Schedule of Benefits for Professional Fees 2019 Vascular Procedures CONSULTATION PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE Claimable by vascular surgeon assisting in ALIF 647012 Co-surgery benefit for vascular surgeon who assists in ALIF spinal surgery (I.P.) Yes Independent procedure spinal surgery procedure €1,002.45 €684.00 €759.53 €543.00 ANASTOMOSIS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE 820 Arteriovenous anastomosis in arm No €563.75 €183.00 €337.23 €117.00 1453 Arteriovenous anastomosis, open by basilic vein transposition No Possible co-payment please check Table of Cover €972.73 €518.00 €497.13 €290.00 1465 Splenorenal anastomosis No Possible co-payment please check Table of Cover €989.13 €455.00 €635.50 €225.00 ANEURYSMS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or 1401 without patch graft; for ruptured aneurysm, abdominal aorta No Possible co-payment please check Table of Cover €2,670.13 €1,422.00 €1,371.45 €802.00 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or 1402 without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, No Possible co-payment please check Table of Cover €3,124.20 €1,662.00 €1,603.10 €935.00 coeliac, renal) Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with 1403 or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, No Possible co-payment please check Table of Cover €2,809.53 €1,496.00 €1,438.08 €843.00 hypogastric external) Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, using aorto-aortic tube 1404 prosthesis No Possible co-payment please check Table of Cover €1,438.08 €765.00 €868.18 €507.00 1409 Aorta bi-iliac bypass for atherosclerosis or aneurysm; endovascular (using prosthesis) (I.P.) No Independent Procedure €2,244.75 €728.00 €1,128.53 €283.00 1416 Thrombin injection into groin for pseudoaneurysm (including ultrasound guidance) No €254.20 €135.00 €182.45 €108.00 1427 Supra-renal aneurysm repair No Possible co-payment please check Table of Cover €2,416.95 €728.00 €1,216.68 €283.00 1428 Repair of supra-renal aortic aneurysm rupture No Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00 1436 Repair of ruptured iliac artery aneurysm No Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00 1461 Repair of subclavian aneurysm No Possible co-payment please check Table of Cover €1,089.58 €364.00 €746.20 €254.00 1474 Repair of femoral artery aneurysm No Possible co-payment please check Table of Cover €1,089.58 €455.00 €547.35 €196.00 BYPASS PROCEDURES PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE 1432 Aorto bi-iliac bypass for atherosclerosis or aneurysm (I.P.) No Independent Procedure Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00 1433 Aorto-femoral or bifemoral bypass for atherosclerosis or aneurysm (I.P.) No Independent Procedure Possible co-payment please check Table of Cover €2,244.75 €728.00 €1,128.53 €283.00 1443 Obturator bypass from aorta or iliac to profunda or distal femoral bypass No Possible co-payment please check Table of Cover €1,686.13 €455.00 €806.68 €196.00 1446 Aortic exclusion by axillo-femoral bypass No Possible co-payment please check Table of Cover €1,410.40 €455.00 €713.40 €196.00 1449 Vertebral artery bypass or repair No Possible co-payment please check Table of Cover €1,410.40 €670.00 €735.95 €196.00 1456 Carotid subclavian bypass No Possible co-payment please check Table of Cover €1,410.40 €364.00 €735.95 €254.00 1457 Subclavian subclavian bypass No Possible co-payment please check Table of Cover €1,199.25 €364.00 €536.08 €196.00 1459 Subclavian to branchial bypass or endarterectomy No Possible co-payment please check Table of Cover €1,199.25 €364.00 €730.83 €254.00 1463 Repair or bypass of brachial to radial or ulnar vessel, any method including harvesting of graft material No Possible co-payment please check Table of Cover €1,410.40 €455.00 €713.40 €196.00 1467 Femoral to popliteal bypass, above knee vein No Possible co-payment please check Table of Cover €1,399.13 €455.00 €718.53 €196.00 1468 Femoral to popliteal bypass, above knee synthetic No Possible co-payment please check Table of Cover €1,282.28 €455.00 €658.05 €196.00 1469 