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R 385
Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers, Pharmacies and Hospital Groups - 2012Part III : Procedures3. Musculo-skeletal system |
Specialist |
General Practitioner |
Anaesthetic
|
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U/E |
R |
U/E |
R |
U/E |
R T/M 3. |
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3.1 |
Bones |
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3.1.1 |
Fractures |
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0383 |
Fracture (reduction under general anaesthetic) Scapula |
|
|
|
|
3 |
230.43 +T+M |
||||
0387 |
Fracture (reduction under general anaesthetic): Clavicle |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T+M |
||||
0388 |
Percutaneous pinning supracondylar fracture elbow - stand alone procedure |
175.70 |
2,888.51 |
140.58 |
2,310.81 |
3 |
230.43 +T+M |
||||
0389 |
Fracture (reduction under general anaesthetic): Humerus |
111.60 |
1,834.70 |
111.60 |
1,834.70 |
3 |
230.43 +T+M |
||||
0391 |
Fracture (reduction under general anaesthetic):· Radius and/or ulna |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T+M |
||||
0392 |
Open reduction of both radius and ulna Modifier 0051 not applicable) |
210 |
3,452.40 |
168 |
2,761.92 |
3 |
230.43 +T+M |
||||
0402 |
Fracture (reduction under general anaesthetic): Carpal bone |
64 |
1,052.16 |
64 |
1,052.16 |
3 |
230.43 +T+M |
||||
0403 |
Bennett's fracture-dislocation |
51 |
838.44 |
51 |
838.44 |
3 |
230.43 +T+M |
||||
0405 |
Fracture reduction under general anaesthetic - Open treatment of Metacarpal: Simple |
118.3 |
1,944.85 |
118.3 |
1,944.85 |
3 |
230.43 +T+M |
||||
0409 |
Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Simple |
|
|
|
|
3 |
230.43 +T+M |
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0411 |
Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Compound (open) |
52 |
854.88 |
52 |
854.88 |
3 |
230.43 +T+M |
||||
0413 |
Fracture (reduction under general anaesthetic): Finger phalanx: Proximal or middle: Simple |
48 |
789.12 |
48 |
789.12 |
3 |
230.43 +T |
||||
0415 |
Fracture (reduction under general anaesthetic): Finger phalanx: Proximal or middle: Compound (open) |
102 |
1,676.88 |
102 |
1,676.88 |
3 |
230.43 +T+M |
||||
0417 |
Fracture (reduction under general anaesthetic): Pelvis fracture: Closed (modifier 0051 is applicable) |
|
|
|
|
3 |
230,43 +T |
||||
0419 |
Fracture (reduction under general anaesthetic): Pelvis: Operative reduction and fixation |
320 |
5,260.60 |
256 |
4,206.64 |
3 |
230.43 +T+M |
||||
0421 |
Fracture (reduction under general anaesthetic): Femur: Neck or Shaft |
237 |
3,898.28 |
189.6 |
3,117.02 |
3 |
230.43 +T+M |
||||
0425 |
Fracture (reduction under general anaesthetic): Patella |
51 |
838.44 |
51 |
838.44 |
3 |
230.43 +T+M |
||||
0429 |
Fracture (reduction under general anaesthetic): Tibia with or without Fibula |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0433 |
Fracture (reduction under general anaesthetic): Fibula shaft |
|
|
|
|
3 |
230.43 +T+M |
||||
0435 |
Fracture (reduction under general anaesthetic): Malleolus of ankle |
