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Fee Item C O D E Fee Sch Ed U Le a M O U N T a N Aesth Esia in Ten Sity

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Fee Item C O D E Fee Sch Ed U Le a M O U N T a N Aesth Esia in Ten Sity Fee Item Code Fee Amount Schedule Fee Anaesthesia Intensity level Referral Flag Spec1 Spec2 Spec3 Spec4 Spec5 Time Dependency Item Description Fee Service Clarification Flag Restriction Flag BCMA Status Flag 13 $ 12.45 0 * * INJECTION, INTRA-ARTERIAL * * ** 14 $ 19.84 0 * * INJECTION, INTRA-ARTICULAR * * ** 15 $ 13.20 0 * * INJECTION, INTRA-ARTICULAR * * ** 16 $ 25.14 0 * * INJECTION, INTRATHECAL * * ** 17 $ 23.32 0 * * INSERTION OF CENTRAL VENOUS PRESSURE CATHETER * * ** 18 $ 46.93 0 * * BLOOD TRANSFUSION, AUTOLOGOUS ASCITIC INFUSION * * ** 19 $ 24.51 0 * * VENESECTION FOR POLYCYTHAEMIA OR PHLEBOTOMY * * ** 20 $ 54.65 0 * * BLOOD TRANSFUSION ADMINISTERED OUTSIDE HOSPITAL * * ** 21 $ 36.38 0 * * BLOOD TRANSFUSION IN HOSPITAL * * ** 22 $ 21.74 0 * * SERUM TRANSFUSION * * ** 23 $ 39.21 0 * * BLOOD TRANSFUSION WITH VEIN DISSECTION * * ** 24 $ 34.96 0 * * VEIN DISSECTION FOR I.V. THERAPY * * ** 25 $ 77.43 7 * * HYPERBARIC CHAMBER-IN CHAMBER * * ** 26 $ 39.75 0 * * HYPERBARIC CHAMBER-IN CHAMBER * * ** 27 $ 52.73 5 * * HYPERBARIC CHAMBER-OUTSIDE CHAMBER * * ** 28 $ 28.00 0 * * HYPERBARIC CHAMBER-OUTSIDE CHAMBER * * ** 30 $ 8.42 0 * * SKIN TESTS-DIAGNOSTIC * * ** 31 $ 7.56 0 * * SMALLPOX-VACCINATION * * ** 34 $ 8.42 0 * * INJECTION SUBCUTANEOUS * * ** 39 $ 21.04 0 * * METHADONE TREATMENT ONLY * * ** 40 $ 25.41 0 * * GAVAGE STOMACH * * ** 41 $ 8.42 0 * * ULTRASOUND, TREATMENT * * ** 42 $ 2.59 0 * * MILEAGE * * ** 43 $ 3.40 0 * * ANTICOAGULATION THERAPY * * ** 44 $ 4.45 0 * * MINI TRAY FEE * * ** 45 $ 15.67 0 * * MANIPULATION THERAPY * * ** 46 $ 24.79 0 * * HYPERBARIC CHAMBER - ADDITIONAL CHARGE PER HOUR * * ** 50 $ 105.18 0 * * EYE BANK SERVICES * * ** 51 $ 368.41 0 * * CORNEAL TISSUE PROCESSING * * ** 62 $ 62.03 0 * * ADOPTION-EXAMINATION * * ** 64 $ 27.90 0 * * ADOPTION-SUBSEQUENT EXAM * * ** 65 $ 61.41 0 * * MENTAL ILL-HEALTH-INVESTIGATION * * ** 66 $ 27.60 0 * * MENTAL ILL-HEALTH-DOCUMENTATION * * ** 67 $ 27.52 0 * * MENTAL ILL-HEALTH - VOLUNTARY COMMITTAL * * ** 80 $ 8.89 0 * * MINOR TRAY * * ** 81 $ 88.02 0 * * EMERGENCY BEDSIDE CARE * * ** 82 $ 52.79 0 * * CRITICAL CARE MONITORING * * ** 83 $ 88.02 0 * * CRISIS INTERVENTION * * ** 84 $ 