G04.0 21,600 6,480 15,120 [Encephalitis; Postimmunization Encephalomyelitis NERVOUS SYSTEM INFLAMMATORY DISEASE OF THE CENTRAL G04.1 Tropical spastic paraplegia 21,600 6,480 15,120 NERVOUS SYSTEM Bacterial meningoencephalitis and meningomyelitis, not INFLAMMATORY DISEASE OF THE CENTRAL G04.2 21,600 6,480 15,120 elsewhere classified NERVOUS SYSTEM Other encephalitis, myelitis and encephalomyelitis; INFLAMMATORY DISEASE OF THE CENTRAL G04.8 21,600 6,480 15,120 Postinfectious encephalitis and encephalomyelitis NOS NERVOUS SYSTEM Encephalitis, myelitis and encephalomyelitis, unspecified; INFLAMMATORY DISEASE OF THE CENTRAL G04.9 21,600 6,480 15,120 Ventriculitis (cerebral) NOS NERVOUS SYSTEM Encephalitis, myelitis and encephalomyelitis in other INFLAMMATORY DISEASE OF THE CENTRAL G05.8* 21,600 6,480 15,120 diseases classified elsewhere NERVOUS SYSTEM Intracranial and intraspinal abscess and grauloma in INFLAMMATORY DISEASE OF THE CENTRAL G07* 21,600 6,480 15,120 diseases classified elsewhere NERVOUS SYSTEM Intracranial and intraspinal phlebitis and thrombophlebitis; Septic [embolism, endophlebitis, phlebitis, INFLAMMATORY DISEASE OF THE CENTRAL G08 21,600 6,480 15,120 thrombophlebitis, thrombosis] of intracranial or intraspinal NERVOUS SYSTEM venous sinuses and veins

Measles complicated by encephalitis; Encephalitis, myelitis INFLAMMATORY DISEASE OF THE CENTRAL B05.0+ G05.1* 21,600 6,480 15,120 and encephalomyelitis in viral diseases classified elsewhere NERVOUS SYSTEM

I30.0 Acute nonspecific idiopathic pericarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080

Infective pericarditis; Pneumococcal pericarditis; Purulent I30.1 pericarditis; Staphylococcal pericarditis; Streptococcal INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 pericarditis; Viral pericarditis; Pyopericarditis

I30.8 Other forms of acute pericarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 I30.9 Acute pericarditis, unspecified INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080

Chronic adhesive pericarditis; Accretio cordis; Adherent I31.0 INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 pericardium; Adhesive mediastinopericarditis

Chronic constrictive pericarditis; Concretio cordis; I31.1 INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 Pericardial calcification

Acute and subacute infective endocarditis; Acute bacterial endocarditis; Subacute bacterial endocarditis; Acute infective endocarditis NOS; Subacute infective endocarditis NOS; Acute lenta endocarditis; Subacute lenta endocarditis; I33.0 INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 Acute malignant endocarditis; Subacute malignant endocarditis; Acute septic endocarditis; Subacute septic endocarditis; Acute ulcerative endocarditis; Subacute ulcerative endocarditis

Acute endocarditis, unspecified; Endocarditis, acute or I33.9 subacute; Myoendocarditis, acute or subacute; INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 Periendocarditis, acute or subacute

Endocarditis, valve unspecified; Chronic Endocarditis NOS; Valvular incompetence of unspecified valve NOS or of specified cause, except rheumatic or congenital; Valvular insufficiency of unspecified valve NOS or of specified cause, except rheumatic or congenital; Valvular regurgitation of I38 INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 unspecified valve NOS or of specified cause, except rheumatic or congenital; Valvular stenosis of unspecified valve NOS or of specified cause, except rheumatic or congenital; Chronic valvulitis of unspecified valve NOS or of specified cause, except rheumatic or congenital

Page 47 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee I40.0 Infective myocarditis; Septic myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 I40.1 Isolated myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 I40.8 Other acute myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 I40.9 Acute myocarditis, unspecified INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080 Influenza due to identified zoonotic or pandemic influenza virus; Influenza caused by influenza virus strains of special J09 INFLUENZA 6,600 1,980 4,620 epidemiological importance with an animal-human or inter- human transimission Influenza with pneumonia, seasonal influenza virus J10.0 identified; Influenzal (broncho)pneumonia, other influenza INFLUENZA 6,600 1,980 4,620 virus identified Influenza with other respiratory manifestations, seasonal influenza virus identified; Influenza; Influenzal acute upper respiratory infection, seasonal influenza virus identified; J10.1 Influenzal laryngitis, seasonal influenza virus identified; INFLUENZA 6,600 1,980 4,620 Influenzal pharyngitis, seasonal influenza virus identified; Influenzal pleural effusion, seasonal influenza virus identified

Influenza with other manifestations, seasonal influenza virus identified; Encephalopathy due to influenza, seasonal J10.8 influenza virus identified; Influenzal gastroenteritis, INFLUENZA 6,600 1,980 4,620 seasonal influenza virus identified; Influenzal myocarditis (acute), seasonal influenza virus identified

Influenza with pneumonia, virus not identified; Influenzal J11.0 (broncho) pneumonia, unspecified or specific virus not INFLUENZA 6,600 1,980 4,620 identified Influenza with other respiratory manifestations, virus not identified; Influenza NOS; Influenzal Acute upper respiratory infection, unspecified or specific virus not J11.1 identified; Influenzal laryngitis, unspecified or specific virus INFLUENZA 6,600 1,980 4,620 not identified; Influenzal pharyngitis, unspecified or specific virus not identified; Influenzal pleural effusion, unspecified or specific virus not identified

Influenza with other manifestations, virus not identified; Encephalopathy due to influenza, unspecified or specific J11.8 virus not identified; Influenzal gastroentiritis, unspecified or INFLUENZA 6,600 1,980 4,620 specific virus not identified; Acute influenzal myocarditis, unspecified or specific virus not identified

J11.8+ I41.1* Influenzal myocarditis (acute), virus not identified INFLUENZA 6,600 1,980 4,620 INJURIES DUE TO ENVIRONMENTAL AND OTHER T66 Unspecified effects of radiation 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES INJURIES DUE TO ENVIRONMENTAL AND OTHER T67.6 Heat fatigue, transient 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES INJURIES DUE TO ENVIRONMENTAL AND OTHER T67.8 Other effects of heat and light 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES INJURIES DUE TO ENVIRONMENTAL AND OTHER T68 Hypothermia 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES INJURIES DUE TO ENVIRONMENTAL AND OTHER T69.0 Immersion hand and foot; Trench foot 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES INJURIES DUE TO ENVIRONMENTAL AND OTHER T69.9 Effect of reduced temperature, unspecified 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES Otitic barotrauma; Aero-otitis media; Effects of change in INJURIES DUE TO ENVIRONMENTAL AND OTHER T70.0 ambient atmospheric pressure or water pressure on ears/ 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES on sinuses Other and unspecified effects of high altitude; Alpine INJURIES DUE TO ENVIRONMENTAL AND OTHER T70.2 sickness; Anoxia due to high altitude; Barotrauma NOS; 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES Hypobaropathy; Mountain sickness Caisson disease [decompression sickness]; Compressed-air INJURIES DUE TO ENVIRONMENTAL AND OTHER T70.3 9,300 2,790 6,510 disease; Diver's palsy or paralysis EXTERNAL FACTORS CAUSES Effects of high-pressure fluids; Traumatic jet injection INJURIES DUE TO ENVIRONMENTAL AND OTHER T70.4 9,300 2,790 6,510 (industrial) EXTERNAL FACTORS CAUSES Other effects of air pressure and water pressure; Blast INJURIES DUE TO ENVIRONMENTAL AND OTHER T70.8 9,300 2,790 6,510 injury syndrome EXTERNAL FACTORS CAUSES INJURIES DUE TO ENVIRONMENTAL AND OTHER T70.9 Effect of air pressure and water pressure, unspecified 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES

Effects of vibration; Pneumatic hammer syndrome; INJURIES DUE TO ENVIRONMENTAL AND OTHER T75.2 9,300 2,790 6,510 Traumatic vasospastic syndrome; Vertigo from infrasound EXTERNAL FACTORS CAUSES

Other specified injuries due to environmental and other INJURIES DUE TO ENVIRONMENTAL AND OTHER T75.8 external factors causes; Effects of abnormal gravitation [G] 9,300 2,790 6,510 EXTERNAL FACTORS CAUSES forces; Effects of weightlessness

S14.0 Concussion and oedema of cervical spinal cord INJURIES TO NEURAL STRUCTURES AND NERVES 18,400 5,520 12,880

S34.0 Concussion and oedema of lumbar spinal cord INJURIES TO NEURAL STRUCTURES AND NERVES 18,400 5,520 12,880

Page 48 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee INJURIES TO THE MUSCLES AND TENDONS AND S16 Injury of muscle and tendon at neck level 7,200 2,160 5,040 JOINTS Injury of muscle and tendon of abdomen, lower back and INJURIES TO THE MUSCLES AND TENDONS AND S39.0 7,200 2,160 5,040 pelvis JOINTS Dislocation of shoulder joint; Dislocation of Glenohumeral INJURIES TO THE MUSCLES AND TENDONS AND S43.0 7,200 2,160 5,040 joint JOINTS Sprain and strain of shoulder joint; sprain and strain of INJURIES TO THE MUSCLES AND TENDONS AND S43.4 Coracohumeral (ligament); Sprain and strain of Rotator cuff 7,200 2,160 5,040 JOINTS capsule Sprain and strain of acromioclavicular joint; sprain and INJURIES TO THE MUSCLES AND TENDONS AND S43.5 7,200 2,160 5,040 strain of Acromioclavicular ligament JOINTS

Sprain and strain of other and unspecified parts of shoulder INJURIES TO THE MUSCLES AND TENDONS AND S43.7 7,200 2,160 5,040 girdle; Sprain and strain of shoulder girdle NOS JOINTS

INJURIES TO THE MUSCLES AND TENDONS AND S46.0 Injury of tendon of the rotator cuff of shoulder 7,200 2,160 5,040 JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S46.1 Injury of muscle and tendon of long head of biceps 7,200 2,160 5,040 JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S46.2 Injury of muscle and tendon of other parts of biceps 7,200 2,160 5,040 JOINTS Injury of multiple muscles and tendons at shoulder and INJURIES TO THE MUSCLES AND TENDONS AND S46.7 7,200 2,160 5,040 upper arm level JOINTS Injury of other muscles and tendons at shoulder and upper INJURIES TO THE MUSCLES AND TENDONS AND S46.8 7,200 2,160 5,040 arm level JOINTS Injury of unspecified muscle and tendon at shoulder and INJURIES TO THE MUSCLES AND TENDONS AND S46.9 7,200 2,160 5,040 upper arm level JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S53.4 Sprain and strain of elbow 7,200 2,160 5,040 JOINTS Injury of flexor muscle and tendon of thumb at forearm INJURIES TO THE MUSCLES AND TENDONS AND S56.0 7,200 2,160 5,040 level JOINTS Injury of long flexor muscle and tendon of other finger(s) at INJURIES TO THE MUSCLES AND TENDONS AND S56.1 7,200 2,160 5,040 forearm level JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S56.2 Injury of other flexor muscle and tendon at forearm level 7,200 2,160 5,040 JOINTS Injury of extensor or abductor muscles and tendons of INJURIES TO THE MUSCLES AND TENDONS AND S56.3 7,200 2,160 5,040 thumb at forearm level JOINTS Sprain and strain of wrist; Sprain and strain of Carpal joint; INJURIES TO THE MUSCLES AND TENDONS AND S63.5 Sprain and strain of Radiocarpal joint; Sprain and strain of 7,200 2,160 5,040 JOINTS Radiocarpal ligament Sprain and strain of finger(s); Sprain and strain of Interphalangeal joint, hand; Sprain and strain INJURIES TO THE MUSCLES AND TENDONS AND S63.6 7,200 2,160 5,040 Metacarpophalangeal joint; Sprain and strain of Phalanx, JOINTS hand; Sprain and strain of Thumb INJURIES TO THE MUSCLES AND TENDONS AND S63.7 Sprain and strain of other and unspecified parts of hand 7,200 2,160 5,040 JOINTS Injury of flexor muscle and tendon of other finger at wrist INJURIES TO THE MUSCLES AND TENDONS AND S66.1 7,200 2,160 5,040 and hand level JOINTS Injury of extensor muscle and tendon of other finger at INJURIES TO THE MUSCLES AND TENDONS AND S66.3 7,200 2,160 5,040 wrist and hand level JOINTS Injury of intrinsic muscle and tendon of other finger at wrist INJURIES TO THE MUSCLES AND TENDONS AND S66.5 7,200 2,160 5,040 and hand level JOINTS Injury of multiple flexor muscles and tendons at wrist and INJURIES TO THE MUSCLES AND TENDONS AND S66.6 7,200 2,160 5,040 hand level JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S66.8 Injury of other muscles and tendons at wrist and hand level 7,200 2,160 5,040 JOINTS Injury of unspecified muscle and tendon at wrist and hand INJURIES TO THE MUSCLES AND TENDONS AND S66.9 7,200 2,160 5,040 level JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S73.1 Sprain and strain of hip 7,200 2,160 5,040 JOINTS Injury of quadriceps muscle and tendon; injury of Patellar INJURIES TO THE MUSCLES AND TENDONS AND S76.1 7,200 2,160 5,040 ligament (tendon) JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S76.2 Injury of adductor muscle and tendon of thigh 7,200 2,160 5,040 JOINTS Injury of muscle and tendon of the posterior muscle group INJURIES TO THE MUSCLES AND TENDONS AND S76.3 7,200 2,160 5,040 at thigh level JOINTS Injury of other and unspecified muscles and tendons at INJURIES TO THE MUSCLES AND TENDONS AND S76.4 7,200 2,160 5,040 thigh level JOINTS Sprain and strain involving fibular collateral ligament of INJURIES TO THE MUSCLES AND TENDONS AND S83.4 knee; Sprain and strain involving tibial collateral ligament of 7,200 2,160 5,040 JOINTS knee Sprain and strain involving anterior cruciate ligament of INJURIES TO THE MUSCLES AND TENDONS AND S83.5 knee; Sprain and strain involving posterior cruciate 7,200 2,160 5,040 JOINTS ligament of knee Sprain and strain of other and unspecified parts of knee; INJURIES TO THE MUSCLES AND TENDONS AND S83.6 7,200 2,160 5,040 Tibiofibular joint and ligament, superior JOINTS INJURIES TO THE MUSCLES AND TENDONS AND S86.8 Injury of other muscles and tendons at lower leg level 7,200 2,160 5,040 JOINTS

Page 49 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee INJURIES TO THE MUSCLES AND TENDONS AND S86.9 Injury of unspecified muscle and tendon at lower leg level 7,200 2,160 5,040 JOINTS

Sprain and strain of ankle including Calcaneofibular INJURIES TO THE MUSCLES AND TENDONS AND S93.4 (ligament), Deltoid (ligament), Internal collateral (ligament), 7,200 2,160 5,040 JOINTS Talofibular (ligament), Tibiofibular , distal (ligament)

Sprain and strain of toe(s) including Interphalangeal INJURIES TO THE MUSCLES AND TENDONS AND S93.5 7,200 2,160 5,040 (joint(s), metatarsophalangeal (joint(s) JOINTS Sprain and strain of other and unspecified parts of foot INJURIES TO THE MUSCLES AND TENDONS AND S93.6 7,200 2,160 5,040 including Tarsal (ligament), Tarsometatarsal (ligament) JOINTS Injury of muscle and tendon of long flexor muscle of toe at INJURIES TO THE MUSCLES AND TENDONS AND S96.0 7,200 2,160 5,040 ankle and foot level JOINTS Injury of unspecified muscle and tendon at ankle and foot INJURIES TO THE MUSCLES AND TENDONS AND S96.9 7,200 2,160 5,040 level JOINTS INJURIES TO THE MUSCLES AND TENDONS AND T03.9 Multiple dislocations, sprains and strains, unspecified 7,200 2,160 5,040 JOINTS Pulmonary oedema; Acute oedema of lung; Passive J81 INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800 pulmonary congestion; Lung dropsy Pulmonary , not elsewhere classified; J82 Eosinophilic asthma; Loffler's pneumonia; Tropical INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800 pulmonary eosinophilia NOS Alveolar and parietoalveolar conditions; Alveolar J84.0 INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800 proteinosis; Pulmonary alveolar microlithiasis

Other interstitial pulmonary diseases with fibrosis; Diffuse J84.1 pulmonary fibrosis; Cryptogenic fibrosing alveolitis; INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800 Hamman-Rich syndrome; Idiopathic pulmonary fibrosis

J84.8 Other specified interstitial pulmonary diseases INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800 Interstitial pulmonary disease, unspecified; Interstitial J84.9 INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800 pneumonia NOS

Acute vascular disorders of intestine; Acute fulminant ischaemic colitis; Acute intestinal infarction; Acute small intestine ischaemia; Mesentric artery embolism; Mesentric K55.0 INTESTINAL DISORDERS 9,500 2,850 6,650 vein embolism; Mesentric artery infarction; Mesentric vein infarction; Mesentric artery thrombosis; Mesenteric vein thrombosis; Subacute ischaemic colitis

Chronic vascular disorders of intestine; Chronic ischaemic colitis; Chronic ischaemic enteritis; Chronic ischaemic K55.1 INTESTINAL DISORDERS 9,500 2,850 6,650 enterocolitis; Ischaemic stricture of intestine; Mesentric atherosclerosis; Mesentric vascular insufficiency

K55.2 of colon; Angiodysplasia of intestine NOS INTESTINAL DISORDERS 9,500 2,850 6,650

Vascular disorder of intestine, unspecified; Ischaemic colitis K55.9 INTESTINAL DISORDERS 9,500 2,850 6,650 NOS; Ischaemic enteritis NOS; Ischaemic enterocolitis NOS

Diverticular disease of small intestine with perforation and K57.0 abscess; Diverticular disease of small intestine with INTESTINAL DISORDERS 9,500 2,850 6,650 peritonitis

Diverticular disease of small intestine without perforation K57.1 INTESTINAL DISORDERS 9,500 2,850 6,650 or abscess; Diverticular disease of small intestine NOS

Diverticular disease of large intestine with perforation and K57.2 abscess; Diverticular disease/ Diverticulitis/ / INTESTINAL DISORDERS 9,500 2,850 6,650 Diverticulum of colon with peritonitis

Diverticular disease of large intestine without perforation K57.3 INTESTINAL DISORDERS 9,500 2,850 6,650 or abscess; Diverticular disease of colon NOS

Diverticular disease of both small and large intestine with K57.4 perforation and abscess; Diverticular disease of both small INTESTINAL DISORDERS 9,500 2,850 6,650 and large intestine with peritonitis Diverticular disease of both small and large intestine K57.5 without perforation or abscess; Diverticular disease of both INTESTINAL DISORDERS 9,500 2,850 6,650 small and large intestine NOS Diverticular disease of intestine, part unspecified, with K57.8 perforation and abscess; Diverticular disease of intestine INTESTINAL DISORDERS 9,500 2,850 6,650 NOS with peritonitis

Diverticular disease of intestine, part unspecified, without K57.9 INTESTINAL DISORDERS 9,500 2,850 6,650 perforation or abscess; Diverticular disease of intestine NOS

Megacolon, not elsewhere classified; Dilatation of colon; K59.3 INTESTINAL DISORDERS 9,500 2,850 6,650 Other specified functional intestinal disorders; Atony of K59.8 INTESTINAL DISORDERS 9,500 2,850 6,650 colon K59.9 Functional intestinal disorder, unspecified INTESTINAL DISORDERS 9,500 2,850 6,650 K63.0 Abscess of intestine INTESTINAL DISORDERS 9,500 2,850 6,650

Page 50 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee K63.1 Nontraumatic perforation of intestine INTESTINAL DISORDERS 9,500 2,850 6,650 K63.2 Fistula of intestine INTESTINAL DISORDERS 9,500 2,850 6,650 K63.3 Ulcer of intestine; Primary ulcer of small intestine INTESTINAL DISORDERS 9,500 2,850 6,650 K63.4 Enteroptosis INTESTINAL DISORDERS 9,500 2,850 6,650 K63.5 Polyp of colon INTESTINAL DISORDERS 9,500 2,850 6,650 K63.8 Other specified diseases of intestine INTESTINAL DISORDERS 9,500 2,850 6,650 K63.9 Disease of intestine, unspecified INTESTINAL DISORDERS 9,500 2,850 6,650 B05.4 Measles with intestinal complications INTESTINAL DISORDERS 9,500 2,850 6,650 ; Gluten-sensitive ; Idiopathic K90.0 INTESTINAL MALABSORPTION 4,100 1,230 2,870 steatorrhoea; Nontropical sprue K90.1 ; Sprue NOS; Tropical steatorrhoea INTESTINAL MALABSORPTION 4,100 1,230 2,870 Blind loop syndrome, not elsewhere classified; Blind loop K90.2 INTESTINAL MALABSORPTION 4,100 1,230 2,870 syndrome NOS K90.3 Pancreatic steatorrhoea INTESTINAL MALABSORPTION 4,100 1,230 2,870 Malabsorption due to intolerance, not elsewhere classified; Malabsorption due to intolerance to carbohydrate; K90.4 Malabsorption due to intolerance to fat; Malabsorption INTESTINAL MALABSORPTION 4,100 1,230 2,870 due to intolerance to protein; Malabsorption due to intolerance to starch K90.8 Other intestinal malabsorption INTESTINAL MALABSORPTION 4,100 1,230 2,870 K90.9 Intestinal malabsorption, unspecified INTESTINAL MALABSORPTION 4,100 1,230 2,870 Paralytic ileus; Paralysis of bowel; Paralysis of colon; K56.0 INTESTINAL OBSTRUCTION 10,100 3,030 7,070 Paralysis of intestine Intussusception; Intussusception or invagination of bowel; Intussusception or invagination of colon; Intussusception or K56.1 INTESTINAL OBSTRUCTION 10,100 3,030 7,070 invagination of intestine; Intussusception or invagination of rectum ; Strangulation of colon or intestine; Torsion of K56.2 INTESTINAL OBSTRUCTION 10,100 3,030 7,070 colon or intestine; Twist of colon or intestine K56.3 Gallstone ileus; Obstruction of intestine by gallstone INTESTINAL OBSTRUCTION 10,100 3,030 7,070 Other impaction of intestine; Enterolith; Impaction of K56.4 INTESTINAL OBSTRUCTION 10,100 3,030 7,070 colon; Impaction of faecal

Intestinal adhesions [bands] with obstruction; Peritoneal K56.5 INTESTINAL OBSTRUCTION 10,100 3,030 7,070 adhesions [bands] with intestinal obstruction

Other and unspecified intestinal obstruction; Enterotenosis; K56.6 Obstructive ileus NOS; Occlusion of colon or intestine; INTESTINAL OBSTRUCTION 10,100 3,030 7,070 Stenosis of colon or intestine; Stricture of colon or intestine

K56.7 Ileus, unspecified INTESTINAL OBSTRUCTION 10,100 3,030 7,070

Intracranial abscess and granuloma; Abscess (embolic)(of) brain [any part]; Abscess (embolic)(of) cerebellar; Abscess (embolic)(of) cerebral; Abscess (embolic)(of) otogenic; INTRACRANIAL AND INTRASPINAL ABSCESS AND G06.0 27,900 8,370 19,530 IIntracranial abscess or granuloma, epidural; Intracranial GRANULOMA abscess or granuloma, extradural; Intracranial abscess or granuloma, subdural

Intraspinal abscess and granuloma; Abscess (embolic) of spinal cord [any part]; Intraspinal abscess or granuloma INTRACRANIAL AND INTRASPINAL ABSCESS AND G06.1 27,900 8,370 19,530 epidural; Intraspinal abscess or granuloma extradural; GRANULOMA Intraspinal abscess or granuloma subdural

Encephalitis, myelitis and encephalomyelitis in Extradural INTRACRANIAL AND INTRASPINAL ABSCESS AND G06.2 27,900 8,370 19,530 and subdural abscess, unspecified GRANULOMA

Injury of optic nerve and pathways; Injury of Optic chiasm; S04.0 INTRACRANIAL INJURIES 8,800 2,640 6,160 Injury of 2nd cranial nerve; Injury of Visual cortex

S04.1 Injury of oculomotor nerve; injury of 3rd cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160 S04.4 Injury of abducent nerve; injury of 6th cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160 S04.5 Injury of facial nerve; injury of 7th cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160 Injury of acoustic nerve; injury of Auditory nerve; injury of S04.6 INTRACRANIAL INJURIES 8,800 2,640 6,160 8th cranial nerve

Injury of other cranial nerves; injury of Glossopharyngeal S04.8 [9th] nerve; injury of Hypoglossal [12th] nerve; injury of; INTRACRANIAL INJURIES 8,800 2,640 6,160 injury of Olfactory [1st] nerve; injury of Vagus [10th] nerve

S04.9 Injury of unspecified cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160 Injury of conjunctiva and corneal abrasion without mention S05.0 INTRACRANIAL INJURIES 8,800 2,640 6,160 of foreign body Concussion; Commotio cerebri (without open intracranial S06.00 INTRACRANIAL INJURIES 8,800 2,640 6,160 wound) Concussion; Commotio cerebri (with open intracranial S06.01 INTRACRANIAL INJURIES 8,800 2,640 6,160 wound) Traumatic cerebral oedema (without open intracranial S06.10 INTRACRANIAL INJURIES 8,800 2,640 6,160 wound)

Page 51 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Diffuse brain injury; Cerebral contusion NOS; Cerebral S06.20 laceration NOS; Traumatic compression of brain NOS (with INTRACRANIAL INJURIES 8,800 2,640 6,160 open intracranial wound) Diffuse brain injury; Cerebral contusion NOS; Cerebral S06.21 laceration NOS; Traumatic compression of brain NOS INTRACRANIAL INJURIES 8,800 2,640 6,160 (without open intracranial wound)

Focal brain injury; Focal cerebral; Focal cerebral contusion; S06.30 Focal cerebral laceration; Focal traumatic intracerebral INTRACRANIAL INJURIES 8,800 2,640 6,160 haemorrhage (without open intracranial wound)

Focal brain injury; Focal cerebral; Focal cerebral contusion; S06.31 Focal cerebral laceration; Focal traumatic intracerebral INTRACRANIAL INJURIES 8,800 2,640 6,160 haemorrhage (with open intracranial wound)

Epidural haemorrhage; Extradural haemorrhage, traumatic S06.40 INTRACRANIAL INJURIES 8,800 2,640 6,160 (without open intracranial wound) Epidural haemorrhage; Extradural haemorrhage, traumatic S06.41 INTRACRANIAL INJURIES 8,800 2,640 6,160 (with open intracranial wound) Traumatic subdural haemorrhage (without open S06.50 INTRACRANIAL INJURIES 8,800 2,640 6,160 intracranial wound) Traumatic subdural haemorrhage (with open intracranial S06.51 INTRACRANIAL INJURIES 8,800 2,640 6,160 wound) Traumatic subarachnoid haemorrhage (without open S06.60 INTRACRANIAL INJURIES 8,800 2,640 6,160 intracranial wound) Traumatic subarachnoid haemorrhage (with open S06.61 INTRACRANIAL INJURIES 8,800 2,640 6,160 intracranial wound) Intracranial injury with prolonged coma (without open S06.70 INTRACRANIAL INJURIES 8,800 2,640 6,160 intracranial wound) Other intracranial injuries; traumatic haemorrhage S06.80 cerebellar; traumatic haemorrhage intracranial NOS INTRACRANIAL INJURIES 8,800 2,640 6,160 (without open intracranial wound) Other intracranial injuries; traumatic haemorrhage S06.81 cerebellar; traumatic haemorrhage intracranial NOS (with INTRACRANIAL INJURIES 8,800 2,640 6,160 open intracranial wound) Intracranial injury, unspecified; brain injury NOS (without S06.90 INTRACRANIAL INJURIES 8,800 2,640 6,160 open intracranial wound) Intracranial injury, unspecified; brain injury NOS (with open S06.91 INTRACRANIAL INJURIES 8,800 2,640 6,160 intracranial wound)

S09.0 Injury of blood vessels of head, not elsewhere classified INTRACRANIAL INJURIES 8,800 2,640 6,160

S09.1 Injury of muscle and tendon of head INTRACRANIAL INJURIES 8,800 2,640 6,160 S09.2 Traumatic rupture of ear drum INTRACRANIAL INJURIES 8,800 2,640 6,160 S09.7 Multiple injuries of head INTRACRANIAL INJURIES 8,800 2,640 6,160 S09.8 Other specified injuries of head INTRACRANIAL INJURIES 8,800 2,640 6,160 Unspecified injury of head; Injury of face NOS; Injury of ear S09.9 INTRACRANIAL INJURIES 8,800 2,640 6,160 NOS; Injury of nose NOS Intraventricular (nontraumatic) haemorrhage, grade 1, of INTRAVENTRICULAR P52.0 fetus and newborn; Subependymal haemorrhage (without HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 intraventricular extension) THE NEWBORN Intraventricular (nontraumatic) haemorrhage, grade 2, of INTRAVENTRICULAR P52.1 fetus and newborn; Subependymal haemorrhage with HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 intraventricular extension THE NEWBORN INTRAVENTRICULAR Unspecified intraventricular (nontraumatic) haemorrhage P52.3 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 of fetus and newborn THE NEWBORN INTRAVENTRICULAR Intracerebral (nontraumatic) haemorrhage of fetus and P52.4 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 newborn THE NEWBORN INTRAVENTRICULAR Subarachnoid (nontraumatic) haemorrhage of fetus and P52.5 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 newborn THE NEWBORN INTRAVENTRICULAR Cerebellar (nontraumatic) and posterior fossa haemorrhage P52.6 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 of fetus and newborn THE NEWBORN INTRAVENTRICULAR Other intracranial (nontraumatic) haemorrhages of fetus P52.8 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 and newborn THE NEWBORN INTRAVENTRICULAR Intracranial (nontraumatic) haemorrhage of fetus and P52.9 HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN 25,600 7,680 17,920 newborn, unspecified THE NEWBORN

Acute transmural of anterior wall [or duration of <4 weeks] KILLIPS stage unspecified; Acute transmural infarction of anterior wall NOS [or duration of ISCHEMIC HEART DISEASE WITH MYOCARDIAL I21.0 18,900 5,670 13,230 <4 weeks] KILLIPS stage unspecified; Acute anteroapical; INFARCTION anterolateral; anteroseptal transmural infarction [or duration of <4 weeks] KILLIPS stage unspecified;

Page 52 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Acute transmural myocardial infarction of inferior wall [or duration of <4 weeks] KILLIPS I; Acute transmural infarction of diaphragmatic wall [or duration of <4 weeks] KILLIPS I; ISCHEMIC HEART DISEASE WITH MYOCARDIAL I21.1 18,900 5,670 13,230 Acute transmural infarction of inferior wall NOS; INFARCTION inferolateral; inferoposterior [or duration of <4 weeks]KILLIPS I; Acute transmural myocardial infarction of other sites [or duration of <4 weeks] KILLIPS II; Acute apical-lateral transmural infarction [or duration of <4 weeks] KILLIPS II; ISCHEMIC HEART DISEASE WITH MYOCARDIAL I21.2 Acute basal-lateral transmural infarction [or duration of <4 18,900 5,670 13,230 INFARCTION weeks] KILLIPS II; high lateral; lateral wall NOS; posterior (true); posterobasal; posterolateral; posteroseptal; septal NOS Acute transmural myocardial infarction of unspecified site; ISCHEMIC HEART DISEASE WITH MYOCARDIAL I21.3 18,900 5,670 13,230 Transmural myocardial infarction NOS INFARCTION Acute subendocardial myocardial infarction; ISCHEMIC HEART DISEASE WITH MYOCARDIAL I21.4 18,900 5,670 13,230 Nontransmural myocardial infarction NOS INFARCTION Acute myocardial infarction, unspecified [or duration of <4 ISCHEMIC HEART DISEASE WITH MYOCARDIAL I21.9 weeks] KILLIPS I; Acute myocardial infarction NOS [or 18,900 5,670 13,230 INFARCTION duration of <4 weeks] KILLIPS I Subsequent myocardial infarction of anterior wall; Acute Subsequent infarction of anterior wall NOS; Acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL I22.0 subsequent infarction of anteroapical wall; Acute 18,900 5,670 13,230 INFARCTION subsequent infarction of anterolateral wall; Acute subsequent infarction of anteroseptal wall Subsequent myocardial infarction of inferior wall; Acute subsequent infarction of diaphragmatic wall; Acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL I22.1 subsequent infarction of inferior wall NOS; Acute 18,900 5,670 13,230 INFARCTION subsequent infarction of inferolateral wall; Acute subsequent infarction of inferoposterior wall

Subsequent myocardial infarction of other sites; Acute myocardial infarction of apical-lateral wall; Acute myocardial infarction of basal-lateral wall; Acute myocardial ISCHEMIC HEART DISEASE WITH MYOCARDIAL I22.8 18,900 5,670 13,230 infarction of high lateral wall; Acute myocardial infarction INFARCTION of lateral wall NOS; posterior (true); posterobasal; posterolateral; posteroseptal; septal NOS ISCHEMIC HEART DISEASE WITH MYOCARDIAL I22.9 Subsequent myocardial infarction of unspecified site 18,900 5,670 13,230 INFARCTION Haemopericardium as current following acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.0 18,900 5,670 13,230 myocardial infarction INFARCTION Atrial septal defect as current complication following acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.1 18,900 5,670 13,230 myocardial infarction INFARCTION Ventricular septal defect as current complication following ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.2 18,900 5,670 13,230 acute myocardial infarction INFARCTION

Rupture of cardiac wall without haemopericardium as ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.3 18,900 5,670 13,230 current complication following acute myocardial infarction INFARCTION

Rupture of chordae tendineae as current complication ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.4 18,900 5,670 13,230 following acute myocardial infarction INFARCTION Rupture of papillary muscle as current complication ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.5 18,900 5,670 13,230 following acute myocardial infarction INFARCTION Other current complications following acute myocardial ISCHEMIC HEART DISEASE WITH MYOCARDIAL I23.8 18,900 5,670 13,230 infarction INFARCTION ISCHEMIC HEART DISEASE WITH MYOCARDIAL I24.1 Dressler's syndrome; Postmyocardial infarction syndrome 18,900 5,670 13,230 INFARCTION Unstable angina; Angina crescendo; Angina de novo effort; ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I20.0 Angina worsening effort; Intermediate coronary syndrome; 12,000 3,600 8,400 INFARCTION Preinfarction syndrome Angina pectoris with documented spasm; Angiospastic ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I20.1 Angina ; Prinzmetal Angina ; spasm-induced Angina ; 12,000 3,600 8,400 INFARCTION Variant Angina Other forms of angina pectoris; Angina of effort; ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I20.8 12,000 3,600 8,400 Stenocardia INFARCTION Angina pectoris, unspecified; Angina NOS; Cardiac Angina ; ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I20.9 12,000 3,600 8,400 Anginal syndrome; Ischaemic chest pain INFARCTION

Coronary thrombosis not resulting in myocardial infarction; Coronary artery embolism not resulting in myocardial infaction; Coronary vein embolism not resulting in myocardial infarction; Coronary artery occlusion not ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I24.0 12,000 3,600 8,400 resulting in myocardial infarction; Coronary artery INFARCTION thromboembolism not resulting in myocardial infarction; Coronary vein thromboembolism not resulting in myocardial infarction;

Other forms of acute ischaemic heart disease; Coronary ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I24.8 12,000 3,600 8,400 failure; Coronary insufficiency INFARCTION

Page 53 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I25.5 Ischaemic cardiomyopathy 12,000 3,600 8,400 INFARCTION ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I25.6 Silent myocardial ischaemia 12,000 3,600 8,400 INFARCTION ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I25.8 Other forms of chronic ischaemic heart disease 12,000 3,600 8,400 INFARCTION Chronic ischaemic heart disease, unspecified; Chronic ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL I25.9 12,000 3,600 8,400 Ischaemic heart disease NOS INFARCTION P57.0 Kernicterus due to isoimmunization JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 P57.8 Other specified kernicterus JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 P57.9 Kernicterus, unspecified JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 P58.1 Neonatal jaundice due to bleeding JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 P58.2 Neonatal jaundice due to infection JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 P58.3 Neonatal jaundice due to polycythaemia JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 Neonatal jaundice due to drugs or toxins transmitted from P58.4 JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 mother or given to newborn Neonatal jaundice due to other specified excessive P58.8 JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 haemolysis

P58.9 Neonatal jaundice due to excessive haemolysis, unspecified JAUNDICE IN THE NEWBORN 7,400 2,220 5,180

Neonatal jaundice associated with preterm delivery; P59.0 Hyperbilirubinaemia of prematurity; Jaundice due to JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 delayed conjucation associated with preterm delivery P59.1 Inspissated bile syndrome JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 Neonatal jaundice from other and unspecified P59.2 JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 hepatocellular damage P59.3 Neonatal jaundice from breast milk inhibitor JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 P59.8 Neonatal jaundice from other specified causes JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 Neonatal jaundice, unspecified; Intense physiological P59.9 JAUNDICE IN THE NEWBORN 7,400 2,220 5,180 jaundice, NOS; Prolonged physiological jaundice, NOS A30.0 Hansen's disease: Indeterminate leprosy; I leprosy LEPROSY 8,800 2,640 6,160 A30.1 Hansen's disease : Tuberculoid leprosy; TT leprosy LEPROSY 8,800 2,640 6,160 Hansen's disease: Borderline tuberculoid leprosy; BT A30.2 LEPROSY 8,800 2,640 6,160 leprosy Hansen's disease: Borderline lepromatous leprosy; BL A30.4 LEPROSY 8,800 2,640 6,160 leprosy A30.5 Hansen's disease: Lepromatous leprosy; LL leprosy LEPROSY 8,800 2,640 6,160 A30.8 Other forms of leprosy LEPROSY 8,800 2,640 6,160 Leprosy, unspecified A30.9 LEPROSY 8,800 2,640 6,160 Hansen Disease icterohaemorrhagica; Leptospirosis due to A27.0 LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700 Leptospira interrogans serovar icterohaemorrhagiae A27.8 Other forms of leptospirosis LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700 A27.9 Leptospirosis, unspecified LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700 K70.0 Alcoholic fatty liver LIVER DISEASES I 11,800 3,540 8,260 K70.1 LIVER DISEASES I 11,800 3,540 8,260 K70.2 Alcoholic fibrosis and sclerosis of liver LIVER DISEASES I 11,800 3,540 8,260 Alcoholic cirrhosis of liver; Alcoholic cirrhosis NOS; K70.3 LIVER DISEASES I 11,800 3,540 8,260 Laennec's cirrhosis K70.9 , unspecified LIVER DISEASES I 11,800 3,540 8,260 Toxic liver disease with ; Cholestatis with K71.0 LIVER DISEASES I 11,800 3,540 8,260 hepatocyte injury; Pure cholestasis

Toxic liver disease with hepatic necrosis; Acute hepatic K71.1 LIVER DISEASES I 11,800 3,540 8,260 failure due to drugs; Chronic hepatic failure due to drugs

K71.2 Toxic liver disease with acute hepatitis LIVER DISEASES I 11,800 3,540 8,260 K71.3 Toxic liver disease with chronic persistent hepatitis LIVER DISEASES I 11,800 3,540 8,260 Toxic liver disease with chronic active hepatitis; Toxic liver K71.5 LIVER DISEASES I 11,800 3,540 8,260 disease with lupoid hepatitis

K71.6 Toxic liver disease with hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260

Toxic liver disease with other disorders of liver; Toxic liver disease with focal nodular hyperplasia; Toxic liver disease K71.8 with hepatic granulomas; Toxic liver disease with peliosis LIVER DISEASES I 11,800 3,540 8,260 hepatis; Toxic liver disease with veno-occlusive disease of liver K71.9 Toxic liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260 K73.0 Chronic persistent hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260 Chronic active hepatitis, not elsewhere classified; Lupoid K73.2 LIVER DISEASES I 11,800 3,540 8,260 hepatitis NEC K73.8 Other chronic hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260 K73.9 Chronic hepatitis, unspecified LIVER DISEASES I 11,800 3,540 8,260 K74.1 Hepatic sclerosis LIVER DISEASES I 11,800 3,540 8,260 Oesophageal varices in other and unspecified cirrhosis of K74.6+I98.2* LIVER DISEASES I 11,800 3,540 8,260 liver

Page 54 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Abscess of liver; Hepatic abscess NOS; Cholangitic hepatic K75.0 abscess; Haematogenic hepatic abscess; Lymphogenic LIVER DISEASES I 11,800 3,540 8,260 hepatic abscess; Pylephlebitic hepatic abscess

K75.1 Phlebitis of portal vein; Pylephlebitis LIVER DISEASES I 11,800 3,540 8,260 K75.2 Nonspecific reactive hepatitis LIVER DISEASES I 11,800 3,540 8,260 K75.3 Granulomatous hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260 K75.4 LIVER DISEASES I 11,800 3,540 8,260 Other specified inflammatory liver diseases K75.8 LIVER DISEASES I 11,800 3,540 8,260 Non alcoholic (NASH) K75.9 Inflammatory liver disease, unspecified; Hepatitis NOS LIVER DISEASES I 11,800 3,540 8,260 K76.0 Fatty (change of) liver, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260 Other specified diseases of liver; Focal nodular hyperplasia K76.8 LIVER DISEASES I 11,800 3,540 8,260 of liver; Hepatoptosis K76.9 Liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260 K71.4 Toxic liver disease with chronic lobular hepatitis LIVER DISEASES II 15,100 4,530 10,570 K71.7 Toxic liver disease with fibrosis and cirrhosis of liver LIVER DISEASES II 15,100 4,530 10,570 K74.0 Hepatic fibrosis LIVER DISEASES II 15,100 4,530 10,570 K74.2 Hepatic fibrosis with hepatic sclerosis LIVER DISEASES II 15,100 4,530 10,570 Other and unspecified cirrhosis of liver; Cirrhosis of liver NOS; Cryptogenic cirrhosis of liver; Macronodular cirrhosis K74.6 of liver; Micronodular cirrhosis of liver; Mixed type cirrhosis LIVER DISEASES II 15,100 4,530 10,570 of liver; Portal cirrhosis of liver; Postnecrotic cirrhosis of liver; Chronic passive congestion of liver; Cardiac cirrhosis (so- K76.1 LIVER DISEASES II 15,100 4,530 10,570 called) of liver; Cardiac sclerosis of liver K76.2 Central haemorrhagic necrosis of liver LIVER DISEASES II 15,100 4,530 10,570 K76.3 Infarction of liver LIVER DISEASES II 15,100 4,530 10,570 K76.4 ; Hepatic angiomatosis LIVER DISEASES II 15,100 4,530 10,570 K76.6 LIVER DISEASES II 15,100 4,530 10,570 K76.7 LIVER DISEASES II 15,100 4,530 10,570