58 |
953.52 |
58 |
953.52 |
3 |
230.43 +T+M |
||||
0437 |
Fracture-dislocation of ankle |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0438 |
Open reduction: Talus fracture (Modifier 0051 not applicable) |
198.7 |
3,266.63 |
158.96 |
2,613.30 |
3 |
230.43 +T+M |
||||
0439 |
Fracture (reduction under general anaesthetic): Tarsal bones (excluding talus and calcaneus) |
64 |
1,052.16 |
64 |
1,052,16 |
3 |
230.43 +T+M |
||||
0440 |
Open reduction Calcaneus fracture (Modifier 0051 not applicable) |
403.50 |
6,633.54 |
322.5 |
5,301.90 |
3 |
230.43 +T+M |
||||
0441 |
Fracture (reduction under general anaesthetic): Metatarsal |
41.8 |
687.19 |
41.8 |
687.19 |
3 |
230.43 +T+M |
||||
0443 |
Fracture (reduction under general anaesthetic): Toe phalanx: Distal Simple |
|
|
|
|
3 |
230.43 +T |
||||
0445 |
Fracture (reduction under general anaesthetic): Toe phalanx: Compound |
32 |
526.08 |
32 |
526.08 |
3 |
230.43 +T+M |
||||
0447 |
Fracture (reduction under general anaesthetic): Other: Simple |
26 |
427.44 |
26 |
427.44 |
3 |
230.43 +T |
||||
0449 |
Fracture (reduction under general anaesthetic): Other: Compound |
52 |
854.88 |
52 |
854.88 |
3 |
230.43 +T+M |
||||
0451 |
Fracture (reduction under general anaesthetic): Sternum and/or ribs: Closed |
|
|
|
|
3 |
230.43 +T |
||||
0452 |
Fracture (reduction under general anaesthetic): Sternum and/or ribs. Open reduction and fixation of multiple fractured ribs for flail chest. |
230 |
3,781.20 |
184 |
3,024.96 |
3 |
230.43 +T+M |
||||
0455 |
Fracture (reduction under general anaesthetic): Spine: with or without paralysis: Cervical |
|
|
|
|
3 |
230.43 +T+M |
||||
0456 |
Fracture (reduction under general anaesthetic): Spine: with or without paralysis: Rest |
|
|
|
|
3 |
230.43 +T+M |
||||
0459 |
DELETED 2009: Open reduction and internal fixation for fracture and/or dislocation of spit> |
|
|
|
|
3 |
230.43 +T+M |
||||
0461 |
Fracture (reduction under general anaesthetic): Compression fracture: Cervical |
|
|
|
|
3 |
230.43 +T+M |
||||
0462 |
Fracture (reduction under general anaesthetic) Compression fracture: Rest |
|
|
|
|
3 |
230.43 +T+M |
||||
0463 |
Fracture (reduction under general anaesthetic): Spinous or transverse processes: Cervical |
|
|
|
|
3 |
230.43 +T+M |
||||
0464 |
Fracture (reduction under general anaesthetic): Spinous or transverse processes: Rest |
|
|
|
|
3 |
230.43 +T+M |
||||
3.1.1.1 |
Operations for fractures |
|
|||||||||
0465 |
Fractures involving large joints (includes the item for the relative bone). This item may not be used as a modifier) |
288 |
4,734.72 |
230.4 |
3,787.78 |
3 |
230.43 +T+M |
||||
0473 |
Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pin. (Not subject to rule G) (Modifier 0005 not applicable) |
43 |
706.92 |
43 |
706.92 |
3 |
230.43 +T |
||||
0475 |
Bone grafting or internal fixation for malunion or non-union: femur, tibia, Humerus, Radius and Ulna. |
282 |
4,636.08 |
225.6 |
3,708.86 |
3 |
230.43 +T+M |
||||
0479 |
Bone grafting or internal fixation for malunion or non-union: Other bones (not applicable to fingers and toes) |
154 |
2,531.76 |
123.2 |