185.00 0 * * ACCOMPANYING PATIENTS * * ** 90 $ 26.68 0 * * MAJOR TRAY * * ** 94 $ 55.59 0 * 6 * YAG LASER TRAY SERVICE FEE * * ** 100 $ 27.90 0 * * VISIT IN OFFICE (AGE 2 - 59) * * ** 101 $ 62.03 0 * * COMPLETE EXAMINATION IN OFFICE (AGE 2-59) * * ** 103 $ 64.56 0 * * VISIT, HOME * * ** 104 $ 32.28 0 * * EXTRA PATIENTS SEEN DURING SAME HOUSE CALL * * ** 105 $ 51.25 0 * * ON CALL, ON SITE HOSPITAL VISIT - NIGHT * * ** 108 $ 31.31 0 * * VISIT, HOSPITAL * * ** 109 $ 74.23 0 * * FIRST HOSPITAL VISIT * * ** 110 $ 62.03 0 * * CONSULTATION (IN OR OUT OF OFFICE): AGE 2-59 * * ** 111 $ 104.09 0 * * VISIT, EMERGENCY HOME * * ** 112 $ 81.47 0 * * VISIT, EMERGENCY * * ** 113 $ 36.44 0 * * ON CALL, ON SITE HOSPITAL VISIT - EVENING * * ** 114 $ 21.74 0 * * VISIT NURSING HOME ONE OR MULTIPLE PATIENTS * * ** 115 $ 64.56 0 * * VISIT NURSING HOME ONE PATIENT SPECIAL DAY CALL * * ** 116 $ 136.37 0 * 0 * CONSULTATION, SPECIAL IN-HOSPITAL * * ** 117 $ 8.79 0 * * ECG INTERPRETATION ONLY G.P. * * ** 118 $ 80.23 0 * * CAESAREAN SECTION-ATTENDANCE * * ** 119 $ 61.41 0 * * NEWBORN CARE, ROUTINE, IN HOSPITAL * * ** 120 $ 48.57 0 * * INDIVIDUAL COUNSELLING IN OFFICE (AGE 2-59) * * ** 121 $ 79.40 0 * * GROUP COUNSELLING-FIRST FULL HOUR * * ** 122 $ 39.75 0 * * GROUP COUNSELLING-2ND HOUR/PER HALF OR MAJOR PART * * ** 123 $ 36.44 0 * * ON CALL, ON SITE HOSPITAL VISIT - SAT, SUN OR HOLS * * ** 127 $ 31.31 0 * * HOSPITAL VISIT FOR TERMINAL CARE * * ** 128 $ 26.51 0 * * SUPPORTIVE CARE * * ** 129 $ 67.19 0 * * WCB EMERGENCY CALL OUT * * ** 130 $ 22.27 0 * 30 * CHIROPRACTOR'S SERVICES - INITIAL OFFICE VISIT * * ** 133 $ 27.05 0 * 30 * CHIROPRACTOR'S SERVICE - HOME OR INSTITUTIONAL * * ** 136 $ 34.85 0 * 30 * CHIRO EMERG VISIT, NIGHT SUNDAY OR STAT. * * ** 137 $ 17.35 0 * 30 * CHIROPRACTOR'S SERVICE - SUBSEQUENT OFFICE * * ** 138 $ 23.00 0 * 30 * CHIROPRACTIC SERVICE * * ** 145 $ 23.00 0 * 31 * NATUROPATHY SERVICE * * ** 152 $ 36.87 0 * 38 * PODIATRISTS' SERVICE - SURGICAL CONSULTATION * * ** 155 $ 27.11 0 * 38 * PODIATRY NON REFERRED PRE-OPERATIVE ASSESSMENT * * ** 171 $ 36.87 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 172 $ 36.87 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 173 $ 49.02 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 174 $ 73.41 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 175 $ 61.18 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 176 $ 98.04 