Nonspecific mesenteric lymphadenitis; Acute Mesenteric I88.0 LYMPHADENITIS 6,800 2,040 4,760 lymphadenitis; Chronic Mesenteric lymphadenitis

Lymphangitis; Lymphangitis NOS; Chronic Lymphangitis; I89.1 LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230 Subacute Lymphangitis Other specified noninfective disorders of lymphatic vessels I89.8 and lymph nodes; Chylocele (nonfilarial); Lipomelanotic LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230 reticulosis Noninfective disorder of lymphatic vessels and lymph I89.9 LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230 nodes, unspecified; Disease of lymphatic vessels NOS Malignant neoplasm of kidney, except renal pelvis & renal C64 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 calyces

Malignant neoplasm of renal pelvis; Malignant neoplasm of C65 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 Pelviureteric junction; Malignant neoplasm of Renal calyces

C66 Malignant neoplasm of ureter MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.0 Malignant neoplasm of Trigone of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.1 Malignant neoplasm of Dome of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.2 Malignant neoplasm of Lateral wall of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.3 Malignant neoplasm of Anterior wall of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 Malignant neoplasm of Bladder neck; Malignant neoplasm C67.5 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 of Internal urethral orifice C67.6 Malignant neoplasm of Ureteric orifice MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.7 Malignant neoplasm of Urachus MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.8 Malignant neoplasm of Overlapping lesion of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C67.9 Malignant neoplasm of Bladder, unspecified MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 C68.0 Malignant neoplasm of Urethra MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 Malignant neoplasm of Urinary organ, unspecified; C68.9 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 Malignant neoplasm of Urinary system NOS

C79.0 Secondary malignant neoplasm of kidney and renal pelvis MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870

Secondary malignant neoplasm of bladder and other and C79.1 MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870 unspecified urinary organs Malignant neoplasm of Scapula and long bones of upper MALIGNANT NEOPLASMS OF BONE AND C40.0 16,500 4,950 11,550 limb ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C40.1 Malignant neoplasm of Short bones of upper limb 16,500 4,950 11,550 ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C40.2 Malignant neoplasm of Long bones of lower limb 16,500 4,950 11,550 ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C40.3 Malignant neoplasm of Short bones of lower limb 16,500 4,950 11,550 ARTICULAR CARTILAGE Malignant neoplasm of Bone and articular cartilage of limb, MALIGNANT NEOPLASMS OF BONE AND C40.9 16,500 4,950 11,550 unspecified ARTICULAR CARTILAGE Malignant neoplasm of Bones of skull and face; Malignant MALIGNANT NEOPLASMS OF BONE AND C41.0 neoplasm o f Superior maxilla; Malignant neoplasm of 16,500 4,950 11,550 ARTICULAR CARTILAGE Orbital bone

Page 55 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Malignant neoplasm of Mandible; Malignant neoplasm of MALIGNANT NEOPLASMS OF BONE AND C41.1 16,500 4,950 11,550 Lower jaw bone ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C41.2 Malignant neoplasm of Vertebral column 16,500 4,950 11,550 ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C41.3 Malignant neoplasm of Ribs, sternum and clavicle 16,500 4,950 11,550 ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C41.4 Malignant neoplasm of Pelvic bones, sacrum and coccyx 16,500 4,950 11,550 ARTICULAR CARTILAGE Malignant neoplasm of Overlapping lesion of bone and MALIGNANT NEOPLASMS OF BONE AND C41.8 16,500 4,950 11,550 articular cartilage ARTICULAR CARTILAGE Malignant neoplasm of Bone and articular cartilage, MALIGNANT NEOPLASMS OF BONE AND C41.9 16,500 4,950 11,550 unspecified ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF BONE AND C79.5 Secondary malignant neoplasm of bone and bone marrow 16,500 4,950 11,550 ARTICULAR CARTILAGE MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C70.0 Malignant neoplasm of Cerebral meninges 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C70.1 Malignant neoplasm of Spinal meninges 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C70.9 Malignant neoplasm of Meninges, unspecified 16,900 5,070 11,830 SYSTEM Malignant neoplasm of Cerebrum, except lobes and MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.0 16,900 5,070 11,830 ventricles; Malignant neoplasm of Supratentorial NOS SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.1 Malignant neoplasm of Frontal lobe 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.2 Malignant neoplasm of Temporal lobe 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.3 Malignant neoplasm of Parietal lobe 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.4 Malignant neoplasm of Occipital lobe 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.5 Malignant neoplasm of Cerebral ventricle 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.6 Malignant neoplasm of Cerebellum 16,900 5,070 11,830 SYSTEM

Malignant neoplasm of Brain stem; Malignant neoplasm of MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.7 16,900 5,070 11,830 Fourth Ventricle; Malignant neoplasm of Infratentorial NOS SYSTEM

MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.8 Malignant neoplasm of Overlapping lesion of brain 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C71.9 Malignant neoplasm of Brain, unspecified 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.0 Malignant neoplasm of Spinal cord 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.1 Malignant neoplasm of Cauda equina 16,900 5,070 11,830 SYSTEM Malignant neoplasm of Olfactory nerve; Malignant MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.2 16,900 5,070 11,830 neoplasm of Olfactory bulb SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.3 Malignant neoplasm of Optic nerve 16,900 5,070 11,830 SYSTEM MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.4 Malignant neoplasm of Acoustic nerve 16,900 5,070 11,830 SYSTEM Malignant neoplasm of Other and unspecified cranial MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.5 16,900 5,070 11,830 nerves; Malignant neoplasm of Cranial nerve NOS SYSTEM Malignant neoplasm of Overlapping lesion of brain and MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.8 16,900 5,070 11,830 other parts of central nervous system SYSTEM

Malignant neoplasm of Central nervous system, MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C72.9 16,900 5,070 11,830 unspecified; Malignant neoplasm of Nervous system NOS SYSTEM

Secondary malignant neoplasm of brain and cerebral MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C79.3 16,900 5,070 11,830 meninges SYSTEM Secondary malignant neoplasm of other and unspecified MALIGNANT NEOPLASMS OF CENTRAL NERVOUS C79.4 16,900 5,070 11,830 parts of nervous system SYSTEM

C15.0 Malignant neoplasm of Cervical part of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C15.2 Malignant neoplasm of Abdominal part of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C15.3 Malignant neoplasm of Upper third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C15.4 Malignant neoplasm of Middle third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C15.5 Malignant neoplasm of Lower third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C15.8 Malignant neoplasm of Overlapping lesion of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C15.9 Malignant neoplasm of Oesophagus, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Page 56 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

C16 Dermato(poly)myositis in Malignant neoplasm of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Cardia; Malignant neoplasm of Cardiac orifice; Malignant neoplasm of Cardio-oesophageal C16.0 junction; Malignant neoplasm of MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Gastro-oesophageal junction; Malignant neoplasm of Oesophagus and stomach

C16.1 Malignant neoplasm of Fundus of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C16.2 Malignant neoplasm of Body of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Pyloric antrum; Malignant C16.3 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 neoplasm of Gastric antrum Malignant neoplasm of Pylorus; Malignant neoplasm of C16.4 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Prepylorus; Malignant neoplasm of pyloric canal Malignant neoplasm of Lesser curvature of stomach, C16.5 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 unspecified Malignant neoplasm of Greater curvature of stomach, C16.6 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 unspecified Malignant neoplasm of Stomach, unspecified; Gastric C16.9 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 cancer NOS

C17.0 Malignant neoplasm of Duodenum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C17.1 Malignant neoplasm of Jejunum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C17.2 Malignant neoplasm of Ileum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C17.9 Malignant neoplasm of Small intestine, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Caecum; Malignant neoplasm of C18.0 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Ileocaecal valve

C18.1 Malignant neoplasm of Appendix MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C18.2 Malignant neoplasm of Ascending colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C18.3 Malignant neoplasm of Hepatic flexure MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C18.4 Malignant neoplasm of Transverse colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C18.5 Malignant neoplasm of Splenic flexure MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C18.6 Malignant neoplasm of Descending colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Sigmoid colon; Malignant neoplasm C18.7 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 of Sigmoid flexure

C18.8 Malignant neoplasm of Overlapping lesion of colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Colon, unspecified; Malignant C18.9 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 neoplasm of Large intestine NOS Malignant neoplasm of rectosigmoid junction; Malignant C19 neoplasm of Colon with rectum; Malignant neoplasm of MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Rectosigmoid colon Malignant neoplasm of rectum; Malignant neoplasm of C20 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Rectal ampulla

C21.0 Malignant neoplasm of Anus, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Anal canal; Malignant neoplasm of C21.1 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Anal sphincter Malignant neoplasm of Overlapping lesion of rectum, anus C21.8 and anal canal; Malignant neoplasm of Anorectal junction; MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Malignant neoplasm of Anorectum Liver cell carcinoma; C22.0 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Hepatoma

C22.1 Intrahepatic bile duct carcinoma; Cholangiocarcinoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C22.2 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C22.3 Angiosarcoma of liver; Kupffer cell MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C22.4 Other of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C22.7 Other specified carcinomas of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C22.9 Liver, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C23 Malignant neoplasm of gallbladder MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Page 57 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Malignant neoplasm of Extrahepatic bile duct; Malignant neoplasm of Biliary duct or passage NOS; Malignant C24.0 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 neoplasm of ; Malignant neoplasm of Cystic duct; Malignant neoplasm of Hepatic duct

C24.1 Malignant neoplasm of Ampulla of Vater MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C24.8 Malignant neoplasm of Overlapping lesion of biliary tract MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C24.9 Malignant neoplasm of Biliary tract, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C25.0 Malignant neoplasm of Head of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C25.1 Malignant neoplasm of Body of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C25.2 Malignant neoplasm of Tail of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C25.3 Malignant neoplasm of Pancreatic duct MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Endocrine pancreas; Malignant C25.4 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 neoplasm of Islets of Langerhans Malignant neoplasm of Other parts of pancreas; Malignant C25.7 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 neoplasm of Neck of pancreas

C25.8 Malignant neoplasm of Overlapping lesion of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C25.9 Malignant neoplasm of Pancreas, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Intestinal tract, part unspecified; C26.0 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Malignant neoplasm of Intestine NOS

C26.1 Malignant neoplasm of Spleen MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Malignant neoplasm of Overlapping lesion of digestive C26.8 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 system

Malignant neoplasm of Ill-defined sites within the digestive C26.9 system; Malignant neoplasm of Alimentary canal or tract MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 NOS; Malignant neoplasm of NOS

Mesothelioma of peritoneum; of Mesentery; Mesothelioma of Mesocolon; Mesothelioma of Omentum; C45.1 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 Mesothelioma of Parietal Peritoneum; Mesothelioma of Pelvic Peritoneum

Malignant neoplasm of Specified parts of peritoneum; Malignant neoplasm of Mesentery; Malignant neoplasm of C48.1 Mesocolon; Malignant neoplasm of Omentum; Malignant MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 neoplasm of Parietal Peritoneum; Malignant neoplasm of Pelvic peritoneum

C48.2 Malignant neoplasm of Peritoneum, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

C76.2 Malignant neoplasm of Abdomen MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Secondary and unspecified malignant neoplasm of Intra- C77.2 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 abdominal lymph nodes

C78.4 Secondary malignant neoplasm of small intestine MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Secondary malignant neoplasm of large intestine and C78.5 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 rectum Secondary malignant neoplasm of retroperitoneum and C78.6 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 peritoneum; Malignant ascites NOS

C78.7 Secondary malignant neoplasm of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940

Secondary malignant neoplasm of other and unspecified C78.8 MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940 digestive organs Malignant neoplasm of Nasal cavity; Malignant neoplasm of Cartilage of nose; Malignant neoplasm of nasal Concha; C30.0 Malignant neoplasm of Internal nose; Malignant neoplasm MALIGNANT NEOPLASMS OF EARS AND NOSE 10,300 3,090 7,210 of Septum of nose; Malignant neoplasm of Vestibule of nose Malignant neoplasm of Middle ear; Malignant neoplasm of Eustachian tube; Malignant neoplasm of Inner ear; C30.1 MALIGNANT NEOPLASMS OF EARS AND NOSE 10,300 3,090 7,210 Malignant neoplasm of Mastoid air cells C69.1 Malignant neoplasm of Cornea MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 C69.2 Malignant neoplasm of Retina MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 C69.3 Malignant neoplasm of Choroid MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 Malignant neoplasm of Ciliary body; Malignant neoplasm C69.4 MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 of Eyeball

Page 58 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Malignant neoplasm of Lacrimal gland and duct; Malignant C69.5 neoplasm of Lacrimal sac; Malignant neoplasm of MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 Nasolacrimal duct Malignant neoplasm of Orbit; Malignant neoplasm of Connective tissue of orbit; Malignant neoplasm of C69.6 Extraocular muscle; Malignant neoplasm of Peripheral MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 nerves of orbit; Malignant neoplasm of Retrobulbar tissue; Malignant neoplasm of Retro-ocular tissue C69.9 Malignant neoplasm of Eye, unspecified MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830 Malignant neoplasm of Labium majus; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL C51.0 11,400 3,420 7,980 of Bartholin's [greater vestibular] gland TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C51.1 Malignant neoplasm of Labium minus 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C51.2 Malignant neoplasm of Clitoris 11,400 3,420 7,980 TRACT Malignant neoplasm of Vulva, unspecified; Malignant MALIGNANT NEOPLASMS OF FEMALE GENITAL C51.9 neoplasm of External female genitalia NOS; Malignant 11,400 3,420 7,980 TRACT neoplasm of Pudendum MALIGNANT NEOPLASMS OF FEMALE GENITAL C52 Malignant neoplasm of vagina 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C53.0 Malignant neoplasm of Endocervix 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C53.1 Malignant neoplasm of Exocervix 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C53.8 Malignant neoplasm of Overlapping lesion of cervix uteri 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C53.9 Malignant neoplasm of Cervix uteri, unspecified 11,400 3,420 7,980 TRACT Malignant neoplasm of Isthmus uteri; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL C54.0 11,400 3,420 7,980 of Lower uterine segment TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C54.1 Malignant neoplasm of Endometrium 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C54.2 Malignant neoplasm of Myometrium 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C54.3 Malignant neoplasm of Fundus uteri 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C54.8 Malignant neoplasm of Overlapping lesion of corpus uteri 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C54.9 Corpus uteri, unspecified 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C55 Malignant neoplasm of uterus, part unspecified 11,400 3,420 7,980 TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C56 Malignant neoplasm of ovary 11,400 3,420 7,980 TRACT

Malignant neoplasm of Fallopian tube; Malignant MALIGNANT NEOPLASMS OF FEMALE GENITAL C57.0 11,400 3,420 7,980 neoplasm of Oviduct; Malignant neoplasm of Uterine tube TRACT

Malignant neoplasm of Parametrium; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL C57.3 11,400 3,420 7,980 of Uterine ligament NOS TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C57.4 Malignant neoplasm of Uterine adnexa, unspecified 11,400 3,420 7,980 TRACT Malignant neoplasm of Other specified female genital MALIGNANT NEOPLASMS OF FEMALE GENITAL C57.7 11,400 3,420 7,980 organs; Malignant neoplasm of Wolffian body or duct TRACT Malignant neoplasm of Overlapping lesion of female genital MALIGNANT NEOPLASMS OF FEMALE GENITAL C57.8 organs; Malignant neoplasm of Tubo-ovarian; Malignant 11,400 3,420 7,980 TRACT neoplasm of Utero-ovarian

Malignant neoplasm of Female genital organ, unspecified; MALIGNANT NEOPLASMS OF FEMALE GENITAL C57.9 11,400 3,420 7,980 Malignant neoplasm of Female genitourinary tract NOS TRACT

Malignant neoplasm of placenta; Choriocarcinoma NOS; MALIGNANT NEOPLASMS OF FEMALE GENITAL C58 11,400 3,420 7,980 Chorionepithelioma NOS TRACT MALIGNANT NEOPLASMS OF FEMALE GENITAL C79.6 Secondary malignant neoplasm of ovary 11,400 3,420 7,980 TRACT Malignant neoplasm of External upper lip; Malignant neoplasm of Upper lip NOS; Malignant neoplasm of Upper MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C00.0 11,500 3,450 8,050 lip; Malignant neoplasm of lipstick area; Malignant PHARYNX neoplasm of Upper lip, vermilion border MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C00.9 Malignant neoplasm of Lip, unspecified 11,500 3,450 8,050 PHARYNX Malignant neoplasm of base of Dorsal surface of tongue ; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C01 Malignant neoplasm of Fixed part of tongue NOS; 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Posterior third of tongue Malignant neoplasm of Dorsal surface of base of tongue; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.0 Malignant neoplasm of Anterior two-thirds of dorsal 11,500 3,450 8,050 PHARYNX surface of tongue Malignant neoplasm of Border of tongue; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.1 11,500 3,450 8,050 neoplasm of Tip of tongue PHARYNX

Page 59 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Malignant neoplasm of Ventral surface of tongue; Malignant neoplasm of Anterior two-thirds of ventral MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.2 11,500 3,450 8,050 surface of tongue; Malignant neoplasm of Frenulum PHARYNX linguae

Malignant neoplasm of Anterior two-thirds of tongue, part MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.3 unspecified; Malignant neoplasm of Middle third of tongue 11,500 3,450 8,050 PHARYNX NOS; Malignant neoplasm of Mobile part of tongue NOS

MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.4 Malignant neoplasm of Lingual tonsil 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.8 Malignant neoplasm of Overlapping lesion of tongue 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C02.9 Malignant neoplasm of Tongue, unspecified 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C03.0 Malignant neoplasm of Upper gum 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C03.1 Malignant neoplasm of Lower gum 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C03.9 Malignant neoplasm of Gum, unspecified 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C04.9 Malignant neoplasm of Floor of mouth, unspecified 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C05.0 Malignant neoplasm of Hard palate 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C05.1 Malignant neoplasm of Soft palate 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C05.9 Malignant neoplasm of Palate, unspecified 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Cheek mucosa; Malignant neoplasm MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C06.0 of Buccal mucosa NOS; Malignant neoplasm of Internal 11,500 3,450 8,050 PHARYNX cheek

Malignant neoplasm of Vestibule of mouth; Malignant neoplasm of Upper buccal sulcus; Malignant neoplasm of MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C06.1 11,500 3,450 8,050 Lower buccal sulcus; Malignant neoplasm of Upper Labial PHARYNX sulcus; Malignant neoplasm of Lower Labial sulcus

MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C06.2 Malignant neoplasm of Retromolar area 11,500 3,450 8,050 PHARYNX

Malignant neoplasm of Mouth, unspecified; Minor MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C06.9 Malignant neoplasm of minor salivary gland, unspecified 11,500 3,450 8,050 PHARYNX site; Malignant neoplasm of Oral cavity NOS

MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C07 Malignant neoplasm of parotid gland 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Submandibular gland; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C08.0 11,500 3,450 8,050 neoplasm of Submaxillary gland PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C08.1 Malignant neoplasm of Sublingual gland 11,500 3,450 8,050 PHARYNX

Malignant neoplasm of Major salivary gland, unspecified; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C08.9 11,500 3,450 8,050 Malignant neoplasm of Major Salivary gland NOS PHARYNX

MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C09.0 Malignant neoplasm of Tonsillar fossa 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Tonsil, unspecified; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C09.9 neoplasm of Tonsil NOS; Malignant neoplasm of Faucial 11,500 3,450 8,050 PHARYNX Tonsil; Malignant neoplasm of Palatine Tonsil MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C10.0 Malignant neoplasm of Vallecula 11,500 3,450 8,050 PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C10.3 Malignant neoplasm of Posterior wall of oropharynx 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Branchial cleft; Malignant neoplasm MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C10.4 11,500 3,450 8,050 of Branchial cyst PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C10.9 Malignant neoplasm of Oropharynx, unspecified 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Superior wall of nasopharynx; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C11.0 11,500 3,450 8,050 Malignant neoplasm of Roof of nasopharynx PHARYNX Malignant neoplasm of Posterior wall of nasopharynx; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C11.1 Malignant neoplasm of Adenoid; Malignant neoplasm of 11,500 3,450 8,050 PHARYNX Pharyngeal tonsil Malignant neoplasm of Lateral wall of nasopharynx; Malignant neoplasm of Fossa of Rosenmüller; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C11.2 11,500 3,450 8,050 neoplasm of Opening of auditory tube; Malignant PHARYNX neoplasm of Pharyngeal recess

Page 60 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Malignant neoplasm of Anterior wall of nasopharynx; Malignant neoplasm of A nterior Nasopharyngeal surface of soft palate; Malignant neoplasm of Posterior MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C11.3 11,500 3,450 8,050 Nasopharyngeal surface of soft palate; Malignant PHARYNX neoplasm of Posterior margin of nasal choana; Malignant of Posterior margin of nasal septum;

MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C11.9 Malignant neoplasm of Nasopharynx, unspecified 11,500 3,450 8,050 PHARYNX

Malignant neoplasm of Aryepiglottic fold, hypopharyngeal aspect hypopharynx ; Malignant neoplasm of Aryepiglottic MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C13.1 11,500 3,450 8,050 fold, hypopharynx NOS; Malignant neoplasm of PHARYNX Aryepiglottic fold, marginal zone, hypopharynx

Malignant neoplasm of Hypopharynx, unspecified; MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C13.9 11,500 3,450 8,050 Malignant neoplasm of Hypopharyngeal wall NOS PHARYNX MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C14.0 Malignant neoplasm of Pharynx, unspecified 11,500 3,450 8,050 PHARYNX Malignant neoplasm of Overlapping lesion of lip, oral cavity MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C14.8 11,500 3,450 8,050 and pharynx PHARYNX

Malignant neoplasm of Head, face and neck; Malignant MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C76.0 11,500 3,450 8,050 neoplasm of Cheek NOS; Malignant neoplasm of Nose NOS PHARYNX

Secondary and unspecified malignant neoplasm of Lymph MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY, C77.0 nodes of head, face and neck; Malignant neoplasm of 11,500 3,450 8,050 PHARYNX Supraclavicular lymph nodes Human immunodeficiency virus [HIV] disease resulting in MALIGNANT NEOPLASMS OF LYMPHOID, B21.1 13,900 4,170 9,730 Burkitt's lymphoma HEMATOPOIETIC AND RELATED TISSUE Human immunodeficiency virus [HIV] disease resulting in MALIGNANT NEOPLASMS OF LYMPHOID, B21.2 13,900 4,170 9,730 other types of non-Hodgkin's lymphoma HEMATOPOIETIC AND RELATED TISSUE Human immunodeficiency virus [HIV] disease resulting in MALIGNANT NEOPLASMS OF LYMPHOID, B21.3 other malignant neoplasms of lymphoid, haematopoietic 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE and related tissue

Hodgkin's disease (Lymphocytic predominance); Hodgkin's MALIGNANT NEOPLASMS OF LYMPHOID, C81.0 disease (Lymphocytic-histiocytic predominance) 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Nodular lymphocyte predominant Hodgkin lymphoma

MALIGNANT NEOPLASMS OF LYMPHOID, C81.1 Hodgkin's disease( Nodular sclerosis) 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C81.9 Hodgkin's disease, unspecified 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Small cleaved cell, follicular non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID, C82.0 13,900 4,170 9,730 Follicular lymphoma grade I HEMATOPOIETIC AND RELATED TISSUE Mixed small cleaved non-Hodgkin's lymphoma and large MALIGNANT NEOPLASMS OF LYMPHOID, C82.1 cell, follicular non-Hodgkin's lymphoma 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Follicular lymphoma grade II Large cell, follicular non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID, C82.2 13,900 4,170 9,730 Follicular lymphoma grade III, unspecified HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C82.7 Other types of follicular non-Hodgkin's lymphoma 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Follicular non-Hodgkin's lymphoma, unspecified; Nodular MALIGNANT NEOPLASMS OF LYMPHOID, C82.9 13,900 4,170 9,730 non-Hodgkin's lymphoma NOS HEMATOPOIETIC AND RELATED TISSUE Small cell diffuse non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID, C83.0 13,900 4,170 9,730 Small cell B-cell lymphoma HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C83.2 Mixed small and large cell diffuse non-Hodgkin's lymphoma N/A N/A N/A HEMATOPOIETIC AND RELATED TISSUE Large cell diffuse non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID, C83.3 13,900 4,170 9,730 Diffuse large B-cell lymphoma HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C83.4 Immunoblastic diffuse non-Hodgkin's lymphoma N/A N/A N/A HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C83.5 Lymphoblastic diffuse non-Hodgkin's lymphoma 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Burkitt's tumour MALIGNANT NEOPLASMS OF LYMPHOID, C83.7 13,900 4,170 9,730 Burkitt"s lymphoma HEMATOPOIETIC AND RELATED TISSUE Other types of diffuse non-Hodgkin's lymphoma MALIGNANT NEOPLASMS OF LYMPHOID, C83.8 13,900 4,170 9,730 Other non-follicular lymphoma HEMATOPOIETIC AND RELATED TISSUE Diffuse non-Hodgkin's lymphoma, unspecified MALIGNANT NEOPLASMS OF LYMPHOID, C83.9 13,900 4,170 9,730 Non-follicular lymphoma, unspecified HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C84.0 Mycosis fungoides 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C84.1 Sézary's disease 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C84.3 Lymphoepithelioid lymphoma; Lennert's lymphoma N/A N/A N/A HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C84.4 Peripheral T-cell lymphoma 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE

Page 61 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee MALIGNANT NEOPLASMS OF LYMPHOID, C84.5 Other and unspecified T-cell lymphomas 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C85.0 Lymphosarcoma N/A N/A N/A HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C85.1 B-cell lymphoma, unspecified 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Other specified types of non-Hodgkin's lymphoma; MALIGNANT NEOPLASMS OF LYMPHOID, C85.7 Malignant reticuloendotheliosis; Malignant reticulosis; 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Microglioma Non-Hodgkin's lymphoma, unspecified type; Lymphoma MALIGNANT NEOPLASMS OF LYMPHOID, C85.9 13,900 4,170 9,730 NOS HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C90.0 Multiple myeloma; Kahler's disease; Myelomatosis 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C90.1 Plasma cell leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Extramedullary Plasmacytoma; Malignant plasma cell MALIGNANT NEOPLASMS OF LYMPHOID, C90.2 13,900 4,170 9,730 tumour NOS; Plasmacytoma NOS ; Solitary myeloma HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.0 Acute lymphoblastic leukemia; Acute lymphocytic leukemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.1 Chronic lymphocytic leukaemia of B-cell type 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.2 Subacute lymphocytic leukaemia of B-cell type 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.3 Prolymphocytic leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.4 Hairy-cell leukaemia; Leukaemic reticuloendotheliosis 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.5 Adult T-cell leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.7 Other lymphoid leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C91.9 Lymphoid leukaemia, unspecified 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Acute myeloid leukaemia MALIGNANT NEOPLASMS OF LYMPHOID, C92.0 13,900 4,170 9,730 Acute myeloblastic leukaemia HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.1 Chronic myeloid leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.2 Subacute myeloid leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.3 Myeloid sarcoma; Chloroma; Granulocytic sarcoma 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.4 Acute promyelocytic leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.5 Acute myelomonocytic leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.7 Other myeloid leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C92.9 Myeloid leukaemia, unspecified 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C93.0 Acute monocytic leukaemia 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Chronic monocytic leukaemia MALIGNANT NEOPLASMS OF LYMPHOID, C93.1 13,900 4,170 9,730 Chronic myelomonocytic leukaemia HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C93.9 Monocytic leukaemia, unspecified 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Acute erythraemia and erythroleukaemia; Acute MALIGNANT NEOPLASMS OF LYMPHOID, C94.0 erythraemic myelosis; Di Guglielmo's disease 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Acute erythroid leukaemia Acute megakaryoblastic leukaemia; Acute megakaryocytic MALIGNANT NEOPLASMS OF LYMPHOID, C94.2 13,900 4,170 9,730 Leukaemia HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C94.4 Acute panmyelosis 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C94.5 Acute myelofibrosis 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Acute leukaemia of unspecified cell type; Blast cell MALIGNANT NEOPLASMS OF LYMPHOID, C95.0 13,900 4,170 9,730 leukaemia; Stem cell leukaemia HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C95.1 Chronic leukaemia of unspecified cell type 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C95.2 Subacute leukaemia of unspecified cell type N/A N/A N/A HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C95.7 Other leukaemia of unspecified cell type 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE MALIGNANT NEOPLASMS OF LYMPHOID, C95.9 Leukaemia, unspecified 13,900 4,170 9,730 HEMATOPOIETIC AND RELATED TISSUE Letterer-Siwe disease; Nonlipid reticuloendotheliosis; MALIGNANT NEOPLASMS OF LYMPHOID, C96.0 13,900 4,170 9,730 Nonlipid reticulosis HEMATOPOIETIC AND RELATED TISSUE

Page 62 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee MALIGNANT NEOPLASMS OF LYMPHOID, C96.1 Malignant histiocytosis; Histiocytic medullary reticulosis N/A N/A N/A HEMATOPOIETIC AND RELATED TISSUE Malignant mast cell tumour; Malignant ; MALIGNANT NEOPLASMS OF LYMPHOID, C96.2 13,900 4,170 9,730 Malignant mastocytosis; HEMATOPOIETIC AND RELATED TISSUE Other specified malignant neoplasms of lymphoid, MALIGNANT NEOPLASMS OF LYMPHOID, C96.7 13,900 4,170 9,730 haematopoietic and related tissue HEMATOPOIETIC AND RELATED TISSUE Malignant neoplasm of lymphoid, haematopoietic and MALIGNANT NEOPLASMS OF LYMPHOID, C96.9 13,900 4,170 9,730 related tissue, unspecified HEMATOPOIETIC AND RELATED TISSUE Malignant neoplasm of Penis, unspecified; Malignant MALIGNANT NEOPLASMS OF MALE GENITAL C60.9 13,400 4,020 9,380 neoplasm of Skin of penis NOS TRACT MALIGNANT NEOPLASMS OF MALE GENITAL C61 Malignant neoplasm of prostate 13,400 4,020 9,380 TRACT Malignant neoplasm of Undescended testis; Ectopic testis MALIGNANT NEOPLASMS OF MALE GENITAL C62.0 13,400 4,020 9,380 ; Malignant neoplasm of Retained testis TRACT Malignant neoplasm of Descended testis; Malignant MALIGNANT NEOPLASMS OF MALE GENITAL C62.1 13,400 4,020 9,380 neoplasm of Scrotal Testis TRACT MALIGNANT NEOPLASMS OF MALE GENITAL C62.9 Malignant neoplasm of Testis, unspecified 13,400 4,020 9,380 TRACT MALIGNANT NEOPLASMS OF MALE GENITAL C63.0 Malignant neoplasm of Epididymis 13,400 4,020 9,380 TRACT MALIGNANT NEOPLASMS OF MALE GENITAL C63.1 Malignant neoplasm of Spermatic cord 13,400 4,020 9,380 TRACT Malignant neoplasm of Scrotum; Malignant neoplasm of MALIGNANT NEOPLASMS OF MALE GENITAL C63.2 13,400 4,020 9,380 Skin of scrotum TRACT Malignant neoplasm of Seminal vesicle; Malignant MALIGNANT NEOPLASMS OF MALE GENITAL C63.7 13,400 4,020 9,380 neoplasm of Tunica vaginalis TRACT Malignant neoplasm of Male genital organ, unspecified; MALIGNANT NEOPLASMS OF MALE GENITAL C63.9 13,400 4,020 9,380 Male genitourinary tract NOS TRACT C45.2 Mesothelioma of pericardium MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420 C45.7 Mesothelioma of other sites MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420 C45.9 Mesothelioma, unspecified MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420 C48.0 Malignant neoplasm of Retroperitoneum MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420 Malignant neoplasm of Pelvis; Malignant neoplasm of Groin NOS; Malignant neoplasm of C76.3 MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 Sites overlapping systems within the pelvis, such as rectovaginal (septum) & rectovesical (septum) C76.4 Malignant neoplasm of Upper limb MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 C76.5 Malignant neoplasm of Lower limb MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 C76.7 Malignant neoplasm of Other ill-defined sites MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 Malignant neoplasm of Overlapping lesion of other and ill- C76.8 MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 defined sites

Secondary and unspecified malignant neoplasm of Axillary C77.3 and upper limb lymph nodes; Secondary and unspecified MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 malignant neoplasm of Pectoral lymph nodes

Secondary and unspecified malignant neoplasm of Lymph C77.9 MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 node, unspecified C79.7 Secondary malignant neoplasm of adrenal gland MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 C79.8 Secondary malignant neoplasm of other specified sites MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 Malignant neoplasm without specification of site; Unspecified site whether primary or secondary [Cancer, Carcinoma, Carcinomatosis, Generalized cancer, C80 MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270 Generalized malignancy, Malignancy, Multiple cancer]; Malignant cachexia; Malignant neoplasm of Primary site unknown Malignant neoplasm of Peripheral nerves of head, face and C47.0 MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310 neck Malignant neoplasm of Peripheral nerves of upper limb, C47.1 MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310 including shoulder Malignant neoplasm of Peripheral nerves of lower limb, C47.2 MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310 including hip

C47.3 Malignant neoplasm of Peripheral nerves of thorax MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310

C47.4 Malignant neoplasm of Peripheral nerves of abdomen MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310

C47.5 Malignant neoplasm of Peripheral nerves of pelvis MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310

Malignant neoplasm of Peripheral nerves of trunk, C47.6 MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310 unspecified Malignant neoplasm of Peripheral nerves and autonomic C47.9 MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310 nervous system, unspecified

Malignant neoplasm of Glottis; Malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND C32.0 14,600 4,380 10,220 Intrinsic larynx; Malignant neoplasm of true Vocal cord NOS INTRATHORACIC ORGANS

Page 63 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Malignant neoplasm of Supraglottis: Malignant neoplasm of Aryepiglottic fold, laryngeal aspect; Malignant neoplasm of Epiglottis (suprahyoid portion) NOS; Malignant neoplasm MALIGNANT NEOPLASMS OF RESPIRATORY AND C32.1 14,600 4,380 10,220 of Extrinsic larynx; Malignant neoplasm of False vocal cord; INTRATHORACIC ORGANS Malignant neoplasm of posterior laryngeal surface of epiglottis; Malignant neoplasm of ventricular bands

MALIGNANT NEOPLASMS OF RESPIRATORY AND C32.2 Malignant neoplasm of Subglottis 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C32.3 Malignant neoplasm of Laryngeal cartilage 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C32.9 Malignant neoplasm of Larynx, unspecified 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C33 Malignant neoplasm of trachea 14,600 4,380 10,220 INTRATHORACIC ORGANS

Malignant neoplasm of Main bronchus; Malignant MALIGNANT NEOPLASMS OF RESPIRATORY AND C34.0 14,600 4,380 10,220 neoplasm of Carina; Malignant neoplasm of Hilus of lung INTRATHORACIC ORGANS

MALIGNANT NEOPLASMS OF RESPIRATORY AND C34.1 Malignant neoplasm of Upper lobe, bronchus or lung 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C34.2 Malignant neoplasm of Middle lobe, bronchus or lung 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C34.3 Malignant neoplasm of Lower lobe, bronchus or lung 14,600 4,380 10,220 INTRATHORACIC ORGANS Malignant neoplasm of Overlapping lesion of bronchus and MALIGNANT NEOPLASMS OF RESPIRATORY AND C34.8 14,600 4,380 10,220 lung INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C34.9 Malignant neoplasm of Bronchus or lung, unspecified 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C37 Malignant neoplasm of thymus 14,600 4,380 10,220 INTRATHORACIC ORGANS Malignant neoplasm of Heart; Malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND C38.0 14,600 4,380 10,220 Pericardium INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C38.1 Malignant neoplasm of Anterior mediastinum 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C38.3 Malignant neoplasm of Mediastinum, part unspecified 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C38.4 Malignant neoplasm of Pleura 14,600 4,380 10,220 INTRATHORACIC ORGANS Malignant neoplasm of Overlapping lesion of heart, MALIGNANT NEOPLASMS OF RESPIRATORY AND C38.8 14,600 4,380 10,220 mediastinum and pleura INTRATHORACIC ORGANS Malignant neoplasm of Upper respiratory tract, part MALIGNANT NEOPLASMS OF RESPIRATORY AND C39.0 14,600 4,380 10,220 unspecified INTRATHORACIC ORGANS Malignant neoplasm of Overlapping lesion of respiratory MALIGNANT NEOPLASMS OF RESPIRATORY AND C39.8 14,600 4,380 10,220 and intrathoracic organs INTRATHORACIC ORGANS Malignant neoplasm of Ill-defined sites within the MALIGNANT NEOPLASMS OF RESPIRATORY AND C39.9 14,600 4,380 10,220 respiratory system; Respiratory tract NOS INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C45.0 Mesothelioma of pleura 10,600 3,180 7,420 INTRATHORACIC ORGANS Malignant neoplasm of Thorax; Malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND C76.1 Axilla NOS; Malignant neoplasm of Intrathoracic NOS; 14,600 4,380 10,220 INTRATHORACIC ORGANS Malignant neoplasm of Thoracic NOS Secondary and unspecified malignant neoplasm of MALIGNANT NEOPLASMS OF RESPIRATORY AND C77.1 14,600 4,380 10,220 Intrathoracic lymph nodes INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C78.0 Secondary malignant neoplasm of lung 14,600 4,380 10,220 INTRATHORACIC ORGANS MALIGNANT NEOPLASMS OF RESPIRATORY AND C78.1 Secondary malignant neoplasm of mediastinum 14,600 4,380 10,220 INTRATHORACIC ORGANS Secondary malignant neoplasm of pleura; Malignant pleural MALIGNANT NEOPLASMS OF RESPIRATORY AND C78.2 14,600 4,380 10,220 effusion NOS INTRATHORACIC ORGANS Secondary malignant neoplasm of other and unspecified MALIGNANT NEOPLASMS OF RESPIRATORY AND C78.3 14,600 4,380 10,220 respiratory organs INTRATHORACIC ORGANS Malignant neoplasm of Maxillary sinus; Malignant C31.0 neoplasm of Antrum (Highmore); Malignant neoplasm of MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050 Antrum (maxillary) C31.1 Malignant neoplasm of Ethmoidal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050 C31.2 Malignant neoplasm of Frontal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050 C31.3 Malignant neoplasm of Sphenoidal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050 Malignant neoplasm of Overlapping lesion of accessory C31.8 MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050 sinuses C31.9 Malignant neoplasm of Accessory sinus, unspecified MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050 Human Immunodeficiency Virus [HIV] Disease resulting in B21.0 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 Kaposi's Sarcoma C46.9 Kaposi's sarcoma, unspecified MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400

Malignant neoplasm of Connective and soft tissue of head, C49.0 face and neck; Malignant neoplasm of Connective tissue of MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 ear; Malignant neoplasm of Connective tissue of eyelid

Page 64 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Malignant neoplasm of Connective and soft tissue of upper C49.1 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 limb, including shoulder Malignant neoplasm of Connective and soft tissue of lower C49.2 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 limb, including hip Malignant neoplasm of Connective and soft tissue of thorax; Malignant neoplasm of Connective and soft tissue C49.3 of Axilla; Malignant neoplasm of Connective and soft tissue MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 of Diaphragm; Malignant neoplasm of Connective and soft tissue of Great vessels Malignant neoplasm of Connective and soft tissue of abdomen; Malignant neoplasm of Connective and soft C49.4 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 tissue of Abdominal wall; Malignant neoplasm of Connective and soft tissue of Hypochondrium Malignant neoplasm of Connective and soft tissue of pelvis; Malignant neoplasm of Connective and soft tissue of C49.5 Buttock; Malignant neoplasm of Connective and soft tissue MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 of Groin; Malignant neoplasm of Connective and soft tissue of Perineum Malignant neoplasm of Connective and soft tissue of trunk, C49.6 unspecified; Malignant neoplasm of Connective and soft MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 tissue of Back NOS Malignant neoplasm of Overlapping lesion of connective C49.8 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 and soft tissue Malignant neoplasm of Connective and soft tissue, C49.9 MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400 unspecified MALIGNANT NEOPLASMS OF THYROID AND C73 Malignant neoplasm of thyroid gland 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C74.0 Malignant neoplasm of Cortex of adrenal gland 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C74.1 Malignant neoplasm of Medulla of adrenal gland 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C74.9 Malignant neoplasm of Adrenal gland, unspecified 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C75.0 Malignant neoplasm of Parathyroid gland 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C75.1 Malignant neoplasm of Pituitary gland 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C75.3 Malignant neoplasm of Pineal gland 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C75.5 Malignant neoplasm of Aortic body and other paraganglia 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS MALIGNANT NEOPLASMS OF THYROID AND C75.9 Malignant neoplasm of Endocrine gland, unspecified 11,400 3,420 7,980 OTHER ENDOCRINE GLANDS E40 Kwashiorkor MALNUTRITION 11,700 3,510 8,190

E41 Nutritional marasmus; Severe malnutrition with marasmus MALNUTRITION 11,700 3,510 8,190