2,025.41 |
3 |
230.43 +T+M |
||||
3.1.2 |
Bony operations |
|
|||||||||
3.1.2.1 |
Bone grafting |
|
|||||||||
0497 |
Resection of bone with or without grafting (benign) |
282 |
4,836.08 |
225.6 |
3,708.85 |
3 |
230.43 +T+M |
||||
0498 |
Resection of bone or tumour (malignant) with or without grafting (does not include digits) |
340 |
5,589.60 |
272 |
4,471.68 |
3 |
230.43 +T+M |
||||
0499 |
Grafts to cysts: Large bones |
192 |
3,156.48 |
153.6 |
2,525.18 |
3 |
230.43 +T+M |
||||
0501 |
Grafts to cysts: Small bones |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0503 |
Grafts to cysts: Cartilage graft |
206 |
3,386.64 |
164.8 |
2,709.31 |
3 |
230.43 +T+M |
||||
0505 |
Grafts to cysts: Inter-metacarpal bone graft |
147 |
2,416.68 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0507 |
Removal of autogenous bone for grafting (not subject to modifier 0005) |
50 |
822.00 |
50 |
822.00 |
3 |
230.43 +T+M |
||||
3.1.2.2 |
Acute/chronic osteomyelitis |
|
|||||||||
0509 |
Conservative treatment |
|
|
|
|
|
|
||||
0511 |
Operation Tariff which would be applicable for compound (open) fracture of the bone involved, including six weeks post-operative care. |
|
|
|
|
|
|
||||
0512 |
Sternum sequestrectomy and drainage, including six weeks after-care |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
3.1.2.3 |
Osteotomy |
|
|||||||||
0514 |
Osteotomy: Sternum: Repair of pectus-excavatum |
330 |
5,.425.20 |
254 |
4,340.16 |
3 |
230.43 +T+M |
||||
0515 |
Osteotomy: Sternum: Repair of pectus carinatum |
330 |
5,425.20 |
264 |
4,340.16 |
3 |
230.43 +T+M |
||||
0518 |
Osteotomy: Pelvic |
320 |
5,280.80 |
256 |
4,208.84 |
3 |
230.43 +T+M |
||||
0521 |
Osteotomy: Femoral: Proximal (Modifier 0051 is applicable) |
320 |
5,260.80 |
256 |
4,208.84 |
3 |
230.43 +T+M |
||||
0527 |
Osteotomy: Knee region (Modifier 0051 is applicable) |
320 |
5,280.80 |
256 |
4,208.64 |
3 |
230.43 +T+M |
||||
0528 |
Osteotomy: Os Calcis (Dwyer operation) (Modifier 0051 is applicable) |
115 |
1,890.60 |
115 |
1,890.60 |
3 |
230.43 +T+M |
||||
0530 |
Osteotomy: Metacarpal and phalanx: Corrective for mal-union or rotation (Modifier 0051 is applicable) |
120 |
1,972.80 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0531 |
Rotational osteotomy tibia and fibula - stand alone procedure |
278.90 |
4,585.12 |
223.12 |
3,668.09 |
3 |
230.43 +T+M |
||||
0532 |
Rotation osteotomy of the Radius, Ulna or Humerus (modifier 0051 is applicable) |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0533 |
Osteotomy single metatarsal (modifier 0051 is applicable) |
60 |
986.40 |
60 |
986.40 |
3 |
230.43 +T+M |
||||
0534 |
Multiple metatarsal osteotomies (modifier 0051 is applicable) |
150 |
2,466.00 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
3.1.2.4 |
Exostosis |
|
|||||||||
0535 |
Exostosis: Excision: Readily accessible sites |
60 |
986.40 |
60 |
986.40 |
3 |
230.43 +T+M |
||||
0537 |
Exostosis: Excision: Less accessible sites |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T+M |
||||
3.1.2.5 |
Biopsy |
|
|||||||||
0539 |
Needle Biopsy: Spine (no after-care). Modifier 0005 not applicable |