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 179 $ 98.04 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 180 $ 122.15 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 183 $ 98.04 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 186 $ 29.55 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 187 $ 85.96 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 188 $ 130.00 0 * 38 * NAILS - PERMANENT PARTIAL MATRIXECTOMY * * ** 189 $ 23.00 0 * 38 * PODIATRY SERVICE * * ** 190 $ 27.60 0 * 0 2 5 6 7 * ELECTROSURG./CRYOTHERAPY FOR REMOVAL OF WARTS ETC. * * ** 193 $ 24.70 0 * * NON-CVT CERT. SURGICAL ASSIST @ OPEN HEART SURGERY * * ** 194 $ 65.21 0 * * SURGICAL ASSIST LESS THAN $105.00 * * ** 195 $ 115.58 0 * * SURGICAL ASSIST.$105.00 TO 314.00 INCLUSIVE * * ** 196 $ 162.97 0 * * SURGICAL ASSIST $314.01 TO 523.00 INCLUSIVE * * ** 197 $ 213.40 0 * * SURGICAL ASSISTANCE - OPERATIONS OVER $523.00 * * ** 198 $ 24.41 0 * * SURGICAL ASSIST TIME AFTER 3 HRS - PER 15 MINS * * ** 204 $ 20.87 0 * 1 * DIRECTIVE CARE BY CONSULTANTS * * ** 205 $ 82.99 0 * 1 * VISIT, EMERGENCY, DERMATOLOGY * * ** 206 $ 125.64 0 * 1 * EXAMINATION SYSTEMIC DISEASES DERMATOLOGICAL * * ** 207 $ 21.89 0 * 1 * VISIT, OFFICE, DERMATOLOGY * * ** 208 $ 20.87 0 * 1 * VISIT, HOSPITAL, DERMATOLOGY * * ** 209 $ 41.58 0 * 1 * VISIT, HOME DERMATOLOGY * * ** 210 $ 52.95 0 * 1 * CONSULTATION, DERMATOLOGY * * ** 214 $ 36.15 0 * 1 * CONSULTATION, DERMATOLOGY - REPEAT/LIMITED * * ** 217 $ 10.29 0 * 1 * SKIN DISORDERS/LESIONS - SPECIAL THERAPY * * ** 218 $ 57.28 0 * * CURETTAGE AND ELECTROSURGERY OF SKIN CARCINOMA * * ** 219 $ 28.62 0 * * CURETTAGE SKIN CARCINOMA, ADDITIONAL LESION * * ** 222 $ 19.94 0 * * PSORALEN ULTRA VIOLET A TREATMENT - WHOLE BODY * * ** 223 $ 19.94 0 * * PSORALEN ULTRA VIOLET A TREATMENT - PARTIAL BODY * * ** 224 $ 19.94 0 * * ULTRA VIOLET B TREATMENT, WHOLE OR PARTIAL BODY * * ** 225 $ 341.56 0 * 1 * MOH'S TECHNIQUE-INITIAL CUT * * ** 226 $ 295.85 0 * 1 * MOH'S TECHNIQUE-ADDITIONAL CUTS * * ** 227 $ 318.49 0 * 1 * MOH'S TECHNIQUE-TECHNICAL COMPONENT * * ** 228 $ 27.88 0 * * PHOTO EPILATION OF FACIAL HAIR - PER 1/4 HR * * ** 235 $ 66.61 3 * * PULSED LASER- FACE/NECK: < 50CM2 * * ** 236 $ 99.91 3 * * PULSED LASER - FACE/NECK > 50CM2 OR EYE SHIELDS * * ** 237 $ 37.21 0 * * ADDITIONAL FEE FOR PULSED LASER - UNDER GA * * ** 240 $ 11.94 0 * 38 * BIOPSY SKIN - PODIATRY * * ** 242 $ 36.87 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 