Marasmic kwashiorkor; Severe protein-energy malnutrition, E42 intermediate form; Severe protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190 with signs of both kwashiorkor and marasmus

E43 Unspecified severe protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190 E44.0 Moderate protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190 E44.1 Mild protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190 Retarded development following protein-energy E45 malnutrition; Nutritional short stature; Nutritional MALNUTRITION 11,700 3,510 8,190 stunting; Physical retardation due to malnutrition Unspecified protein-energy malnutrition; Malnutrition NOS; E46 MALNUTRITION 11,700 3,510 8,190 Protein-energy imbalance NOS Pre-existing essential hypertension complicating pregnancy O10.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 child birth and the puerperium Pre-existing hypertensive heart disease complicating O10.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy, childbirth and the puerperium Pre-existing hypertensive renal disease complicating O10.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy childbirth and the puerperium Pre-existing hypertensive heart and renal disease O10.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 complicating pregnancy, childbirth and the puerperium Pre-existing secondary hypertension complicating O10.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy, childbirth and the puerperium Unspecified pre-existing hypertension complicating O10.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy, childbirth and the puerperium Pre-existing hypertensive disorder with superimposed O11 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 proteinuria O12.1 Gestational proteinuria MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O12.2 Gestational oedema with proteinuria MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Gestational [pregnancy-induced] hypertension wihtout O13 significant proteinuria; Gestational hypertension NOS; Mild MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pre-eclampsia

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FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee O14.0 Moderate pre-eclampsia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O14.1 Severe pre-eclampsia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O14.9 Pre-eclampsia, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O15.0 Eclampsia in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O15.1 Eclampsia in labour MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O15.9 Eclampsia, unspecified as to time period; Eclampsia NOS MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O16 Unspecified maternal hypertension MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Threatened abortion; Haemorrhage specified as due to O20.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 threatened abortion O20.8 Other haemorrhage in early pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O20.9 Haemorrhage in early pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Mild ; Hyperemesis gravidarum, O21.0 mild or unspecified, starting before the end of the 22nd MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 week of gestation

Hyperemesis gravidarum with metabolic disturbance; Hyperemesis gravidarum, starting before the end of the O21.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 22nd week of gestation, with metabolic disturbance such as carbohydrate depletion, dehydration, elctrolyte imbalance

Late vomiting of pregnancy; Excessive vomiting starting O21.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 after 22 completed weeks of gestation

Other vomiting complicating pregnancy; Vomiting due to O21.8 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 disease classified elsewhere, complicating pregnancy

O21.9 Vomiting of pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Deep phlebothrombosis in pregnancy; Deep-vein O22.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 thrombosis, antepartum Cerebral venous thrombosis in pregnancy; Cerebrovenous O22.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 sinus thrombosis in pregnancy Venous complication in pregnancy, unspecified; Gestational O22.9 phlebitis NOS; Gestational phlebopathy NOS; Gestational MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 thrombosis NOS O23.0 Infections of kidney in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O23.3 Infections of other parts of urinary tract in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O24.0 Pre-existing diabetes mellitus, insulin-dependent MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O24.1 Pre-existing diabetes mellitus, non-insulin-dependent MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O24.2 Pre-existing malnutrition-related diabetes mellitus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O24.3 Pre-existing diabetes mellitus, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Diabetes mellitus arising in pregnancy; Gestational diabetes O24.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 mellitus NOS O24.9 Diabetes mellitus in pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O26.2 Pregnancy care of habitual aborter MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O26.3 Retained in trauterine contraceptive device in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O26.4 Herpes gestationis MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal hypotension syndrome; Supine hypotensive O26.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 syndrome

O26.6 Liver disorders in pregnancy, childbirth and the puerperium MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Subluxation of symphysis (pubis) in pregnancy childbirth O26.7 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 and the puerperium

Other specified pregnancy-related conditions; Exhaustion O26.8 and fatigue pregnancy-related; Peripheral neuritis MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy-related; Renal disease pregnancy-related

O26.9 Pregnancy-relatedcondition, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Abnormal haematological finding on antenatal screening of O28.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 mother Abnormal ultrasonic finding on antenatal screening of O28.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 mother Abnormal chromosomal and genetic finding on antenatal O28.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 screening of mother

O28.8 Other abnormal findings on antenatal screening of mother MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Abnormal finding on antenatal screening of mother, O28.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 unspecified O29.8 Other complications of anaesthesia during pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O30.0 Twin pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O30.1 Triplet pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O30.8 Other multiple gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O30.9 Multiple gestation, unspecified; Multiple pregnancy NOS MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O31.0 Papyraceous fetus; Fetus compressus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O31.1 Continuing pregnancy after abortion of one fetus or more MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

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FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Continuing pregnancy after intrauterine death of one fetus O31.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 or more O31.8 Other complications specific to multiple gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O32.0 Maternal care for unstable lie MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O32.1 Maternal care for breech presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for transverse and oblique lie; Oblique O32.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 presentation; Transverse presentation O32.3 Maternal care for face, brow and chin presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for high head at term; Failure of head to O32.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 enter pelvic brim Maternal care for multiple gestation with malpresentation O32.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 of one fetus or more O32.6 Maternal care for compound presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O32.8 Maternal care for other malpresentation of fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O32.9 Maternal care for malpresentation of fetus, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Maternal care for disproportion due to deformity of O33.0 maternal pelvic bones; Pelvic deformity causing MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 disproportion NOS Maternal care for disproportion due to generally O33.1 contracted pelvis; Contracted pelvis NOS causing MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 disproportion

Maternal care for disproportion due to inlet contraction of O33.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pelvis; Inlet contraction (pelvis) causing disproportion

Maternal care for disproportion due to outlet contraction of pelvis; Mid-cavity contraction pelvis causing O33.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 disproportion; Outlet contraction pelvis causing disproportion Maternal care for disproportion of mixed maternal and O33.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 fetal origin Maternal care for disproportion due to unusually large O33.5 fetus; Disproportion of fetal origin with normally formed MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 fetus; Fetal disproportion NOS

O33.6 Maternal care for disproportion due to hydrocephalic fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Maternal care for disproportion due to other fetal deformities; Conjoined twins; Fetal ascites causing disproportion; Fetal hydrops causing disproportion; Fetal O33.7 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 meaningomyelocele causing disproportion; Fetal tumour causing disproportion; Sacral teratoma causing disproportion

Maternal care for disproportion, unspecified; Cephalopelvic O33.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 disproportion NOS; Fetopelvic disproportion NOS

Maternal care for congenital malformation of uterus; O34.0 Maternal care for double uterus; Maternal care for Uterus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 bicornis Maternal care for tumour of corpus uteri; Maternal for O34.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 polyp of corpus uteri; Maternal care for Maternal care due to uterine scar from previous surgery; O34.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for scar from previous Maternal care for cervical incompetence; Maternal care for cerclage with or without mention of cervical incompetence; O34.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for Shirodkar suture with or without mention of cervical incompetence

Maternal care for other abnormalities of cervix; Maternal care for polyp of cervix; Maternal care for previous surgery O34.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 to cervix; Maternal care for stricture or stenosis of cervix; Maternal care for tumour of cervix

Maternal care for other abnormalities of gravid uterus; Maternal care for incarceratiion of gravid uterus; Maternal O34.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 care for prolapse of gravid uterus; Maternal care for retroversion of gravid uterus Maternal care for abnormality of vagina; Maternal care for previous surgery to vagina; Maternal care for septate O34.6 vagina; Maternal care for acquired stenosis of vagina; MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for congenital stenosis of vagina; Maternal care for tumour of vagina

Maternal care for abnormality of vulva and perineum; Maternal care for fibrosis of perineum; Maternal care for O34.7 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 previous surgery to perineum or vulva; Maternal care for rigid perineum; Maternal care for tumour of vulva

Page 67 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Maternal care for other abnormalities of pelvic organs; Maternal care for cystocele; Maternal care for previous O34.8 pelvic floor repair; Maternal care for pendulous abdomen; MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for rectocele; Maternal care for rigid pelvic floor

O34.9 Maternal care for abnormality of pelvic organ, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Maternal care for (suspected) central nervous system O35.0 malformation in fetus; Maternal care for suspected fetal MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 anencephaly; Maternal care for suspected fetal spina bifida

O35.2 Maternal care for (suspected) hereditary disease in fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Maternal care for (suspected) damage to fetus from viral disease in mother; Maternal care for suspected damage to O35.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 fetus from maternal infection; Maternal care for suspected damage to fetus from maternal rubella

Maternal care for (suspected) damage to fetus by drugs; O35.5 Maternal care for suspected damage to fetus from drug MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 addiction

Maternal care for other (suspected) fetal abnormality and damage; Maternal care for suspected damage to fetus from O35.8 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 maternal listeriosis; Maternal care for suspected damage to fetus from maternal toxoplasmosis

Maternal care for (suspected) fetal abnormality and O35.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 damage, unspecified Maternal care for rhesus isoimmunization; Anti-D [Rh] O36.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 ; Rh incompatibility (with hydrops fetalis) Maternal care for other isoimmunization; ABO O36.1 isoimmunization; Isoimmunization NOS (with hydrops MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 fetalis) Maternal care for hydrops fetalis; Hydrops fetalis NOS; O36.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Hydrops fetalis not associated with isoimmunization O36.3 Maternal care for signs of fetal hypoxia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O36.4 Maternal care for intrauterine death MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternal care for poor fetal growth; Maternal care for known or suspected light-for-dates; Maternal care for O36.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 known or suspected placental insufficiency; Maternal care for known or suspected small-for-dates Maternal care for excessive fetal growth; Maternal care for O36.6 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 known or suspected large-for-dates O36.8 Maternal care for other specified fetal problems MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O36.9 Maternal care for fetal problem, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O40 Polyhydramnios; Hydramnios MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Oligohydramnios; Oligohydramnios without mention of O41.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 rupture of membrane Infection of amniotic sac and membranes; Amnionitis; O41.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Chorioamnionitis; Membranitis; Placentitis

O41.8 Other specified disorders of amniotic fluid and membranes MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Disorder of amniotic fluid and membranes, unspecified; O41.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Premature rupture of membranes Premature rupture of membranes on set of labour within O42.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 24 hours Premature rupture of membranes on set of labour after 24 O42.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 hours Premature rupture of membranes, labour delayed by O42.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 therapy O42.9 Premature rupture of membranes, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Placental transfusion syndromes; Fetomaternal transfusion; O43.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Maternofetal transfusion; Twin-to-twin transfusion

Malformation of placenta; Abnormal placenta NOS; O43.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Circumvallate placenta Other placental disorders; Placental dysfunction; Placental O43.8 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 infarction O43.9 Placental disorder, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Placenta praevia specified as without haemorrhage; Low O44.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 implantation of placenta, NOS or with haemorrhage

Placenta praevia with haemorrhage; Low implantation of placenta, NOS or with haemorrhage; Placenta praevia, O44.1 marginal NOS or with haemorrhage; Placenta praevia, MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 partial NOS or with haemorrhage; Placenta praevia, total NOS or with haemorrhage

Page 68 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Premature separation of placenta with coagulation defect; Abruptio placentae with (excessive) haemorrhage associated with afibrinogenaemia; Abruptio placentae with (excessive) haemorrhage associated with disseminated O45.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 intravascular coagulation; Abruptio placentae with (excessive) hemorrhage associated with hyperfibrinogenaemia; Abruptio placentae with (excessive) haemorrhage associated with hypofibrinogenaemia

O45.8 Other premature separation of placenta MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Premature separation of placenta, unspecified; Abruptio O45.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 placenta NOS

Antepartum haemorrhage with coagulation defect; Antepartum haemorrhage (excessive) associated with afibrinogenaemia; Antepartum haemorrhage (excessive) O46.0 associated with disseminated intravascular coagulation; MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Antepartum haemorrhage (excessive) associated with hyperfibrinolysis; Antepartum haemorrahge (excessive) associated with hypofibrinogenaemia

O46.8 Other antepartum haemorrhage MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O46.9 Antepartum haemorrhage, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O47.0 False labour before 37 completed weeks of gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O47.1 False labour at or after 37 completed weeks of gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

O47.9 False labour, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 O48 Prolonged pregnancy; Post-dates; Post-term MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Tuberculosis complicating pregnancy, childbirth and the O98.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 puerperium Syphilis complicating pregnancy, childbirth and the O98.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 puerperium Gonorrhoea complicating pregnancy, childbirth and the O98.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 puerperium Other infections with apredominantly sexual mode of O98.3 transmission complicating pregnancy, childbirth and the MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 puerperium complicating pregnancy, childbirth and the O98.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 puerperium Other viral diseases complicating pregnancy, childbirth and O98.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 the puerperium Protozoal diseases complicating pregnancy, childbirth and O98.6 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 the puerperium Other maternal infectious and parasitic diseases O98.8 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 complicating pregnancy, childbirth and the puerperium Unspecified maternal infectious or O98.9 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 complicating pregnancy, childbirth and the puerperium Anaemia complicating pregnancy, childbirth and the O99.0 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 puerperium

Other diseases of the blood and blood-forming organs and O99.1 certain disorders involving the immune mechanism MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 complicating pregnancy, childbirth and the puerperium

Endocrine, nutritional and metabolic diseases complicating O99.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy, childbirth and the puerperium Mental disorders and diseases of the nervous system O99.3 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 complicating pregnancy, childbirth and the puerperium Diseases of the circulatory system complicating pregnancy, O99.4 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 childbirth and the puerperium Diseases of the respiratory system complicating pregnancy, O99.5 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 childbirth and the puerperium Diseases of the digestive system complicating pregnancy, O99.6 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 childbirth and the puerperium Diseases of the skin and subcutaneous tissue complicating O99.7 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy, childbirth and the puerperium Other specified diseases and conditions complicating O99.8 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 pregnancy, childbirth and the puerperium O60.0 Preterm labor, not resulting to delivery MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z34.0 Supervision of normal first pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z34.8 Supervision of other normal pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z34.9 Supervision of normal pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z35.0 Supervision of pregnancy with history of infertility MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Supervision of pregnancy with history of abortive outcome; Supervision of pregnancy with history of hydatidiform Z35.1 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 mole; Supervision of pregnancy with history of vesicular mole

Page 69 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Supervision of pregnancy with other poor reproductive or obstetric history; Supervision of pregnancy with history of Z35.2 MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 neonatal death; Supervision of pregnancy with history of stillbirth Z35.4 Supervision of pregnancy with grand multiparity MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z35.5 Supervision of elderly primigravida MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z35.6 Supervision of very young primigravida MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Z35.7 Supervision of high-risk pregnancy due to social problems MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760

Z35.8 Supervision of other high-risk pregnancies MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 Z35.9 Supervision of high-risk pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760 A87.8 Other viral meningitis MENINGITIS 25,700 7,710 17,990 A87.9 Viral meningitis, unspecified MENINGITIS 25,700 7,710 17,990 meningitis; Meningitis due to Haemophilus G00.0 MENINGITIS 25,700 7,710 17,990 influenzae G00.1 Pneumococcal meningitis MENINGITIS 25,700 7,710 17,990 G00.2 Streptococcal meningitis MENINGITIS 25,700 7,710 17,990 G00.3 Staphylococcal meningitis MENINGITIS 25,700 7,710 17,990 Other bacterial meningitis; Meningitis due to Escherichia G00.8 coli; Meningitis due to Friedländer bacillus; Meningitis due MENINGITIS 25,700 7,710 17,990 to Klebsiella

Bacterial meningitis, unspecified; Meningitis purulent NOS; G00.9 MENINGITIS 25,700 7,710 17,990 Meningitis pyogenic NOS; Meningitis suppurative NOS

G03.0 Nonpyogenic meningitis; Nonbacterial meningitis MENINGITIS 25,700 7,710 17,990 G03.1 Chronic meningitis MENINGITIS 25,700 7,710 17,990 G03.8 Meningitis due to other specified causes MENINGITIS 25,700 7,710 17,990 G03.9 Meningitis, unspecified; Arachnoiditis (spinal) NOS MENINGITIS 25,700 7,710 17,990 Measles complicated by meningitis; Meningitis in viral B05.1+ G02.0* MENINGITIS 25,700 7,710 17,990 diseases classified elsewhere A39.2 Acute meningococcaemia MENINGOCOCCAL INFECTION 19,800 5,940 13,860 A39.3 Chronic meningococcaemia MENINGOCOCCAL INFECTION 19,800 5,940 13,860 Meningococcaemia, unspecified; Meningococcal A39.4 MENINGOCOCCAL INFECTION 19,800 5,940 13,860 bacteraemia NOS Meningococcal infection, unspecified; Meningococcal A39.9 MENINGOCOCCAL INFECTION 19,800 5,940 13,860 disease NOS Primary amenorrhoea; Failure to start menstruation at N91.0 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 puberty. Secondary amenorrhoea; Absence of menstruation in a N91.1 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 woman who had previously menstruated.

N91.2 Amenorrhoea, unspecified; Absence of menstruation NOS MENSTRUAL IRREGULARITIES 6,600 1,980 4,620

N91.5 Oligomenorrhoea, unspecified; Hypomenorrhoea NOS MENSTRUAL IRREGULARITIES 6,600 1,980 4,620

Excessive and frequent menstruation with regular cycle; N92.0 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 Heavy periods NOS; Menorrhagia NOS; Polymenorrhoea

Excessive and frequent menstruation with irregular cycle; Irregular intermenstrual bleeding; Irregular, shortened N92.1 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 intervals between menstrual bleeding; Menometrorrhagia; Metrorrhagia Excessive menstruation at puberty; Excessive bleeding N92.2 associated with onset of menstrual periods; Pubertal MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 menorrhagia; Puberty bleeding N92.3 Ovulation bleeding; Regular intermenstrual bleeding MENSTRUAL IRREGULARITIES 6,600 1,980 4,620

Excessive bleeding in the premenopausal period; Climateric menorrhagia or metrorrhagia; Menopausal menorrhagia or N92.4 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 metrorrhagia; Preclimateric menorrhagia or metrorrhagia; Premenopausal menorrhagia or metrorrhagia

N92.5 Other specified irregular menstruation MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 Irregular menstruation, unspecified; Irregular bleeding N92.6 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 NOS; Irregular periods NOS N93.0 Postcoital and contact bleeding MENSTRUAL IRREGULARITIES 6,600 1,980 4,620

Other specified abnormal uterine and vaginal bleeding; N93.8 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 Dysfunctional or functional uterine or vaginal bleeding NOS

Abnormal uterine and vaginal bleeding, unspecified N93.9 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 Uterine hemorrhage not due to menstraution Other specified conditions associated with female genital N94.8 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 organs and menstrual cycle Unspecified condition associated with female genital N94.9 MENSTRUAL IRREGULARITIES 6,600 1,980 4,620 organs and menstrual cycle

F01.1 Multi-infarct dementia; Predominantly cortical dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460

F01.8 Other vascular dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F01.9 Vascular dementia, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460

Page 70 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Unspecified dementia; Presenile dementia NOS; Presenile F03 psychosis NOS; Senile dementia NOS; Senile dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 depressed or paranoid type; Senile psychosis NOS

Organic amnesic syndrome, not induced by alcohol and F04 other psychoactive substances; Korsakov's psychosis or MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 syndrome, nonalcoholic F05.0 Delirium not superimposed on dementia, so described MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F05.8 Other delirium MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F05.9 Other delirium/Delirium, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Organic hallucinosis; Organic hallucinatory state F06.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 (nonalcoholic) Organic delusional [schizophrenia-like] disorder; Paranoid F06.2 and paranoid-hallucinatory organic states; Schizophrenia- MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 like psychosis in epilepsy F06.3 Organic mood [affective] disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F06.4 Organic anxiety disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F06.7 Mild cognitive disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Other specified mental disorders due to brain damage and F06.8 dysfunction and to physical disease; Epileptic psychosis MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS Unspecified mental disorder due to brain damage and F06.9 dysfunction and to physical disease; Organic brain MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 syndrome NOS; Organic mental disorder NOS Organic personality disorder; Organic pseudopsychopathic personality; F07.0 Organic pseudoretarded personality; Frontal lobe MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Syndrome; Limbic epilepsy personality Syndrome ; Lobotomy Syndrome; Postleucotomy Syndrome F07.1 Postencephalitic syndrome MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Postconcussional syndrome; Postcontusional syndrome F07.2 (encephalopathy); Post-traumatic brain syndrome, MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 nonpsychotic Unspecified organic personality and behavioural disorder F07.9 due to brain disease, damage and dysfunction; Organic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychosyndrome Unspecified organic or symptomatic mental disorder; F09 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Organic Psychosis NOS; Symptomatic Psychosis NOS Mental and behavioural disorders due to use of alcohol in F10.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 acute intoxication Mental and behavioural disorders due to use of F10.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 alcohol:harmful use Mental and behavioural disorders due to use of alcohol: F10.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 dependency syndrome Mental and behavioural disorders due to use of F10.3 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 alcohol:withdrawal state Mental and behavioural disorders due to use of alcohol: F10.4 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 withdrawal state with delirium Mental and behavioural disorders due to use of alcohol: F10.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychotic disorder Mental and behavioural disorders due to use of alcohol: F10.6 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 amnesic syndrome Mental and behavioural disorders due to use of alcohol: F10.7 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 residual and late-onset psychotic disorder Mental and behavioural disorders due to use of alcohol: F10.8 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 other mental and behavioural disorders Mental and behavioural disorders due to use of alcohol: F10.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 unspecified mental and behavioural disorder Mental and behavioural disorders due to use of opioids: F11.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 harmful use Mental and behavioural disorders due to use of opioids: F11.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 dependence syndrome Mental and behavioural disorders due to use of opioids: F11.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychotic disorder Mental and behavioural disorders due to use of opioids: F11.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 unspecified mental and behavioural disorder Mental and behavioural disorders due to use of F12.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 cannabinoids: acute intoxication Mental and behavioural disorders due to use of F12.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 cannabinoids: psychotic disorder Mental and behavioural disorders due to use of sedatives F13.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 or hypnotics: harmful use Mental and behavioural disorders due to use of sedatives F13.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 or hypnotics: dependence syndrome Mental and behavioural disorders due to use of sedatives F13.3 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 or hypnotics: withdrawal state

Page 71 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Mental and behavioural disorders due to use of sedatives F13.4 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 or hypnotics: withdrawal state with delirium Mental and behavioural disorders due to use of sedatives F13.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 or hypnotics: psychotic disorder

Mental and behavioural disorders due to use of sedatives F13.7 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 or hypnotics: residual and late-onset psychotic disorder

Mental and behavioural disorders due to use of cocaine: F14.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 acute intoxication Mental and behavioural disorders due to use of cocaine: F14.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 dependence syndrome Mental and behavioural disorders due to use of cocaine: F14.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychotic disorder Mental and behavioural disorders due to use of cocaine: F14.6 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 amnesic syndrome Mental and behavioural disorders due to use of cocaine: F14.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 unspecified mental and behavioural disorder Mental and behavioural disorders due to use of other F15.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 stimulants, including caffeine: acute intoxication Mental and behavioural disorders due to use of other F15.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 stimulants, including caffeine: harmful use Mental and behavioural disorders due to use of other F15.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 stimulants, including caffeine: dependence syndrome Mental and behavioural disorders due to use of other F15.3 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 stimulants, including caffeine: withdrawal state Mental and behavioural disorders due to use of other F15.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 stimulants, including caffeine: psychotic disorder Mental and behavioural disorders due to use of other F15.8 stimulants, including caffeine: other mental and MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 behavioural disorders Mental and behavioural disorders due to use of other F15.9 stimulants, including caffeine: unspecified mental and MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 behavioural disorder Mental and behavioural disorders due to use of F16.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 hallucinogens: acute intoxication Mental and behavioural disorders due to use of F16.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 hallucinogens: harmful use Mental and behavioural disorders due to use of F16.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 hallucinogens: dependence syndrome Mental and behavioural disorders due to use of F16.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 hallucinogens: psychotic disorder Mental and behavioural disorders due to use of tobacco: F17.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 dependence syndrome Mental and behavioural disorders due to use of tobacco: F17.3 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 withdrawal state Mental and behavioural disorders due to use of volatile F18.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 solvents: acute intoxication Mental and behavioural disorders due to use of volatile F18.4 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 solvents: withdrawal state with delirium Mental and behavioural disorders due to use of volatile F18.6 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 solvents: amnesic syndrome Mental and behavioural disorders due to multiple drug use F19.1 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: harmful use Mental and behavioural disorders due to multiple drug use F19.2 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: dependence syndrome Mental and behavioural disorders due to multiple drug use F19.3 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: withdrawal state Mental and behavioural disorders due to multiple drug use F19.5 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: psychotic disorder

Mental and behavioural disorders due to multiple drug use F19.7 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: residual and late-onset psychotic disorder

Mental and behavioural disorders due to multiple drug use F19.8 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: other mental and behavioural disorders

Mental and behavioural disorders due to multiple drug use F19.9 and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS: unspecified mental and behavioural disorder

F20.0 Paranoid schizophrenia; Paraphrenic schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Hebephrenic schizophrenia; Disorganized schizophrenia; F20.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Hebephrenia

Page 72 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Catatonic schizophrenia; Catatonic stupor; Schizophrenic F20.2 catalepsy; Schizophrenic catatonia; Schizophrenic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 flexibilitas cerea F20.3 Undifferentiated schizophrenia; Atypical schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Residual schizophrenia; Chronic undifferentiated F20.5 schizophrenia; Restzustand (schizophrenic); Schizophrenic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 residual state F20.6 Simple schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Other schizophrenia; Cenesthopathic schizophrenia; F20.8 Schizophreniform disorder NOS; Schizophreniform MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychosis NOS F20.9 Schizophrenia, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Schizotypal disorder; Latent schizophrenic reaction; Schizophrenia borderline; Schizophrenia latent; Schizophrenia prepsychotic; Schizophrenia prodromal; F21 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Schizophrenia pseudoneurotic; Schizophrenia pseudopsychopathic; Schizotypal personality disorder

Delusional disorder; Paranoia; Paranoid psychosis; Paranoid F22.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 state; Paraphrenia (late); Sensitiver Beziehungswahn

Other persistent delusional disorders; Delusional F22.8 dysmorphophobia; Involutional paranoid state; Paranoia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 querulans

Acute polymorphic psychotic disorder without symptoms of schizophrenia; Bouffée délirante without symptoms of F23.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 schizophrenia or unspecified; Cycloid psychosis without symptoms of schizophrenia or unspecified

Acute polymorphic psychotic disorder with symptoms of schizophrenia; Bouffée délirante with symptoms of F23.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 schizophrenia; Cycloid psychosis with symptoms of schizophrenia Acute schizophrenia-like psychotic disorder;Acute (undifferentiated) schizophrenia;Brief schizophreniform F23.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 disorder; Brief schizophreniform psychosis; Oneirophrenia; Schizophrenic reaction

Other acute predominantly delusional psychotic disorders; F23.3 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Paranoid reaction; Psychogenic paranoid psychosis

F23.8 Other acute and transient psychotic disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Acute and transient psychotic disorder, unspecified; Brief F23.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 reactive psychosis NOS; Reactive psychosis Induced delusional disorder; Folie à deux; Induced paranoid F24 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 disorder; Induced psychotic disorder Schizoaffective disorder, manic type; Schizoaffective F25.0 psychosis, manic type; Schizophreniform psychosis, manic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 type Schizoaffective disorder, depressive type; Schizoaffective F25.1 psychosis, depressive type; Schizophreniform psychosis, MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 depressive type

Schizoaffective disorder, mixed type; Cyclic schizophrenia; F25.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Mixed schizophrenic and affective psychosis

F25.8 Other schizoaffective disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Schizoaffective disorder, unspecified; Schizoaffective F25.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychosis NOS Other nonorganic psychotic disorders; Chronic F28 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 hallucinatory psychosis F29 Unspecified nonorganic psychosis; Psychosis NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F30.0 Hypomania MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F30.1 Mania without psychotic symptoms MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Mania with psychotic symptoms; Mania with mood- F30.2 congruent psychotic symptoms; Mania with mood- MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 incongruent psychotic symptoms; Manic stupor F30.9 Manic episode, unspecified; Mania NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F31.0 Bipolar affective disorder, current episode hypomanic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Bipolar affective disorder, current episode manic without F31.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychotic symptoms Bipolar affective disorder, current episode manic with F31.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychotic symptoms Bipolar affective disorder, current episode mild or F31.3 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 moderate depression Bipolar affective disorder, current episode severe F31.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 depression with psychotic symptoms F31.6 Bipolar affective disorder, current episode mixed MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F31.7 Bipolar affective disorder, currently in remission MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460

Page 73 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other bipolar affective disorders; Bipolar II disorder; F31.8 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Recurrent manic episodes NOS F31.9 Bipolar affective disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F32.0 Mild depressive episode MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F32.1 Moderate depressive episode MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460

Severe depressive episode without psychotic symptoms; F32.2 [Agitated depression, Major depression, Vital depression] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 single episode without psychotic symptoms

Severe depressive episode with psychotic symptoms; Single episodes of major depression with psychotic symptoms; F32.3 Single episodes of psychogenic depressive psychosis; Single MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 episodes of psychotic depression; Single episodes of reactive depressive psychosis Other depressive episodes; Atypical depression; Single F32.8 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 episodes of "masked" depression NOS Depressive episode, unspecified; Depression NOS; F32.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Depressive disorder NOS

Recurrent depressive disorder, current episode severe without psychotic symptoms; Endogenous depression without psychotic symptoms; Major depression, recurrent F33.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 without psychotic symptoms; Manic-depressive psychosis, depressed type without psychotic symptoms; Vital depression, recurrent without psychotic symptoms

Recurrent depressive disorder, current episode severe with psychotic symptoms including Endogenous depression with psychotic symptoms; Manic-depressive psychosis, depressed type with psychotic symptoms; Recurrent severe F33.3 episodes of major depression with psychotic symptoms; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Recurrent severe episodes of psychogenic depressive psychosis; Recurrent severe episodes of psychotic depression; Recurrent severe episodes of reactive depressive psychosis

F33.8 Other recurrent depressive disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Recurrent depressive disorder, unspecified; Monopolar F33.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 depression NOS Cyclothymia; Affective personality disorder; Cycloid F34.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 personality; Cyclothymic personality Dysthymia; Depressive neurosis; Depressive personality F34.1 disorder; Neurotic depression; Persistent anxiety MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 depression F42.1 Predominantly compulsive acts [obsessional rituals] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F42.2 Mixed obsessional thoughts and acts MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F42.8 Other obsessive-compulsive disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F42.9 Obsessive-compulsive disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Acute stress reaction including Acute crisis reaction; Acute F43.0 reaction to stress; Combat fatigue; Crisis state; Psychic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 shock F43.1 Post-traumatic stress disorder; Traumatic neurosis MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Adjustment disorders; Culture shock; Grief reaction; F43.2 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Hospitalism in children F43.8 Other reactions to severe stress MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F44.0 Dissociative amnesia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Dissociative motor disorders; Psychogenic aphonia; F44.4 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Psychogenic dysphonia Other dissociative [conversion] disorders; Ganser's F44.8 syndrome; Multiple personality; Psychogenic confusion; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Psychogenic twilight state F44.9 Dissociative [conversion] disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Somatization disorder; Briquet’s disorder; Multiple F45.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychosomatic disorder Undifferentiated somatoform disorder; Undifferentiated F45.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychosomatic disorder Hypochondriacal disorder; Body dysmorphic disorder; F45.2 Dysmorphophobia (nondelusional); Hypochondriacal MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 neurosis; Hypochondriasis; Nosophobia

Page 74 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Somatoform autonomic dysfunction; Cardiac neurosis; Da Costa's syndrome; Gastric neurosis ; Neurocirculatory asthenia Psychogenic forms of aerophagy; Psychogenic forms of cough, Psychogenic forms of diarrhea; Psychogenic forms of dyspepsia; Psychogenic forms of dysuria; psychogenic F45.3 forms of flatulence; Psychogenic forms of hiccough; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Psychogenic forms of hyperventilation; Psychogenic forms of increased frequency of micturition; Psychogenic forms of irritable bowel syndrome; Psychogenic forms of pylorospasm Psychogenic urine retention Psychogenic polyuria Persistent somatoform pain disorder; Psychalgia; F45.4 Psychogenic backache; Psychogenic headache; Somatoform MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 pain disorder Other somatoform disorders; Psychogenic dysmenorrhoea; Psychogenic dysphagia, including "globus hystericus"; F45.8 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Psychogenic pruritus; Psychogenic torticollis; Teeth- grinding Somatoform disorder, unspecified; Psychosomatic disorder F45.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS Other specified neurotic disorders; Dhat syndrome; Occupational neurosis, including writer's cramp; F48.8 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Psychasthenia; Psychasthenic neurosis; Psychogenic syncope F48.9 Neurotic disorder, unspecified; Neurosis NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F50.2 ; Bulimia NOS; Hyperorexia nervosa MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Mild mental and behavioural disorders associated with the F53.0 puerperium, not elsewhere classified; Depression postnatal MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS; Depression postpartum NOS Severe mental and behavioural disorders associated with F53.1 the puerperium, not elsewhere classified; Puerperal MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 psychosis NOS F53.9 Puerperal mental disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460

Abuse of non-dependence-producing substances; Abuse of F55 ; Abuse of herbal or folk remedies; Abuse of MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 steroids or hormones; Abuse of vitamins; Laxative habit

Unspecified behavioural syndromes associated with F59 physiological disturbances and physical factors; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Psychogenic physiological dysfunction NOS Mild mental retardation; feeble-mindedness; mild mental F70.0 subnormality with the statement of no, or minimal, MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 impairment of behaviour

Severe mental retardation; severe mental subnormality F72.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 without mention of impairment of behaviour

Other mental retardation with significant impairment of F78.1 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 behaviour requiring attention or treatment Other mental retardation with other impairments of F78.8 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 behaviour Other mental retardation without mention of impairment F78.9 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 of behaviour Unspecified mental retardation; mental deficiency NOS; F79.8 mental subnormality NOS with other impairments of MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 behaviour F80.3 Acquired aphasia with epilepsy [Landau-Kleffner] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Specific developmental disorder of motor function; Clumsy F82 child syndrome; Developmental coordination disorder; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Developmental dyspraxia Childhood autism; Autistic disorder; Infantile autism; F84.0 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Infantile psychosis; Kanner's syndrome F84.2 Rett's syndrome MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Other childhood disintegrative disorder; Dementia F84.3 infantilis; Disintegrative psychosis; Heller's syndrome; MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Symbiotic psychosis Asperger's syndrome; Autistic psychopathy; Schizoid F84.5 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 disorder of childhood F84.9 Pervasive developmental disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Unspecified disorder of psychological development; F89 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Developmental disorder NOS F90.8 Other hyperkinetic disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 F92.0 Depressive conduct disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 Nonorganic encopresis; Functional encopresis; F98.1 Incontinence of faeces of nonorganic origin; Psychogenic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 encopresis

Page 75 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Mental disorder, not otherwise specified; Mental illness F99 MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460 NOS

Disorders of plasma-protein metabolism, not elsewhere E88.0 METABOLIC DISORDERS 10,700 3,210 7,490 classified; a-1-Antitrypsin deficiency; Bisalbuminaemia

E88.1 Lipodystrophy, not elsewhere classified; Lipodystrophy NOS METABOLIC DISORDERS 10,700 3,210 7,490

Other specified metabolic disorders; Launois-Bensaude E88.8 METABOLIC DISORDERS 10,700 3,210 7,490 adenolipomatosis; Trimethylaminuria E88.9 , unspecified METABOLIC DISORDERS 10,700 3,210 7,490

P70.0 Syndrome of infant of mother with gestational diabetes METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510

Syndrome of infant of a diabetic mother; Maternal diabetes P70.1 mellitus (pre-existing) affecting fetus or newborn with METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 hypoglycaemia P70.2 Neonatal diabetes mellitus METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P70.3 Iatrogenic neonatal hypoglycaemia METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 Other neonatal hypoglycaemia; Transitory neonatal P70.4 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 hypoglycaemia Transitory disorder of carbohydrate metabolism of fetus P70.9 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 and newborn, unspecified P71.0 Cow's milk hypocalcaemia in newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P71.1 Other neonatal hypocalcaemia METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 Neonatal tetany without calcium or magnesium deficiency; P71.3 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 Neonatal tetany NOS P71.4 Transitory neonatal hypoparathyroidism METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 Transitory neonatal disorder of calcium and magnesium P71.9 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 metabolism, unspecified Neonatal goitre, not elsewhere classified; Transitory P72.0 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 congenital goitre with normal function Transitory neonatal hyperthyroidism; neonatal P72.1 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 thyrotoxicosis

Other transitory neonatal disorders of thyroid function, not P72.2 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 elsewhere classified; Transitory neonatal hypothyroidism

P72.8 Other specified transitory neonatal endocrine disorders METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510

P72.9 Transitory neonatal endocrine disorder, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P74.0 Late metabolic acidosis of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P74.1 Dehydration of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P74.2 Disturbances of sodium balance of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P74.4 Other transitory electrolyte disturbances of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P74.8 Other transitory metabolic disturbances of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510

P74.9 Transitory metabolic disturbance of newborn, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510

P80.9 Hypothermia of newborn, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 P81.0 Environmental hyperthermia of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 Other specified disturbances of temperature regulation of P81.8 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 newborn Disturbance of temperature regulation of newborn, P81.9 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 unspecified; Fever of newborn NOS P83.1 Neonatal erythema toxicum METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 Breast engorgement of newborn; Noninfective mastitis of P83.4 METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 newborn Other specified conditions of integument specific to fetus P83.8 and newborn; Bronze baby syndrome; Neonatal METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510 scleroderma; Urticaria neonatorum

Blighted ovum and nonhydatidiform mole; Carneous mole; O02.0 MISCARRIAGE 5,000 1,500 3,500 Fleshy mole; Intrauterine mole NOS; Pathological ovum

Missed abortion; Early fetal death with retention of dead O02.1 MISCARRIAGE 5,000 1,500 3,500 fetus O02.8 Other specified abnormal products of conception MISCARRIAGE 5,000 1,500 3,500 O02.9 Abnormal product of conception, unspecified MISCARRIAGE 5,000 1,500 3,500

O03.4 Spontaneous abortion, incomplete, without complication MISCARRIAGE 5,000 1,500 3,500

Spontaneous abortion, complete or unspecified, without O03.9 MISCARRIAGE 5,000 1,500 3,500 complication O05.4 Other abortion, incomplete, without complication MISCARRIAGE 5,000 1,500 3,500 Other abortion, complete or unspecified, without O05.9 MISCARRIAGE 5,000 1,500 3,500 complication Unspecified abortion or induced abortion NOS, incomplete, O06.4 MISCARRIAGE 5,000 1,500 3,500 without complication Unspecified abortion or induced abortion NOS, complete or O06.9 MISCARRIAGE 5,000 1,500 3,500 unspecified, without complication

Page 76 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Failed medical abortion, complicated by genital tract and pelvic infection with Endometritis; Oophoritis; Parametritis; O07.0 MISCARRIAGE 5,000 1,500 3,500 Parametritis; Pelvic peritonitis; Salpingitis; Salpingo- oophoritis; ; Septic shock; Septicaemia

Failed medical abortion with other and unspecified complications with Shock following abortion and ectopic and molar pregnancy; Circulatory collapase; Postoperative O07.3 MISCARRIAGE 5,000 1,500 3,500 Shock; Renal failure following abortion and ectopic and molar pregnancy; Oliguria; Acute Renal failure; Renal shutdown; Renal tubular necrosis; Uraemia

Failed medical abortion without complication; Failed O07.4 MISCARRIAGE 5,000 1,500 3,500 medical abortion NOS Other and unspecified failed attempted abortion with other and unspecified complications with with Shock following abortion and ectopic and molar pregnancy; Circulatory O07.8 collapase; Postoperative Shock; Renal failure following MISCARRIAGE 5,000 1,500 3,500 abortion and ectopic and molar pregnancy; Afibrinogenaemia; Defibrination syndrome; Intravascular coagulation Other and unspecified failed attempted abortion without O07.9 MISCARRIAGE 5,000 1,500 3,500 complication; Failed attempted abortion NOS

Spontaneous abortion, incomplete, complicated by Genital tract and pelvic infection with Genital tract and pelvic infection following abortion and ectopic and molar O03.0 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic peritonitis; Salpingitis; Salpingo-oophoritis and/or Sepsis and/or Septic shock and/or Septicaemia

Spontaneous abortion, incomplete, complicated Delayed or excessive haemorrhage with Delayed or excessive O03.1 haemorrhage following abortion and ectopic and molar MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 pregnancy; Afibrinogenaemia; Defibrination syndrome; Intravascular coagulation Spontaneous abortion, incomplete, complicated by Embolism with Embolism NOS or Air embolism or Amniotic O03.2 fluid embolism or Blood-clot embolism or Pulmonary MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 embolism or Pyaemic embolism or Septic or septicopyaemic embolism or Soap embolism

Spontaneous abortion, incomplete, with other and unspecified complications with Shock following abortion and ectopic and molar pregnancy; Circulatory collapase; O03.3 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Postoperative Shock; Renal failure following abortion and ectopic and molar pregnancy; Oliguria; Acute Renal failure; Renal shutdown; Renal tubular necrosis; Uraemia

Spontaneous abortion, complete, complicated by Genital tract and pelvic infection with Genital tract and pelvic infection following abortion and ectopic and molar O03.5 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic peritonitis; Salpingitis; Salpingo-oophoritis and/or Sepsis and/or Septic shock and/or Septicaemia

Spontaneous abortion, complete or unspecified, complicated Delayed or excessive haemorrhage with O03.6 Delayed or excessive haemorrhage following abortion and MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 ectopic and molar pregnancy; Afibrinogenaemia; Defibrination syndrome; Intravascular coagulation