50 |
822.00 |
50 |
822.00 |
4 |
307.24 +T |
||||
0541 |
Needle Biopsy: Other sites (no after-care). Modifier 0005 not applicable |
32 |
526.08 |
32 |
526.06 |
4 |
307.24 +T |
||||
0543 |
Biopsy: Open (modifier 0005 is not applicable): Readily accessible site |
64 |
1,052.18 |
64 |
1,052.18 |
|
As per bone |
||||
0545 |
Biopsy: Open (modifier 0005 is not applicable): Less accessible site |
96 |
1,578.24 |
96 |
1,578.24 |
|
As per bone |
||||
3.2 |
Joints |
|
|||||||||
3.2.1 |
Dislocations |
|
|||||||||
0547 |
Joint: Dislocation: Clavicle: either end |
38 |
624.72 |
38 |
624.72 |
3 |
230.43 +T+M |
||||
0549 |
Joint: Dislocation: Shoulder |
51 |
838.44 |
51 |
838.44 |
3 |
230.43 +T+M |
||||
0551 |
Joint Dislocation: Elbow |
51 |
838.44 |
51 |
838.44 |
3 |
230.43 +T+M |
||||
0552 |
Joint: Dislocation: Wrist |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T+M |
||||
0553 |
Joint: Dislocation: Perilunar transscaphoid fracture dislocation |
130 |
2,137.20 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0555 |
Joint: Dislocation: Lunate |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T+M |
||||
0556 |
Joint: Dislocation: Carpo-metacarpo dislocation |
51 |
838.44 |
51 |
838.44 |
3 |
230.43 +T+M |
||||
0557 |
Joint: Dislocation Metacarpo-phalangeal or interphalangeal joints (hand) |
26 |
427.44 |
26 |
427.44 |
3 |
230.43 +T+M |
||||
0559 |
Joint: Dislocation. Hip |
109 |
1,791.96 |
109 |
1,791.96 |
3 |
230.43 +T+M |
||||
0561 |
Joint: Dislocation. Knee |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T+M |
||||
0563 |
Joint: Dislocation: Patella |
32 |
526.08 |
32 |
526.08 |
3 |
230.43 +T+M |
||||
0565 |
Joint: Dislocation: Ankle |
90 |
1,479.60 |
90 |
1,479.60 |
3 |
230.43 +T+M |
||||
0567 |
Joint: Dislocation: Sub-Talar dislocation |
90 |
1,479.60 |
90 |
1,479.60 |
3 |
230.43 +T+M |
||||
0569 |
Joint: Dislocation: lntertarsal or Tarsometatarsal or Mid-tarsal |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T+M |
||||
0571 |
Joint: Dislocation: Meta-tarsophalangeal or Interphalangeal Joints (foot) |
14 |
230.16 |
14 |
230.16 |
3 |
230.43 +T+M |
||||
0573 |
Joint: Dislocation Spine with or without paralysis |
|
|
|
|
|
|
||||
3.2.2 |
Operations for dislocations |
|
|||||||||
0578 |
Recurrent dislocation of shoulder |
200 |
3,288.00 |
160 |
2,630.40 |
3 |
230.43 +T+M |
||||
0579 |
Recurrent dislocation of large joints |
161 |
2,646.84 |
128.8 |
2,117.47 |
3 |
230.43 +T+M |
||||
3.2.3 |
Capsular operations |
|
|||||||||
0582 |
Capsulotomy or arthrotomy or biopsy or drainage of joint: Small joint (Including three weeks after-care) |
51 |
838.44 |
51 |
838.44 |
3 |
230.43 +T+M |
||||
0583 |
Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint (including three weeks after-care) |
95 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T+M |
||||
0585 |
Capsulotomy or arthrotomy or biopsy or drainage of joint: Capsulectomy digital joint |
64 |
1,052.16 |
64 |
1,052.16 |
3 |
230.43 +T+M |
||||
0586 |
Multiple percutaneous capsulotomies of metacarpo-phalangeal joints |
90 |
1,479.80 |
90 |
1,479.60 |
3 |
230.43 +T+M |
||||
0587 |
