ALBERTA HEALTH CARE INSURANCE PLAN Medical Procedure List As Of 01 October 2019 Superseded Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page i Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 I. CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES . 1 01 NONOPERATIVE ENDOSCOPY . 1 01.0 Nonoperative endoscopy of respiratory tract . 1 01.1 Nonoperative endoscopy of upper gastrointestinal tract . 1 01.2 Nonoperative endoscopy of lower gastrointestinal tract . 2 01.3 Other nonoperative endoscopy . 4 02 DIAGNOSTIC RADIOLOGY AND RELATED TECHNIQUES . 4 Radiology Section - Please See Section X 02.7 Other x-ray . 4 02.8 Diagnostic ultrasound . 4 03 CLINICAL EVALUTION AND EXAMINATION . 5 03.0 Diagnostic interview and evaluation or consultation . 5 03 CLINICAL EVALUATION AND EXAMINATION . 5 03.0 Diagnostic interview and evaluation or consultation . 5 03.1 Measurements and manual examinations of nervous system and sense organs . 52 03.2 Measurements and manual examinations of genitourinary system . 53 03.3 Other measurements and manual examinations Refer to GRs 11.2.1 and 11.2.2 for additional information pertaining to HSCs 03.37A to 03.38X inclusive. 54 03.4 Cardiac stress tests and pacemaker checks . 56 03.5 Other cardiac function tests . 56 03.6 Other cardiovascular measurements . 57 03.7 General physical examination . 57 Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page ii Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 06 NUCLEAR MEDICINE . 58 06.3 Other therapeutic radiology and nuclear medicine . 58 07 PHYSICAL MEDICINE, REHABILITATION, AND RELATED PROCEDURES . 59 07.0 Diagnostic physical medicine . 59 07.2 Other physical medicine - musculoskeletal manipulation . 59 07.4 Skeletal traction and other traction . 59 07.5 Other immobilization, pressure, and attention to wound . 59 08 DIAGNOSTIC AND THERAPEUTIC PSYCHOLOGY AND PSYCHIATRY . 60 08.1 Psychiatric evaluations, interviews, and consultations . 60 08.3 Psychiatric drug and shock therapy . 68 08.4 Other psychiatric therapeutic procedures . 68 09 OPHTHALMOLOGICAL AND OTOLOGICAL DIAGNOSIS AND TREATMENT . 70 09.0 General and subjective eye examination . 70 09.1 Examinations of form and structure of eye . 71 09.2 Objective functional tests of eye . 72 09.4 Nonoperative procedures related to hearing . 72 10 NONOPERATIVE INTUBATION, IRRIGATION, AND MANIPULATION PROCEDURES . 74 10.0 Nonoperative intubation of respiratory and gastrointestinal tracts . 74 10.2 Other nonoperative dilation and manipulation procedures . 75 10.3 Nonoperative alimentary tract irrigation, cleaning and local instillation . 75 10.5 Nonoperative irrigation, cleaning, and local instillation of genitourinary system . 75 11 REPLACEMENT AND REMOVAL OF THERAPEUTIC APPLIANCES . 75 Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page iii Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 11.0 Nonoperative replacement of gastrointestinal appliances . 75 11.2 Other nonoperative replacement . 76 11.7 Nonoperative removal of therapeutic device from genital system . 76 11.8 Other nonoperative removal of therapeutic device . 76 12 NONOPERATIVE REMOVAL OF FOREIGN BODY . 76 12.0 Removal of (non-penetrating) intraluminal foreign body from respiratory tract without incision . 76 12.1 Removal of (non-penetrating) intraluminal foreign body from digestive system without incision . 76 12.2 Removal of (non-penetrating) intraluminal foreign body from other sites without incision . 77 12.3 Removal of other foreign body from head and neck without incision . 77 13 OTHER NONOPERATIVE PROCEDURES . 77 13.4 Injection or infusion of other therapeutic or prophylactic substance . 77 13.5 Other injection or infusion of other therapeutic or prophylactic substance . 77 13.6 Respiratory therapy . 79 13.7 Conversion of cardiac rhythm . 80 13.8 Miscellaneous physical procedures . 80 13.9 Other miscellaneous diagnostic and therapeutic procedures . 80 II. OPERATIONS ON THE NERVOUS SYSTEM . 92 14 INCISION AND EXCISION OF SKULL, BRAIN AND CEREBRAL MENINGES Intracranial procedure involving microsurgical technique,for a second neurosurgeon, refer to Price List . 92 14.0 Cranial puncture . 