Spontaneous abortion, complete or unspecified, with other complicated by Embolism with Embolism following O03.7 abortion and ectopic and molar pregnancy; Embolism NOS; MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Air embolism; Amniotic fluid embolism; Blood-clot embolism; Pulmonary embolism; Pyaemic embolism

Spontaneous abortion, complete or unspecified, with other and unspecified complications with Shock following O03.8 abortion and ectopic and molar pregnancy; Circulatory MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 collapase; Postoperative Shock; Renal failure following abortion and ectopic and molar pregnancy

Other abortion, incomplete, complicated by Genital tract and pelvic infection with Endometritis and/or Oophoritis O05.0 and/or Parametritis and/or Pelvic peritonitis and/or MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Salpingitis and/or Salpingo-oophoritis and/or Sepsis and/or Septic shock and/or Septicaemia

Page 77 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other abortion, incomplete, complicated Delayed or excessive haemorrhage with Delayed or excessive O05.1 haemorrhage following abortion and ectopic and molar MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 pregnancy; Afibrinogenaemia; Defibrination syndrome; Intravascular coagulation Other abortion, complete, with other and unspecified complications with Shock following abortion and ectopic O05.8 and molar pregnancy; Circulatory collapase; Postoperative MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Shock; Renal failure following abortion and ectopic and molar pregnancy; Oliguria Acute Unspecified abortion or induced abortion NOS, incomplete, complicated by Genital tract and pelvic infection with Endometritis and/or Oophoritis and/or Parametritis and/or O06.0 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Pelvic peritonitis and/or Salpingitis and/or Salpingo- oophoritis and/or Sepsis and/or Septic shock and/or Septicaemia Unspecified abortion or induced abortion NOS, incomplete, complicated Delayed or excessive haemorrhage with O06.1 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Afibrinogenaemia or Defibrination syndrome or Intravascular coagulation

Unspecified abortion or induced abortion NOS, incomplete, complicated by Embolism or Embolism NOS with Air O06.2 embolism or Amniotic fluid embolism or Blood-clot MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 embolism or Pulmonary embolism or Pyaemic embolism or Septic or septicopyaemic embolism or Soap embolism

Unspecified abortion or induced abortion NOS, incomplete, with other and unspecified complications with Shock following abortion and ectopic and molar pregnancy; O06.3 Circulatory collapase; Postoperative Shock; Renal failure MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 following abortion and ectopic and molar pregnancy; Oliguria; Acute Renal failure; Renal shutdown; Renal tubular necrosis; Uraemia Unspecified abortion or induced abortion NOS, complete, or unspecified, complicated by Genital tract and pelvic infection or Endometritis and/or Oophoritis and/or O06.5 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Parametritis and/or Pelvic peritonitis and/or Salpingitis and/or Salpingo-oophoritis and/or Sepsis and/or Septic shock and/or Septicaemia Unspecified abortion or induced abortion NOS, complete, complicated by Delayed or excessive haemorrhage or O06.6 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Afibrinogenaemia or Defibrination syndrome or Intravascular coagulation

Unspecified abortion or induced abortion NOS, complete, complicated by Embolism or Embolism NOS or Air O06.7 embolism or Amniotic fluid embolism or Blood-clot MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 embolism or Pulmonary embolism or Pyaemic embolism or Septic or septicopyaemic embolism or Soap embolism

Unspecified abortion or induced abortion NOS, complete, with other and unspecified complications with Shock following abortion and ectopic and molar pregnancy; O06.8 Circulatory collapase; Postoperative Shock; Renal failure MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 following abortion and ectopic and molar pregnancy; Oliguria; Acute Renal failure; Renal shutdown; Renal tubular necrosis; Uraemia Failed medical abortion complicated by delayed or excessive haemorrhage; Afibrinogenaemia with Delayed or O07.1 excessive haemorrhage following abortion and ectopic and MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 molar pregnancy; Afibrinogenaemia; Defibrination syndrome; Intravascular coagulation Other and unspecified failed attempted abortion complicated by genital tract and pelvic infection with O07.5 Endometritis; Oophoritis; Parametritis; Pelvic peritonitis; MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Salpingitis; Salpingo-oophoritis; Sepsi; Septic shock; Septicaemia Other and unspecified failed attempted abortion complicated by delayed or excessive haemorrhage with O07.6 Delayed or excessive haemorrhage following abortion and MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 ectopic and molar pregnancy; Afibrinogenaemia; Defibrination syndrome; Intravascular coagulation Shock following abortion and ectopic and molar pregnancy; O08.3 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 Circulatory collapase; Postoperative Shock

Other complications following abortion and ectopic and O08.8 MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830 molar pregnancy; Cardiac arrest; Urinary tract infection

M60.0 Infective myositis; Tropical MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

Page 78 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M60.00 Infective myositis; Tropical pyomyositis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M60.01 Infective myositis; Tropical pyomyositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M60.02 Infective myositis; Tropical pyomyositis Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Infective myositis; Tropical pyomyositis Pelvic region and M60.05 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 thigh M60.06 Infective myositis; Tropical pyomyositis Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.07 Infective myositis; Tropical pyomyositis Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.08 Infective myositis; Tropical pyomyositis Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M60.09 Infective myositis; Tropical pyomyositis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M60.1 Interstitial myositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.11 Interstitial myositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Foreign body granuloma of soft tissue, not elsewhere M60.2 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 classified Foreign body granuloma of soft tissue, not elsewhere M60.21 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 classified Shoulder region Foreign body granuloma of soft tissue, not elsewhere M60.23 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 classified Forearm Foreign body granuloma of soft tissue, not elsewhere M60.27 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 classified Ankle and foot M60.8 Other myositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.80 Other myositis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.81 Other myositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.88 Other myositis Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.89 Other myositis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.9 Myositis, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.90 Myositis, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.91 Myositis, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.92 Myositis, unspecified Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.95 Myositis, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.96 Myositis, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.98 Myositis, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M60.99 Myositis, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Calcification and ossification of muscles associated with M61.3 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 burns; Myositis ossificans associated with burns M61.55 Other ossification of muscle Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M61.59 Other ossification of muscle Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M61.9 Calcification and ossification of muscle, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.0 Diastasis of muscle MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.05 Diastasis of muscle Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.08 Diastasis of muscle Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.1 Other rupture of muscle (nontraumatic) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.48 Contracture of muscle Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.49 Contracture of muscle Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Muscle wasting and atrophy, not elsewhere classified; M62.56 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Disuse atrophy NEC Lower leg Muscle wasting and atrophy, not elsewhere classified; M62.59 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Disuse atrophy NEC Site unspecified M62.60 Muscle strain Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.61 Muscle strain Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.62 Muscle strain Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.63 Muscle strain Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.65 Muscle strain Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.66 Muscle strain Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.67 Muscle strain Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.68 Muscle strain Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.69 Muscle strain Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.8 Muscle (sheath) hernia MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.80 Muscle (sheath) hernia Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.85 Muscle (sheath) hernia Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.86 Muscle (sheath) hernia Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.88 Muscle (sheath) hernia Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.89 Muscle (sheath) hernia Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.9 Disorder of muscle, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.90 Disorder of muscle, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.91 Disorder of muscle, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.95 Disorder of muscle, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.96 Disorder of muscle, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.97 Disorder of muscle, unspecified Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.98 Disorder of muscle, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M62.99 Disorder of muscle, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.0 Abscess of tendon sheath MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.1 Other infective tenosynovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.13 Other infective (teno)synovitis Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.2 Calcific tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.20 Calcific tendinitis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

Page 79 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M65.22 Calcific tendinitis Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.25 Calcific tendinitis Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.29 Calcific tendinitis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.3 Trigger finger;Nodular tendinous disease MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.4 Radial styloid tenosynovitis [de Quervain] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.8 Other synovitis and tenosynovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.80 Other synovitis and tenosynovitis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.84 Other synovitis and tenosynovitis Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.86 Other synovitis and tenosynovitis Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.87 Other synovitis and tenosynovitis Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.89 Other synovitis and tenosynovitis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.9 Synovitis and tenosynovitis, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.90 Synovitis and tenosynovitis, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M65.91 Synovitis and tenosynovitis, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M65.92 Synovitis and tenosynovitis, unspecified Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.93 Synovitis and tenosynovitis, unspecified Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M65.94 Synovitis and tenosynovitis, unspecified Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Synovitis and tenosynovitis, unspecified Pelvic region and M65.95 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 thigh M65.96 Synovitis and tenosynovitis, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M65.97 Synovitis and tenosynovitis, unspecified Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M65.99 Synovitis and tenosynovitis, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M66.0 Rupture of popliteal cyst MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M66.4 Spontaneous rupture of other tendons MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Spontaneous rupture of unspecified tendon; Rupture at M66.5 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 musculotendinous junction, nontraumatic M67.0 Short Achilles tendon (acquired) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M67.1 Other contracture of tendon (sheath) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M67.2 Synovial hypertrophy, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M67.3 Transient synovitis; Toxic synovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M67.4 Ganglion; Ganglion of joint or tendon (sheath) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M67.8 Other specified disorders of synovium and tendon MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M67.9 Disorder of synovium and tendon, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.0 Chronic crepitant synovitis of hand and wrist MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.1 Bursitis of hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.2 Olecranon bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.3 Other bursitis of elbow MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.4 Prepatellar bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.5 Other bursitis of knee MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.6 Trochanteric bursitis; Trochanteric tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M70.7 Other bursitis of hip; Ischial bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Other soft tissue disorders related to use, overuse and M70.8 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 pressure Unspecified soft tissue disorder related to use, overuse and M70.9 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 pressure M71.1 Other infective bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.2 Synovial cyst of popliteal space [Baker] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.3 Other bursal cyst; Synovial cyst NOS MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.31 Other bursal cyst; Synovial cyst NOS Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.5 Other bursitis, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.51 Other bursitis, not elsewhere classified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.8 Other specified bursopathies MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.9 Bursopathy, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.91 Bursopathy, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M71.99 Bursopathy, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M72.0 Palmar fascial [Dupuytren] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M72.2 Plantar fascial fibromatosis; Plantar fasciitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M72.5 Fasciitis, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M72.88 Other fibroblastic disorders; Abscess of fascia Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Fibroblastic disorder, unspecified; Fasciitis NOS; M72.9 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Fibromatosis NOS Fibroblastic disorder, unspecified; Fasciitis NOS; M72.98 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Fibromatosis NOS Other Fibroblastic disorder, unspecified; Fasciitis NOS; M72.99 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Fibromatosis NOS Site unspecified Adhesive capsulitis of shoulder; Frozen shoulder; M75.0 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Periarthritis of shoulder Rotator cuff syndrome; Rotator cuff or supraspinatus tear M75.1 or rupture complete)(incomplete), not specified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 as traumatic; Supraspinatus syndrome M75.2 Bicipital tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M75.3 Calcific tendinitis of shoulder; Calcified bursa of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M75.4 Impingement syndrome of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

Page 80 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M75.5 Bursitis of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M75.8 Other shoulder lesions MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M75.9 Shoulder lesion, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76 Enthesopathies of lower limb, excluding foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.0 Gluteal tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.1 Psoas tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.3 Iliotibial band syndrome MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.4 Tibial collateral bursitis [Pellegrini-Stieda] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.5 Patellar tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.6 Achilles tendinitis; Achilles bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M76.7 Peroneal tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Other enthesopathies of lower limb, excluding foot; M76.8 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Anterior tibial syndrome; Posterior tibial tendinitis M76.9 Enthesopathy of lower limb, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M77.0 Medial epicondylitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M77.1 Lateral epicondylitis; Tennis elbow MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M77.3 Calcaneal spur MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M77.5 Other enthesopathy of foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M77.8 Other enthesopathies, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Enthesopathy, unspecified; Bone spur NOS; Capsulitis NOS; M77.9 MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 Periarthritis NOS; Tendinitis NOS M79.80 Other specified soft tissue disorders Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.81 Other specified soft tissue disorders Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.82 Other specified soft tissue disorders Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.84 Other specified soft tissue disorders Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M79.85 Other specified soft tissue disorders Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M79.86 Other specified soft tissue disorders Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.87 Other specified soft tissue disorders Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.88 Other specified soft tissue disorders Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.89 Other specified soft tissue disorders Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.91 Soft tissue disorder, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M79.95 Soft tissue disorder, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550

M79.98 Soft tissue disorder, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.99 Soft tissue disorder, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550 M79.00 Rheumatism, unspecified Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.01 Rheumatism, unspecified Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.02 Rheumatism, unspecified Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.05 Rheumatism, unspecified Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.07 Rheumatism, unspecified Ankle and foot MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.08 Rheumatism, unspecified Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.09 Rheumatism, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.10 Myalgia Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.11 Myalgia Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.12 Myalgia Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.15 Myalgia Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.16 Myalgia Lower leg MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.18 Myalgia Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.19 Myalgia Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.20 Neuralgia and neuritis, unspecified Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.21 Neuralgia and neuritis, unspecified Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.22 Neuralgia and neuritis, unspecified Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130

M79.25 Neuralgia and neuritis, unspecified Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130

M79.28 Neuralgia and neuritis, unspecified Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.29 Neuralgia and neuritis, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M79.39 Panniculitis, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 M96.8 Other postprocedural musculoskeletal disorders MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130 P94.0 Transient neonatal myasthenia gravis MYASTHENIA GRAVIS NEWBORN 11,600 3,480 8,120 G70.0 Myasthenia gravis MYOPATHIES 7,900 2,370 5,530 G70.2 Congenital and developmental myasthenia MYOPATHIES 7,900 2,370 5,530 G70.8 Other specified myoneural disorders MYOPATHIES 7,900 2,370 5,530 G70.9 Myoneural disorder, unspecified MYOPATHIES 7,900 2,370 5,530

Muscular dystrophy; Muscular dystrophy autosomal recessive, childhood type, resembling Duchenne or Becker; Muscular dystrophy benign [Becker]; Muscular dystrophy benign; capuloperoneal with early contractures [Emery- G71.0 Dreifuss]; Muscular dystrophy distal; Muscular dystrophy MYOPATHIES 7,900 2,370 5,530 facioscapulohumeral; Muscular dystrophy limb-girdle; Muscular dystrophy ocular; Muscular dystrophy oculopharyngeal; Muscular dystrophy scapuloperoneal; Muscular dystrophy severe [Duchenne]

Page 81 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Myotonic disorders; Dystrophia myotonica [Steinert]; Myotonia, chondrodystrophic; Myotonia, drug-induced; Myotonia, symptomatic; Myotonia, congenita NOS; G71.1 MYOPATHIES 7,900 2,370 5,530 Myotonia, congenita dominant [Thomsen]; Myotonia, congenital recessive [Becker]; Neuromyotonia [Isaac]; Paramyotonia congenita; Pseudomyotonia

Congenital myopathies; Congenital muscular dystrophy NOS; Congenital muscular dystrophy with specific morphological abnormalities of the muscle fibre; Central G71.2 MYOPATHIES 7,900 2,370 5,530 coreDisease ; Minicore Disease ; MulticoreDisease ; Fibre- type disproportion; Myopathy myotubular (centronuclear); Myopathy nemaline

Primary disorder of muscle, unspecified; Hereditary G71.9 MYOPATHIES 7,900 2,370 5,530 myopathy NOS G72.0 Drug-induced myopathy MYOPATHIES 7,900 2,370 5,530 G72.1 Alcoholic myopathy MYOPATHIES 7,900 2,370 5,530 G72.2 Myopathy due to other toxic agents MYOPATHIES 7,900 2,370 5,530 Periodic paralysis; Periodic paralysis (familial) hyperkalaemic; Periodic paralysis (familial) hypokalaemic; G72.3 MYOPATHIES 7,900 2,370 5,530 Periodic paralysis (familial) myotonic; Periodic paralysis (familial) normokalaemic G72.4 Inflammatory myopathy, not elsewhere classified MYOPATHIES 7,900 2,370 5,530 G72.8 Other specified myopathies MYOPATHIES 7,900 2,370 5,530 G72.9 Myopathy, unspecified MYOPATHIES 7,900 2,370 5,530 P91.0 Neonatal cerebral ischaemia NEONATAL CEREBRAL 25,800 7,740 18,060 Fetus and newborn affected by maternal hypertensive P00.0 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 disorders Fetus and newborn affected by maternal renal and urinary P00.1 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 tract diseases Fetus and newborn affected by maternal infectious and P00.2 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 parasitic diseases Fetus and newborn affected by other maternal circulatory P00.3 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 and respiratory diseases Fetus and newborn affected by maternal nutritional P00.4 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 disorders; Maternal nutriotion NOS P00.5 Fetus and newborn affected by maternal injury NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by surgical procedure on P00.6 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 mother Fetus and newborn affected by other medical procedures P00.7 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 on mother, not elsewhere classified

Fetus and newborn affected by other maternal conditions; Fetus or newborn affected by maternal genital tract and P00.8 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 other localized infections; Fetus or newborn affected by maternal systemic lupus erythematosus

Fetus and newborn affected by unspecified maternal P00.9 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 condition P01.0 Fetus and newborn affected by incompetent cervix NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by premature rupture of P01.1 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 membranes P01.2 Fetus and newborn affected by oligohydramnios NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by polyhydramnios; P01.3 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Hydramnios Fetus and newborn affected by ectopic pregnancy; P01.4 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Abdominal pregnancy Fetus and newborn affected by multiple pregnancy; Triplet P01.5 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 pregnance; Twin pregnancy P01.6 Fetus and newborn affected by maternal death NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390

Fetus and newborn affected by malpresentation before labour; Breech presentation before labor; External version P01.7 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 before labour; Face presentation before labour; Transverse lie before labour; Unstable lie before labour

Fetus and newborn affected by other maternal P01.8 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 complications of pregnancy; Spontaneous abortion, fetus

Fetus and newborn affected by maternal complication of P01.9 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 pregnancy, unspecified P02.0 Fetus and newborn affected by placenta praevia NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by other forms of placental separation and haemorrhage; Abruptio placentae; Accidental haemorrhage; Antepartum haemorrhage; P02.1 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Damage to placenta from amniocentesis, caesarian section or surgical induction; Maternal blood loss; Premature separation of placenta

Page 82 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Fetus and newborn affected by other and unspecified morphological and functional abnormalities of placenta; P02.2 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Placental dysfunction; Placental infarction; Placental insufficiency Fetus and newborn affected by placental transfusion P02.3 syndromes; Placental and cord abnormalities resulting in NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 twin-to-twin or other transplacental transfusion P02.4 Fetus and newborn affected by prolapsed cord NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by other compression of P02.5 umbilical cord; Cord (tightly) around neck; Entanglement of NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 cord; Knot in cord Fetus and newborn affected by other and unspecified P02.6 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 conditions of umbilical cord; Short cord; Vasa praevia Fetus and newborn affected by chorioamnionitis; P02.7 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Amnionitis; Membranitis; Placentitis Fetus and newborn affected by other abnormalities of P02.8 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 membranes Fetus and newborn affected by abnormality of membranes, P02.9 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 unspecified Fetus and newborn affected by breech delivery and P03.0 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 extraction Fetus and newborn affected by other malpresentation, malposition and disproportion during labour and delivery; P03.1 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Contracted pelvis; Persistent occipitoposterior; Transverse lie P03.2 Fetus and newborn affected by forceps delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by delivery by vacuum P03.3 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 extractor [ventouse] P03.4 Fetus and newborn affected by caesarean delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 P03.5 Fetus and newborn affected by precipitate delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by abnormal uterine contractions; Fetus and newborn affected by abnormal P03.6 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Hypertonic lahour; Fetus and newborn affected by abnormal Uterine inertia Fetus and newborn affected by other specified P03.8 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 complications of labour and delivery Fetus and newborn affected by complication of labour and P03.9 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 delivery, unspecified Fetus and newborn affected by maternal anaesthesia and P04.0 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 analgesia in pregnancy, labour and delivery Fetus and newborn affected by other maternal ; P04.1 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Cancer chemotherapy; Cytotoxic drugs

P04.2 Fetus and newborn affected by maternal use of tobacco NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390

P04.3 Fetus and newborn affected by maternal use of alcohol NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 Fetus and newborn affected by maternal use of nutritional P04.5 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 chemical substances Fetus and newborn affected by other maternal noxious P04.8 NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390 influences

Neoplasm of uncertain or unknown behaviour of Lip, oral cavity and pharynx; Neoplasm of uncertain or unknown behaviour of Aryepiglottic fold NOS; Neoplasm of uncertain or unknown behaviour of hypopharyngeal aspect D37.0 of Aryepiglottic fold; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 behaviour of marginal zone of Aryepiglottic fold; Neoplasm of uncertain or unknown behaviour of Major and minor salivary glands; Neoplasm of uncertain or unknown behaviour of Vermilion border of lip

D37.1 Neoplasm of uncertain or unknown behaviour of Stomach NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

Neoplasm of uncertain or unknown behaviour of Small D37.2 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 intestine

D37.3 Neoplasm of uncertain or unknown behaviour of Appendix NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

D37.4 Neoplasm of uncertain or unknown behaviour of Colon NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Neoplasm of uncertain or unknown behaviour of Rectum; D37.5 Neoplasm of uncertain or unknown behaviour of NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Rectosigmoid junction Neoplasm of uncertain or unknown behaviour of Liver, D37.6 gallbladder and bile ducts; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unknown behaviour of Ampulla of Vater

Page 83 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Neoplasm of uncertain or unknown behaviour of Other digestive organs; Neoplasm of uncertain or unknown behaviour of Anal canal; Neoplasm of uncertain or unknown behaviour of Anal sphincter; Neoplasm of D37.7 uncertain or unknown behaviour of Anus NOS; Neoplasm NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 of uncertain or unknown behaviour of Intestine NOS; Neoplasm of uncertain or unknown behaviour of Oesophagus; Neoplasm of uncertain or unknown behaviour of Pancreas Neoplasm of uncertain or unknown behaviour of Digestive D37.9 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 organ, unspecified

Neoplasm of uncertain or unknown behaviour of Larynx; Neoplasm of uncertain or unknown behaviour of laryngeal D38.0 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 aspect of Aryepiglottic fold; Neoplasm of uncertain or unknown behaviour of Suprahyoid portion of Epiglottis

Neoplasm of uncertain or unknown behaviour of Trachea, D38.1 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 bronchus and lung

D38.2 Neoplasm of uncertain or unknown behaviour of Pleura NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

Neoplasm of uncertain or unknown behaviour of D38.3 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Mediastinum

D38.4 Neoplasm of uncertain or unknown behaviour of Thymus NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

Neoplasm of uncertain or unknown behaviour of Other respiratory organs; Neoplasm of uncertain or unknown behaviour of Accessory sinuses; Neoplasm of uncertain or D38.5 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unknown behaviour of Cartilage of nose; Neoplasm of uncertain or unknown behaviour of Middle ear; Neoplasm of uncertain or unknown behaviour of Nasal cavities

Neoplasm of uncertain or unknown behaviour of D38.6 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Respiratory organ, unspecified

D39.0 Neoplasm of uncertain or unknown behaviour of Uterus NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

D39.1 Neoplasm of uncertain or unknown behaviour of Ovary NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Neoplasm of uncertain or unknown behaviour of Placenta; D39.2 Chorioadenoma destruens; Invasive Hydatidiform mole; NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Malignant Hydatidiform mole Neoplasm of uncertain or unknown behaviour of Other D39.7 female genital organs; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 behaviour of Skin of female genital organs Neoplasm of uncertain or unknown behaviour of Female D39.9 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 genital organ, unspecified

D40.0 Neoplasm of uncertain or unknown behaviour of Prostate NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

D40.1 Neoplasm of uncertain or unknown behaviour of Testis NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Neoplasm of uncertain or unknown behaviour of Other D40.7 male genital organs; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 behaviour of Skin of male genital organs Neoplasm of uncertain or unknown behaviour of Male D40.9 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 genital organ, unspecified

D41.0 Neoplasm of uncertain or unknown behaviour of Kidney NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

Neoplasm of uncertain or unknown behaviour of Renal D41.1 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 pelvis

D41.2 Neoplasm of uncertain or unknown behaviour of Ureter NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

D41.3 Neoplasm of uncertain or unknown behaviour of Urethra NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

D41.4 Neoplasm of uncertain or unknown behaviour of Bladder NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540

Neoplasm of uncertain or unknown behaviour of Urinary D41.9 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 organ, unspecified Neoplasm of uncertain or unknown behaviour of Cerebral D42.0 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 meninges Neoplasm of uncertain or unknown behaviour of Spinal D42.1 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 meninges Neoplasm of uncertain or unknown behaviour of Meninges, D42.9 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unspecified

Page 84 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Neoplasm of uncertain or unknown behaviour of Brain, supratentorial; Neoplasm of uncertain or unknown behaviour of Cerebral ventricle; Neoplasm of uncertain or unknown behaviour of Cerebrum; Neoplasm of uncertain D43.0 or unknown behaviour of Frontal lobe; Neoplasm of NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 uncertain or unknown behaviour of Occipital lobe; Neoplasm of uncertain or unknown behaviour of Parietal lobe; Neoplasm of uncertain or unknown behaviour of Temporal lobe Neoplasm of uncertain or unknown behaviour of Brain, infratentorial; Neoplasm of uncertain or unknown D43.1 behaviour of Brain stem; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unknown behaviour of Cerebellum; Neoplasm of uncertain or unknown behaviour of Fourth ventricle Neoplasm of uncertain or unknown behaviour of Brain, D43.2 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unspecified Neoplasm of uncertain or unknown behaviour of Cranial D43.3 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 nerves Neoplasm of uncertain or unknown behaviour of Spinal D43.4 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 cord Neoplasm of uncertain or unknown behaviour of Other D43.7 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 parts of central nervous system

Neoplasm of uncertain or unknown behaviour of Central D43.9 nervous system, unspecified; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unknown behaviour of Central Nervous system NOS

Neoplasm of uncertain or unknown behaviour of Thyroid D44.0 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 gland Neoplasm of uncertain or unknown behaviour of Adrenal D44.1 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 gland Neoplasm of uncertain or unknown behaviour of D44.2 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Parathyroid gland Neoplasm of uncertain or unknown behaviour of Pituitary D44.3 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 gland Neoplasm of uncertain or unknown behaviour of D44.4 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Craniopharyngeal duct Neoplasm of uncertain or unknown behaviour of Pineal D44.5 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 gland Neoplasm of uncertain or unknown behaviour of Carotid D44.6 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 body Neoplasm of uncertain or unknown behaviour of Aortic D44.7 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 body and other paraganglia Neoplasm of uncertain or unknown behaviour of D44.8 Pluriglandular involvement; Multiple endocrine NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 adenomatosis Neoplasm of uncertain or unknown behaviour of Endocrine D44.9 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 gland, unspecified D45 Polycythaemia vera NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 D46 Myelodysplastic syndromes NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 D46.7 Other myelodysplastic syndromes NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Myelodysplastic syndrome, unspecified; Myelodysplastic D46.9 syndrome NOS; Myelodysplasia NOS; Preleukaemia NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 syndrome NOS Histiocytic and mast cell tumours of uncertain and D47.0 unknown behaviour; Mast cell tumour NOS; Mastocytoma NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 NOS Chronic myeloproliferative disease; Myelofibrosis with myeloid ; Myeloproliferative disease, D47.1 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unspecified; Megakaryocytic Myelosclerosis with myeloid metaplasia D47.2 Monoclonal gammopathy NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Essential thrombocythaemia; Haemorrhagic D47.3 thrombocythaemia; Idiopathic haemorrhagic NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 thrombocythaemia

Other specified neoplasms of uncertain or unknown D47.7 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 behaviour of lymphoid, haematopoietic and related tissue

Neoplasm of uncertain or unknown behaviour of lymphoid, D47.9 haematopoietic and related tissue, unspecified; NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Lymphoproliferative disease NOS Neoplasm of uncertain or unknown behaviour of Bone and D48.0 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 articular cartilage

Neoplasm of uncertain or unknown behaviour of Connective and other soft tissue; Neoplasm of uncertain or D48.1 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 unknown behaviour of Connective tissue of ear; Neoplasm of uncertain or unknown behaviour of eyelid

Page 85 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Neoplasm of uncertain or unknown behaviour of Peripheral D48.2 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 nerves and autonomic nervous system Neoplasm of uncertain or unknown behaviour of D48.3 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Retroperitoneum Neoplasm of uncertain or unknown behaviour of D48.4 NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Peritoneum

Neoplasm of uncertain or unknown behaviour of Breast; D48.6 Neoplasm of uncertain or unknown behaviour of NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 Connective tissue of breast; Cystosarcoma phyllodes

Neoplasm of uncertain or unknown behaviour of Other specified sites; Neoplasm of uncertain or unknown D48.7 behaviour of Eye; Neoplasm of uncertain or unknown NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 behaviour of Heart; Neoplasm of uncertain or unknown behaviour of Peripheral nerves of orbit Neoplasm of uncertain or unknown behaviour, unspecified; D48.9 "Growth" NOS ; Neoplasm NOS; NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540 New growth NOS; Tumour NOS G54.0 Brachial plexus disorders; Thoracic outlet syndrome NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 G54.1 Lumbosacral plexus disorders NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 G54.2 Cervical root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 G54.3 Thoracic root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 G54.4 Lumbosacral root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 Neuralgic amyotrophy; Parsonage-Aldren-Turner G54.5 NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 syndrome; Shoulder-girdle neuritis G54.8 Other nerve root and plexus disorders NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 G54.9 Nerve root and plexus disorder, unspecified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 Nerve root and plexus compressions in other diseases G55.8* NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530 classified elsewhere NEWBORN COMPLICATED- LOW BIRTH P05.0 Light for gestational age 16,900 5,070 11,830 WEIGHT/PRETERM NEWBORN COMPLICATED- LOW BIRTH P05.1 Small for gestational age 16,900 5,070 11,830 WEIGHT/PRETERM Fetal malnutrition without mention of light or small for NEWBORN COMPLICATED- LOW BIRTH P05.2 16,900 5,070 11,830 gestational age WEIGHT/PRETERM Slow fetal growth, unspecified; Fetal growth retardation NEWBORN COMPLICATED- LOW BIRTH P05.9 16,900 5,070 11,830 NOS WEIGHT/PRETERM NEWBORN COMPLICATED- LOW BIRTH P07.0 Extremely low birth weight; Birth weight 999 g or less. 16,900 5,070 11,830 WEIGHT/PRETERM NEWBORN COMPLICATED- LOW BIRTH P07.1 Other low birth weight; Birth weight 1000-2499 g. 16,900 5,070 11,830 WEIGHT/PRETERM Extreme immaturity; Less than 28 completed weeks (less NEWBORN COMPLICATED- LOW BIRTH P07.2 16,900 5,070 11,830 than 196 completed days) of gestation. WEIGHT/PRETERM

Other preterm infants; 28 completed weeks or more but NEWBORN COMPLICATED- LOW BIRTH P07.3 less than 37 completed weeks (196 completed days but less 16,900 5,070 11,830 WEIGHT/PRETERM than 259 completed days) of gestation; Prematurity NOS

Exceptionally large baby; Usually implies a birth weight of P08.0 NEWBORN COMPLICATED-LARGE BABY 7,000 2,100 4,900 4500 g or more. Other heavy for gestational age infants; Other fetus or P08.1 infant heavy- or large-for-dates regardless of period of NEWBORN COMPLICATED-LARGE BABY 7,000 2,100 4,900 gestation.

Post-term infant, not heavy for gestational age; Fetus or infant with gestation period of 42 completed weeks or P08.2 NEWBORN COMPLICATED-POSTTERM 7,500 2,250 5,250 more (294 days or more), not heavy- or large-for-dates; Postmaturity NOS

P36.0 Sepsis of newborn due to streptococcus, group B NEWBORN SEPSIS 11,700 3,510 8,190 Sepsis of newborn due to other and unspecified P36.1 NEWBORN SEPSIS 11,700 3,510 8,190 streptococci P36.2 Sepsis of newborn due to Staphylococcus aureus NEWBORN SEPSIS 11,700 3,510 8,190 Sepsis of newborn due to other and unspecified P36.3 NEWBORN SEPSIS 11,700 3,510 8,190 staphylococci P36.4 Sepsis of newborn due to Escherichia coli NEWBORN SEPSIS 11,700 3,510 8,190 P36.5 Sepsis of newborn due to anaerobes NEWBORN SEPSIS 11,700 3,510 8,190 P36.8 Other bacterial sepsis of newborn NEWBORN SEPSIS 11,700 3,510 8,190 Bacterial sepsis of newborn, unspecified P36.9 Sepsis neonatorum NEWBORN SEPSIS 11,700 3,510 8,190 Septicemia, newborn Other noninflammatory disorders of ovary, fallopian tube NONINFLAMMATORY DISORDERS OF THE FEMALE N83.8 and broad ligament; Broad ligament laceration syndrome 8,500 2,550 5,950 GENITAL TRACT [Allen-Masters] Noninflammatory disorder of ovary, fallopian tube and NONINFLAMMATORY DISORDERS OF THE FEMALE N83.9 8,500 2,550 5,950 broad ligament, unspecified GENITAL TRACT Other specified noninflammatory disorders of uterus; NONINFLAMMATORY DISORDERS OF THE FEMALE N85.8 8,500 2,550 5,950 Atrophy of uterus, acquired; Fibrosis of uterus NOS GENITAL TRACT

Page 86 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Noninflammatory disorder of uterus, unspecified; Disorder NONINFLAMMATORY DISORDERS OF THE FEMALE N85.9 8,500 2,550 5,950 of uterus NOS GENITAL TRACT E50.0 Vitamin A deficiency with conjunctival xerosis NUTRITIONAL DISORDER 9,200 2,760 6,440 Vitamin A deficiency with Bitot's spot and conjunctival E50.1 NUTRITIONAL DISORDER 9,200 2,760 6,440 xerosis; Bitot's spot in the young child Other manifestations of vitamin A deficiency; Follicular E50.8 keratosis due to vitamin A deficiency; Xeroderma due to NUTRITIONAL DISORDER 9,200 2,760 6,440 vitamin A deficiency

E50.9 Vitamin A deficiency, unspecified; Hypovitaminosis A NOS NUTRITIONAL DISORDER 9,200 2,760 6,440

E51.1 Dry Beriberi NUTRITIONAL DISORDER 9,200 2,760 6,440 E51.2 Wernicke's encephalopathy NUTRITIONAL DISORDER 9,200 2,760 6,440 E51.8 Other manifestations of thiamine deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E51.9 Thiamine deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440 E53.1 Pyridoxine deficiency; Vitamin B6 deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 Deficiency of other specified B group vitamins; Biotin Deficiency; Cyanocobalamin Deficiency; Folate Deficiency; E53.8 NUTRITIONAL DISORDER 9,200 2,760 6,440 Folic acid Deficiency; Pantothenic acid Deficiency; Vitamin B12 Deficiency E53.9 Vitamin B deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440

E54 Ascorbic acid deficiency; Deficiency of vitamin C; Scurvy NUTRITIONAL DISORDER 9,200 2,760 6,440

Rickets, active; Infantile Osteomalacia; Juvenile E55.0 NUTRITIONAL DISORDER 9,200 2,760 6,440 Osteomalacia E55.9 Vitamin D deficiency, unspecified; Avitaminosis D NUTRITIONAL DISORDER 9,200 2,760 6,440 E56.0 Deficiency of vitamin E NUTRITIONAL DISORDER 9,200 2,760 6,440 E56.1 Deficiency of vitamin K NUTRITIONAL DISORDER 9,200 2,760 6,440 E56.8 Deficiency of other vitamins NUTRITIONAL DISORDER 9,200 2,760 6,440 E56.9 Vitamin deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440 E58 Dietary calcium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E60 Dietary zinc deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E61.1 Iron deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E61.2 Magnesium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E61.6 Vanadium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E61.9 Deficiency of nutrient element, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440 E63.1 Imbalance of constituents of food intake NUTRITIONAL DISORDER 9,200 2,760 6,440 E63.8 Other specified nutritional deficiencies NUTRITIONAL DISORDER 9,200 2,760 6,440 E63.9 Nutritional deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440 E64.9 Sequelae of unspecified nutritional deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440 E67.0 Hypervitaminosis A NUTRITIONAL DISORDER 9,200 2,760 6,440 E67.1 Hypercarotenaemia NUTRITIONAL DISORDER 9,200 2,760 6,440 E67.3 Hypervitaminosis D NUTRITIONAL DISORDER 9,200 2,760 6,440

Extreme obesity with alveolar hypoventilation; Obesity E66.2 OBESITY HYPOVENTILATION 13,600 4,080 9,520 hypoventilation syndrome (OHS); Pickwickian syndrome

N13.0 Hydronephrosis with ureteropelvic junction obstruction OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790

Hydronephrosis with ureteral stricture, not elsewhere N13.1 OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 classified Hydronephrosis with renal and ureteral calculous N13.2 OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 obstruction N13.3 Other and unspecified hydronephrosis OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 N13.4 Hydroureter OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 N13.5 Kinking and stricture of ureter without hydronephrosis OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 Pyonephrosis; Conditions in N13.0-N13.5 with infection; N13.6 OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 Obstructive uropathy with infection

Vesicoureteral-reflux-associated uropathy; Vesicoureteral N13.7 OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 reflux NOS; Vesicoureteral reflux with scarring

N13.8 Other obstructive and reflux uropathy OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 Obstructive and reflux uropathy, unspecified; Urinary tract N13.9 OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790 obstruction NOS Orchitis, epididymitis and epididymo-orchitis with abscess; N45.0 ORCHITIS 7,900 2,370 5,530 Abscess of epididymis or testis Orchitis, epididymitis and epididymo-orchitis without N45.9 ORCHITIS 7,900 2,370 5,530 abscess; Epididymitis NOS; Orchitis NOS M86.0 Acute haematogenous osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.1 Other acute osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.15 Other acute osteomyelitis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.17 Other acute osteomyelitis Ankle and foot OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.19 Other acute osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.2 Subacute osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.29 Subacute osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.4 Chronic osteomyelitis with draining sinus OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.5 Other chronic haematogenous osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100

M86.50 Other chronic haematogenous osteomyelitis Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100

Page 87 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee M86.6 Other chronic osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.60 Other chronic osteomyelitis Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.61 Other chronic osteomyelitis Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.62 Other chronic osteomyelitis Upper arm OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.63 Other chronic osteomyelitis Forearm OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.65 Other chronic osteomyelitis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.66 Other chronic osteomyelitis Lower leg OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.67 Other chronic osteomyelitis Ankle and foot OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.68 Other chronic osteomyelitis Other OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.69 Other chronic osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.8 Other osteomyelitis; Brodie's abscess OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.80 Other osteomyelitis; Brodie's abscess Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.81 Other osteomyelitis; Brodie's abscess Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M86.88 Other osteomyelitis; Brodie's abscess Other OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Osteomyelitis, unspecified; Infection of bone NOS; M86.9 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis NOS

Osteomyelitis, unspecified; Infection of bone NOS; M86.90 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis without mention of osteomyelitis Multiple site

Osteomyelitis, unspecified; Infection of bone NOS; M86.91 Periostitis without mention of osteomyelitis Shoulder OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 region

Osteomyelitis, unspecified; Infection of bone NOS; M86.92 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis without mention of osteomyelitis Upper arm

Osteomyelitis, unspecified; Infection of bone NOS; M86.94 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis without mention of osteomyelitis Hand Osteomyelitis, unspecified; Infection of bone NOS; M86.95 Periostitis without mention of osteomyelitis Pelvic region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 and thigh Osteomyelitis, unspecified; Infection of bone NOS; M86.96 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis without mention of osteomyelitis Lower leg

Osteomyelitis, unspecified; Infection of bone NOS; M86.97 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis without mention of osteomyelitis Ankle and foot

Osteomyelitis, unspecified; Infection of bone NOS; M86.98 OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 Periostitis without mention of osteomyelitis Other Osteomyelitis, unspecified; Infection of bone NOS; M86.99 Periostitis without mention of osteomyelitis Site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 unspecified

M87.05 Idiopathic aseptic necrosis of bone Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100

M87.2 Osteonecrosis due to previous trauma OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.8 Other osteonecrosis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.85 Other osteonecrosis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.86 Other osteonecrosis Lower leg OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.9 Osteonecrosis, unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.90 Osteonecrosis, unspecified Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.91 Osteonecrosis, unspecified Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.95 Osteonecrosis, unspecified Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M87.99 Osteonecrosis, unspecified Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M88.0 Paget's disease of skull OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 M88.9 Paget's disease of bone, unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100 A31.8 Other mycobacterial infections OTHER BACTERIAL DISEASES 8,900 2,670 6,230 Mycobacterial infection, unspecified ; Atypical mycobacterium infection Not Otherwise Specified; A31.9 OTHER BACTERIAL DISEASES 8,900 2,670 6,230 Mycobacteriosis NOS; Listeriosis (listerial foodborne infection) A42.0 Pulmonary actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A42.1 Abdominal actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A42.2 Cervicofacial actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A42.7 Actinomycotic septicaemia OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A42.8 Other forms of actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A42.9 Actinomycosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A43.1 Cutaneous nocardiosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A43.9 Nocardiosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230 Cutaneous and mucocutaneous ; Verruga A44.1 OTHER BACTERIAL DISEASES 8,900 2,670 6,230 peruana A44.9 Bartonellosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A48.8 Other specified bacterial diseases OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A49.0 Staphylococcal infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A49.2 infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230 A49.3 Mycoplasma infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230

Other specified cardia arrhythmias; Brugada syndrome; ont A49.8 QT syndrome; Long QT syndrome; coronary sinus rhythm OTHER BACTERIAL DISEASES 8,900 2,670 6,230 disorder; ectopic shythm disorder; nodal rhythm disorder

Page 88 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee A49.9 Bacterial infection, unspecified; Bacteraemia NOS OTHER BACTERIAL DISEASES 8,900 2,670 6,230 B20.1 HIV disease resulting in other bacterial infections OTHER BACTERIAL DISEASES 8,900 2,670 6,230 Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's M89.0 OTHER BONE DISORDERS 8,800 2,640 6,160 atrophy; Sympathetic reflex dystrophy

Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's M89.01 OTHER BONE DISORDERS 8,800 2,640 6,160 atrophy; Sympathetic reflex dystrophy Shoulder region