Release of digital joint contracture |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
3.2.4 |
Synovectomy |
|
|||||||||
0589 |
Synovectomy: Digital joint |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T+M |
||||
0592 |
Synovectomy· Large joint |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0593 |
Tendon synovectomy |
203.7 |
3,348.83 |
162.96 |
2 679.08 |
3 |
230.43 +T+M |
||||
3.2.5 |
Arthrodesis |
|
|||||||||
0597 |
Arthrodesis: Shoulder |
224 |
3,682.58 |
179.2 |
2,946.05 |
3 |
230.43 +T+M |
||||
0598 |
Arthrodesis: Elbow |
180 |
2.959.20 |
144 |
2,367.36 |
3 |
230.43 +T+M |
||||
0599 |
Arthrodesis: Wrist |
180 |
2,959.20 |
144 |
2,367.36 |
3 |
230.43 +T+M |
||||
0600 |
Arthrodesis: Digital joint |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0601 |
Arthrodesis: Hip |
320 |
5,260.80 |
256 |
4,208.64 |
3 |
230.43 +T+M |
||||
0602 |
Arthrodesis: Knee |
180 |
2,959.20 |
144 |
2,367.36 |
3 |
230.43 +T+M |
||||
0603 |
Arthrodesis· Ankle |
180 |
2,959.20 |
144 |
2,367.36 |
3 |
230.43 +T+M |
||||
0604 |
Arthrodesis: Sub-talar |
130 |
2,137.20 |
120 |
1,972.60 |
3 |
230.43 +T+M |
||||
0605 |
Arthrodesis: Stabilisation of foot (triple-arthrodeses) |
180 |
2,959.20 |
144 |
2,367.36 |
3 |
230.43 +T+M |
||||
0607 |
Arthrodesis: Mid-tarsal wedge resection |
180 |
2,959.20 |
144 |
2,367.36 |
3 |
230.43 +T+M |
||||
3.2.6 |
Arthroplasty |
|
|||||||||
0614 |
Arthroplasty: Debridement large joints |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0615 |
Arthroplasty: Excision medial or lateral end of clavicle |
116 |
1,907.04 |
116 |
1,907.04 |
3 |
230.43 +T+M |
||||
0617 |
Shoulder: Acromioplasty |
192 |
3,156.46 |
153.6 |
2,525.18 |
3 |
230.43 +T+M |
||||
0619 |
Shoulder: Partial replacement |
277 |
4,553.88 |
221.5 |
3,643.10 |
5 |
384.05 +T+M |
||||
0620 |
Shoulder Total replacement |
416 |
6,839.04 |
332.8 |
5,471.23 |
5 |
384.05 +T+M |
||||
0621 |
Elbow: Excision head of radius |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T+M |
||||
0622 |
Elbow: Excision |
192 |
3,156.48 |
153.6 |
2,525.18 |
3 |
230.43 +T+M |
||||
0623 |
Elbow: Partial replacement |
188 |
3,090.72 |
150.4 |
2,472.58 |
3 |
230.43 +T+M |
||||
0624 |
Elbow: Total replacement |
282 |
4,636.08 |
225.6 |
3,706.86 |
3 |
230.43 +T+M |
||||
0625 |
Wrist: Excision distal end of ulna |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T+M |
||||
0626 |
Wrist: Excision single bone |
110 |
1,808.40 |
110 |
1,808.40 |
3 |
230.43 +T+M |
||||
0627 |
Wrist: Excision proximal row |
166 |
2,729.04 |
132.8 |
2,183.23 |
3 |
230.43 +T+M |
||||
0631 |
Wrist: Total replacement |
249 |
4,093.56 |
199.2 |
3,274.85 |
3 |
230.43 +T+M |
||||
0635 |
Digital joint: Total replacement |
192 |
3,156.46 |
153.6 |
2,525.18 |
3 |
230.43 +T+M |
||||
0637 |
Hip: Total replacement |
415 |
6,839.04 |
332.8 |
5,471.23 |
3 |
230.43 +T+M |
||||
0641 |
Hip: Prosthetic replacement of femoral head |
288 |
4,734.72 |
230.4 |
3,787.78 |
3 |
230.43 +T+M |
||||
0643 |
Hip:· Girdlestone |
320 |
5,260.80 |
256 |
4,208.64 |
3 |
230.43 +T+M |
||||
0645 |
Knee: Partial replacement |
277 |
4,553.88 |
221.5 |
3,643.10 |
3 |