92 14.1 Craniotomy and craniectomy . 92 Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page iv Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 14.2 Incision of brain and cerebral meninges . 92 14.3 Operations on thalamus and globus pallidus (including ansa and cingulus) . 92 14.4 Other excision or destruction of brain and meninges . 92 14.8 Invasive diagnostic procedures on skull, brain, and cerebral meninges . 93 15 OTHER OPERATIONS ON SKULL, BRAIN, AND CEREBRAL MENINGES . 93 15.0 Cranioplasty . 93 15.1 Repair of cerebral meninges . 94 15.2 Ventriculostomy . 94 15.3 Extracranial ventricular shunt . 94 15.4 Revision of ventricular shunt . 94 15.9 Other operations on skull, brain, and cerebral meninges . 94 16 OPERATIONS ON SPINAL CORD AND SPINAL CANAL STRUCTURES . 95 NOTE: The listed benefits are payable irrespective of the number of vertebrae involved if one incision utilized, unless otherwise stated. 16.0 Exploration and decompression of spinal canal . 95 16.1 Division of intraspinal nerve root . 96 16.2 Chordotomy . 96 16.3 Excision or destruction of lesion of spinal cord and spinal meninges . 96 16.4 Plastic operations on spinal cord and spinal meninges . 97 16.5 Freeing of adhesions of spinal cord and nerve roots . 98 16.8 Invasive diagnostic procedures on spinal cord and spinal canal structures . 98 16.9 Other operations on spinal cord and canal structures . 99 Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page v Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 17 OPERATIONS ON CRANIAL AND PERIPHERAL NERVES . 100 17.0 Incision, division, and excision of cranial and peripheral nerves . 100 17.1 Destruction of cranial and peripheral nerves . 101 17.2 Suture of cranial and peripheral nerves . 101 17.3 Freeing of adhesions and decompression of cranial and peripheral nerves . 101 17.4 Cranial or peripheral nerve graft . 102 17.5 Transposition of cranial and peripheral nerves . 103 17.6 Other cranial or peripheral neuroplasty . 103 17.7 Injection into peripheral nerve . 103 17.8 Invasive diagnostic procedures on peripheral nervous system . 103 17.9 Other operations on cranial and peripheral nerves . 104 18 OPERATIONS ON SYMPATHETIC NERVES OR GANGLIA . 104 18.1 Sympathectomy . 104 18.2 Injection into sympathetic nerve or ganglion . 104 III. OPERATIONS ON THE ENDOCRINE SYSTEM . 105 19 OPERATIONS ON THYROID AND PARATHYROID GLANDS . 105 19.0 Incision of thyroid field . 105 19.1 Unilateral thyroid lobectomy . 105 19.3 Complete thyroidectomy . 105 19.6 Excision of thyroglossal duct or tract . 105 19.7 Parathyroidectomy . 105 19.8 Invasive diagnostic procedures on thyroid and parathyroid glands . 105 20 OPERATIONS ON OTHER ENDOCRINE GLANDS . 106 Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page vi Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 20.1 Partial adrenalectomy . 106 20.5 Hypophysectomy . 106 20.7 Thymectomy . 106 IV. OPERATIONS ON THE EYES . 107 21 OPERATIONS ON LACRIMAL APPARATUS . 107 21.3 Manipulation of lacrimal passage (tract) . 107 21.4 Incision of lacrimal sac and passage . 107 21.6 Repair of canaliculus and punctum . 107 21.7 Fistulization of lacrimal tract to nasal cavity . 107 22 OPERATIONS ON EYELIDS . 107 22.1 Excision of lesion or tissue of eyelid . 107 22.3 Correction of entropion or ectropion . 108 22.4 Correction of blepharoptosis . 108 22.5 Blepharorrhaphy . 108 22.6 Other repair of eyelid . 108 22.7 Epilation of eyelid . 109 22.8 Invasive diagnostic procedures on eyelid . 109 23 OPERATIONS ON OCULAR MUSCLES OR TENDONS . 109 23.9 Other operations on ocular muscles or tendons . 109 24 OPERATIONS ON CONJUNCTIVA . 109 24.1 Other incision of conjunctiva . 109 24.2 Excision or destruction of lesion or tissue of conjunctiva . 110 24.3 Conjunctivoplasty . 110 Superseded ALBERTA HEALTH CARE INSURANCE PLAN Page vii Generated 2019/07/24 TABLE OF CONTENTS As of 2019/10/01 24.5 Suture of conjunctiva . 110 24.9 Other operations on conjunctiva . 110 25 OPERATIONS ON CORNEA . 110 25.1 Incision of cornea . 110 25.2 Excision of pterygium . 110 25.3 Excision or destruction of other lesion or tissue of cornea . 111 25.4 Suture of cornea . 111 25.5 Corneal transplant . ..