M89.2 Other disorders of bone development and growth OTHER BONE DISORDERS 8,800 2,640 6,160 Other hypertrophic osteoarthropathy; Marie-Bamberger M89.4 OTHER BONE DISORDERS 8,800 2,640 6,160 disease; Pachydermoperiostosis Other hypertrophic osteoarthropathy; Marie-Bamberger M89.48 OTHER BONE DISORDERS 8,800 2,640 6,160 disease; Pachydermoperiostosis Other M89.5 Osteolysis OTHER BONE DISORDERS 8,800 2,640 6,160 M89.54 Osteolysis Hand OTHER BONE DISORDERS 8,800 2,640 6,160 M89.6 Osteopathy after poliomyelitis OTHER BONE DISORDERS 8,800 2,640 6,160

Other specified disorders of bone; Infantile cortical M89.8 OTHER BONE DISORDERS 8,800 2,640 6,160 hyperostoses; Post-traumatic subperiosteal ossification

Other specified disorders of bone; Infantile cortical M89.85 hyperostoses; Post-traumatic subperiosteal ossification OTHER BONE DISORDERS 8,800 2,640 6,160 Pelvic region and thigh Other specified disorders of bone; Infantile cortical M89.86 hyperostoses; Post-traumatic subperiosteal ossification OTHER BONE DISORDERS 8,800 2,640 6,160 Lower leg Other specified disorders of bone; Infantile cortical M89.87 hyperostoses; Post-traumatic subperiosteal ossification OTHER BONE DISORDERS 8,800 2,640 6,160 Ankle and foot Other specified disorders of bone; Infantile cortical M89.88 hyperostoses; Post-traumatic subperiosteal ossification OTHER BONE DISORDERS 8,800 2,640 6,160 Other Other specified disorders of bone; Infantile cortical M89.89 hyperostoses; Post-traumatic subperiosteal ossification OTHER BONE DISORDERS 8,800 2,640 6,160 Site unspecified M89.95 Disorder of bone, unspecified Pelvic region and thigh OTHER BONE DISORDERS 8,800 2,640 6,160 M89.98 Disorder of bone, unspecified Other OTHER BONE DISORDERS 8,800 2,640 6,160 M89.99 Disorder of bone, unspecified Site unspecified OTHER BONE DISORDERS 8,800 2,640 6,160 Juvenile osteochondrosis of head of femur [LEGG-CALVÉ- M91.1 OTHER BONE DISORDERS 8,800 2,640 6,160 PERTHES] Other juvenile osteochondrosis after reduction of M91.8 OTHER BONE DISORDERS 8,800 2,640 6,160 congenital dislocation of hip M94.0 Chondrocostal junction syndrome [Tietze] OTHER BONE DISORDERS 8,800 2,640 6,160 M94.8 Other specified disorders of cartilage OTHER BONE DISORDERS 8,800 2,640 6,160 M99.8 Other biomechanical lesions OTHER BONE DISORDERS 8,800 2,640 6,160 M99.9 Biomechanical lesion, unspecified OTHER BONE DISORDERS 8,800 2,640 6,160 I65.2 Occlusion and stenosis of carotid artery OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 I67.0 Dissection of cerebral arteries, nonruptured OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 Cerebral aneurysm, nonruptured; Cerebral aneurysm NOS; I67.1 OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 Cerebral arteriovenous fistula, acquired I67.2 Cerebral atherosclerosis; Atheroma of cerebral arteries OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 Progressive vascular leukoencephalopathy; Binswanger's I67.3 OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 disease I67.5 Moyamoya disease OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 Nonpyogenic thrombosis of intracranial venous system; I67.6 Nonpyogenic thrombosis of cerebral vein; Nonpyogenic OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 thrombosis of intracrannial venous sinus I67.7 Cerebral arteritis, not elsewhere classified OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 Other specified cerebrovascular diseases; Acute I67.8 cerebrovascular insufficiency NOS; Chronic Cerebral OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 ischaemia Other lacunar syndrome in unspecified cerebrovascular I67.9+G46.7* OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 disease Other vascular syndrome in unspecified cerebrovascular I67.9+G46.8* OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640 disease A56.4 Chlamydial infection of pharynx OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950 Active stage of trachoma; Trachomatous Granular A71.1 conjunctivitis; Trachomatous follicular conjunctivitis; OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950 Trachomatous pannus A71.9 Trachoma, unspecified OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950 A74.9 Chlamydial infection, unspecified; Chlamydiosis NOS OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950 Q85.1 Tuberous sclerosis; Bourneville's disease; Epiloia OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Congenital malformation syndromes predominantly affecting facial appearance; Acrocephalopolysyndactyly; Acrocephalosyndactyly [Apert]; Cryptophthalmos Q87.0 OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 syndrome; Cyclopia; Goldenhar Syndrome; Moebius Syndrome; oro-facial-digital Syndrome; Robin Syndrome; Whistling face

Page 89 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Congenital malformation syndromes predominantly associated with short stature; Aarskog Syndrome; Cockayne Syndrome; De Lange Syndrome ; Dubowitz Q87.1 Syndrome; Noonan Syndrome; Prader-Willi Syndrome; OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Robinow-Silverman-Smith Syndrome ; Russell-Silver Syndrome; Seckel syndrome; Smith-Lemli- Opitz syndrome Congenital malformation syndromes predominantly involving limbs; Holt-Oram Syndrome; Klippel-Trénaunay- Weber Syndrome; nail patella Syndrome; Q87.2 OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Rubinstein-Taybi Syndrome; sirenomelia Syndrome; thrombocytopenia Syndrome with absent radius [TAR]; VATER Congenital malformation syndromes involving early Q87.3 overgrowth; Beckwith-Wiedemann Syndrome; Sotos; OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Syndrome Weaver Syndrome Q87.4 Marfan's syndrome OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Other specified congenital malformation syndromes, not Q87.8 elsewhere classified; Alport Syndrome; Laurence-Moon(- OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Bardet)-Biedl Syndrome; Zellweger Syndrome Congenital malformations of spleen; Asplenia (congenital); Q89.0 OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Congenital splenomegaly Q89.1 Congenital malformations of adrenal gland OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Congenital malformations of other endocrine glands; Q89.2 Congenital malformation of parathyroid or thyroid gland; OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Persistent thyroglossal duct; Thyroglossal cyst Conjoined twins; Craniopagus; Dicephaly; Double monster; Q89.4 OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Pygopagus; Thoracopagus Multiple congenital malformations, not elsewhere Q89.7 classified; Monster NOS; Multiple congenital anomalies OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 NOS; Multiple congenital deformities NOS Q89.8 Other specified congenital malformations OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 Congenital malformation, unspecified; Congenital anomaly Q89.9 OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120 NOS; Congenital deformity NOS Phlebitis and thrombophlebitis of superficial vessels of I80.0 OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 lower extremities I80.1 Phlebitis and thrombophlebitis of femoral vein OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 Phlebitis and thrombophlebitis of other deep vessels of I80.2 OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 lower extremities; Deep vein thrombosis NOS Phlebitis and thrombophlebitis of lower extremities, I80.3 unspecified; Embolism or thrombosis of lower extermity OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 NOS I80.8 Phlebitis and thrombophlebitis of other sites OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I80.9 Phlebitis and thrombophlebitis of unspecified site OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I81 Portal vein thrombosis; Portal (vein) obstruction OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I82.0 Budd-Chiari syndrome OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I82.1 Thrombophlebitis migrans OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I82.2 Embolism and thrombosis of vena cava OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I82.3 Embolism and thrombosis of renal vein OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 I82.8 Embolism and thrombosis of other specified veins OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 Embolism and thrombosis of unspecified vein; Embolism of I82.9 OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680 vein NOS; Thrombosis (vein) NOS Nondiabetic hypoglycaemic coma; Nondiabetic hypoglycaemic coma; Drug-induced insulin coma in E15 OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670 nondiabetic; Hyperinsulinism with hypoglycaemic coma; Hypoglycaemic coma NOS E16.0 Drug-induced hypoglycaemia without coma OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670

Other hypoglycaemia; Functional nonhyperinsulinaemic hypoglycaemia; Hyperinsulinism NOS; Functional E16.1 OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670 Hyperinsulinism; Hyperplasia of pancreatic islet beta cells NOS; Posthypoglycaemic coma encephalopathy

Increased secretion of glucagon; Hyperplasia of pancreatic E16.3 endocrine cells with glucagon excess; Hyperplasia of OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670 pancreatic endocrine cells with glucagon excess

Abnormal secretion of ; Hypergastrinaemia; Zollinger- E16.4 OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670 Ellison syndrome

Other specified disorders of pancreatic internal secretion; Increased secretion from endocrine pancreas of growth hormone-releasing hormone; Increased secretion from E16.8 endocrine pancreas of pancreatic polypeptide; Increased OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670 secretion from endocrine pancreas of ; Increased secretion from endocrine pancreas of vasoactive- intestinal polypeptide

Page 90 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Disorder of pancreatic internal secretion, unspecified; Islet- E16.9 cell hyperplasia NOS; Pancreatic endocrine cell hyperplasia OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670 NOS OTHER DISORDERS OF THE FEMALE GENITAL N82.0 Vesicovaginal fistula 7,800 2,340 5,460 TRACT Follicular cyst of ovary; Cyst of graafian follicle; OTHER DISORDERS OF THE FEMALE GENITAL N83.0 7,800 2,340 5,460 Haemorrhagic follicular cyst of ovary TRACT OTHER DISORDERS OF THE FEMALE GENITAL N83.3 Acquired atrophy of ovary and fallopian tube 7,800 2,340 5,460 TRACT OTHER DISORDERS OF THE FEMALE GENITAL N83.6 Haematosalpinx 7,800 2,340 5,460 TRACT OTHER DISORDERS OF THE FEMALE GENITAL N83.7 Haematoma of broad ligament 7,800 2,340 5,460 TRACT OTHER DISORDERS OF THE FEMALE GENITAL N85.7 Haematometra; Haematosalpinx with haematometra 7,800 2,340 5,460 TRACT Haematocolpos; Haematocolpos with haematometra or OTHER DISORDERS OF THE FEMALE GENITAL N89.7 7,800 2,340 5,460 haematosalpinx TRACT OTHER DISORDERS OF THE FEMALE GENITAL Q51.2 Other doubling of uterus' Doubling of uterus NOS 7,800 2,340 5,460 TRACT OTHER DISORDERS OF THE FEMALE GENITAL Q51.3 Bicornate uterus 7,800 2,340 5,460 TRACT Other congenital malformations of uterus and cervix; OTHER DISORDERS OF THE FEMALE GENITAL Q51.8 7,800 2,340 5,460 Hypoplasia of uterus and cervix TRACT OTHER DISORDERS OF THE FEMALE GENITAL Q52.1 Doubling of vagina; Septate vagina 7,800 2,340 5,460 TRACT OTHER DISORDERS OF THE FEMALE GENITAL Q52.2 Congenital rectovaginal fistula 7,800 2,340 5,460 TRACT OTHER DISORDERS OF THE FEMALE GENITAL Q52.3 Imperforate hymen 7,800 2,340 5,460 TRACT Other specified congenital malformations of female OTHER DISORDERS OF THE FEMALE GENITAL Q52.8 7,800 2,340 5,460 genitalia TRACT Redundant prepuce, phimosis and paraphimosis; Adherent N47 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 prepuce; Tight foreskin

Other specified disorders of penis; Atrophyof corpus N48.8 cavernosum and penis ; Hypertrophy of corpus cavernosum OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 and penis ; Thrombosis of corpus cavernosum and penis

N50.0 Atrophy of testis OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480

Vascular disorders of male genital organs; Haematocele of N50.1 male genital organs NOS; Haemorrhage of male genital OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 organs;, Thrombosis of male genital organs

Other specified disorders of male genital organs; Atrophy of scrotum, seminal vesicle, spermatic cord, testis [except atrophy], tunica vaginalis and vas deferens; Hypertrophy of scrotum, seminal vesicle, spermatic cord, testis [except atrophy], tunica vaginalis and vas deferens; Oedema of scrotum, seminal vesicle, spermatic cord, testis [except N50.8 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 atrophy], tunica vaginalis and vas deferens; Ulcer of scrotum, seminal vesicle, spermatic cord, testis [except atrophy], tunica vaginalis and vas deferens; Chylocele, tunica vaginalis (nonfilarial) NOS; Fistula, urethroscrotal; Stricture of spermatic cord; Stricture of tunica vaginalis; Stricture of vas deferens

Q55.0 Absence and aplasia of testis; Monorchism OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480

Q55.1 Hypoplasia of testis and scrotum; Fusion of testes OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480

Other congenital malformations of testis and scrotum; Q55.2 Congenital malformation of testis or scrotum NOS; OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 Polyorchism; Retractile testis; Testis migrans Other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate; Absence or aplasia of prostate; Absence or aplasia of spermatic cord; Q55.4 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 Congenital malformation of vas deferens, epididymis, seminal vesicles or prostate NOS Other congenital malformations of penis; Congenital Q55.6 malformation of penis NOS; Curvature of penis (lateral); OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 Hypoplasia of penis

Congenital malformation of male genital organ, Q55.9 unspecified; Congenital anomalyNOS of male genital organ OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 ; Congenital deformity NOS of male genital organ

Page 91 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Male pseudohermaphroditism, not elsewhere classified; Q56.1 OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480 Male pseudohermaphroditism NOS

Q56.3 Pseudohermaphroditism, unspecified OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480

Idiopathic peripheral autonomic neuropathy; Carotid sinus G90.0 OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 syncope G90.1 Familial dysautonomia [Riley-Day] OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 G90.2 Horner's syndrome; Bernard(-Horner) syndrome OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Multi-system degeneration; Neurogenic orthostatic G90.3 OTHER DISORDERS OF THE NERVOUS SYSTEM N/A N/A N/A hypotension [Shy-Drager] G90.4 Autonomic dysreflexia OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Disorder of autonomic nervous system, unspecified; G90.9 acquired hydrocephalus OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Autonomic neuropathy

G93.0 Cerebral cysts; Arachnoid cyst; Porencephalic cyst, acquired OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060

G93.2 Benign intracranial hypertension OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Postviral fatigue syndrome; Benign myalgic G93.3 OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 encephalomyelitis G93.4 Encephalopathy, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 G93.7 Reye's syndrome OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 G93.8 Other specified disorders of brain OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 G93.9 Disorder of brain, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Other specified disorders of brain in diseases classified G94.8* OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 elswhere G95.0 Syringomyelia and syringobulbia OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Vascular myelopathies; Acute infarction of spinal cord (embolic)(nonembolic); Arterial thrombosis of spinal cord; G95.1 Haematomyelia; Nonpyogenic intraspinal phlebitis and OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 thrombophlebitis; Oedema of spinal cord; Subacute necrotic myelopathy G95.2 Cord compression, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060

Other specified diseases of spinal cord; Cord bladder NOS; G95.8 elopathy drug-induced; Myelopathy radiation-induced OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Spinal sclerosis

G95.9 Disease of spinal cord, unspecified; Myelopathy NOS OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 G96.0 Cerebrospinal fluid leak OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060

Disorders of meninges, not elsewhere classified; Cerebral G96.1 OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Meningeal adhesions; Spinal Meningeal adhesions

G96.8 Other specified disorders of central nervous system OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 G96.9 Disorder of central nervous system, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 Other disorders of nervous system, not elsewhere G98 OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060 classified; Nervous system disorder NOS Convulsions of newborn P90 OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 Seizures, newborn P91.1 Acquired periventricular cysts of newborn OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 P91.2 Neonatal cerebral leukomalacia OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 P94.1 Congenital hypertonia OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400

P94.2 Congenital hypotonia; Nonspecific floppy baby syndrome OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400

P94.9 Disorder of muscle tone of newborn, unspecified OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 Complications of intrauterine procedures, not elsewhere P96.5 OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 classified Other specified conditions originating in the perinatal P96.8 OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 period Condition originating in the perinatal period, unspecified; P96.9 OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400 Congenital debility NOS Acute thyroiditis; Abscess of thyroid; Pyogenic Thyroiditis; E06.0 OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Suppurative Thyroiditis Subacute thyroiditis; de Quervain Thyroiditis; Giant-Cell E06.1 Thyroiditis; Granulomatous Thyroiditis; Nonsuppurative OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Thyroiditis E06.2 Chronic thyroiditis with transient thyrotoxicosis OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Autoimmune thyroiditis; Hashimoto's thyroiditis ; Transient E06.3 hashitoxicosis; Lymphadenoid goitre; lymphocytic OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 thyroiditis; Struma lymphomatosa

Other chronic thyroiditis; Chronic Thyroiditis NOS; Chronic E06.5 OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Fibrous Thyroiditis; Ligneous Thyroiditis; Riedel Thyroiditis

E06.9 Thyroiditis, unspecified OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Hypersecretion of calcitonin; C-cell hyperplasia of thyroid; E07.0 OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Hypersecretion of thyrocalcitonin Dyshormogenetic goitre; Familial dyshormogenetic goitre; E07.1 OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 Pendred's syndrome

Page 92 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other specified disorders of thyroid; Abnormality of thyroid- E07.8 binding globulin; Haemorrhage of thyroid; Infarction of OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950 thyroid; Sick-euthyroid syndrome Adrenogenital disorder, unspecified; Adrenogenital E25.9 OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 syndrome NOS E28.8 Other ovarian dysfunction; Ovarian hyperfunction NOS OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630

Testicular hypofunction; Defective biosynthesis of testicular E29.1 androgen NOS; 5-a-Reductase deficiency (with male OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 pseudohermaphroditism); Testicular hypogonadism NOS

E29.9 Testicular dysfunction, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 E31.0 Autoimmune polyglandular failure OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 E31.1 Polyglandular hyperfunction OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 E31.9 Polyglandular dysfunction, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630

E32.0 Persistent hyperplasia of thymus; Hypertrophy of thymus OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630

E32.8 Other diseases of thymus OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 E32.9 Disease of thymus, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 E34.0 Carcinoid syndrome OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 Other specified endocrine disorders; Pineal gland E34.8 OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 dysfunction; Progeria Endocrine disorder, unspecified; Endocrine Disturbance E34.9 OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630 NOS; Hormone Disturbance NOS Renal osteodystrophy; Azotaemic osteodystrophy; N25.0 Phosphate-losing tubular disorders; Renal rickets; Renal OTHER NEPHROPATHY 9,500 2,850 6,650 short stature Other disorders resulting from impaired renal tubular function; Lightwood-Albright syndrome; Renal tubular N25.8 OTHER NEPHROPATHY 9,500 2,850 6,650 acidosis NOS; Secondary hyperparathyroidism of renal origin Disorder resulting from impaired renal tubular function, N25.9 OTHER NEPHROPATHY 9,500 2,850 6,650 unspecified Cyst of kidney, acquired; Multiple cyst of kidney, acquired; N28.1 OTHER NEPHROPATHY 9,500 2,850 6,650 Solitary cyst of kidney, acquired Pleural plaque without asbestos; Pleural plaque NOS; J92.9 OTHER PLEURAL CONDITIONS 13,500 4,050 9,450 Pleural thickening J94.0 Chylous effusion; Chyliform effusion OTHER PLEURAL CONDITIONS 13,500 4,050 9,450 J94.1 Fibrothorax OTHER PLEURAL CONDITIONS 13,500 4,050 9,450 J94.8 Other specified pleural conditions; Hydrothorax OTHER PLEURAL CONDITIONS 13,500 4,050 9,450 J94.9 Pleural condition, unspecified OTHER PLEURAL CONDITIONS 13,500 4,050 9,450 Diseases of bronchus, not elsewhere classified; Broncholithiasis; Calcification of bronchus; Stenosis of J98.0 OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140 bronchus; Ulcer of bronchus; Tracheobronchial collapse; Tracheobronchial dyskinesia Other disorders of lung; Calcification of lung; Acquired J98.4 OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140 cystic lung disease; Lung disease NOS; Pulmolithiasis

Diseases of mediastinum, not elsewhere classified; Fibrosis J98.5 of mediastinum; Hernia of mediastinum; Retraction of OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140 mediastinum; Mediastinitis of mediastinum

Disorders of diaphragm; Diaphragmatitis; Paralysis of J98.6 OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140 diaphragm; Relaxation of diaphragm J98.8 Other specified respiratory disorders OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140 Respiratory disorder, unspecified; Chronic respiratory J98.9 OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140 disease NOS A66.9 Yaws, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160 Intermediate lesions of pinta; Erythematous plaques of A67.1 carate pinta; Hyperchromic lesions of carate pinta; OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160 Hyperkeratosis of carate pinta; Pintids of carate pinta A68.9 Relapsing fever, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160

Necrotizing ulcerative stomatitis; Cancrum oris; A69.0 OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160 Fusospirochaetal gangrene; Noma; Stomatitis gangrenosa

Other Vincent's infections; Fusospirochaetal pharyngitis ; Acute Necrotizing Ulcerative gingivitis; Acute Necrotizing A69.1 OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160 Ulcerative Gingivostomatitis; Spirochaetal stomatitis, Trench mouth; Vincent's angina; Vincent’s gingivitis

Lyme disease; Erythema chronicum migrans due to Borrelia A69.2 OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160 burgdorferi A69.9 Spirochaetal infection, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160 Acute serous otitis media; Acute and subacute secretory H65.0 OTITIS MEDIA 7,800 2,340 5,460 otitis media

Page 93 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Other acute nonsuppurative otitis media; Acute otitis media; Subacute otitis media; Acute Mucoid allergic otitis media; Subacute mucoid allergic otitis media; Acute allergic Sanguinous otitis media; Subacute Sanguinous allergic otitis media; Acute allergic serous otitis media; H65.1 OTITIS MEDIA 7,800 2,340 5,460 Subacute allergic serous otitis media; Acute nonsuppurative NOS otitis media; Subcute nonsuppurative NOS otitis media; Acute sanguinous otitis media; Subacute sanguinous otitis media; Acute seromucinous otitis media; Subacute seromucinous otitis media

H65.2 Chronic serous otitis media; Chronic tubotympanal catarrh OTITIS MEDIA 7,800 2,340 5,460

Chronic mucoid otitis media; Glue ear; Otitis media, chronic H65.3 mucinous; Otitis media, chronic secretory; Otitis media, OTITIS MEDIA 7,800 2,340 5,460 chronic transudative Other chronic nonsuppurative otitis media; Otitis media, chronic allergic; Otitis media, chronic exudative; Otitis H65.4 media, chronic nonsuppurative NOS; Otitis media, chronic OTITIS MEDIA 7,800 2,340 5,460 seromucinous; Otitis media, chronic with effusion (nonpurulent) Nonsuppurative otitis media, unspecified; Allergic Otitis media ; Catarrhal Otitis media; Exudative Otitis media ; Mucoid Otitis media ; Secretory Otitis media ; H65.9 OTITIS MEDIA 7,800 2,340 5,460 Seromucinous otitis media; Serous Otitis media; Transudative Otitis media; Otitis media with (nonpurulent) effusion H66.0 Acute suppurative otitis media OTITIS MEDIA 7,800 2,340 5,460 Chronic tubotympanic suppurative otitis media; Benign H66.1 chronic suppurative otitis media; Chronic tubotympanic OTITIS MEDIA 7,800 2,340 5,460 disease Chronic atticoantral suppurative otitis media; Chronic H66.2 OTITIS MEDIA 7,800 2,340 5,460 atticoantral disease Other chronic suppurative otitis media; Chronic H66.3 OTITIS MEDIA 7,800 2,340 5,460 suppurative otitis media NOS Suppurative otitis media, unspecified; Purulent otitis media H66.4 OTITIS MEDIA 7,800 2,340 5,460 NOS Otitis media, unspecified; Otitis media NOS; Acute Otitis H66.9 OTITIS MEDIA 7,800 2,340 5,460 media NOS; Chronic Otitis media NOS B05.3+ H67.1* Otitis media in measles OTITIS MEDIA 7,800 2,340 5,460 N83.1 Corpus luteum cyst; Haemorrhagic corpus luteum cyst OVARIAN CYSTS 7,800 2,340 5,460 Other and unspecified ovarian cysts; Retention cyst of N83.2 OVARIAN CYSTS 7,900 2,370 5,530 ovary; Simple cyst of ovary N70.0 Acute salpingitis and oophoritis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N70.1 Chronic salpingitis and oophoritis; Hydrosalpinx PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N70.9 Salpingitis and oophoritis, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N71.0 Acute inflammatory disease of uterus PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N71.1 Chronic inflammatory disease of uterus PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N71.9 Inflammatory disease of uterus, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 Inflammatory disease of cervix uteri; Cervicitis with or without erosion or ectropion; Endocervicitis with or N72 PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 without erosion or ectropion; Exocervicitis with or without erosion or ectropion Acute parametritis and pelvic cellulitis; Acute abcess of N73.0 broad ligament; Acute abscess of parametrium; Acute PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 pelvic cellulitis, female N73.1 Chronic parametritis and pelvic cellulitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N73.2 Unspecified parametritis and pelvic cellulitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N73.3 Female acute pelvic peritonitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N73.4 Female chronic pelvic peritonitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N73.5 Female pelvic peritonitis, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N73.6 Female pelvic peritoneal adhesions PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 N73.8 Other specified female pelvic inflammatory diseases PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 Female pelvic inflammatory disease, unspecified; Female N73.9 PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 pelvic infection or inflammation NOS Female pelvic inflammatory disorders in other diseases N74.8* PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 classified elsewhere Genital tract and pelvic infection following abortion and ectopic and molar pregnancy; Endometritis; Oophoritis; O08.0 PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300 Parametritis; Pelvic peritonitis; Salpingitis; Salpingo- oophoritis; Sepsis; Septic shock; Septicaemia N94.0 Mittelschmerz PELVIC PAIN 4,800 1,440 3,360 N94.1 Dyspareunia PELVIC PAIN 4,800 1,440 3,360 N94.2 Vaginismus PELVIC PAIN 4,800 1,440 3,360 N94.3 Premenstrual tension syndrome PELVIC PAIN 4,800 1,440 3,360 N94.4 Primary dysmenorrhoea PELVIC PAIN 4,800 1,440 3,360 N94.5 Secondary dysmenorrhoea PELVIC PAIN 4,800 1,440 3,360

Page 94 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee N94.6 Dysmenorrhoea, unspecified PELVIC PAIN 4,800 1,440 3,360

Gastric ulcer, acute / Acute erosion of stomach/ Pylorus K25.0 WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer / Stomach peptic ulcer with hemorrhage

Gastric ulcer, acute/ Acute erosion of stomach/ Pylorus K25.1 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer / Stomach peptic ulcer with perforation

Gastric ulcer, acute / Acute erosion of stomach/ Pylorus K25.2 peptic ulcer / Stomach peptic ulcer with both haemorrhage PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 and perforation Gastric ulcer, acute / Acute erosion of stomach/ Pylorus K25.4 peptic ulcer / Stomach peptic ulcer, chronic or unspecified PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 with haemorrhage Gastric ulcer, acute / Acute erosion of stomach/ Pylorus K25.5 peptic ulcer / Stomach peptic ulcer, chronic or unspecified PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 with perforation Gastric ulcer, acute / Acute erosion of stomach/ Pylorus K25.6 peptic ulcer / Stomach peptic ulcer, chronic or unspecified PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 with both haemorrhage and perforation Duodenal ulcer, acute / Acute erosion of duodenum/ K26.0 Duodenal peptic ulcer/ Postpyloric peptic ulcer with PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 haemorrhage Duodenal ulcer, acute / Acute erosion of duodenum/ K26.1 Duodenal peptic ulcer/ Postpyloric peptic ulcer with PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 perforation Chronic Duodenal/ Postpyloric ulcer/ erosion, or K26.4 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified with haemorrhage Chronic Duodenal/ Postpyloric ulcer/ erosion, or K26.5 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified with perforation Chronic Duodenal/ Postpyloric ulcer/ erosion, or K26.6 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified with both haemorrhage and perforation Acute Peptic ulcer/ Gastroduodenal ulcer NOS, site K27.0 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified, with haemorrhage Acute Peptic ulcer / Gastroduodenal ulcer, site unspecified, K27.1 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 with perforation Acute Peptic/ Gastroduodenal ulcer, site unspecified, with K27.2 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 both haemorrhage and perforation Chronic or unspecified Peptic/ Gastroduodenal ulcer, site K27.4 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified, with haemorrhage Chronic or unspecified Peptic/ Gastroduodenal ulcer, site K27.5 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified with perforation

Chronic or unspecified Peptic/ Gastroduodenal ulcer, site K27.6 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 unspecified, with both haemorrhage and perforation

Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.0 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.1 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.2 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.3 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Chronic or unspecified Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.4 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion

Page 95 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Chronic or unspecified Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.5 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Chronic or unspecified Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.6 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Acute haemorrhagic gastritis; Acute erosive gastritis with K29.0 PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960 haemorrhage Gastric ulcer, acute / Acute erosion of stomach/ Pylorus K25.3 peptic ulcer / Stomach peptic ulcer without haemorrhage PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 or perforation Gastric/ Peptic/ Pyloric ulcer/ erosion, chronic without K25.7 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 haemorrhage or perforation Gastric/ Peptic/ Pyloric ulcer/ erosion, unspecified as acute K25.9 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 or chronic, without haemorrhage or perforation Duodenal ulcer, acute / Acute erosion of duodenum/ K26.3 Duodenal peptic ulcer/ Postpyloric peptic ulcer without PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 haemorrhage or perforation Chronic Duodenal/ Postpyloric ulcer/ erosion, without K26.7 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 haemorrhage or perforation Duodenal/ Postpyloric ulcer/ erosion, unspecified as acute K26.9 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 or chronic, without haemorrhage or perforation Acute Peptic/ Gastroduodenal ulcer, site unspecified, K27.3 without haemorrhage or perforation; gastroduodenal ulcer PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 NOS; Peptic ulcer NOS Chronic Peptic/ Gastroduodenal ulcer, site unspecified, K27.7 without haemorrhage or perforation; gastroduodenal ulcer PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 NOS; Peptic ulcer NOS Peptic/ Gastroduodenal ulcer, unspecified as acute or K27.9 chronic, without haemorrhage or perforation; PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 gastroduodenal ulcer NOS; Peptic ulcer NOS Chronic Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ Gastrojejunal K28.7 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion/ Stomal peptic ulcer or erosion Unspecified as acute or chronic Gastrojejunal ulcer/ Anastomotic peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/ K28.9 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 Gastrojejunal peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/ Marginal peptic ulcer or erosion; Stomal peptic ulcer or erosion

K29.1 Other acute gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

K29.2 Alcoholic gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

K29.3 Chronic superficial gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

K29.4 Chronic ; Gastric atrophy PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

Chronic gastritis, unspecified; Chronic Antral gastritis; K29.5 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 Chronic Fundal gastritis Other gastritis; Giant hypertrophic gastritis; Granulomatous K29.6 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270 gastritis; Menetrier's disease

K29.7 Gastritis, unspecified PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

K29.8 PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

K29.9 Gastroduodenitis, unspecified PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270

P23.0 Congenital pneumonia due to viral agent PERINATAL INFECTIONS 12,700 3,810 8,890 P23.1 Congenital pneumonia due to Chlamydia PERINATAL INFECTIONS 12,700 3,810 8,890 P23.2 Congenital pneumonia due to staphylococcus PERINATAL INFECTIONS 12,700 3,810 8,890 P23.3 Congenital pneumonia due to streptococcus, group B PERINATAL INFECTIONS 12,700 3,810 8,890 P23.4 Congenital pneumonia due to Escherichia coli PERINATAL INFECTIONS 12,700 3,810 8,890 P23.5 Congenital pneumonia due to Pseudomonas PERINATAL INFECTIONS 12,700 3,810 8,890 Congenital pneumonia due to other bacterial agents; P23.6 Haemophilus influenzae; Klebsiella pneumonia; PERINATAL INFECTIONS 12,700 3,810 8,890 Mycoplasma; Streptococcus, except group B P23.9 Congenital pneumonia, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890

Page 96 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Congenital rubella syndrome; Congenital rubella P35.0 PERINATAL INFECTIONS 12,700 3,810 8,890 pneumonitis P35.1 Congenital cytomegalovirus infection PERINATAL INFECTIONS 12,700 3,810 8,890 P35.2 Congenital herpesviral [herpes simplex] infection PERINATAL INFECTIONS 12,700 3,810 8,890 P35.3 Congenital viral hepatitis PERINATAL INFECTIONS 12,700 3,810 8,890 Other congenital viral diseases; Congenital varicella P35.8 PERINATAL INFECTIONS 12,700 3,810 8,890 [chickenpox] P35.9 Congenital viral disease, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890 P37.0 Congenital tuberculosis PERINATAL INFECTIONS 12,700 3,810 8,890 Congenital toxoplasmosis; Hydrocephalus due to congenital P37.1 PERINATAL INFECTIONS 12,700 3,810 8,890 toxoplasmosis P37.3 Congenital falciparum malaria PERINATAL INFECTIONS 12,700 3,810 8,890 P37.5 Neonatal PERINATAL INFECTIONS 12,700 3,810 8,890

P37.8 Other specified congenital infectious and parasitic diseases PERINATAL INFECTIONS 12,700 3,810 8,890

P37.9 Congenital infectious and parasitic disease, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890

P38 Omphalitis of newborn with or without mild haemorrhage PERINATAL INFECTIONS 12,700 3,810 8,890

P39.0 Neonatal infective mastitis PERINATAL INFECTIONS 12,700 3,810 8,890 Neonatal conjunctivitis and dacryocystitis; Neonatal P39.1 PERINATAL INFECTIONS 12,700 3,810 8,890 chlaydial conjunctivitis; Ophthalmia neonatorum NOS

P39.2 Intra-amniotic infection of fetus, not elsewhere classified PERINATAL INFECTIONS 12,700 3,810 8,890

P39.3 Neonatal urinary tract infection PERINATAL INFECTIONS 12,700 3,810 8,890 P39.4 Neonatal skin infection; Neonatal pyoderma PERINATAL INFECTIONS 12,700 3,810 8,890

P39.8 Other specified infections specific to the perinatal period PERINATAL INFECTIONS 12,700 3,810 8,890

P39.9 Infection specific to the perinatal period, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890

Peritoneal adhesions; Adhesions of abdominal wall; Adhesions of diaphragm; Adhesions of intestine; Adhesions K66.0 PERITONEAL DISORDERS 10,800 3,240 7,560 of male pelvis; Mesenteric Adhesions; Adhesions of omentum; Adhesions of stomach; Adhesive bands

K66.8 Other specified disorders of peritoneum PERITONEAL DISORDERS 10,800 3,240 7,560 K66.9 Disorder of peritoneum, unspecified PERITONEAL DISORDERS 10,800 3,240 7,560 Acute peritonitis; Abdominopelvic abscess; Mesenteric abscess; Abscess of omentum; Abscess of peritoneum; Retrocaecal abscess; Retroperitoneal abscess; K65.0 Subdiaphragmatic abscess; Subhepatic abscess; Subphrenic PERITONITIS 14,700 4,410 10,290 abscess; Acute Generalized peritonitis; Acute male pelvic peritonitis; Acute subphrenic peritonitis; Acute suppurative peritonitis Other peritonitis; Chronic proliferative peritonitis; K65.8 Mesentric fat necrosis; Mesentric saponification; Peritonitis PERITONITIS 14,700 4,410 10,290 due to bile; Peritonitis due to urine K65.9 Peritonitis, unspecified PERITONITIS 14,700 4,410 10,290 Other phakomatoses, not elsewhere classified; Peutz- Q85.8 Jeghers Syndrome; Sturge-Weber(-Dimitri)Syndrome; von PHAKOMATOSES 10,800 3,240 7,560 Hippel-Lindau Syndrome Q85.9 Phakomatosis, unspecified; Hamartosis NOS PHAKOMATOSES 10,800 3,240 7,560 Pleural effusion, not elsewhere classified; with J90 PLEURAL EFFUSION 14,200 4,260 9,940 effusion J91* Pleural effusion in conditions classified elsewhere PLEURAL EFFUSION 14,200 4,260 9,940

B20.6 HIV disease resulting in pneumocystis carinii pneumonia PNEUMONIA HIGH RISK 32,000 9,600 22,400

J12.03 Adenoviral pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J12.13 Respiratory syncytial virus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J12.23 Parainfluenza virus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J12.33 Human metapneumovirus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J12.93 Viral pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 Pneumonia [bronchopneumonia]due to Streptococcus J13.3 PNEUMONIA HIGH RISK 32,000 9,600 22,400 pneumoniae, high risk Pneumonia [bronchopneumonia] due to Haemophilus J14.3 PNEUMONIA HIGH RISK 32,000 9,600 22,400 influenzae, high risk J15.03 Pneumonia due to , high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J15.13 Pneumonia due to Pseudomonas, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J15.23 Pneumonia due to staphylococcus, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J15.33 Pneumonia due to streptococcus, group B, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J15.43 Pneumonia due to other streptococci, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J15.53 Pneumonia due to Escherichia coli, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400

Pneumonia due to other aerobic Gram-negative ; J15.63 PNEUMONIA HIGH RISK 32,000 9,600 22,400 Pneumonia due to , high risk

J15.73 Pneumonia due to Mycoplasma pneumoniae, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J15.93 Bacterial pneumonia [bronchopneumonia], high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J16.03 Chlamydial pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J18.03 Bronchopneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400

Page 97 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee J18.13 Lobar pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 J18.23 Hypostatic pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400 Community-acquired pneumonia IV (This classification utilized the American Thoracic Society recommendation. This is equivalent to CAP, high risk in the Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of Community- J18.93 acquired Pneumonia in Immunocompetent Adults, 2010 PNEUMONIA HIGH RISK 32,000 9,600 22,400 update) Adult high risk Community Acquired Pneumonia (CAP), organism is not specified Pedia Community Acquired Pneumonia D (PCAP-D) high risk, organism is not specified Nosocomial pneumonia J18.99, Y95 PNEUMONIA HIGH RISK 32,000 9,600 22,400 Health care associated pneumonia A01.0+ J17.0* Pneumonia in PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A02.2+ J17.0* Pneumonia in salmonella infection PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A21.2+ J17.0* Pneumonia in PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A22.1+ J17.0* Pneumonia in anthrax PNEUMONIA MODERATE RISK 15,000 4,500 10,500 Pulmonary mycobacterial infection; Infection due to A31.0 Mycobacterium avium, Mycobacterium intracellulare PNEUMONIA MODERATE RISK 15,000 4,500 10,500 [Battey bacillus]; Mycobacterium kansasii

A37.0+ J17.0* Pneumonia in due to Bordatella pertusis PNEUMONIA MODERATE RISK 15,000 4,500 10,500

Pneumonia in whooping cough due to Bordatella A37.1+ J17.0* PNEUMONIA MODERATE RISK 15,000 4,500 10,500 parapertusis Pneumonia in whooping cough due to Bordatella species A37.8+ J17.0* PNEUMONIA MODERATE RISK 15,000 4,500 10,500 other than pertusis or parapertusis A37.9+ J17.0* Pneumonia in whooping cough PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A42.0+ J17.0* Pneumonia in actinomycoses PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A48.1 Legionnaires' disease PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A43.0+ J17.0* Pneumonia in nocardiosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A54.8+ J17.0* Pneumonia in PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A69.8+ J17.8* Pneumonia in spirochaetal PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A70+ J17.8* Pneumonia in ornithosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 A78+ J17.8* Pneumonia in PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B01.2+ J17.1* Pneumonia in varicella PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B05.2+ J17.1* Pneumonia in measles PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B06.8+ J17.1* Pneumonia in rubella PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B25.0+ J17.1* Pneumonia in cytomegalovirus disease PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B37.1+ J17.2* Pneumonia in candidiasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B38.0+ J17.2* Pneumonia in acute pulmonary coccidiomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B38.1+ J17.2* Pneumonia in chronic pulmonary coccidiomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B38.2+ J17.2* Pneumonia in pulmonary coccidioidomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500

B39.0+ J17.2* Pneumonia in acute pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500

B39.1+ J17.2* Pneumonia in chronic pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500

B39.2+ J17.2* Pneumonia in pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B39.9+ J17.2* Pneumonia in histoplasmosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B44.0+ J17.2* Pneumonia in invasive pulmonary aspergillosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B44.1+ J17.2* Pneumonia in other pulmonary aspergillosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B58.3+ J17.3* Pneumonia in taxoplasmosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 Pneumonia in schistosomiasis due to Schistosoma B65.0+ J17.3* PNEUMONIA MODERATE RISK 15,000 4,500 10,500 hematobium

B65.1+ J17.3* Pneumonia in schistosomiasis due to Schistosoma mansoni PNEUMONIA MODERATE RISK 15,000 4,500 10,500

Pneumonia in schistosomiasis due to Schistosoma B65.2+ J17.3* PNEUMONIA MODERATE RISK 15,000 4,500 10,500 japonicum Pneumonia in schistosomiasis due to Schistosoma B65.8+ J17.3* PNEUMONIA MODERATE RISK 15,000 4,500 10,500 intercalatum; mattheei; mekongi B65.9+ J17.3* Pneumonia in schistosomiasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 B77.8+ J17.3* Pneumonia in ascariasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500 I00+ J17.8* Pneumonia in rheumatic fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J12.02 Adenoviral pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J12.12 Respiratory syncytial virus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J12.22 Parainfluenza virus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J12.32 Human metapneumovirus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J12.92 Viral pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 Pneumonia [bronchopneumonia] due to Streptococcus J13.2 PNEUMONIA MODERATE RISK 15,000 4,500 10,500 pneumoniae, moderate risk Pneumonia [bronchopneumonia]due to Haemophilus J14.2 PNEUMONIA MODERATE RISK 15,000 4,500 10,500 influenzae, moderate risk

J15.02 Pneumonia due to Klebsiella pneumoniae, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500

J15.12 Pneumonia due to Pseudomonas, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J15.22 Pneumonia due to staphylococcus, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500

Page 98 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

J15.32 Pneumonia due to streptococcus, group B, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500

J15.42 Pneumonia due to other streptococci, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J15.52 Pneumonia due to Escherichia coli, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500