Femoral to popliteal bypass, below knee vein No Possible co-payment please check Table of Cover €1,526.23 €455.00 €767.73 €196.00 1471 Femoral to popliteal bypass, below knee synthetic No Possible co-payment please check Table of Cover €1,305.85 €455.00 €658.05 €196.00 Femoral tibial artery bypass, including tibial-peroneal and peroneal artery bypass, or other distal 1478 vessels No Possible co-payment please check Table of Cover €1,847.05 €728.00 €928.65 €283.00 1479 Popliteal aneurysm artery repair or bypass No Possible co-payment please check Table of Cover €1,199.25 €455.00 €602.70 €196.00 1481 Femorofemoral bypass No Possible co-payment please check Table of Cover €1,305.85 €455.00 €658.05 €196.00 EMBOLUS / THROMBUS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE 1280 Common femoral artery embolectomy No Possible co-payment please check Table of Cover €597.58 €273.00 €382.33 €136.00 1306 Transcatheter embolisation, extremity, arteriovenous malformation (AVM) (I.P.) No Independent Procedure Possible co-payment please check Table of Cover €591.43 €273.00 €382.33 €136.00 1307 Transcatheter removal of intravascular thrombus or foreign body No Possible co-payment please check Table of Cover €591.43 €273.00 €387.45 €136.00 Transcatheter therapy, infusion for thrombolysis other than coronary, including necessary local 1308 anaesthesia, all lesser order selective catheterisation used in the approach and any necessary pre No Side Room €502.25 €267.00 €260.35 €151.00 and post-injection care 1430 Iliac or femoral veins - removal of thrombus No €492.00 €227.00 €260.35 €88.00 1437 Endarterectomy of iliac vessels alone No Possible co-payment please check Table of Cover €1,305.85 €728.00 €824.10 €283.00 1439 Renal artery anastomosis, endarterectomy or re-implantation or bypass No Possible co-payment please check Table of Cover €1,686.13 €728.00 €850.75 €283.00 EMBOLUS / THROMBUS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE 1441 Embolectomy of visceral branches, superior mesenteric or renal arteries No Possible co-payment please check Table of Cover €1,199.25 €364.00 €519.68 €136.00 Endarterectomy of internal/ external common carotid artery with or without patch graft, with or 1447 without shunt No Possible co-payment please check Table of Cover €2,178.13 €728.00 €1,094.70 €283.00 1462 Brachial embolectomy No Possible co-payment please check Table of Cover €652.93 €364.00 €382.33 €136.00 1476 Popliteal artery embolectomy No Possible co-payment please check Table of Cover €984.00 €455.00 €525.83 €196.00 1477 Tibial artery embolectomy No Possible co-payment please check Table of Cover €1,199.25 €455.00 €602.70 €196.00 ENDARTERECTOMY PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE 1434 Endarterectomy of abdominal aorta and iliac vessels No Possible co-payment please check Table of Cover €1,526.23 €728.00 €835.38 €283.00 1472 Profundaplasty with or without patch or endarterectomy No Possible co-payment please check Table of Cover €984.00 €455.00 €492.00 €196.00 1473 Common femoral artery endarterectomy No Possible co-payment please check Table of Cover €757.48 €273.00 €382.33 €136.00 ENDOVASCULAR PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION PRE-APPROVAL PAYMENT PAYMENT RULES CONSULTANT CONSULTANT ANAESTHETIST ANAESTHETIST REQUIRED INDICATORS RATE RATE RATE RATE 1419 Transluminal dilation of iliac vessels with or without stent or graft No Possible co-payment please check Table of Cover €679.58 €363.00 €348.50 €202.00 1421 Transluminal dilation with or without stent of carotid vessels No Possible co-payment please check Table of Cover €707.25 €377.00 €358.75 €211.00 1422 Transluminal dilation with or without stent or graft of femoral vessels No Possible co-payment please check Table of Cover €707.25 €377.00 €358.75 €211.00 1423 Transluminal dilation with stent of distal vessels No Possible co-payment please check Table of Cover €707.25 €377.00 €358.75 €211.00 1424 Transluminal dilation of distal vessels No Possible co-payment please check Table of Cover €525.83 €281.00 €265.48 €156.00 VARICOSE VEINS PARTICIPATING STANDARD PARTICIPATING STANDARD CODE DESCRIPTION