244 $ 207.77 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 245 $ 183.78 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 246 $ 133.05 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 247 $ 49.02 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 248 $ 18.38 0 * 38 * PODIATRISTS' SERVICE - SURGICAL SERVICE-PROCEDURES * * ** 251 $ 107.77 0 * 38 * PODIATRISTS' SERVICE - SPECIAL SURGICAL-PROCEDURES * * ** 252 $ 85.96 0 * 38 * PODIATRISTS' SERVICE - SPECIAL SURGICAL-PROCEDURES * * ** 253 $ 85.96 0 * 38 * SPECIAL SURGICAL AND OTHER PROCEDURES - * * ** 254 $ 85.96 0 * 38 * PODIATRISTS' SERVICE - REPAIR OF DEFORMITIES OF * * ** 255 $ 122.15 0 * 38 * PODIATRISTS' SERVICE - REPAIR OF DEFORMITIES OF * * ** 256 $ 183.78 0 * 38 * PODIATRISTS' SERVICE - REPAIR OF DEFORMITIES OF * * ** 257 $ 218.14 0 * 38 * PODIATRISTS' SERVICE - HALLUX VALGUS - SIMPLE * * ** 258 $ 244.86 0 * 38 * PODIATRISTS' SERVICE - HALLUX VALGUS - OSTEOTOMY * * ** 259 $ 124.88 0 * 38 * PODIATRISTS' SERVICE - HALLUX VALGUS -EXCISION OF * * ** 260 $ 85.96 0 * 38 * PODIATRISTS' SERVICE - HALLUX VALGUS - EXCISION * * ** 261 $ 92.71 0 * 38 * PODIATRISTS' SERVICE - HALLUX VALGUS - * * ** 262 $ 61.18 0 * 38 * PODIATRISTS' SERVICE - HALLUX VALGUS - EXOSTOSIS * * ** 269 $ 239.94 0 * 38 * PODIATRISTS' SERVICE - SURGICAL & OTHER PROCEDURES * * ** 270 $ 36.43 0 * 34 * OSTEOPATHY-FOR AN INITIAL OFFICE VISIT (AGE 0-69) * * ** 271 $ 28.60 0 * 34 * OSTEOPATHY - SUBSEQUENT OFFICE VISIT, MANIPULATION * * ** 272 $ 79.25 0 * 34 * OSTEOPATHIC CONSULTATION, IN OR OUT OF OFFICE * * ** 273 $ 43.58 0 * 34 * OSTEO-INITIAL OFFICE VISIT PATIENT AGE 70+ * * ** 274 $ 35.74 0 * 34 * OSTEO-SUBSEQUENT OFFICE VISIT PATIENT AGE 70+ * * ** 275 $ 95.15 0 * 34 * OSTEOPATHIC CONSULTATION (IN OR OUT) 70+ * * ** 276 $ 49.78 0 * 34 * PROLONGED VISIT/OR COUNSELING COMPLEX CASE 0-69 * * ** 277 $ 62.24 0 * 34 * PROLONGED VISIT AND/OR COUNSELING COMPLEX CASE 70+ * * ** 301 $ 217.85 0 * 24 * GERIATRIC ASSESSMENT * * ** 302 $ 59.62 0 * 24 * GERIATRIC REASSESSMENT * * ** 305 $ 93.00 0 * 15 * VISIT, EMERGENCY, INT. MED. * * ** 306 $ 38.19 0 * 15 * DIRECTIVE CARE, INTERNAL MEDICINE * * ** 307 $ 39.89 0 * 15 * VISIT, OFFICE, INT. MED. * * ** 308 $ 23.51 0 * 15 * VISIT, HOSPITAL, INT. MED. * * ** 309 $ 41.97 0 * 15 * VISIT, HOME, INT. MED. * * ** 310 $ 137.05 0 * 15 * CONSULTATION,
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