Pneumonia due to other aerobic Gram-negative bacteria; J15.62 PNEUMONIA MODERATE RISK 15,000 4,500 10,500 Pneumonia due to Serratia marcescens, moderate risk

Pneumonia due to Mycoplasma pneumoniae, moderate J15.72 PNEUMONIA MODERATE RISK 15,000 4,500 10,500 risk

J15.92 Bacterial pneumonia [bronchopneumonia], moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500

J16.02 Chlamydial pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J18.02 Bronchopneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J18.12 Lobar pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 J18.22 Hypostatic pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500 Community-acquired pneumonia III (This classification utilized the American Thoracic Society recommendation. This is equivalent to CAP, moderate risk in the Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of J18.92 Community- acquired Pneumonia in Immunocompetent PNEUMONIA MODERATE RISK 15,000 4,500 10,500 Adults, 2010 update) Adult moderate risk Community Acquired Pneumonia (CAP), organism is not specified Pedia Community Acquired Pneumonia C (PCAP-C) moderate risk, organism is not specified J93.0 Spontaneous tension pneumothorax PNEUMOTHORAX 15,300 4,590 10,710 Other spontaneous pneumothorax J93.1 PNEUMOTHORAX 15,300 4,590 10,710 Spontaneous pneumothorax J93.8 Other pneumothorax PNEUMOTHORAX 15,300 4,590 10,710 J93.9 Pneumothorax, unspecified PNEUMOTHORAX 15,300 4,590 10,710 Poisoning by Otheropioids; Poisoning by Codeine; POISONING CAUSED BY ANESTHETICS AND DRUGS T40.2 6,700 2,010 4,690 Poisoning by Morphine AFFECTING THE NERVOUS SYSTEM Poisoning by Other synthetic narcotics; Poisoning by POISONING CAUSED BY ANESTHETICS AND DRUGS T40.4 6,700 2,010 4,690 Pethidine AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T40.6 Poisoning by Other and unspecified narcotics 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T40.7 Poisoning by Cannabis (derivatives) 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Poisoning by Other and unspecified psychodysleptics POISONING CAUSED BY ANESTHETICS AND DRUGS T40.9 [hallucinogens]; Poisoning by Mescaline; Poisoning by 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Psilocin; Poisoning by Psilocybine POISONING CAUSED BY ANESTHETICS AND DRUGS T41.0 Poisoning by Inhaled anaesthetics 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T41.1 Poisoning by Intravenous anaesthetics; Thiobarbiturates 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T41.3 Poisoning by Local anaesthetics 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T41.5 Poisoning by Therapeutic gases; dioxide; Oxygen 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T42.0 Poisoning by Hydantoin derivatives 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T42.1 Poisoning by Iminostilbenes; Carbamazepine 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T42.2 Poisoning by Succinimides and oxazolidinediones 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T42.3 Poisoning by Barbiturates 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T42.4 Poisoning by Benzodiazepines 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Poisoning by Other antiepileptic and sedative- POISONING CAUSED BY ANESTHETICS AND DRUGS T42.6 hypnoticdrugs; Poisoning by Methaqualone;Poisoning by 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Valproic acid

Poisoning by Antiepileptic and sedative-hypnotic drugs, POISONING CAUSED BY ANESTHETICS AND DRUGS T42.7 unspecified; Poisoning by Draught sleeping NOS; Poisoning 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM by Sleeping drug NOS;Poisoning by Sleeping tablet NOS

Poisoning by Antiparkinsonism drugs and other central POISONING CAUSED BY ANESTHETICS AND DRUGS T42.8 6,700 2,010 4,690 muscle-tone depressants; Poisoning by Amantadine AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T43.2 Poisoning by Other and unspecified antidepressants 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T43.3 Poisoning by Phenothiazine antipsychotics and neuroleptics 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Poisoning by Butyrophenone and thioxanthene POISONING CAUSED BY ANESTHETICS AND DRUGS T43.4 6,700 2,010 4,690 neuroleptics AFFECTING THE NERVOUS SYSTEM Poisoning by Other and unspecified antipsychotics and POISONING CAUSED BY ANESTHETICS AND DRUGS T43.5 6,700 2,010 4,690 neuroleptics AFFECTING THE NERVOUS SYSTEM

Page 99 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee POISONING CAUSED BY ANESTHETICS AND DRUGS T43.6 Poisoning by Psychostimulants with abuse potential 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T43.9 Poisoning by Psychotropic drug, unspecified 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T44.1 Poisoning by Other parasympathomimetics [cholinergics] 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Poisoning by Ganglionic blocking drugs, not elsewhere POISONING CAUSED BY ANESTHETICS AND DRUGS T44.2 6,700 2,010 4,690 classified AFFECTING THE NERVOUS SYSTEM

Poisoning by Other parasympatholytics [ POISONING CAUSED BY ANESTHETICS AND DRUGS T44.3 and antimuscarinics] and spasmolytics, not elsewhere 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM classified; Poisoning byPapaverine

Poisoning by Predominantly α-adrenoreceptor agonists, not POISONING CAUSED BY ANESTHETICS AND DRUGS T44.4 6,700 2,010 4,690 elsewhere classified; Poisoning by Metaraminol AFFECTING THE NERVOUS SYSTEM

Poisoning by Predominantly ß-adrenoreceptor agonists, not POISONING CAUSED BY ANESTHETICS AND DRUGS T44.5 6,700 2,010 4,690 elsewhere classified AFFECTING THE NERVOUS SYSTEM Poisoning by α-Adrenoreceptor antagonists, not elsewhere POISONING CAUSED BY ANESTHETICS AND DRUGS T44.6 6,700 2,010 4,690 classified AFFECTING THE NERVOUS SYSTEM Poisoning by ß-Adrenoreceptor antagonists, not elsewhere POISONING CAUSED BY ANESTHETICS AND DRUGS T44.7 6,700 2,010 4,690 classified AFFECTING THE NERVOUS SYSTEM Poisoning by Other and unspecified drugs primarily POISONING CAUSED BY ANESTHETICS AND DRUGS T44.9 affecting the autonomic nervous system; Drug stimulating 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM both α-and ß-adrenoreceptors POISONING CAUSED BY ANESTHETICS AND DRUGS T45.0 Poisoning by Antiallergic and antiemetic drugs 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Poisoning by Antineoplastic and immunosuppressive drugs; POISONING CAUSED BY ANESTHETICS AND DRUGS T45.1 Poisoning by Antineoplastic ; Poisoning by 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Cytarabine POISONING CAUSED BY ANESTHETICS AND DRUGS T45.2 Poisoning by Vitamins, not elsewhere classified 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T45.3 Poisoning by Enzymes, not elsewhere classified 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM POISONING CAUSED BY ANESTHETICS AND DRUGS T50.7 Poisoning by Analeptics and opioid receptor antagonists 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM Drugs, medicaments and biological substances causing POISONING CAUSED BY ANESTHETICS AND DRUGS Y46.2 adverse effects in therapeutic 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM use: Hydantoin derivatives Drugs, medicaments and biological substances causing POISONING CAUSED BY ANESTHETICS AND DRUGS Y46.6 adverse effects in therapeutic 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM use: Other and unspecified antiepileptics Drugs, medicaments and biological substances causing POISONING CAUSED BY ANESTHETICS AND DRUGS Y47.0 adverse effects in therapeutic 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM use: Barbiturates, not elsewhere classified Drugs, medicaments and biological substances causing POISONING CAUSED BY ANESTHETICS AND DRUGS Y47.1 adverse effects in therapeutic 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM use: Benzodiazepines Drugs, medicaments and biological substances causing adverse effects in therapeutic POISONING CAUSED BY ANESTHETICS AND DRUGS Y47.9 use: Sedative, hypnotic and antianxiety drug, 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM unspecified;sleeping draught NOS;sleeping drug NOS;sleeping tablet NOS Drugs, medicaments and biological substances causing POISONING CAUSED BY ANESTHETICS AND DRUGS Y49.5 adverse effects in therapeutic 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM use: Other antipsychotics and neuroleptics Drugs, medicaments and biological substances causing POISONING CAUSED BY ANESTHETICS AND DRUGS Y49.6 adverse effects in therapeutic 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM use: Psychodysleptics [hallucinogens] Drugs, medicaments and biological substances causing adverse effects in therapeutic POISONING CAUSED BY ANESTHETICS AND DRUGS Y51.3 use: Other parasympatholytics [anticholinergics and 6,700 2,010 4,690 AFFECTING THE NERVOUS SYSTEM antimuscarinics] and spasmolytics, not elsewhere classified;papaverine Drugs, medicaments and biological substances causing adverse effects in therapeutic POISONING CAUSED BY ANESTHETICS AND DRUGS Y51.7 6,700 2,010 4,690 use: Beta-adrenoreceptor antagonists, not elsewhere AFFECTING THE NERVOUS SYSTEM classified T36.0 Poisoning by Penicillins POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110

T36.1 Poisoning by Cefalosporins and other ß-lactam antibiotics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110

T36.2 Poisoning by Chloramphenicol group POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T36.3 Poisoning by Macrolides POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T36.4 Poisoning by POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T36.5 Poisoning by Aminoglycosides; Streptomycin POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T36.6 Poisoning by Rifamycins POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T36.8 Poisoning by Other systemic antibiotics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T36.9 Poisoning by Systemic , unspecified POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110

Page 100 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee T37.0 Poisoning by Sulfonamides POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T37.1 Poisoning by Antimycobacterial drugs POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 Poisoning by Antimalarials and drugs acting on other blood T37.2 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 protozoa T37.4 Poisoning by Anthelminthics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 T37.5 Poisoning by Antiviral drugs POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110

Poisoning by Other specified systemic anti-infectives and T37.8 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 antiparasitics; Poisoning by Hydroxyquinoline derivatives

Poisoning by Systemic anti-infective and antiparasitic, T37.9 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 unspecified Drugs, medicaments and biological substances causing Y40.0 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Penicillins Drugs, medicaments and biological substances causing adverse effects in therapeutic Y40.1 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Cefalosporins and other beta- lactam antibiotics Drugs, medicaments and biological substances causing Y40.2 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Chloramphenicol group Drugs, medicaments and biological substances causing Y40.4 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Tetracyclines Drugs, medicaments and biological substances causing Y40.6 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Rifamycins Drugs, medicaments and biological substances causing Y40.8 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Other systemic antibiotics

Drugs, medicaments and biological substances causing Y40.9 adverse effects in therapeutic POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 use: Systemic antibiotics: Systemic antibiotic, unspecified

Drugs, medicaments and biological substances causing Y41.0 adverse effects in therapeutic use: Other systemic anti- POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 infectives and antiparasitics; Sulfonamides Drugs, medicaments and biological substances causing Y41.1 adverse effects in therapeutic use: Other systemic anti- POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 infectives and antiparasitics; Antimycobacterial drugs Drugs, medicaments and biological substances causing Y41.5 adverse effects in therapeutic use: Other systemic anti- POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 infectives and antiparasitics; Antiviral drugs Drugs, medicaments and biological substances causing adverse effects in therapeutic use: Other specified Y41.8 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 systemic anti-infectives and antiparasitics; hydroxyquinoline derivatives Drugs, medicaments and biological substances causing Y41.9 adverse effects in therapeutic use: Systemic anti-infective POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 and antiparasitic, unspecified Drugs, medicaments and biological substances causing adverse effects in therapeutic use: Topical agents primarily affecting skin and mucous membrane and Y56.0 POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110 ophthalmological, otorhinolaryngological and dental drugs: Local antifungal, anti-infective and anti-inflammatory drugs, not elsewhere classified POISONING CAUSED BY ANTI-INFLAMMATORY T39.0 Poisoning by Salicylates 7,400 2,220 5,180 AGENTS POISONING CAUSED BY ANTI-INFLAMMATORY T39.1 Poisoning by 4-Aminophenol derivatives 7,400 2,220 5,180 AGENTS Poisoning by Other nonsteroidal anti-inflammatory drugs POISONING CAUSED BY ANTI-INFLAMMATORY T39.3 7,400 2,220 5,180 [NSAID] AGENTS Poisoning by Other nonopioid analgesics and antipyretics, POISONING CAUSED BY ANTI-INFLAMMATORY T39.8 7,400 2,220 5,180 not elsewhere classified AGENTS Poisoning by Nonopioid analgesic, antipyretic and POISONING CAUSED BY ANTI-INFLAMMATORY T39.9 7,400 2,220 5,180 antirheumatic, unspecified AGENTS POISONING CAUSED BY ANTI-INFLAMMATORY Y45.8 Other analgesics and antipyretics 7,400 2,220 5,180 AGENTS Drugs, medicaments and biological substances causing adverse effects in therapeutic POISONING CAUSED BY ANTI-INFLAMMATORY Y45.9 7,400 2,220 5,180 use: Analgesic, antipyretic and anti-inflammatory drug, AGENTS unspecified Poisoning by Cardiac-stimulant glycosides and drugs of T46.0 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 similar action

T46.1 Poisoning by Calcium-channel blockers POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750

Page 101 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Poisoning by Other antidysrhythmic drugs, not elsewhere T46.2 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 classified Poisoning by Coronary vasodilators, not elsewhere T46.3 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 classified; Poisoning by Dipyridamole Poisoning by Other antihypertensive drugs, not elsewhere T46.5 classified; Poisoning by Clonidine;Poisoning by POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 Guanethidine; Poisoning by Rauwolfia Poisoning by Antihyperlipidaemic and antiarteriosclerotic T46.6 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 drugs Poisoning by Peripheral vasodilators;Poisoning by Nicotimic T46.7 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 acid (derivatives) Poisoning by Other and unspecified agents primarily T46.9 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 affecting the cardiovascular system Drugs, medicaments and biological substances causing adverse effects in therapeutic Y52.0 POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 use: Cardiac-stimulant glycosides and drugs of similar action

Drugs, medicaments and biological substances causing Y52.2 adverse effects in therapeutic POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750 use: Other antidysrhythmic drugs, not elsewhere classified

POISONING CAUSED BY DRUGS AFFECTING THE T48.3 Poisoning by Antitussives 6,200 1,860 4,340 PULMONARY SYSTEM POISONING CAUSED BY DRUGS AFFECTING THE T48.4 Poisoning by Expectorants 6,200 1,860 4,340 PULMONARY SYSTEM POISONING CAUSED BY DRUGS AFFECTING THE T48.5 Poisoning by Anti-common-cold drugs 6,200 1,860 4,340 PULMONARY SYSTEM Poisoning by Antiasthmatics, not elsewhere classified; β- POISONING CAUSED BY DRUGS AFFECTING THE T48.6 adrenoreceptor agonists used in asthma theraphy; 6,200 1,860 4,340 PULMONARY SYSTEM Poisoning by Salbutamol Drugs, medicaments and biological substances causing POISONING CAUSED BY DRUGS AFFECTING THE Y55.3 adverse effects in therapeutic 6,200 1,860 4,340 PULMONARY SYSTEM use: Antitussives Drugs, medicaments and biological substances causing POISONING CAUSED BY DRUGS AFFECTING THE Y55.4 adverse effects in therapeutic 6,200 1,860 4,340 PULMONARY SYSTEM use: Expectorants Drugs, medicaments and biological substances causing adverse effects in therapeutic POISONING CAUSED BY DRUGS AFFECTING THE Y55.6 6,200 1,860 4,340 use: Antiasthmatics, not elsewhere classified: PULMONARY SYSTEM aminophylline, salbutamol, theobromine;theophylline POISONING CAUSED BY DRUGS AFFECTING THE T50.0 Poisoning by Mineralocorticoids and their antagonists 6,300 1,890 4,410 RENAL SYSTEM POISONING CAUSED BY DRUGS AFFECTING THE T50.1 Poisoning by Loop [high-ceiling] diuretics 6,300 1,890 4,410 RENAL SYSTEM Poisoning by Carbonic-anhydrase inhibitors, POISONING CAUSED BY DRUGS AFFECTING THE T50.2 benzothiadiazides and other diuretics;Poisoning by 6,300 1,890 4,410 RENAL SYSTEM Acetazolamide POISONING CAUSED BY DRUGS AFFECTING THE T50.4 Poisoning by Drugs affecting uric acid metabolism 6,300 1,890 4,410 RENAL SYSTEM Poisoning by Other and unspecified drugs, medicaments and biological substances; Poisoning by Acidifying agents; Poisoning by Alkalizing agents; Poisoning by POISONING CAUSED BY DRUGS AFFECTING THE T50.9 6,300 1,890 4,410 Immunoglobulin; Poisoning by Immunologicals; Poisoning RENAL SYSTEM by Lipotropic drugs; Poisoning by Parathyroid hormones and derivatives POISONING CAUSED BY GASTROINTESTINAL T47.0 Poisoning by HistamineH2-receptor antagonists 8,300 2,490 5,810 DRUGS Poisoning by Other antacids and anti-gastric-secretion POISONING CAUSED BY GASTROINTESTINAL T47.1 8,300 2,490 5,810 drugs DRUGS POISONING CAUSED BY GASTROINTESTINAL T47.2 Poisoning by Stimulant laxatives 8,300 2,490 5,810 DRUGS POISONING CAUSED BY GASTROINTESTINAL T47.3 Poisoning by Saline and osmotic laxatives 8,300 2,490 5,810 DRUGS Poisoning by Other laxatives; Poisoning by Intestinal atonia POISONING CAUSED BY GASTROINTESTINAL T47.4 8,300 2,490 5,810 drugs DRUGS POISONING CAUSED BY GASTROINTESTINAL T47.5 Poisoning by Digestants 8,300 2,490 5,810 DRUGS POISONING CAUSED BY GASTROINTESTINAL T47.6 Poisoning by Antidiarrhoeal drugs 8,300 2,490 5,810 DRUGS Poisoning by Other agents primarily affecting the POISONING CAUSED BY GASTROINTESTINAL T47.8 8,300 2,490 5,810 gastrointestinal system DRUGS Poisoning by Agent primarily affecting the gastrointestinal POISONING CAUSED BY GASTROINTESTINAL T47.9 8,300 2,490 5,810 system, unspecified DRUGS Poisoning by relaxants [neuromuscular POISONING CAUSED BY GASTROINTESTINAL T48.1 8,300 2,490 5,810 blocking agents] DRUGS

Page 102 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Drugs, medicaments and biological substances causing adverse effects in therapeutic POISONING CAUSED BY GASTROINTESTINAL Y53.8 8,300 2,490 5,810 use: Other agents primarily affecting the gastrointestinal DRUGS system

T45.4 Poisoning by Iron and its compounds POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110

T45.5 Poisoning by Anticoagulants POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110

T45.6 Poisoning by Fibrinolysis-affecting drugs POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110

Poisoning by antagonists, vitamin K and T45.7 POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110 other coagulants

Poisoning by Other primarily systemic and haematological agents; Poisoning by Liver preparations and other T45.8 POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110 antianaemic agents; Poisoning by Natural blood and blood products; Poisoning by Plasma substitute

T45.9 Primarily systemic and haematological agent, unspecified POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110

Drugs, medicaments and biological substances causing Y44.2 adverse effects in therapeutic POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110 use: Anticoagulants Drugs, medicaments and biological substances causing adverse effects in therapeutic Y44.3 POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110 use: Anticoagulant antagonists, vitamin K and other coagulants T38.0 Poisoning by and synthetic analogues POISONING CAUSED BY HORMONES 8,500 2,550 5,950 T38.1 Poisoning by Thyroid hormones and substitutes POISONING CAUSED BY HORMONES 8,500 2,550 5,950 T38.2 Poisoning by Antithyroid drugs POISONING CAUSED BY HORMONES 8,500 2,550 5,950 Poisoning by Insulin and oral hypoglycaemic [antidiabetic] T38.3 POISONING CAUSED BY HORMONES 8,500 2,550 5,950 drugs Poisoning by Oral contraceptives; Poisoning by Multiple- T38.4 POISONING CAUSED BY HORMONES 8,500 2,550 5,950 and-single-ingredient preparations Poisoning by Other estrogens and progestogens; Mixtures T38.5 POISONING CAUSED BY HORMONES 8,500 2,550 5,950 and substitutes Poisoning by Antigonadotrophins, antiestrogens, T38.6 antiandrogens, not elsewhere classified; Poisoning by POISONING CAUSED BY HORMONES 8,500 2,550 5,950 Tamoxifen T38.7 Poisoning by Androgens and anabolic congeners POISONING CAUSED BY HORMONES 8,500 2,550 5,950 Drugs, medicaments and biological substances causing Y42.0 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Glucocorticoids and synthetic analogues Drugs, medicaments and biological substances causing Y42.2 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Antithyroid drugs

Drugs, medicaments and biological substances causing Y42.3 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Insulin and oral hypoglycaemic [antidiabetic] drugs

Drugs, medicaments and biological substances causing adverse effects in therapeutic Y42.4 POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Oral contraceptives;multiple-and single-ingredient preparations Drugs, medicaments and biological substances causing adverse effects in therapeutic Y42.5 POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Other estrogens and progestogens;mixtures and substitutes Drugs, medicaments and biological substances causing Y45.1 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Salicylates

Drugs, medicaments and biological substances causing Y45.2 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Propionic acid derivatives;propanoic acid derivatives

Drugs, medicaments and biological substances causing Y45.3 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: Other nonsteroidal anti-inflammatory drugs [NSAID]

Drugs, medicaments and biological substances causing Y45.5 adverse effects in therapeutic POISONING CAUSED BY HORMONES 8,500 2,550 5,950 use: 4-Aminophenol derivatives POISONING CAUSED BY ORGANIC SUBSTANCES T51.0 Toxic effect of Ethanol;Toxic effect of Ethyl alcohol 6,400 1,920 4,480 AND Toxic effect of 2-Propanol; Toxic effect of Isoprophyl POISONING CAUSED BY ORGANIC SUBSTANCES T51.2 6,400 1,920 4,480 aclohol AND HEAVY METALS

Page 103 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Toxic effect of Fusel oil; Toxic effect of Amyl alcohol; Toxic POISONING CAUSED BY ORGANIC SUBSTANCES T51.3 effect of Butyl alcohol [1-butanol]; Toxic effect of Propyl 6,400 1,920 4,480 AND HEAVY METALS alcohol [1-proponol] POISONING CAUSED BY ORGANIC SUBSTANCES T51.8 Toxic effect of Other alcohols 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T51.9 Toxic effect of Alcohol, unspecified 6,400 1,920 4,480 AND HEAVY METALS Toxic effect of Petroleum products; Toxic effect of Gasoline [petrol]; Toxic effect of Kerosine [paraffin oil]; POISONING CAUSED BY ORGANIC SUBSTANCES T52.0 Toxic effect of Paraffin wax; Toxic effect of Petroleum 6,400 1,920 4,480 AND HEAVY METALS ether; Toxic effect of Petroleum naphtha; Toxic effect of Petroleum spirits Toxic effect of Homologues of benzene; Toxic effect of POISONING CAUSED BY ORGANIC SUBSTANCES T52.2 Toluene [methylbenzene]; Toxic effect of Xylene 6,400 1,920 4,480 AND HEAVY METALS [dimethylbenzene] POISONING CAUSED BY ORGANIC SUBSTANCES T52.4 Toxic effect of Ketones 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T52.8 Toxic effect of Other organic solvents 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T52.9 Toxic effect of Organic solvent, unspecified 6,400 1,920 4,480 AND HEAVY METALS Toxic effect of Carbon tetrachloride;Toxic effect of POISONING CAUSED BY ORGANIC SUBSTANCES T53.0 6,400 1,920 4,480 Tetrachloromethane AND HEAVY METALS Toxic effect of Chloroform; Toxic effect of POISONING CAUSED BY ORGANIC SUBSTANCES T53.1 6,400 1,920 4,480 Trichloromethane AND HEAVY METALS Toxic effect of Dichloromethane;Toxic effect of Methylene POISONING CAUSED BY ORGANIC SUBSTANCES T53.4 6,400 1,920 4,480 chloride AND HEAVY METALS Toxic effect of Other halogen derivatives of aliphatic POISONING CAUSED BY ORGANIC SUBSTANCES T53.6 6,400 1,920 4,480 hydrocarbons AND HEAVY METALS Toxic effect of Halogen derivative of aliphatic and aromatic POISONING CAUSED BY ORGANIC SUBSTANCES T53.9 6,400 1,920 4,480 hydrocarbons, unspecified AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T54.1 Toxic effect of Other corrosive organic compounds 6,400 1,920 4,480 AND HEAVY METALS Toxic effect of Corrosive and acid-like substances; POISONING CAUSED BY ORGANIC SUBSTANCES T54.2 Toxic effect of Acid hydrochlorie;Toxic effect of Acid 6,400 1,920 4,480 AND HEAVY METALS sulfurie Toxic effect of Corrosive alkalis and alkali-like substances; POISONING CAUSED BY ORGANIC SUBSTANCES T54.3 Toxic effect of Potassium hydroxide;Toxic effect of Sodium 6,400 1,920 4,480 AND HEAVY METALS hydroxide POISONING CAUSED BY ORGANIC SUBSTANCES T54.9 Toxic effect of Corrosive substance, unspecified 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T55 Toxic effect of soaps and detergents 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T56.0 Toxic effect of Lead and its compounds 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T56.1 Toxic effect of Mercury and its compounds 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T56.5 Toxic effect of Zinc and its compounds 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T56.8 Toxic effect of Other metals 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T57.0 Toxic effect of Arsenic and its compounds 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T57.1 Toxic effect of Phosphorus and its compounds 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T57.3 Toxic effect of Hydrogen cyanide 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T57.8 Toxic effect of Other specified in organic substances 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T57.9 Toxic effect of Inorganic substance, unspecified 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T58 Toxic effect of carbon monoxide from all sources 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.0 Toxic effect of Nitrogen oxides 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.2 Toxic effect of Formal dehyde 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.3 Toxic effect of Lacrimogenic gas; Toxic effect of Tear gas 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.4 Toxic effect of Chlorine gas 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.7 Toxic effect of 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.8 Toxic effect of Other specified gases, fumes and vapours 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T59.9 Toxic effect of Gases, fumes and vapours, unspecified 6,400 1,920 4,480 AND HEAVY METALS

Page 104 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Toxic effect of Organophosphate and carbamate POISONING CAUSED BY ORGANIC SUBSTANCES T60.0 6,400 1,920 4,480 insecticides AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T60.1 Toxic effect of Halogenated insecticides 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T60.2 Other and unspecified insecticides 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T60.3 Toxic effect of Herbicides and fungicides 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T60.4 Toxic effect of Rodenticides; Toxic effect of Thallium 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T60.8 Toxic effect of Other pesticides 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T60.9 Toxic effect of Pesticide, unspecified 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T65.0 Toxic effect of Cyanides 6,400 1,920 4,480 AND HEAVY METALS Toxic effect of Nitro derivatives and aminoderivatives of benzene and its homologues; Toxic effect of Aniline POISONING CAUSED BY ORGANIC SUBSTANCES T65.3 6,400 1,920 4,480 [benzenamine]; Toxic effect of Nitrobenzene; Toxic effect AND HEAVY METALS of Trinitrotoluene POISONING CAUSED BY ORGANIC SUBSTANCES T65.4 Toxic effect of Carbondisulfide 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T65.6 Toxic effect of Paints and dyes, not elsewhere classified 6,400 1,920 4,480 AND HEAVY METALS POISONING CAUSED BY ORGANIC SUBSTANCES T65.8 Toxic effect of other specified substances 6,400 1,920 4,480 AND HEAVY METALS T49.2 Poisoning by Local astringents and local detergents POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 T49.3 Poisoning by Emollients, demulcents and protectants POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 Poisoning by Keratolytics, keratoplastics and other hair T49.4 POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 treatment drugs and preparations

Poisoning by Ophthalmological drugs and preparations; T49.5 POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 Poisoning by Eye, nose and throat anti-infectives

T49.7 Poisoning by Dental drugs, topically applied POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 T49.8 Othertopical agents; Spermicides POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 T49.9 Poisoning by Topical agent, unspecified POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 Drugs, medicaments and biological substances causing Y56.2 adverse effects in therapeutic POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 use: Local astringents and local detergents Drugs, medicaments and biological substances causing Y56.3 adverse effects in therapeutic POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710 use: Emollients, demulcents and protectants T61.0 Toxic effect of Ciguatera fish poisoning POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Toxic effect of Scombroid fish poisoning;Toxic effect of T61.1 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 -like syndrome Toxic effect of Other fish and shellfish poisoning T61.2 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Fish poisoning T61.8 Toxic effect of other seafoods POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Toxic effect of unspecified seafood T61.9 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Seafood poisoning T62.0 Toxic effect of Ingested mushrooms POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 T62.1 Toxic effect of Ingested berries POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 T62.2 Toxic effect of Other ingested (parts of) plant(s) POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Toxic effect of Other specified noxious substances eaten as T62.8 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 food Toxic effect of Noxious substance eaten as food, T62.9 unspecified POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Food poisoning Toxic effect of Snake venom;Toxic effect of Sea-snake T63.0 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 venom Toxic effect of Venom of other reptiles; Toxic effect of T63.1 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Lizard venom T63.2 Toxic effect of Venom of scorpion POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 T63.3 Toxic effect of Venom of spider POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Toxic effect of Venom of other arthropods;Toxic effect of T63.4 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Insect bite or sting, venomous T63.5 Toxic effect of contact with fish POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Toxic effect of contact with other marine animals; Jellyfish; T63.6 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Sea anemone; Shellfish; Starfish Toxic effect of contact with other venomous animals; T63.8 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 Venom of amphibian

T63.9 Toxic effect of contact with unspecified venomous animal POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990

Toxic effect of aflation and other mycotoxin food T64 POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990 contaminants T65.2 Toxic effect of Tobacco and nicotine POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990

Page 105 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Drugs, medicaments and biological substances causing Y43.0 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Antiallergic and antiemetic drugs Drugs, medicaments and biological substances causing Y54.3 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Benzothiadiazine derivatives Drugs, medicaments and biological substances causing Y54.8 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Agents affecting uric acid metabolism Drugs, medicaments and biological substances causing Y55.0 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Oxytocic drugs;ergot alkaloids Drugs, medicaments and biological substances causing Y56.6 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Otorhinolaryngological drugs and preparations Drugs, medicaments and biological substances causing Y58.0 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: BCG vaccine Drugs, medicaments and biological substances causing Y58.4 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Tetanus vaccine Drugs, medicaments and biological substances causing Y59.9 adverse effects in therapeutic POISONING OTHERS 8,300 2,490 5,810 use: Vaccine or biological substance, unspecified Hereditary motor and sensory neuropathy; Disease Charcot- Marie-Tooth; Disease Déjerine-Sottas; Hereditary motor and sensory neuropathy, types I-IV; Hypertrophic G60.0 POLYNEUROPATHIES 10,600 3,180 7,420 neuropathy of infancy; Peroneal muscular atrophy axonal type; Peroneal muscular atrophy hypertrophic type; Roussy- Levy syndrome G60.1 Refsum's disease POLYNEUROPATHIES 10,600 3,180 7,420 G60.2 Neuropathy in association with hereditary ataxia POLYNEUROPATHIES 10,600 3,180 7,420 G60.3 Idiopathic progressive neuropathy POLYNEUROPATHIES 10,600 3,180 7,420 Other hereditary and idiopathic neuropathies; Morvan's disease; Nelaton's syndrome; Sensory neuropathy G60.8 POLYNEUROPATHIES 10,600 3,180 7,420 dominantly inherited; Sensory neuropathy recessively inherited G60.9 Hereditary and idiopathic neuropathy, unspecified POLYNEUROPATHIES 10,600 3,180 7,420 Guillain-Barré syndrome; Acute post- infective polyneuritis; G61.0 POLYNEUROPATHIES 10,600 3,180 7,420 Acute infective polyneuritis G61.8 Other inflammatory polyneuropathies POLYNEUROPATHIES 10,600 3,180 7,420 G61.9 Inflammatory polyneuropathy, unspecified POLYNEUROPATHIES 10,600 3,180 7,420 G62.0 Drug-induced polyneuropathy POLYNEUROPATHIES 10,600 3,180 7,420 G62.1 Alcoholic polyneuropathy POLYNEUROPATHIES 10,600 3,180 7,420 G62.2 Polyneuropathy due to other toxic agents POLYNEUROPATHIES 10,600 3,180 7,420 Other specified polyneuropathies; Radiation-induced G62.8 POLYNEUROPATHIES 10,600 3,180 7,420 polyneuropathy Polyneuropathy, unspecified; Neuropathy NOS G62.9 POLYNEUROPATHIES 10,600 3,180 7,420 Peripheral neuropathy Polyneuropathy in other diseases classified elsewhere; G63.8* POLYNEUROPATHIES 10,600 3,180 7,420 Uraemic neuropathy Other disorders of peripheral nervous system; Disorder of G64 POLYNEUROPATHIES 10,600 3,180 7,420 peripheral nervous system NOS Polyp of corpus uteri; Polyp of endometrium; Polyp of N84.0 POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640 uterus NOS N84.1 Polyp of cervix uteri; Mucous polyp of cervix POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640 N84.2 Polyp of vagina POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640 N84.3 Polyp of vulva; Polyp of labia POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640 N84.8 Polyp of other parts of female genital tract POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640 N84.9 Polyp of female genital tract, unspecified POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640 Embolism following abortion and ectopic and molar pregnancy; Embolism NOS; Air embolism; Amniotic fluid O08.2 embolism; Blood-clot embolism; Pulmonary embolism; POST PARTUM COMPLICATIONS 9,300 2,790 6,510 Pyaemic embolism; Septic or septicopyaemic embolism; Soap embolism Metabolic disorders following abortion and ectopic and O08.5 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 molar pregnancy Complication following abortion and ectopic and molar O08.9 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 pregnancy, unspecified Other intrapartum haemorrhage; Excessive intrapartum O67.8 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 haemorrhage O71.0 Rupture of uterus before on set of labour POST PARTUM COMPLICATIONS 9,300 2,790 6,510 Rupture of uterus during labour; Rupture of uterus not O71.1 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 stated as occuring before onset of labour O71.2 Post partum inversion of uterus POST PARTUM COMPLICATIONS 9,300 2,790 6,510

O71.3 Obstetric laceration of cervix; Annular detachment of cervix POST PARTUM COMPLICATIONS 9,300 2,790 6,510

Page 106 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Other obstetric injury to pelvic organs; Obstetric injury to O71.5 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 bladder; Obstetric injury to urethra Obstetric haematoma of pelvis; Obstetric haematoma of O71.7 perineum; Obstetric haematoma of vagina; Obstetric POST PARTUM COMPLICATIONS 9,300 2,790 6,510 haematoma of vulva O71.8 Other specified obstetric trauma POST PARTUM COMPLICATIONS 9,300 2,790 6,510 O71.9 Obstetric trauma, unspecified POST PARTUM COMPLICATIONS 9,300 2,790 6,510 Aspiration pneumonitis due to anaesthesia during labour and delivery; Inhalation of stomach contents or secretions O74.0 NOS due to anaesthesia during labour and delivery; POST PARTUM COMPLICATIONS 9,300 2,790 6,510 Mendelson's syndrome due to anaesthesia during labour and delivery Cardiac complications of anaesthesia during labour and delivery; Cardiac arrest due to anaesthesia during labour O74.2 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 and delivery; Cardiac failure due to anaesthesia during labour and delivery Other complications of anaesthesia during labour and O74.8 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 delivery Shock during or following labour and delivery; Obstetic O75.1 POST PARTUM COMPLICATIONS 9,300 2,790 6,510 shock O75.8 Other specified complications of labour and delivery POST PARTUM COMPLICATIONS 9,300 2,790 6,510 O75.9 Complication of labour and delivery, unspecified POST PARTUM COMPLICATIONS 9,300 2,790 6,510 Venous complication in the puerperium, unspecified; O87.9 Puerperal phlebitis NOS; Puerperal phlebopathy NOS; POST PARTUM COMPLICATIONS 9,300 2,790 6,510 Puerperal thrombosis NOS Care and examination immediately after delivery; Care and Z39.0 POSTPARTUM CARE FOR DELIVERIES IN TRANSIT 2,000 600 1,400 observation in uncomplicated cases Postprocedural hypothyroidism; Postirradiation E89.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 hypothyroidism; Postsurgical hypothyroidism

E89.2 Postprocedural hypoparathyroidism; Parathyroprival tetany POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

Postprocedural hypopituitarism; Postirradiation E89.3 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 hypopituitarism E89.4 Postprocedural ovarian failure POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 E89.5 Postprocedural testicular hypofunction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postprocedural adrenocortical hypofunction; E89.6 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postprocedural adreno-medullary hypofunction

E89.8 Other postprocedural endocrine and metabolic disorders POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

G97.1 Other reaction to spinal and lumbar puncture POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 G97.8 Other postprocedural disorders of nervous system POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

Vitreous syndrome following cataract surgery H59.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Keratopathy (bullous aphakic) following cataract surgery

Other postprocedural disorders of eye and adnexa; H59.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Chorioretinal scars after surgery for detachment

H59.9 Postprocedural disorder of eye and adnexa, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

H95.8 Other postprocedural disorders of ear and mastoid process POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

I97.0 Postcardiotomy syndrome POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postmastectomy lymphoedema syndrome; Elephantiasis I97.2 due to mastectomy; Obliteration of lymphatic vessels due POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 to mastectomy Tracheostomy malfunction; Haemorrhage from tracheostomy stoma; Obstruction of tracheostomy airway; J95.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Sepsis of tracheostomy stoma; Tracheo-oesophageal fistula following tracheostomy

J95.1 Acute pulmonary insufficiency following thoracic surgery POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

Acute pulmonary insufficiency following nonthoracic J95.2 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 surgery Mendelson syndrome; Chemical pneumonitis due to J95.4 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 aspiration during anaesthesia J95.5 Postprocedural subglottic stenosis POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 J95.8 Other postprocedural respiratory disorders POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 J95.9 Postprocedural respiratory disorder, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 K91.0 Vomiting following gastrointestinal surgery POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postgastric surgery syndromes; ; K91.1 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postgastrectomy syndrome; Postvagotomy syndrome Postsurgical malabsorption, not elsewhere classified; K91.2 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postsurgical blind loop syndrome K91.3 Postoperative intestinal obstruction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 K91.4 Colostomy and enterostomy malfunction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 K91.5 Postcholecystectomy syndrome POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Other postprocedural disorders of digestive system, not K91.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 elsewhere classified

Page 107 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

K91.9 Postprocedural disorder of digestive system, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

N99.0 Postprocedural renal failure POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Postprocedural urethral stricture; Postcatheterization N99.1 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 urethral stricture N99.4 Postprocedural pelvic peritoneal adhesions POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Other postprocedural disorders of genitourinary system; N99.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Residual ovary syndrome Postprocedural disorder of genitourinary system, N99.9 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 unspecified Haemorrhage and haematoma complicating a procedure, T81.0 not elsewhere classified; Haemorrhage at any site resulting POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 from a procedure

Shock during or resulting from a procedure not elsewhere classified; Collapse NOS during or following a procedure; T81.1 Endotoxic shock during or following a procedure; POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Hypovolaemic during or following a procedure; Septic shock during or following a procedure;

Accidental puncture and laceration during a procedure not elsewhere classified; Accidental perforation of blood vessel T81.2 by catheter, endoscope, instrument, probe during a POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 procedure; Accidental perforation of nerve by catheter, endoscope, instrument, probe Disruption of operation wound, not elsewhere classified; T81.3 Dehiscene of operation wound; Rupture of operation POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 wound

Infection following a procedure, not elsewhere classified; Intra-abdominal abscess postprocedural abcess; Intra- T81.4 abdominal stitch postprocedural abscess; Intra-abdominal POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 subphrenic postprocedural abcess; Intra-abdominal wound postprocedural abcess; Septicemia

Other complications of procedures, not elsewhere classified; Complication of inhalation therapy; Emphysema T81.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 (subcutaneous) resulting from a procedure; Persistent postoperative fistula Mechanical complication of heart valve prosthesis; Mechanical breakdown due to heart valve prosthesis; Displacement due to heart valve prosthesis; Failure due to heart valve prosthesis; Leakage due to heart valve T82.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 prosthesis; Malposition due to heart valve prosthesis; Mechanical obstruction due to heart valve prosthesis; Perforation due to heart valve prosthesis; Protrusion due to heart valve prosthesis;

Mechanical complication of cardiac electronic device; T82.1 Conditions listed in T82.0 due to electrodes; Conditions POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 listed in T82.0 due to pulse generator (battery)

Mechanical complication of coronary artery bypass and T82.2 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 valve grafts Mechanical complication of other vascular grafts; Condition listed in T82.0 due to aortic (bifurcation) graft T82.3 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 (replacement); Condition listed in T82.0 due to arterial (carotid) (femoral) graft (bypass) T82.4 Mechanical complication of vascular dialysis catheter POSTPROCEDURAL DISORDERS 10,300 3,090 7,210

Mechanical complication of other cardiac and vascular devices and implants; Conditions listed in T82.0 due to T82.5 arteriovenous fistula surgically created; arterivenous POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Shunt surgically created; Artificial heart; Balloon counterpulsation device; Infusion catheter; umbrella device

Infection and inflammatory reaction due to other cardiac T82.7 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 and vascular devices, implants and grafts

Other complications of cardiac and vascular prosthetic devices, implants and grafts; Complication due to cardiac and vascular prosthetic devices, implants and grafts; Embolism due to cardiac and vascular prosthetic devices, implants and grafts; Fibrosis due to cardiac and vascular prosthetic devices, implants and grafts; Haemorrhage due T82.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 to cardiac and vascular prosthetic devices, implants and grafts; Pain due to cardiac and vascular prosthetic devices, implants and grafts; Stenosis due to cardiac and vascular prosthetic devices, implants and grafts; Thrombosis due to cardiac and vascular prosthetic devices, implants and grafts;

Page 108 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Mechanical complication of other urinary devices and implants; Concditions listed in T82.0 due to Urinary T83.1 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 electronic stimultor device; Urinary sphincter implant; Urinary stent T83.2 Mechanical complication of graft of urinary organ POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Mechanical complication of intrauterine contraceptive T83.3 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 device Infection and inflammatory reaction due to prosthetic T83.5 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 device, implant and graft in urinary system Other complications of genitourinary prosthetic devices, T83.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 implants and grafts Unspecified complication of genitourinary prosthetic T83.9 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 device, implants and grafts T84.0 Mechanical complication of internal joint prosthesis POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Mechanical complication of internal fixation device of T84.1 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 bones of limb Mechanical complication of internal fixation device of other T84.2 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 bones Mechanical complication of other internal orthopaedic T84.4 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 devices, implants and grafts Infection and inflammatory reaction due to internal joint T84.5 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 prosthesis Infection and inflammatory reaction due to internal fixation T84.6 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 device [any site]

Infection and inflammatory reaction due to other internal T84.7 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 orthopaedic prosthetic devices, implants and grafts

Other complications of internal orthopaedic prosthetic T84.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 devices, implants and grafts Unspecified complication of internal orthopaedic prosthetic T84.9 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 device, implant and graft Mechanical complication of ventricular intracranial T85.0 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 (communicating) shunt Mechanical complication of other ocular prosthetic devices, implants and grafts Conditions listed in T82.0 due to T85.3 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 corneal graft; Conditions listed in T82.0 due to prosthetic orbit of eye Mechanical complication of gastrointestinal prosthetic devices implants and grafts; Conditions listed in T82.0 due T85.5 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 to Bile-duct prosthesis; Conditions listed in T82.0 oesophageal anti-reflux device Mechanical complication of other specified internal prosthetic devices, Implants and grafts; Conditions listed in T85.6 T82.0 due to epidural and subdural infusion catheter; POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 Conditions listed in T82.0 due to intraperitonael dialysis catheter; Conditions listed Infection and inflammatory reaction due to other internal T85.7 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 prosthetic devices, implants and grafts Other complications of internal prosthetic devices, implants T85.8 POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 and grafts, not elsewhere classified Unspecified complication of internal prosthetic device, T85.9 implant and graft; Complication of internal prosthetic POSTPROCEDURAL DISORDERS 10,300 3,090 7,210 device, implants and graft NOS

Hyperplasia of prostate; Adenofibromatous hypertrophy of prostate; Adenoma (benign)of prostate ; Enlargement of N40 prostate (benign); of prostate; of PROSTATE DISORDERS 9,200 2,760 6,440 prostate; Hypertrophy of prostate (benign); of prostate; Median bar (prostate); Prostatic obstruction NOS

N41.0 Acute prostatitis PROSTATE DISORDERS 9,200 2,760 6,440 N41.1 Chronic prostatitis PROSTATE DISORDERS 9,200 2,760 6,440 N41.2 Abscess of prostate PROSTATE DISORDERS 9,200 2,760 6,440 N41.3 Prostatocystitis PROSTATE DISORDERS 9,200 2,760 6,440 N41.8 Other inflammatory diseases of prostate PROSTATE DISORDERS 9,200 2,760 6,440 Inflammatory disease of prostate, unspecified; Prostatitis N41.9 PROSTATE DISORDERS 9,200 2,760 6,440 NOS N42.0 Calculus of prostate; Prostatic stone PROSTATE DISORDERS 9,200 2,760 6,440 N42.1 Congestion and haemorrhage of prostate PROSTATE DISORDERS 9,200 2,760 6,440 N42.2 Atrophy of prostate PROSTATE DISORDERS 9,200 2,760 6,440 N42.8 Other specified disorders of prostate PROSTATE DISORDERS 9,200 2,760 6,440 N42.9 Disorder of prostate, unspecified PROSTATE DISORDERS 9,200 2,760 6,440 O15.2 Eclampsia in the puerperium PUERPERAL COMPLICATIONS 6,800 2,040 4,760 Puerperal sepsis; Puerperal endometritis; Puerperal fever; O85 Puerperal peritonitis; Puerperal septicaemia; Postpartum PUERPERAL COMPLICATIONS 10,600 3,180 7,420 sepsis

Page 109 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Infection of obstetric surgical wound; Infected caesarean O86.0 section wound following delivery; Infected perineal repair PUERPERAL COMPLICATIONS 10,600 3,180 7,420 following delivery

Other infection of genital tract following delivery; Cervicitis O86.1 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 following delivery; Vaginitis following delivery

O86.2 Urinary tract infection following delivery PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Other genitourinary tract infections following delivery; O86.3 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Puerperal genitourinary tract infection NOS Pyrexia of unknown origin following delivery; Puerperal O86.4 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 infection NOS; Puerperal pyrexia NOS O86.8 Other specified puerpera linfections PUERPERAL COMPLICATIONS 10,600 3,180 7,420 O87.0 Superficial thrombophlebitis in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Deep phlebothrombosis in the puerperium; Deep-vein O87.1 thrombosis, postpartum; Pelvic thrombophlebitis, PUERPERAL COMPLICATIONS 10,600 3,180 7,420 postpartum O87.2 Haemorrhoids in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Other venous complications in the puerperium; Genital O87.8 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 varices in the puerperium O88.1 Amniotic fluid embolism PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Obstetric blood-clot embolism; Obstetric pulmonary O88.2 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 embolism NOS; Puerperal pulmonary embolism NOS

Pulmonary complications of anaesthesia during the puerperium; Aspiration pneumonitis due to anaesthesia during the puerperium; Chemical pneumonitis due to aspiration, due to anaesthesia during the puerperium; O89.0 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Inhalation of stomach contents or secretions NOS due to anaestheisa during the puerperium; Mendelson syndrome due to anaesthesia during the puerperium; Pressure collapse of lung due to anaesthesia during the puerperium

Cardiac complications of anaesthesia during the puerperium; Cardiac arrest due to anaesthesia during the O89.1 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 puerperium; Cardiac failure due to anaesthesia during the puerperium Central nervous system complications of anaesthesia O89.2 during the puerperium; Cerebral anoxia due to anaesthesia PUERPERAL COMPLICATIONS 10,600 3,180 7,420 during the puerperium Spinal and epidural anaesthesia-induced headache during O89.4 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 the puerperium

O89.8 Other complications of anaesthesia during the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420

Complication of anaesthesia during the puerperium, O89.9 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 unspecified O90.0 Disruption of caesarean section wound PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Disruption of perineal obstetric wound; Disruption of O90.1 wound of episiotomy; Disruption of wound of perineal PUERPERAL COMPLICATIONS 10,600 3,180 7,420 laceration; Secondary perineal tear O90.2 Haematoma of obstetric wound PUERPERAL COMPLICATIONS 10,600 3,180 7,420 O90.3 Cardiomyopathy in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Postpartum acute renal failure; Hepatorenal syndrome O90.4 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 following labour and delivery O90.5 Postpartum thyroiditis PUERPERAL COMPLICATIONS 10,600 3,180 7,420 Other complications of the puerperium, not elsewhere O90.8 PUERPERAL COMPLICATIONS 10,600 3,180 7,420 classified; Placental polyp O90.9 Complication of the puerperium, unspecified PUERPERAL COMPLICATIONS 10,600 3,180 7,420

P20.0 Intrauterine hypoxia first noted before onset of labour PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P20.1 Intrauterine hypoxia first noted during labour and delivery PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P20.9 Intrauterine hypoxia, unspecified PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Severe birth asphyxia; Pulse less than 100 per minute at birth and falling or steady, respiration absent or gasping, P21.0 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 colour poor, tone absent; Asphyxia with 1-minute apgar score 0-3; White asphyxia

Mild and moderate birth asphyxia; Normal respiration not established within one minute, but heart rate 100 or above, P21.1 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 some muscle tone present, some response to stimulation; Asphyxia with 1-minute Apgar score 4-7; Blue asphyxia

Birth asphyxia, unspecified; Anoxia, NOS; Asphyxia, NOS; P21.9 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 Hypoxia, NOS Respiratory distress syndrome of newborn; Hyaline P22.0 membrane disease PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 Respiratory distress syndrome, child

Page 110 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

P22.1 Transient tachypnoea of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P22.8 Other respiratory distress of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P22.9 Respiratory distress of newborn, unspecified PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P24.0 Neonatal aspiration of meconium PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Neonatal aspiration of amniotic fluid and mucus;Aspiration P24.1 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 of liquor (amnii)

P24.2 Neonatal aspiration of blood PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P24.3 Neonatal aspiration of milk and regurgitated food PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P24.8 Other neonatal aspiration syndromes PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Neonatal aspiration syndrome, unspecified; Neonatal P24.9 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 aspiration pneumonia NOS

P25.0 Interstitial emphysema originating in the perinatal period PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Pneumothorax originating in the perinatal period P25.1 Pneumothorax of fetus PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 Pneumothorax of newborn

P25.2 Pneumomediastinum originating in the perinatal period PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Other conditions related to interstitial emphysema P25.8 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 originating in the perinatal period Tracheobronchial haemorrhage originating in the perinatal P26.0 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 period Massive pulmonary haemorrhage originating in the P26.1 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 perinatal period Other pulmonary haemorrhages originating in the perinatal P26.8 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 period Unspecified pulmonary haemorrhage originating in the P26.9 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 perinatal period

P27.0 Wilson-Mikity syndrome; Pulmonary dysmaturity PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Bronchopulmonary dysplasia originating in the perinatal P27.1 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 period Other chronic respiratory diseases originating in the P27.8 perinatal period; Congenital pulmonary fibrosis; Ventilator PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 lung in newborn Unspecified chronic respiratory disease originating in the P27.9 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 perinatal period

Primary atelectasis of newborn; Primary failure to expand P28.0 terminal respiratory units; Pulmonary hypoplasia associated PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 with short gestation; Pulmonary immaturity NOS

Other and unspecified atelectasis of newborn; Atelectasis, P28.1 NOS; Atelectasis, partial; Atelectasis, secondary; Resorption PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 atelectasis without respiratory distress syndrome

P28.2 Cyanotic attacks of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Primary sleep apnoea of newborn; leep apnoea of newborn P28.3 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 NOS

P28.4 Other apnoea of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

P28.5 Respiratory failure of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630

Other specified respiratory conditions of newborn; P28.8 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 congenital laryngeal stridor NOS; Snuffles in newborn

Persistent fetal circulation; Delayed closure of ductus P29.3 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 arteriosus; Persistent pulmonary hypertension of newborn

Cardiovascular disorder originating in the perinatal period, P29.9 PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630 unspecified Pulmonary embolism with mention of acute cor pulmonale; I26.0 PULMONARY EMBOLISM 24,300 7,290 17,010 Acute cor pulmonale NOS Pulmonary embolism without mention of acute cor I26.9 PULMONARY EMBOLISM 24,300 7,290 17,010 pulmonale; Pulmonary embolism NOS Primary pulmonary hypertension; Primary idiopathic I27.0 PULMONARY HEART DISEASE 14,100 4,230 9,870 pulmonary artery hypertension I27.1 Kyphoscoliotic heart disease PULMONARY HEART DISEASE 14,100 4,230 9,870 Other secondary pulmonary hypertension; Pulmonary I27.2 PULMONARY HEART DISEASE 14,100 4,230 9,870 artery hypertension I27.8 Other specified pulmonary heart diseases PULMONARY HEART DISEASE 14,100 4,230 9,870

Page 111 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Pulmonary heart disease, unspecified; Chronic I27.9 PULMONARY HEART DISEASE 14,100 4,230 9,870 cardiopulmonary disease; Chronic Cor pulmonale NOS

Nonobstructive reflux-associated chronic pyelonephritis; N11.0 PYELONEPHRITIS 10,900 3,270 7,630 Chronic Pyelonephritis associated with vesicoureteral reflux

Chronic obstructive pyelonephritis; Chronic pyelonephritis associated with anomaly of [pelviureteric junction, pyeloureteric junction, ureter]; Chronic pyelonephritis N11.1 associated with kinking of [pelviureteric junction, PYELONEPHRITIS 10,900 3,270 7,630 pyeloureteric junction, ureter]; Chronic pyelonephritis associated with stircture of[pelviureteric junction, pyeloureteric junction, ureter]

Other chronic tubulo-interstitial nephritis; Nonobstructive N11.8 PYELONEPHRITIS 10,900 3,270 7,630 chronic pyelonephritis NOS D60.0 Chronic acquired pure red cell aplasia RED CELL APLASIA 7,300 2,190 5,110 D60.8 Other acquired pure red cell aplasias RED CELL APLASIA 7,300 2,190 5,110 D60.9 Acquired pure red cell aplasia, unspecified RED CELL APLASIA 7,300 2,190 5,110 Ischaemia and infarction of kidney; Embolism of renal N28.0 artery; Obstruction of renal artery; Occlusion of renal RENAL INFARCT 9,600 2,880 6,720 artery; Thrombosis of renal artery; Renal infarct N15.1 Renal and perinephric abscess RENAL/BLADDER ABSCESS 13,900 4,170 9,730 N30.8 Other cystitis; Abscess of bladder RENAL/BLADDER ABSCESS 13,900 4,170 9,730 Urethral abscess; Abscess of Cowper's gland; Abscess of N34.0 Littré's gland; Periurethral Abscess ; Abscess of urethral RENAL/BLADDER ABSCESS 13,900 4,170 9,730 gland Coalworker's pneumoconiosis; Anthracosilicosis; RESPIRATORY CONDITIONS DUE TO EXTERNAL J60 14,700 4,410 10,290 Anthracosis; Coalworker's lung AGENTS Pneumoconiosis due to asbestos and other mineral fibres; RESPIRATORY CONDITIONS DUE TO EXTERNAL J61 14,700 4,410 10,290 Asbestosis AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J62.0 Pneumoconiosis due to talc dust 14,700 4,410 10,290 AGENTS Pneumoconiosis due to other dust containing silica; Silicosis RESPIRATORY CONDITIONS DUE TO EXTERNAL J62.8 14,700 4,410 10,290 NOS AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J63.0 Aluminosis (of lung) 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J63.3 Graphite fibrosis (of lung) 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J63.4 Siderosis 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J63.8 Pneumoconiosis due to other specified inorganic dusts 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J64 Unspecified pneumoconiosis 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J65 Pneumoconiosis associated with tuberculosis 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J66.2 Cannabinosis 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J66.8 Airway disease due to other specific organic dusts 14,700 4,410 10,290 AGENTS Farmer's lung; Harvester's lung; Haymaker's lung; Mouldy RESPIRATORY CONDITIONS DUE TO EXTERNAL J67.0 14,700 4,410 10,290 hay disease AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J67.1 Bagassosis; Bagasse disease; Bagasse pneumonitis 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J67.5 Mushroom-worker's lung 14,700 4,410 10,290 AGENTS

Air-conditioner and humidifier lung; Allergic alveolitis due RESPIRATORY CONDITIONS DUE TO EXTERNAL J67.7 to fungi, thermophilic actinomycetees and other organisms 14,700 4,410 10,290 AGENTS growing in ventilation (air-conditioning) systems

Hypersensitivity pneumonitis due to other organic dusts; RESPIRATORY CONDITIONS DUE TO EXTERNAL J67.8 Cheese-washer's lung; Coffee-worker's lung; Fishmeal- 14,700 4,410 10,290 AGENTS worker's lung; Furrier's lung; Sequoiosis Hypersensitivity pneumonitis due to unspecified organic RESPIRATORY CONDITIONS DUE TO EXTERNAL J67.9 dust; Extrinsic allergic alveolitis NOS; Hypersensitivity 14,700 4,410 10,290 AGENTS pneumonitis NOS Bronchitis and pneumonitis due to chemicals, gases, fumes RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.0 14,700 4,410 10,290 and vapours; Acute chemical bronchitis AGENTS

Acute pulmonary oedema due to chemicals, gases, fumes RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.1 14,700 4,410 10,290 and vapours; Acute Chemical pulmonary oedema AGENTS

Upper respiratory inflammation due to chemicals, gases, RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.2 14,700 4,410 10,290 fumes and vapours, not elsewhere classified AGENTS

Other acute and subacute respiratory conditions due to RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.3 chemicals, gases, fumes and vapours; Reactive airways 14,700 4,410 10,290 AGENTS dysfunction syndrome; Hyperactive airway disease

Page 112 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Chronic respiratory conditions due to chemicals, gases, fumes and vapours; Diffuse emphysema due to inhalation of chemicals, gases, fumes and vapours; Chronic emphysema due to inhalation of chemicals, gases, fumes and vapours; Chronic obliterative bronchiolitis due to RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.4 14,700 4,410 10,290 inhalation of chemicals, gases, fumes and vapours; AGENTS Subacute obliterative bronchiolitis due to inhalation of chemicals, gases, fumes and vapours; Chronic pulmonary fibrosis due to inhalation of chemicals, gases, fumes and vapours Other respiratory conditions due to chemicals, gases, fumes RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.8 14,700 4,410 10,290 and vapours AGENTS Unspecified respiratory condition due to chemicals, gases, RESPIRATORY CONDITIONS DUE TO EXTERNAL J68.9 14,700 4,410 10,290 fumes and vapours AGENTS Pneumonitis due to food and vomit; Aspiration pneumonia due to NOS; Aspiration pneumonia due to regurgitated RESPIRATORY CONDITIONS DUE TO EXTERNAL J69.0 food; Aspiration pneumonia due to gastric secretions; 14,700 4,410 10,290 AGENTS Aspiration pneumonia due to milk; Aspiration pneumonia due to vomit RESPIRATORY CONDITIONS DUE TO EXTERNAL J69.1 Pneumonitis due to oils and essences; Lipid pneumonia 14,700 4,410 10,290 AGENTS Pneumonitis due to other solids and liquids; Pneumonitis RESPIRATORY CONDITIONS DUE TO EXTERNAL J69.8 14,700 4,410 10,290 due to aspiration of blood AGENTS Acute pulmonary manifestations due to radiation; RESPIRATORY CONDITIONS DUE TO EXTERNAL J70.0 14,700 4,410 10,290 Radiation pneumonitis AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J70.2 Acute drug-induced interstitial lung disorders 14,700 4,410 10,290 AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J70.4 Drug-induced interstitial lung disorders, unspecified 14,700 4,410 10,290 AGENTS Respiratory conditions due to other specified external RESPIRATORY CONDITIONS DUE TO EXTERNAL J70.8 14,700 4,410 10,290 agents AGENTS RESPIRATORY CONDITIONS DUE TO EXTERNAL J70.9 Respiratory conditions due to unspecified external agent 14,700 4,410 10,290 AGENTS J96.0 Acute respiratory failure RESPIRATORY FAILURE 32,000 9,600 22,400 J96.1 Chronic respiratory failure RESPIRATORY FAILURE 32,000 9,600 22,400 J96.9 Respiratory failure, unspecified RESPIRATORY FAILURE 32,000 9,600 22,400 H34.1 Central retinal artery occlusion RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390

Other retinal artery occlusions; Hollenhorst's plaque; H34.2 Retinal artery occlusion; Retinal artery branch occlusion ; RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390 Retinal artery partial occlusion; Retinal microembolism

Other retinal vascular occlusions; Retinal central vein H34.8 occlusion ; Retinal vein occlusion incipient; Retinal vein RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390 occlusion partial; Retinal vein occlusion tributary H34.9 Retinal vascular occlusion, unspecified RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390

Rheumatic fever without mention of heart involvement; I00 RHEUMATIC FEVER 10,100 3,030 7,070 Arthritis, rheumatic, acute or subacute involvement

I01.0 Acute rheumatic pericarditis; Acute rheumatic pericarditis RHEUMATIC FEVER 10,100 3,030 7,070

I01.1 Acute rheumatic endocarditis; Acute rheumatic valvulitis RHEUMATIC FEVER 10,100 3,030 7,070

I01.2 Acute rheumatic myocarditis; RHEUMATIC FEVER 10,100 3,030 7,070 Other acute rheumatic heart disease; Acute rheumatic I01.8 RHEUMATIC FEVER 10,100 3,030 7,070 pancarditis Acute rheumatic heart disease unspecified; Acute rheumatic carditis; Active rheumatic heart disease; Acute I01.9 RHEUMATIC FEVER 10,100 3,030 7,070 rheumatic heart disease Rheumatic fever with heart involvement Rheumatic chorea with heart involvement; Chorea NOS I02.0 RHEUMATIC FEVER 10,100 3,030 7,070 with heart involvement Rheumatic chorea without heart involvement; Rheumatic I02.9 RHEUMATIC FEVER 10,100 3,030 7,070 chorea NOS I05.0 Mitral stenosis; Rheumatic mitral valve obstruction RHEUMATIC HEART DISEASE 12,800 3,840 8,960 Rheumatic mitral insufficiency; Rheumatic mitral I05.1 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 incompetence; Rheumatic mitral regurgitation Mitral stenosis with insufficiency; Mitral stenosis with I05.2 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 incompetence or regurgitation I05.8 Other mitral valve diseases; Mitral valve failure RHEUMATIC HEART DISEASE 12,800 3,840 8,960 Mitral valve disease unspecified; Chronic mitral valve I05.9 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 disorder NOS Rheumatic aortic stenosis; Rheumatic aortic valve I06.0 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 obstruction Rheumatic aortic insufficiency; Rheumatic aortic I06.1 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 incompetence; Rheumatic aortic regurgitation

Page 113 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Rheumatic aortic stenosis with insufficiency; Rheumatic I06.2 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 aortic stenosis with incompetence or regurgitation

I06.8 Other rheumatic aortic valve diseases RHEUMATIC HEART DISEASE 12,800 3,840 8,960 Rheumatic aortic valve disease unspecified; Rheumatic I06.9 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 aortic valve disease NOS I07.0 Tricuspid stenosis; Rheumatic tricuspid valve stenosis RHEUMATIC HEART DISEASE 12,800 3,840 8,960 Tricuspid insufficiency; Rheumatic tricuspid valve I07.1 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 insufficiency Tricuspid valve disease unspecified; Tricuspid valve disorder I07.9 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 NOS Disorders of both mitral and aortic valves; Involvement of I08.0 both mitral and aortic valves whether specified as RHEUMATIC HEART DISEASE 12,800 3,840 8,960 rheumatic or of unspecified origin I08.1 Disorders of both mitral and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960 I08.2 Disorders of both aortic and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960

I08.3 Combined disorders of mitral aortic and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960

I08.8 Other multiple valve diseases RHEUMATIC HEART DISEASE 12,800 3,840 8,960 I08.9 Multiple valve disease, unspecified RHEUMATIC HEART DISEASE 12,800 3,840 8,960 I09.0 Rheumatic myocarditis RHEUMATIC HEART DISEASE 12,800 3,840 8,960 Rheumatic diseases of endocardium, valve unspecified; I09.1 Chronic rheumatic endocarditis; Chronic rheumatic RHEUMATIC HEART DISEASE 12,800 3,840 8,960 valvulitis

Chronic rheumatic pericarditis; Rheumatic adherent I09.2 pericardium; Chronic rheumatic mediastinopericarditis; RHEUMATIC HEART DISEASE 12,800 3,840 8,960 Chronic rheumatic myopericarditis

Other specified rheumatic heart diseases; Rheumatic I09.8 RHEUMATIC HEART DISEASE 12,800 3,840 8,960 disease of pulmonary valve Epidemic louse-borne fever due to Rickettsia A75.0 prowazekii; Classical typhus fever; RICKETTSIOSES 7,000 2,100 4,900 Epidemic louse-borne typhus A75.9 Typhus fever, unspecified RICKETTSIOSES 7,000 2,100 4,900 due to ; Rocky Mountain A77.0 RICKETTSIOSES 7,000 2,100 4,900 spotted fever; Sao Paulo fever A79.0 ; Quintan fever; Wolhynian fever RICKETTSIOSES 7,000 2,100 4,900 A79.9 , unspecified; Rickettsial infection NOS RICKETTSIOSES 7,000 2,100 4,900 U04.9 Severe Acute Respiratory Syndrome (SARS) SARS A38 Scarlet fever; Scarlatina SCARLET FEVER 8,300 2,490 5,810 A40.0 Sepsis due to streptococcus, group A SEPSIS 32,000 9,600 22,400 A40.1 Sepsis due to streptococcus, group B SEPSIS 32,000 9,600 22,400 Sepsis due to Streptococcus pneumoniae; Pneumococcal A40.3 SEPSIS 32,000 9,600 22,400 septicaemia A40.8 Other streptococcal sepsis SEPSIS 32,000 9,600 22,400 A40.9 Streptococcal septicaemia, unspecified SEPSIS 32,000 9,600 22,400 A41.0 Sepsis due to Staphylococcus aureus SEPSIS 32,000 9,600 22,400 Sepsis due to other specified staphylococcus; Sepsis due A41.1 SEPSIS 32,000 9,600 22,400 to coagulase-negative staphylococcus A41.2 Sepsis due to unspecified staphylococcus SEPSIS 32,000 9,600 22,400 A41.3 Sepsis due to Haemophilus influenzae SEPSIS 32,000 9,600 22,400 A41.4 Sepsis due to anaerobes SEPSIS 32,000 9,600 22,400 Sepsis due to other Gram-negative organisms; Gram- A41.5 SEPSIS 32,000 9,600 22,400 negative septicaemia NOS A41.8 Other specified septicaemia SEPSIS 32,000 9,600 22,400 A41.9 Sepsis , unspecified; Septic shock SEPSIS 32,000 9,600 22,400 A48.3 Toxic shock syndrome SEPSIS 32,000 9,600 22,400 I69.0 Sequelae of subarachnoid haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210 I69.1 Sequelae of intracerebral haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210

I69.2 Sequelae of other nontraumatic intracranial haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210

I69.3 Sequelae of cerebral infarction SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210 Sequelae of stroke, not specified as haemorrhage or I69.4 SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210 infarction

I69.8 Sequelae of other and unspecified cerebrovascular diseases SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210

SEQUELAE OF INFECTIOUS AND PARASITIC B90.0 Sequelae of central nervous system tuberculosis 10,700 3,210 7,490 DISEASES SEQUELAE OF INFECTIOUS AND PARASITIC B90.8 Sequelae of tuberculosis of other organs 10,700 3,210 7,490 DISEASES Sequelae of respiratory and unspecified tuberculosis; SEQUELAE OF INFECTIOUS AND PARASITIC B90.9 10,700 3,210 7,490 sequelae of tuberculosis NOS DISEASES SEQUELAE OF INFECTIOUS AND PARASITIC B94.1 Sequelae of viral encephalitis 10,700 3,210 7,490 DISEASES SEQUELAE OF INFECTIOUS AND PARASITIC B94.2 Sequelae of viral hepatitis 10,700 3,210 7,490 DISEASES

Page 114 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee SEQUELAE OF INFECTIOUS AND PARASITIC B94.8 Sequelae of other specified infectious and parasitic diseases 10,700 3,210 7,490 DISEASES SEQUELAE OF INFECTIOUS AND PARASITIC B94.9 Sequelae of unspecified infectious or parasitic disease 10,700 3,210 7,490 DISEASES Sequelae of inflammatory diseases of central nervous SEQUELAE OF INFLAMMATORY DISEASE OF THE G09 8,000 2,400 5,600 system CENTRAL NERVOUS SYSTEM E64.8 Sequelae of other nutritional deficiencies SEQUELAE OF NUTRITIONAL DEFICIENCIES 8,800 2,640 6,160 T90.0 Sequelae of superficial injury of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T90.1 Sequelae of open wound of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T90.2 Sequelae of fracture of skull and facial bones SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T90.5 Sequelae of intra cranial injury SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T90.8 Sequelae of other specified injuries of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T90.9 Sequelae of unspecified injury of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 Sequelae of superficial injury and open wound of neck and T91.0 SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 trunk T91.1 Sequelae of fracture of spine SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T91.2 Sequelae of other fracture of thorax and pelvis SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T91.3 Sequelae of injury of spinal cord SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T92.0 Sequelae of open wound of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T92.1 Sequelae of fracture of arm SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T92.8 Sequelae of other specified injuries of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T93.0 Sequelae of open wound of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T93.1 Sequelae of fracture of femur SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T93.2 Sequelae of other fractures of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T93.3 Sequelae of dislocation sprain and strain of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T93.8 Sequelae of other specified injuries of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T94.0 Sequelae of injuries involving multiple body regions SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T94.1 Sequelae of injuries, not specified by body regions SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950

T95.0 Sequelae of burn, corrosion and frostbite of head and neck SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950

T95.2 Sequelae of burn, corrosion and frostbite of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T95.3 Sequelae of burn, corrosion and frostbite of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950

T95.8 Sequelae of other specified burn corrosion and frostbite SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950

T95.9 Sequelae of unspecified burn, corrosion and frostbite SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 T98.2 Sequelae of certain early complications of trauma SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950 R57.0 Cardiogenic shock SHOCK 32,000 9,600 22,400 R57.1 Hypovolaemic shock SHOCK 32,000 9,600 22,400 R57.8 Other shock; Endotoxic shock SHOCK 32,000 9,600 22,400

R57.9 Shock, unspecified; Failure of peripheral circulation NOS SHOCK 32,000 9,600 22,400

Shock due to anaesthesia; Shock due to anaesthesia in T88.2 SHOCK 32,000 9,600 22,400 which the correct sustance was properly administered Situs inversus; Dextrocardia with situs inversus; Mirror- image atrial arrangement with situs inversus; Situs inversus Q89.3 or transverses abdominalis; Situs inversus or transversus SITUS INVERSUS 6,700 2,010 4,690 thoracis; Transposition of abdominal viscera; Transposition of thoracic visce Fracture o f vault of skull; Fracture of Frontal bone; S02.0 SKULL FRACTURES 10,700 3,210 7,490 Fracture of Parietal bone Closed fracture o f vault of skull; Fracture of Frontal bone; S02.00 SKULL FRACTURES 10,700 3,210 7,490 Fracture of Parietal bone Open fracture o f vault of skull; Fracture of Frontal bone; S02.01 SKULL FRACTURES 10,700 3,210 7,490 Fracture of Parietal bone

Fracture of base of skull: Fracture of anterior fossa, middle fossa, posterior fossa; Fracture of Occiput; Fracture of S02.1 SKULL FRACTURES 10,700 3,210 7,490 orbital roof; Fracture of ethmoid sinus & frontal sinus; Fracture of Sphenoid; Fracture of temporal bone

Closed fracture of base of skull; fracture of anterior fossa; fracture of middle fossa; fracture of posterior fossa; S02.10 fracture of occiput; fracture of orbital roof; fracture of SKULL FRACTURES 10,700 3,210 7,490 ethmoid sinus; fracture of frontal sinus; fracture of sphenoid; fracture of temporal bone Opem fracture of base of skull; fracture of anterior fossa; fracture of middle fossa; fracture of posterior fossa; S02.11 fracture of occiput; fracture of orbital roof; fracture of SKULL FRACTURES 10,700 3,210 7,490 ethmoid sinus; fracture of frontal sinus; fracture of sphenoid; fracture of temporal bone S02.20 closed fracture of nasal bones SKULL FRACTURES 10,700 3,210 7,490 S02.21 open fracture of nasal bones SKULL FRACTURES 10,700 3,210 7,490 S02.30 Closed fracture of orbital floor SKULL FRACTURES 10,700 3,210 7,490 S02.31 Open fracture of orbital floor SKULL FRACTURES 10,700 3,210 7,490 Closed Fracture of malar and maxillary bones; superior S02.40 SKULL FRACTURES 10,700 3,210 7,490 maxilla; upper jaw (bone); zygoma Open Fracture of malar and maxillary bones; superior S02.41 SKULL FRACTURES 10,700 3,210 7,490 maxilla; upper jaw (bone); zygoma

Page 115 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee S02.50 Closed Fracture of tooth SKULL FRACTURES 10,700 3,210 7,490 S02.60 Closed Fracture of mandible SKULL FRACTURES 10,700 3,210 7,490 S02.61 Open Fracture of mandible SKULL FRACTURES 10,700 3,210 7,490

S02.70 Closed Multiple fractures involving skull and facial bones SKULL FRACTURES 10,700 3,210 7,490

S02.71 Open Multiple fractures involving skull and facial bones SKULL FRACTURES 10,700 3,210 7,490

closed Fractures of other skull and facial bones including S02.80 SKULL FRACTURES 10,700 3,210 7,490 Alveolus, Orbit NOS, Palate open Fractures of other skull and facial bones including S02.81 SKULL FRACTURES 10,700 3,210 7,490 Alveolus, Orbit NOS, Palate

S02.90 Closed Fracture of skull and facial bones, part unspecified SKULL FRACTURES 10,700 3,210 7,490

S02.91 Open Fracture of skull and facial bones, part unspecified SKULL FRACTURES 10,700 3,210 7,490

Sleep apnoea; Central sleep apnoea; obstructive sleep G47.3 SLEEP APNEA 10,800 3,240 7,560 apnoea, M43.0 Spondylolysis SPONDYLOPATHIES 8,300 2,490 5,810 M43.1 Spondylolisthesis SPONDYLOPATHIES 8,300 2,490 5,810 M43.2 Other fusion of spine; Ankylosis of spinal joint SPONDYLOPATHIES 8,300 2,490 5,810 M43.5 Other recurrent vertebral subluxation SPONDYLOPATHIES 8,300 2,490 5,810 M43.6 Torticollis SPONDYLOPATHIES 8,300 2,490 5,810 M45 Ankylosing spondylitis; Rheumatoid arthritis of spine SPONDYLOPATHIES 8,300 2,490 5,810 Spinal enthesopathy; Disorder of ligamentous or muscular M46.0 SPONDYLOPATHIES 8,300 2,490 5,810 attachments of spine M46.1 Sacroiliitis, not elsewhere classified SPONDYLOPATHIES 8,300 2,490 5,810 M46.16 Sacroiliitis, not elsewhere classified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M46.19 Sacroiliitis, not elsewhere classified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M46.2 Osteomyelitis of vertebra SPONDYLOPATHIES 8,300 2,490 5,810

M46.28 Osteomyelitis of vertebra sacral and sacrococcygeal region SPONDYLOPATHIES 8,300 2,490 5,810

M46.29 Osteomyelitis of vertebra site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M46.3 Infection of intervertebral disc (pyogenic) SPONDYLOPATHIES 8,300 2,490 5,810

M46.36 Infection of intervertebral disc (pyogenic) lumbar region SPONDYLOPATHIES 8,300 2,490 5,810

M46.4 Discitis, unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M46.46 Discitis, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M46.47 Discitis, unspecified lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810 M46.49 Discitis, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M46.5 Other infective spondylopathies SPONDYLOPATHIES 8,300 2,490 5,810 M46.8 Other specified inflammatory spondylopathies SPONDYLOPATHIES 8,300 2,490 5,810 Other specified inflammatory spondylopathies lumbosacral M46.87 SPONDYLOPATHIES 8,300 2,490 5,810 region M46.9 Inflammatory spondylopathy, unspecified SPONDYLOPATHIES 8,300 2,490 5,810

M46.92 Inflammatory spondylopathy, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810

Inflammatory spondylopathy, unspecified lumbosacral M46.97 SPONDYLOPATHIES 8,300 2,490 5,810 region Inflammatory spondylopathy, unspecified sacral and M46.98 SPONDYLOPATHIES 8,300 2,490 5,810 sacrococcygeal region

M46.99 Inflammatory spondylopathy, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810

M47.1 Other spondylosis with myelopathy SPONDYLOPATHIES 8,300 2,490 5,810 M47.1+G99.2* Myelopathy in Other spondylosis with myelopathy SPONDYLOPATHIES 8,300 2,490 5,810 M47.2 Other spondylosis with radiculopathy SPONDYLOPATHIES 8,300 2,490 5,810 Other spondylosis with radiculopathy Multiple sites in M47.20 SPONDYLOPATHIES 8,300 2,490 5,810 spine M47.22 Other spondylosis with radiculopathy cervical region SPONDYLOPATHIES 8,300 2,490 5,810 M47.26 Other spondylosis with radiculopathy lumbar region SPONDYLOPATHIES 8,300 2,490 5,810

M47.27 Other spondylosis with radiculopathy lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810

M47.29 Other spondylosis with radiculopathy site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.8 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.80 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy Multiple sites in spine

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.81 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy occipito-atlanto-axial region

Page 116 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.82 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy cervical region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.83 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy cervicothoracic region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.84 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy thoracic region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.85 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy thoracolumbar region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.86 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy lumbar region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.87 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy lumbosacral region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.88 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy sacral and sacrococcygeal region

Cervical spondylosis without myelopathy or radiculopathy; Lumbosacral spondylosis without myelopathy or M47.89 SPONDYLOPATHIES 8,300 2,490 5,810 radiculopathy; Thoracic spondylosis without myelopathy or radiculopathy site unspecified M47.9 Spondylosis, unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M47.90 Spondylosis, unspecified Multiple sites in spine SPONDYLOPATHIES 8,300 2,490 5,810 M47.92 Spondylosis, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810 M47.94 Spondylosis, unspecified thoracic region SPONDYLOPATHIES 8,300 2,490 5,810 M47.95 Spondylosis, unspecified thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M47.96 Spondylosis, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M47.97 Spondylosis, unspecified lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810 M47.99 Spondylosis, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M48.0 Spinal stenosis; Caudal stenosis SPONDYLOPATHIES 8,300 2,490 5,810 M48.00 Spinal stenosis; Caudal stenosis Multiple sites in spine SPONDYLOPATHIES 8,300 2,490 5,810 M48.02 Spinal stenosis; Caudal stenosis cervical region SPONDYLOPATHIES 8,300 2,490 5,810 M48.03 Spinal stenosis; Caudal stenosis cervicothoracic region SPONDYLOPATHIES 8,300 2,490 5,810 M48.04 Spinal stenosis; Caudal stenosis thoracic region SPONDYLOPATHIES 8,300 2,490 5,810 M48.05 Spinal stenosis; Caudal stenosis thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M48.06 Spinal stenosis; Caudal stenosis lumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M48.07 Spinal stenosis; Caudal stenosis lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810 Spinal stenosis; Caudal stenosis sacral and sacrococcygeal M48.08 SPONDYLOPATHIES 8,300 2,490 5,810 region M48.09 Spinal stenosis; Caudal stenosis site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 Ankylosing hyperostosis [Forestier]; Diffuse idiopathic M48.1 SPONDYLOPATHIES 8,300 2,490 5,810 skeletal hyperostosis [DISH] Ankylosing hyperostosis [Forestier]; Diffuse idiopathic M48.16 SPONDYLOPATHIES 8,300 2,490 5,810 skeletal hyperostosis [DISH] lumbar region M48.2 Kissing spine SPONDYLOPATHIES 8,300 2,490 5,810 M48.3 Traumatic spondylopathy SPONDYLOPATHIES 8,300 2,490 5,810 M48.32 Traumatic spondylopathy cervical region SPONDYLOPATHIES 8,300 2,490 5,810 M48.4 Fatigue fracture of vertebra; Stress fracture of vertebra SPONDYLOPATHIES 8,300 2,490 5,810 Collapsed vertebra, not elsewhere classified; Collapsed M48.5 SPONDYLOPATHIES 8,300 2,490 5,810 vertebra NOS; Wedging of vertebra NOS Collapsed vertebra NOS; Wedging of vertebra NOS thoracic M48.54 SPONDYLOPATHIES 8,300 2,490 5,810 region Collapsed vertebra NOS; Wedging of vertebra NOS lumbar M48.56 SPONDYLOPATHIES 8,300 2,490 5,810 region Collapsed vertebra NOS; Wedging of vertebra NOS M48.57 SPONDYLOPATHIES 8,300 2,490 5,810 lumbosacral region Other specified spondylopathies; Ossification of posterior M48.8 SPONDYLOPATHIES 8,300 2,490 5,810 longitudinal ligament Ossification of posterior longitudinal ligament Multiple sites M48.80 SPONDYLOPATHIES 8,300 2,490 5,810 in spine Ossification of posterior longitudinal ligament M48.85 SPONDYLOPATHIES 8,300 2,490 5,810 thoracolumbar region

Page 117 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Ossification of posterior longitudinal ligament lumbar M48.86 SPONDYLOPATHIES 8,300 2,490 5,810 region Ossification of posterior longitudinal ligament site M48.89 SPONDYLOPATHIES 8,300 2,490 5,810 unspecified M48.9 Spondylopathy, unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M48.92 Spondylopathy, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810 M48.95 Spondylopathy, unspecified thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810 M48.96 Spondylopathy, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810 Spondylopathy, unspecified sacral and sacrococcygeal M48.98 SPONDYLOPATHIES 8,300 2,490 5,810 region M48.99 Spondylopathy, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810 M49.0* Tuberculosis of spine; Pott's curvature SPONDYLOPATHIES 8,300 2,490 5,810 M49.8* Spondylopathy in other diseases classified elsewhere SPONDYLOPATHIES 8,300 2,490 5,810 Staphylococcal scalded skin syndrome; Pemphigus L00 STAPHYLOCCOCAL SCALDED SKIN SYNDROME 10,200 3,060 7,140 neonatorum; Ritter's disease

G41.0 Grand mal status epilepticus; Tonic-clonic status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920

G41.1 Petit mal status epilepticus; Epileptic absence status STATUS EPILEPTICUS 15,600 4,680 10,920 G41.2 Complex partial status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920 G41.8 Other status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920 G41.9 Status epilepticus, unspecified STATUS EPILEPTICUS 15,600 4,680 10,920

L51.1 Bullous erythema multiforme; Stevens-Johnson syndrome STEVEN JOHNSONS SYNDROME 12,300 3,690 8,610

Subarachnoid haemorrhage from carotid siphon and I60.0 STROKE - HEMORRHAGIC 38,000 11,400 26,600 bifurcation

I60.1 Subarachnoid haemorrhage from middle cerebral artery STROKE - HEMORRHAGIC 38,000 11,400 26,600

Subarachnoid haemorrhage from anterior communicating I60.2 STROKE - HEMORRHAGIC 38,000 11,400 26,600 artery Subarachnoid haemorrhage from posterior communicating I60.3 STROKE - HEMORRHAGIC 38,000 11,400 26,600 artery I60.4 Subarachnoid haemorrhage from basilar artery STROKE - HEMORRHAGIC 38,000 11,400 26,600 I60.5 Subarachnoid haemorrhage from vertebral artery STROKE - HEMORRHAGIC 38,000 11,400 26,600 Subarachnoid haemorrhage from other intracranial I60.6 STROKE - HEMORRHAGIC 38,000 11,400 26,600 arteries; Multiple involvement of intracranial arteries Subarachnoid haemorrhage from intracranial artery, unspecified; Congenital ruptured berry aneurysm NOS; I60.7 Subarachnoid haemorrhage from cerebral artery NOS; STROKE - HEMORRHAGIC 38,000 11,400 26,600 Subarachnoid haemorrhage from communicating artery NOS Other subarachnoid haemorrhage; Meningeal I60.8 haemorrhage; Rupture of cerebral arteriovenous STROKE - HEMORRHAGIC 38,000 11,400 26,600 malformation Subarachnoid haemorrhage, unspecified; Congenital I60.9 STROKE - HEMORRHAGIC 38,000 11,400 26,600 ruptured cerebral aneurysm NOS Intracerebral haemorrhage in hemisphere, subcortical; I61.0 STROKE - HEMORRHAGIC 38,000 11,400 26,600 Deep intracerebral haemorrhage Intracerebral haemorrhage in hemisphere, cortical; I61.1 Cerebral lobe haemorrhage; Superficial intracerebral STROKE - HEMORRHAGIC 38,000 11,400 26,600 haemorrhage I61.2 Intracerebral haemorrhage in hemisphere, unspecified STROKE - HEMORRHAGIC 38,000 11,400 26,600 I61.3 Intracerebral haemorrhage in brain stem STROKE - HEMORRHAGIC 38,000 11,400 26,600 I61.4 Intracerebral haemorrhage in cerebellum STROKE - HEMORRHAGIC 38,000 11,400 26,600 I61.5 Intracerebral haemorrhage, intraventricular STROKE - HEMORRHAGIC 38,000 11,400 26,600 I61.6 Intracerebral haemorrhage, multiple localized STROKE - HEMORRHAGIC 38,000 11,400 26,600 I61.8 Other intracerebral haemorrhage STROKE - HEMORRHAGIC 38,000 11,400 26,600 Intracerebral haemorrhage, unspecified I61.9 STROKE - HEMORRHAGIC 38,000 11,400 26,600 Cerebrovascular Accident hemorrhage Acute Subdural haemorrhage; Nontraumatic Subdural I62.0 STROKE - HEMORRHAGIC 38,000 11,400 26,600 haemorrhage Nontraumatic extradural haemorrhage; Nontraumatic I62.1 STROKE - HEMORRHAGIC 38,000 11,400 26,600 epidural haemorrhage I62.9 Intracranial haemorrhage (nontraumatic), unspecified STROKE - HEMORRHAGIC 38,000 11,400 26,600 Cerebral infarction due to thrombosis of precerebral I63.0 STROKE - INFARCTION 28,000 8,400 19,600 arteries

I63.1 Cerebral infarction due to embolism of precerebral arteries STROKE - INFARCTION 28,000 8,400 19,600

Cerebral infarction due to unspecified occlusion or stenosis I63.2 STROKE - INFARCTION 28,000 8,400 19,600 of precerebral arteries

Cerebral infarction due to thrombosis of cerebral arteries I63.3 STROKE - INFARCTION 28,000 8,400 19,600 Cerebrovascular disease (CVD), thrombotic infarct

I63.4 Cerebral infarction due to embolism of cerebral arteries STROKE - INFARCTION 28,000 8,400 19,600

Cerebral infarction due to unspecified occlusion or stenosis I63.5 STROKE - INFARCTION 28,000 8,400 19,600 of cerebral arteries

Page 118 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Cerebral infarction due to cerebral venous thrombosis, I63.6 STROKE - INFARCTION 28,000 8,400 19,600 nonpyogenic I63.8 Other cerebral infarction STROKE - INFARCTION 28,000 8,400 19,600 Cerebral infarction, unspecified I63.9 Reversible Ischemic Neurologic Deficit (RIND) STROKE - INFARCTION 28,000 8,400 19,600 CVA with infarction

I63.9+G46.7* Other lacunar syndrome in unspecified cerebral infarction STROKE - INFARCTION 28,000 8,400 19,600

Stroke, not specified as hemorrhage or infarction; I64 Cerebrovascular Accident (CVA) STROKE - INFARCTION 28,000 8,400 19,600 Cardioembolic CVA SYSTEMIC ATROPHIES INVOLVING CENTRAL G10 Huntington's disease; Huntington's chorea 10,400 3,120 7,280 NERVOUS SYSTEM SYSTEMIC ATROPHIES INVOLVING CENTRAL G11.0 Congenital nonprogressive ataxia 10,400 3,120 7,280 NERVOUS SYSTEM Early-onset cerebellar ataxia including Early-onset cerebellar ataxia with essential tremor; Early-onset SYSTEMIC ATROPHIES INVOLVING CENTRAL G11.1 cerebellar ataxia with myoclonus [Hunt's ataxia]; Early- 10,400 3,120 7,280 NERVOUS SYSTEM onset cerebellar ataxia with retained tendon reflexes; Friedreich's ataxia (autosomal recessiv Cerebellar ataxia with defective DNA repair; Ataxia SYSTEMIC ATROPHIES INVOLVING CENTRAL G11.3 10,400 3,120 7,280 telangiectasia [Louis-Bar] NERVOUS SYSTEM

Hereditary ataxia, unspecified; Hereditary cerebellar ataxia SYSTEMIC ATROPHIES INVOLVING CENTRAL G11.9 NOS; Hereditary cerebellar degeneration; Hereditary 10,400 3,120 7,280 NERVOUS SYSTEM cerebellar disease; Hereditary cerebellar syndrome

SYSTEMIC ATROPHIES INVOLVING CENTRAL G12.0 Infantile spinal muscular atrophy, type I [Werdnig-Hoffman] 10,400 3,120 7,280 NERVOUS SYSTEM Other inherited spinal muscular atrophy; Progressive bulbar palsy of childhood [Fazio-Londe]; Spinal muscular atrophy adult form; SYSTEMIC ATROPHIES INVOLVING CENTRAL G12.1 Spinal muscular atrophy childhood form, type II; Spinal 10,400 3,120 7,280 NERVOUS SYSTEM muscular atrophy distal; Spinal muscular atrophy juvenile form, type III [Kugelberg-FWelander]; Spinal muscular atrophy scapuloperoneal form Motor neuron disease; Familial motor neuron disease; AmyotrophicLateral sclerosis; Primary Lateral sclerosis ; SYSTEMIC ATROPHIES INVOLVING CENTRAL G12.2 10,400 3,120 7,280 Progressive bulbar palsy; Progressive spinal muscular NERVOUS SYSTEM atrophy SYSTEMIC ATROPHIES INVOLVING CENTRAL G12.9 Spinal muscular atrophy, unspecified 10,400 3,120 7,280 NERVOUS SYSTEM Parkinson's disease; Hemiparkinsonism; Paralysis agitans; Parkinsonism or Parkinson's disease NOS; Idiopathic SYSTEMIC ATROPHIES INVOLVING CENTRAL G20 10,400 3,120 7,280 Parkinsonism or Parkinson's disease; Primary Parkinsonism NERVOUS SYSTEM or Parkinson's disease

L93.0 Discoid lupus erythematosus; Lupus erythematosus NOS SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330

L93.1 Subacute cutaneous lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330 Other local lupus erythematosus; Lupus erymatosus L93.2 SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330 profundus; Lupus panniculitis M32.0 Drug-induced systemic lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330 M32.8 Other forms of systemic lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330 M32.9 Systemic lupus erythematosus, unspecified SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330 A33 Tetanus neonatorum TETANUS 16,500 4,950 11,550 A34 Obstetrical tetanus TETANUS 16,500 4,950 11,550 A35 Other tetanus; Tetanus NOS TETANUS 16,500 4,950 11,550 R29.0 Tetany; Carpopedal spasm TETANUS 16,500 4,950 11,550 D56.0 Alpha thalassaemia THALASSEMIA 5,600 1,680 3,920 Beta thalassaemia; Cooley's anaemia; Severe beta D56.1 thalassaemia; Sickle-cell bet thalassaemia; Thalassaemia THALASSEMIA 5,600 1,680 3,920 intermedia; Thalassaemia major; D56.2 Delta-beta thalassaemia THALASSEMIA 5,600 1,680 3,920 D56.3 Thalassaemia trait THALASSEMIA 5,600 1,680 3,920 D56.4 Hereditary persistence of fetal haemoglobin [HPFH] THALASSEMIA 5,600 1,680 3,920 D56.8 Other thalassaemias THALASSEMIA 5,600 1,680 3,920 L51.2 Toxic epidermal necrolysis [Lyell] TOXIC EPIDERMAL NECROLYSIS 15,900 4,770 11,130 G45.0 Vertebro-basilar artery syndrome TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 G45.1 Carotid artery syndrome (Hemispheric) TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 G45.2 Multiple and bilateral precerebral artery syndromes TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 G45.3 Amaurosis fugax TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 G45.4 Transient global amnesia TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 Other transient cerebral ischaemic attacks and related G45.8 TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 syndromes

Transient cerebral ischaemic attack, unspecified; Spasm of G45.9 TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110 cerebral artery; Transient cerebral ischaemia NOS

Page 119 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Subdural haemorrhage due to birth injury; Subdural P10.0 TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 haematoma (localized) due to birth injury P10.1 Cerebral haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P10.2 Intraventricular haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P10.3 Subarachnoid haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P10.4 Tentorial tear due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 Unspecified intracranial laceration and haemorrhage due to P10.9 TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 birth injury P11.1 Other specified brain damage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P11.2 Unspecified brain damage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P11.9 Birth injury to central nervous system, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P12.0 Cephalhaematoma due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P12.3 Bruising of scalp due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P12.8 Other birth injuries to scalp TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P12.9 Birth injury to scalp, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P13.2 Birth injury to femur TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P13.4 Fracture of clavicle due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P13.8 Birth injuries to other parts of skeleton TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P13.9 Birth injury to skeleton, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P14.0 Erb's paralysis due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P14.3 Other brachial plexus birth injuries TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660

P15.4 Birth injury to face; Facial congestion due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660

P15.5 Birth injury to external genitalia TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P15.8 Other specified birth injuries TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 P15.9 Birth injury, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660 Tuberculosis of intrathoracic lymph nodes, confirmed bacteriologically & histologicaly; Tuberculosis of hilar lymph nodes, confirmed bacteriologically & histologicaly; A15.4 Tuberculosis of mediastinal lymph nodes, confirmed TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 bacteriologically & histologicaly; Tuberculosis of tracheobronchial lymph nodes, confirmed bacteriologically & histologicaly Tuberculosis of larynx, trachea and bronchus, confirmed bacteriologically and histologically; Tuberculosis of bronchus confirmed bacteriologically and histologically; Tuberculosis of glottis A15.5 TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 confirmed bacteriologically and histologically; Tuberculosis of larynx confirmed bacteriologically and histologically; Tuberculosis of trachea, confirmed bacteriologically and histologically

Tuberculous pleurisy, confirmed bacteriologically and histologically; Tuberculosis of pleura, confirmed A15.6 TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 bacteriologically and histologically; Tuberculous empyema, confirmed bacteriologically & histologically

Other respiratory tuberculosis, confirmed bacteriologically and histologically; Mediastinal tuberculosis, confirmed bacteriologically and histologically; Nasopharyngeal A15.8 tuberculosis, confirmed bacteriologically and histologically; TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 Tuberculosis of nose confirmed bacteriologically and histologically; Tuberculosis of sinus (any nasal) confirmed bacteriologically and histologically

Tuberculosis of intrathoracic lymph nodes, without mention of bacteriological or histological confirmation; Tuberculosis of hillar lymph nodes NOS (without mention of bacteriological or histological confirmation); Tuberculosis of intrathoracic lymph nodes NOS (without A16.3 mention of bacteriological or histological confirmation); TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 Tuberculosis of mediastinal lymp nodes NOS (without mention of bacteriological or histological confirmation); Tuberculosis of tracheobronchial lymph nodes NOS (without mention of bacteriological or histological confirmation) Tuberculosis of larynx, trachea, glottis and bronchus, without mention of bacteriological or histological onfirmation; Tuberculosis of bronchus NOS (without mention of bacteriological or histological onfirmation): Tuberculosis of glottis NOS (without mention of A16.4 TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 bacteriological or histological onfirmation); Tuberculosis of larynx NOS (without mention of bacteriological or histological onfirmation); Tuberculosis of trachea NOS (without mention of bacteriological or histological onfirmation)

Page 120 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Tuberculous pleurisy, without mention of bacteriological or histological confirmation; Tuberculosis of pleura, NOS (without A16.5 mention of bacteriological or histological confirmation); TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 Tuberculous empyema NOS (without mention of bacteriological or histological confirmation); Tuberculous plurisy NOS (without mention of bacteriological or Other respiratory tuberculosis, without mention of bacteriological or histological confirmation; Mediastinal tuberculosis, NOS without mention of bacteriological or histological confirmation; Nasopharyngeal tuberculosis, A16.8 TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 NOS without mention of bacteriological or histological confirmation; Tuberculosis of nose; sinus (any nasal), NOS without mention of bacteriological or histological confirmation Tuberculous peripheral lymphadenopathy; Tuberculous A18.2 TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 adenitis Tuberculosis of intestines, peritoneum and mesenteric glands; Tuberculosis of anus and rectum; Tuberculosis of A18.3 intestine (large)(small); Tuberculosis of retroperitoneal TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 (lymph nodes); Tuberculous ascites; Tuberculous enteritis; Tuberculous peritonitis

Tuberculosis of skin and subcutaneous tissue; Erythema A18.4 tuberculous induratum, ; Lupus exedens; Lupus vulgaris; TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330 Lupus exedens, NOS; Lupus vulgaris, NOS; Scrofuloderma

A19.0 Acute miliary tuberculosis of a single specified site TUBERCULOSIS, MILIARY 15,100 4,530 10,570 A19.1 Acute miliary tuberculosis of multiple sites TUBERCULOSIS, MILIARY 15,100 4,530 10,570 A19.2 Acute miliary tuberculosis, unspecified TUBERCULOSIS, MILIARY 15,100 4,530 10,570 A19.8 Other miliary tuberculosis TUBERCULOSIS, MILIARY 15,100 4,530 10,570 A19.9 Miliary tuberculosis, unspecified TUBERCULOSIS, MILIARY 15,100 4,530 10,570

Tuberculosis of lung, confirmed by sputum microscopy with or without culture; Tuberculous Bronchiectasis' confirmed by sputum microscopy with or without culture; Tuberculous fibrosis of lung, confirmed by sputum A15.0 microscopy with or without culture; Tuberculous TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 pneumonia, confirmed by sputum microscopy with or without culture; Tuberculous pneumothorax, confirmed by sputum microscopy with or without culture

Tuberculosis of lung, confirmed by culture only; A15.1 Tuberculous: Bronchiectasis; fibrosis of lung; pneumonia; TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 pneumothorax, confirmed by culture only

Tuberculosis of lung, confirmed histologically; Tuberculous: A15.2 Bronchiectasis; fibrosis of lung; pneumonia; pneumothorax, TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 confirmed histologically only

Tuberculosis of lung, confirmed by unspecified means; Tuberculous: Bronchiectasis; fibrosis of lung; pneumonia; A15.3 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 pneumothorax, confirmed but unspecified whether bacteriologically or histologically

Primary respiratory tuberculosis, confirmed bacteriologically and histologically A15.7 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 Childhood type (first infection) pulmonary tuberculosis confirmed bacteriologically and histologically Respiratory tuberculosis unspecified, confirmed A15.9 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 bacteriologically and histologically Tuberculosis of lung, bacteriologically and histologically negative; Tuberculous Bronchiectasis , bacteriologically and histologically negative; Tuberculous fibrosis of lung, A16.0 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 bacteriologically and histologically negative; Tuberculous pneumonia, bacteriologically and histologically negative; Tuberculous pneumothorax, bacteriologically and histologically negative

Tuberculosis of lung, bacteriological and histological A16.1 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 examination not done

Page 121 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Tuberculosis of lung, without mention of bacteriological or histological confirmation; Tuberculous: bronchiectasis; A16.2 fibrosis of lung; pneumonia; pneumothorax; NOS ( TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 without mention of bacteriological or histological confirmation) Primary respiratory tuberculosis without mention of bacteriological or histological confirmation; Primary A16.7 respiratory tuberculosis NOS; Primary tuberculous TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 complex Childhood type (first infection) pulmonary tuberculosis Respiratory tuberculosis unspecified, without mention of bacteriological or histological confirmation; Respiratory A16.9 TUBERCULOSIS, PULMONARY 9,800 2,940 6,860 tuberculosis NOS; Tuberculosis NOS Koch's Infection; Koch's Disease A01.0 Typhoid fever; infection due to Salmonella typhi TYPHOID FEVER 10,000 3,000 7,000 A01.1 A TYPHOID FEVER 10,000 3,000 7,000 A01.2 Paratyphoid fever B TYPHOID FEVER 10,000 3,000 7,000 A01.3 Paratyphoid fever C TYPHOID FEVER 10,000 3,000 7,000 Paratyphoid fever, unspecified; Infection due to Salmonella A01.4 TYPHOID FEVER 10,000 3,000 7,000 paratyphi NOS A02.0 Salmonella enteritis; TYPHOID FEVER 10,000 3,000 7,000 A02.1 Salmonella sepsis TYPHOID FEVER 10,000 3,000 7,000

Localized salmonella infections; Salmonella arthritis; A02.2 salmonella meningitis; salmonella osteomyelitis; salmonella TYPHOID FEVER 10,000 3,000 7,000 pneumonia; salmonella renal tubulo-interstitial disease

A02.8 Other specified salmonella infections TYPHOID FEVER 10,000 3,000 7,000 A02.9 Salmonella infection, unspecified TYPHOID FEVER 10,000 3,000 7,000 Unspecified contracted kidney; Atrophy of kidney N26 URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 (terminal); Renal sclerosis NOS N27.0 Small kidney, unilateral URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 N27.1 Small kidney, bilateral URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 N27.9 Small kidney, unspecified URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 Other specified disorders of kidney and ureter; Hypertrophy of kidney; Megaloureter; Nephroptosis; N28.8 URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 Pyelitis cystica; Pyeloureteritis cystica; Ureteritis cystica; Ureterocele Disorder of kidney and ureter, unspecified; Nephropathy N28.9 URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 NOS; Renal disease NOS Other disorders of kidney and ureter in other diseases N29.8* URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910 classified elsewhere N30.0 Acute cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250 N30.1 Chronic Interstitial cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250 N30.2 Other chronic cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250 N30.3 Trigonitis; Urethrotrigonitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250 N30.9 Cystitis, unspecified URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250 N39.0 Urinary tract infection, site not specified URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250 M50.1 Cervical disc disorder with radiculopathy VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M50.2 Other cervical disc displacement VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M50.3 Other cervical disc degeneration VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M50.8 Other cervical vertebral disc disorders VERTEBRAL DISC DISORDERS 7,800 2,340 5,460

Lumbar and other intervertebral disc disorders with M51.1 VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 radiculopathy; Sciatica due to intervertebral disc disorder

Other specified intervertebral disc displacement M51.2 VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 Lumbago due to displacement of intervertebral disc M51.3 Other specified intervertebral disc degenerations VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M51.4 Schmorl's node VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M51.8 Other specified intervertebral disc disorders VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M99.0 Segmental and somatic dysfunction, rib cage VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M99.1 Subluxation complex (vertebral) VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M99.3 Osseous stenosis of neural canal VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 M99.5 Intervertebral disc stenosis of neural canal VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 Connective tissue and disc stenosis of intervertebral M99.7 VERTEBRAL DISC DISORDERS 7,800 2,340 5,460 foramina Ménière's disease; Labyrinthine hydrops; Ménière's H81.0 VERTIGINOUS DISORDERS 5,700 1,710 3,990 syndrome or vertigo H81.1 Benign paroxysmal vertigo VERTIGINOUS DISORDERS 5,700 1,710 3,990 H81.2 Vestibular neuronitis VERTIGINOUS DISORDERS 5,700 1,710 3,990 Other peripheral vertigo; Lermoyez' syndrome; Aural H81.3 VERTIGINOUS DISORDERS 5,700 1,710 3,990 Vertigo ; Otogenic Vertigo; Peripheral NOS Vertigo H81.4 Vertigo of central origin; Central positional nystagmus VERTIGINOUS DISORDERS 5,700 1,710 3,990 H81.8 Other disorders of vestibular function VERTIGINOUS DISORDERS 5,700 1,710 3,990 Disorder of vestibular function, unspecified; Vertiginous H81.9 VERTIGINOUS DISORDERS 5,700 1,710 3,990 syndrome NOS H83.1 Labyrinthine fistula VERTIGINOUS DISORDERS 5,700 1,710 3,990

Page 122 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

Labyrinthine dysfunction; Hypersensitivity of labyrinth; H83.2 VERTIGINOUS DISORDERS 5,700 1,710 3,990 Hypofunction of labyrinth; Loss of function Of labyrinth

R42 Dizziness and giddiness; Light-headedness; Vertigo NOS VERTIGINOUS DISORDERS 5,700 1,710 3,990

A96.0 Junin haemorrhagic fever; Argentinian haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530

A96.1 Machupo haemorrhagic fever; Bolivian haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530

A98.8 Other specified viral haemorrhagic fevers VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530 A99 Unspecified viral haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530 B15.0 Acute Hepatitis A with hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260 Acute hepatitis A without hepatic coma; Hepatitis A B15.9 VIRAL HEPATITIS 11,800 3,540 8,260 (acute)(viral) NOS Acute hepatitis B with delta-agent (coinfection) with B16.0 VIRAL HEPATITIS 11,800 3,540 8,260 hepatic coma Acute hepatitis B with delta-agent (coinfection) without B16.1 VIRAL HEPATITIS 11,800 3,540 8,260 hepatic coma

B16.2 Acute hepatitis B without delta-agent with hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260

Acute hepatitis B without delta-agent and without hepatic B16.9 VIRAL HEPATITIS 11,800 3,540 8,260 coma; Acute hepatitis B (viral) NOS B17.0 Acute delta-(super) infection of hepatitis B carrier VIRAL HEPATITIS 11,800 3,540 8,260 B17.1 Acute VIRAL HEPATITIS 11,800 3,540 8,260 B17.2 Acute hepatitis E VIRAL HEPATITIS 11,800 3,540 8,260 Other specified acute viral hepatitis; Hepatitis non-A non-B B17.8 VIRAL HEPATITIS 11,800 3,540 8,260 (acute)(viral) NEC B18.0 Chronic viral hepatitis B with delta-agent VIRAL HEPATITIS 11,800 3,540 8,260 Chronic viral hepatitis B wtihout delta-agent: Hepatitis B B18.1 VIRAL HEPATITIS 11,800 3,540 8,260 (viral) NOS B18.2 Chronic viral hepatitis C VIRAL HEPATITIS 11,800 3,540 8,260 B18.8 Other chronic viral hepatitis VIRAL HEPATITIS 11,800 3,540 8,260 B18.9 Chronic viral hepatitis, unspecified VIRAL HEPATITIS 11,800 3,540 8,260 B19.0 Unspecified viral hepatitis hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260 Unspecified viral hepatitis without hepatic coma; Viral B19.9 VIRAL HEPATITIS 11,800 3,540 8,260 Hepatitis NOS

A80.1 Acute paralytic poliomyelitis, wild virus, imported VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A80.2 Acute paralytic poliomyelitis, wild virus, indigenous VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A80.9 Acute poliomyelitis, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

Creutzfeldt-Jakob disease; Subacute spongiform A81.0 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 encephalopathy Subacute sclerosing panencephalitis; Dawson's inclusion A81.1 body encephalitis ; Van Bogaert's sclerosing VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 leukoencephalopathy Progressive multifocal leukoencephalopathy; Multifocal A81.2 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 leukoencephalopathy NOS

Atypical virus infection of central nervous system, A81.9 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 unspecified; Prion disease of central nervous system NOS

A82.0 Sylvatic rabies VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A82.1 Urban rabies VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A82.9 Rabies, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A83.0 Japanese encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A83.2 Eastern equine encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

California encephalitis; California meningoencephalitis A83.5 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 La Crosse encephalitis

A83.8 Other mosquito-borne viral encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A83.9 Mosquito-borne viral encephalitis, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A85.2 Arthropod-borne viral encephalitis, unspecified; VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

Other specified viral encephalitis; Encephalitis lethargica; A85.8 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 Von Economo-Cruchet disease Unspecified viral encephalitis; Viral encephalomyelitis NOS; A86 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770 Viral meningoencephalitis NOS

A88.8 Other specified viral infections of central nervous system VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

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FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee

A89 Unspecified viral infection of central nervous system VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770

A37.0 Whooping cough due to WHOOPING COUGH 10,600 3,180 7,420 A37.1 Whooping cough due to WHOOPING COUGH 10,600 3,180 7,420 A37.8 Whooping cough due to other Bordetella species WHOOPING COUGH 10,600 3,180 7,420 A37.9 Whooping cough, unspecified WHOOPING COUGH 10,600 3,180 7,420 A20.0 Bubonic ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A20.9 Plague, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A21.0 Ulceroglandular tularaemia; Ophthalmic tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A21.1 Oculoglandular tularaemia; Ophthalmic tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A21.2 Pulmonary tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A21.3 Gastrointestinal tularaemia; Abdominal tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A21.9 Tularaemia, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 Cutaneous anthrax; Malignant carbuncle; Malignant A22.0 ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 pustule A22.2 Gastrointestinal anthrax ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A22.7 Anthrax sepsis ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A22.9 Anthrax, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A23.1 due to ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A23.9 Brucellosis, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190

A24.0 ; Infection due to Pseudomonas mallei; Malleus ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190

Acute and fulminating ; Melioidosis pneumonia A24.1 ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 ; Melioidosis septicaemia A25.9 Rat-bite fever, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A26.8 Other forms of erysipeloid ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A26.9 Erysipeloid, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A28.0 ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 A28.1 Cat-scratch disease; Cat-scratch fever ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 Other specified zoonotic bacterial diseases, not elsewhere A28.8 ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 classified A28.9 Zoonotic bacterial disease, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190 Insulin-dependent diabetes mellitus with renal complications: diabetic nephropathy; Glomerular disorders in diabetes mellitus; Brittle diabetes (mellitus); Juvenile- DIABETES MELLITUS WITH COMPLICATIONS E10.2+ N08.3* 12,600 3,780 8,820 onset diabetes (mellitus); Ketosis-prone diabetes (mellitus); OTHER THAN COMA AND KETOSIS Type I diabetes (mellitus) Insulin-dependent diabetes mellitus nephropathy

Non-insulin-dependent diabetes mellitus with renal complications: diabetic nephropathy; Glomerular disorders in diabetes mellitus; Adult-onset diabetes (mellitus)(nonobese)(obese); Maturity-onset diabetes (mellitus)(nonobese)(obese); Nonketonic diabetes DIABETES MELLITUS WITH COMPLICATIONS E11.2+ N08.3* 12,600 3,780 8,820 (mellitus)(nonobese)(obese); Stable diabetes OTHER THAN COMA AND KETOSIS (mellitus)(nonobese)(obese); Type II diabetes (mellitus)(nonobese)(obese); Non-insulin-dependent diabetes of the young Non - insulin-dependent diabetes mellitus nephropathy

Malnutrition-related diabetes mellitus with renal DIABETES MELLITUS WITH COMPLICATIONS E12.2+ N08.3* complications: diabetic nephropathy; Glomerular disorders 12,600 3,780 8,820 OTHER THAN COMA AND KETOSIS in diabetes mellitus; Other specified diabetes mellitus with renal complications: DIABETES MELLITUS WITH COMPLICATIONS E13.2+ N08.3* diabetic nephropathy;Glomerular disorders in diabetes 12,600 3,780 8,820 OTHER THAN COMA AND KETOSIS mellitus Unspecified diabetes mellitus with renal complications: DIABETES MELLITUS WITH COMPLICATIONS E14.2+ N08.3* diabetic nephropathy; Glomerular disorders in diabetes 12,600 3,780 8,820 mellitus OTHER THAN COMA AND KETOSIS Measles with other complications; Measles keratitis and B05.8 VIRAL INFECTION (ADMISSIBLE) 7,700 2,310 5,390 keratoconjunctivitis B05.9 Measles without complications; Measles NOS VIRAL INFECTION (ADMISSIBLE) 7,700 2,310 5,390

B01.9 Varicella [chickenpox] without complication; Varicella NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800

Rubella with other complications; Encephalitis Rubella; B06.8 VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 Meningitis Rubella; Meningoencephalitis Rubella B06.9 Rubella without complication; Rubella NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 Unspecified viral infection characterized by skin and B09 mucous membrane lesions; Viral enanthema NOS; Viral VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 exanthem Enterovirus infection, unspecified; Coxsackievirus infection B34.1 VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 NOS; Echovirus infection NOS B34.2 Coronavirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 B34.3 Parvovirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 B34.4 Papovavirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 B34.8 Other viral infections of unspecified site VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 Viral infection, unspecified; Viraemia NOS B34.9 VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 Systemic Viral Infection

Page 124 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee B50.9 Plasmodium falciparum malaria, unspecified MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800 Plasmodium vivax malaria without complications; B51.9 MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800 Plasmodium vivax malaria NOS Plasmodium malariae malaria without complications; B52.9 MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800 Plasmodium malariae malaria NOS Schistosomiasis due to Schistosoma mansoni [intestinal B65.1 PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 schistosomiasis] Schistosomiasis due to Schistosoma japonicum; Asiatic B65.2 PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 schistosomiasis

B65.3 Cercarial dermatitis; Swimmer's itch PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800

Infection due to Schistosoma intercalatum, Schistosoma B65.8 PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800 mattheei , Schistosoma mekongi

B65.9 Schistosomiasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800

B77.9 Ascariasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800

B82.0 Intestinal helminthiasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800

B82.9 Intestinal parasitism, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800

Non-insulin-dependent diabetes mellitus without E11.9 complications (NIDDM) DIABETES MELLITUS WITHOUT COMPLICATIONS 4,000 1,200 2,800 Type II diabetes mellitus Insulin dependent diabetes mellitus without complications E10.9 (IDDM) DIABETES MELLITUS WITHOUT COMPLICATIONS 4,000 1,200 2,800 Type I diabetes mellitus E16.2 Hypoglycemia, unspecified HYPOGLYCEMIA 4,000 1,200 2,800 E86.1 Moderate dehydration DEHYDRATION 4,000 1,200 2,800 E86.2 Severe dehydration DEHYDRATION 4,000 1,200 2,800 CHRONIC HEART DISEASES WITHOUT I25.0 Atherosclerotic cardiovascular disease (ASCVD) 4,000 1,200 2,800 COMPLICATIONS Atherosclerotic heart disease; Coronary artery atheroma; Coronary artery atherosclerosis; ; Coronary artery sclerosis CHRONIC HEART DISEASES WITHOUT I25.1 4,000 1,200 2,800 Arteriosclerotic heart disease (ASHD) COMPLICATIONS Coronary artery disease (CAD) Cardiac sclresosis CHRONIC HEART DISEASES WITHOUT I25.3 Aneurysm of heart; Mural aneurysm; Venticular aneurysm 4,000 1,200 2,800 COMPLICATIONS Coronary artery aneurysm; Coronary arteriovenous fistula, CHRONIC HEART DISEASES WITHOUT I25.4 4,000 1,200 2,800 acquired COMPLICATIONS J03.0 Streptococcal UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J03.8 Acute tonsillitis due to other specified organisms UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Acute tonsillitis, unspecified; Acute tonsillitis NOS; Acute Follicular tonsillitis; Acute Gangrenous tonsillitis; Acute J03.9 UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Infective tonsillitis; Acute Ulcerative tonsillitis; Septic tonsillitis J06.0 Acute laryngopharyngitis UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800

Other acute upper respiratory infections of multiple sites J06.8 UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Acute tonsillopharyngitis

Acute upper respiratory infection, unspecified; Acute upper J06.9 respiratory disease; Upper respiratory infection NOS UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Upper Respiratory Tract Infection

J20.0 Acute bronchitis due to Mycoplasma pneumoniae UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.1 Acute bronchitis due to Haemophilus influenzae UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.2 Acute bronchitis due to streptococcus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.3 Acute bronchitis due to coxsackievirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.4 Acute bronchitis due to parainfluenza virus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.5 Acute bronchitis due to respiratory syncytial virus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.6 Acute bronchitis due to rhinovirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.7 Acute bronchitis due to echovirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.8 Acute bronchitis due to other specified organisms UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 J20.9 Acute bronchitis, unspecified UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Unspecified acute lower respiratory infection; Acute (lower) respiratory (tract) infection NOS J22 LOWER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Acute Respiratory Infection Severe Acute Respiratory Infection Bronchitis, not specified as acute or chronic; Bronchitis J40 NOS; Catarrhal Bronchitis; Bronchitis with tracheitis NOS; UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800 Trancheobronchitis NOS Pulpitis; Pulpal abscess; Pulpal polyp; Acute pulpitis; K04.0 Hyperplastic chronic pulpitis; Ulcerative chronic pulpitis; DENTAL DISORDERS 4,000 1,200 2,800 Supparative pulpitis K04.1 Necrosis of pulp; Pulpal gangrene DENTAL DISORDERS 4,000 1,200 2,800

Page 125 of 127 List of Medical Case Rates (Updated February 2017)

FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Pulp degeneration; Denticles; Pulpal calcifications; Pulpal K04.2 DENTAL DISORDERS 4,000 1,200 2,800 stones Abnormal hard tissue formation in pulp; Secondary or K04.3 DENTAL DISORDERS 4,000 1,200 2,800 irregular dentine Acute apical periodontitis of pulpal origin; Acute apical K04.4 DENTAL DISORDERS 4,000 1,200 2,800 periodontitis NOS Chronic apical periodontitis; Apical or periapical granuloma; K04.5 DENTAL DISORDERS 4,000 1,200 2,800 Apical periodontitis NOS Periapical abscess with sinus; Dental abscess with sinus; K04.6 DENTAL DISORDERS 4,000 1,200 2,800 Dentoalveolar abscess with sinus Periapical abscess without sinus; Dental abscess NOS; K04.7 DENTAL DISORDERS 4,000 1,200 2,800 Dentoalveolar abscess NOS; Periapical abscess NOS Radicular cyst; Periodontal apical cyst; Periapical cyst; K04.8 DENTAL DISORDERS 4,000 1,200 2,800 Residual radicular cyst Other and unspecified diseases of pulp and periapical K04.9 DENTAL DISORDERS 4,000 1,200 2,800 tissues K30 Dyspepsia; BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800

K31.0 Acute dilatation of stomach; Acute distension of stomach BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800

K31.9 Disease of stomach and duodenum, unspecified BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800 K59.0 BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800 L02.0 Cutaneous abscess, furuncle and carbuncle of face SKIN INFECTIONS 4,000 1,200 2,800 L02.1 Cutaneous abscess, furuncle and carbuncle of neck SKIN INFECTIONS 4,000 1,200 2,800

Cutaneous abscess, furuncle and carbuncle of trunk; Cutaneous abscess, furuncle and carbuncle of Abdominal wall; Cutaneous abscess, furuncle and carbuncle of Back [any part, except buttock]; Cutaneous abscess, furuncle and L02.2 SKIN INFECTIONS 4,000 1,200 2,800 carbuncle of Chest wall; Cutaneous abscess, furuncle and carbuncle of Groin; Cutaneous abscess, furuncle and carbuncle of Perineum; Cutaneous abscess, furuncle and carbuncle of Umbilicus

Cutaneous abscess, furuncle and carbuncle of buttock; L02.3 Cutaneous abscess, furuncle and carbuncle of Gluteal SKIN INFECTIONS 4,000 1,200 2,800 region Cutaneous abscess, furuncle and carbuncle of limb, Axilla, L02.4 SKIN INFECTIONS 4,000 1,200 2,800 Hip & Shoulder Cutaneous abscess, furuncle and carbuncle of other sites: L02.8 SKIN INFECTIONS 4,000 1,200 2,800 Head [any part, except face]; Scalp Cutaneous abscess, furuncle and carbuncle, unspecified; L02.9 SKIN INFECTIONS 4,000 1,200 2,800 Furunculosis NOS L72.0 Epidermal cyst CUTANEOUS CYSTS 4,000 1,200 2,800 L72.1 Trichilemmal cyst; Pilar cyst; Sebaceous cyst CUTANEOUS CYSTS 4,000 1,200 2,800 L72.2 Steatocystoma multiplex CUTANEOUS CYSTS 4,000 1,200 2,800 L72.8 Other follicular cysts of skin and subcutaneous tissue CUTANEOUS CYSTS 4,000 1,200 2,800

L72.9 Follicular cyst of skin and subcutaneous tissue, unspecified CUTANEOUS CYSTS 4,000 1,200 2,800

Calculus of kidney; Nephrolithiasis NOS; Renal calculus or N20.0 UROLITHIASIS 4,000 1,200 2,800 stone; Staghorn calculus; Stone in kidney N20.1 Calculus of ureter; Ureteric stone UROLITHIASIS 4,000 1,200 2,800 N20.2 Calculus of kidney with calculus of ureter UROLITHIASIS 4,000 1,200 2,800 N20.9 Urinary calculus, unspecified; Calculous pyelonephritis UROLITHIASIS 4,000 1,200 2,800 N30.4 Irradiation cystitis IRRADIATION CYSTITIS 4,000 1,200 2,800 O23.1 Infections of bladder in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800 O23.2 Infections of urethra in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800 O23.4 Unspecified infection of urinary tract in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800 O23.5 Infections of the genital tract in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800

Other and unspecified genitourinary tract infection in O23.9 URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800 pregnancy; Genitourinary tract infection in pregnancy NOS

S00.0 Superficial injury of scalp SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.1 Contusion of eyelid and periocular area; Black eye SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.2 Other superficial injuries of eyelid and periocular area SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.3 Superficial injury of nose SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.4 Superficial injury of ear SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.5 Superficial injury of lip and oral cavity SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.7 Multiple superficial injuries of head SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.8 Superficial injury of other parts of head SUPERFICIAL INJURIES 4,000 1,200 2,800 S00.9 Superficial injury of head, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.0 Open wound of scalp SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.1 Open wound of eyelid and periocular area SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.2 Open wound of nose SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.3 Open wound of ear SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.4 Open wound of cheek and temporomandibular area SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.5 Open wound of lip and oral cavity SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.7 Multiple open wounds of head SUPERFICIAL INJURIES 4,000 1,200 2,800 S01.8 Open wound of other parts of head SUPERFICIAL INJURIES 4,000 1,200 2,800

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FIRST CASE RATE ICD 10 CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee S01.9 Open wound of head, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800 Open wound of finger(s) without damage to nail; Open S61.0 SUPERFICIAL INJURIES 4,000 1,200 2,800 wound of finger(s) NOS S61.1 Open wound of finger(s) with damage to nail SUPERFICIAL INJURIES 4,000 1,200 2,800 S61.7 Multiple open wounds of wrist and hand SUPERFICIAL INJURIES 4,000 1,200 2,800 S61.8 Open wound of other parts of wrist and hand SUPERFICIAL INJURIES 4,000 1,200 2,800 S61.9 Open wound of wrist and hand part, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800 S81.0 Open wound of knee SUPERFICIAL INJURIES 4,000 1,200 2,800 S81.7 Multiple open wounds of lower leg SUPERFICIAL INJURIES 4,000 1,200 2,800 S81.8 Open wound of other parts of lower leg SUPERFICIAL INJURIES 4,000 1,200 2,800 S81.9 Open wound of lower leg, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800 S91.0 Open wound of ankle SUPERFICIAL INJURIES 4,000 1,200 2,800 Open wound of toe(s) without damage to nail; open wound S91.1 SUPERFICIAL INJURIES 4,000 1,200 2,800 of toe (s) NOS S91.2 Open wound of toe(s) with damage to nail SUPERFICIAL INJURIES 4,000 1,200 2,800 Open wound of other parts of foot; open wound of foot S91.3 SUPERFICIAL INJURIES 4,000 1,200 2,800 NOS S91.7 Multiple open wounds of ankle and foot SUPERFICIAL INJURIES 4,000 1,200 2,800 T00.0 Superficial injuries involving head with neck SUPERFICIAL INJURIES 4,000 1,200 2,800 Superficial injuries involving thorax with abdomen lower T00.1 SUPERFICIAL INJURIES 4,000 1,200 2,800 back and pelvis Superficial injuries involving multiple regions of upper T00.2 SUPERFICIAL INJURIES 4,000 1,200 2,800 limb(s) Superficial injuries involving multiple regions of lower T00.3 SUPERFICIAL INJURIES 4,000 1,200 2,800 limb(s) Superficial injuries involving multiple regions of upper T00.6 SUPERFICIAL INJURIES 4,000 1,200 2,800 limb(s) with lower limb(s) Superficial injuries involving other combinations of body T00.8 SUPERFICIAL INJURIES 4,000 1,200 2,800 regions

Multiple superficial injuries, unspecified; Multiple abrasions NOS; Multiple nonthermal blisters NOS; Multiple bruises T00.9 SUPERFICIAL INJURIES 4,000 1,200 2,800 NOS; Multiple contusions NOS; Multiple haematomas NOS; Multiple nonvenomous insect bite NOS

50,000 up to J12.8, B97.2 Middle East Respiratory Syndrome (MERS-CoV) MIDDLE EAST RESPIRATORY SYNDROME 100,000 110,000 up to A98.4 Ebola Virus Disease (EVD) EBOLA VIRUS DISEASE 222,000 Zika virus disease, unspecified; Zika; Zika virus fever; Zika U06.9 ZIKA VIRUS DISEASE 8,100 2,430 5,670 virus infection

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