230.43 +T+M |
||||
0646 |
Knee: Total replacement |
416 |
6,839.04 |
332.8 |
5,471.23 |
3 |
230.43 +T+M |
||||
0649 |
Ankle: Total replacement |
290.4 |
4,774.18 |
232.32 |
3,819.34 |
3 |
230.43 +T+M |
||||
0650 |
Ankle: : Astragalectomy |
154 |
2,531.76 |
123.2 |
2,025.41 |
3 |
230.43 +T+M |
||||
3.2.7 |
Miscellaneous (Joints) |
|
|||||||||
0661 |
Aspiration of joint or intra-articular injection (not subject to rule G). (Modifier 0005 not applicable) |
9 |
147.96 |
9 |
147.96 |
3 |
230.43 +T+M |
||||
0667 |
Arthroscopy (excluding after-care), modifiers 0005 and 0013 not applicable |
60 |
986.40 |
60 |
986.40 |
3 |
230.43 +T+M |
||||
0669 |
Manipulation large joint under general anaesthetic(not subject to rule G) (Modifier 0005 not applicable) |
14 |
230.16 |
14 |
230,16 |
4
3 |
307.24 Hip+T 230.43 Knee/ Shoulder +T |
||||
0670 |
Only the consultation fee should be charged when manipulation of a large joint is performed with or without local anaesthetic |
|
|
|
|
4
3 |
307.24 Hip+T 230.43 Knee/ Shoulder +T |
||||
0673 |
Menisectomy or operation for other internal derangement of knee |
109 |
1,791.96 |
109 |
1,791.96 |
3 |
230.43 +T+M |
||||
3.2.8 |
Joint ligament reconstruction or suture |
|
|||||||||
0675 |
Joint ligament reconstruction or suture: Ankle: Collateral |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0677 |
Joint ligament reconstruction or suture: Knee: Collateral |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0678 |
Joint ligament reconstruction or suture: Knee: Cruciate |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0679 |
Joint ligament reconstruction or suture: Ligament augmentation procedure of knee |
280 |
4,603.20 |
224 |
3,682.56 |
3 |
230.43 +T+M |
||||
0680 |
Joint ligament reconstruction or suture: Digital joint ligament |
165 |
2,712.60 |
132 |
2,170.08 |
3 |
230.43 +T+M |
||||
3.3 |
Amputations |
|
|||||||||
3.3.1 |
Specific amputations |
|
|||||||||
0682 |
Amputation: Fore-quarter amputation |
294 |
4,833.36 |
235.2 |
3,865.59 |
9 |
691.29 +T+M |
||||
0683 |
Amputation: Through shoulder |
148 |
2,433.12 |
120 |
1,972.80 |
5 |
384.05 +T+M |
||||
0685 |
Amputation: Upper arm or fore-arm |
116 |
1,907.04 |
116 |
1,907.04 |
3 |
230.43 +T+M |
||||
0687 |
Partial amputation of the hand: One ray |
102 |
1,676.88 |
102 |
1,676.88 |
3 |
230.43 +T+M |
||||
0691 |
Amputation: Whole or part of finger (skin flap included) |
116 8 |
1,920.19 |
116 80 |
1,920.19 |
3 |
230.43 +T+M |
||||
0693 |
Hindquarter amputation |
420 |
6,904.80 |
336 |
5,523.84 |
6 |
460.86 +T+M |
||||
0695 |
Amputation: Through hip joint region |
192 |
3,156.48 |
153.6 |
2,525.18 |
6 |
460.86 +T+M |
||||
0697 |
Amputation: Through thigh |
205 |
3,370.20 |
164 |
2,696.16 |
6 |
460.86 +T+M |
||||
0699 |
Amputation· Below knee. through Knee/Syme |
194 |
3,189.36 |
155.2 |
2,551.49 |
5 |
384.05 +T+M |
||||
0701 |
Amputation: Trans-metatarsal or trans-tarsal |
142 |
2,334.48 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0703 |
Amputation: Foot: One ray |
97 |
1,594.68 |
97 |
1,594.68 |
3 |
230.43 +T+M |
||||
0705 |
Amputation: Toe (skin flap included) |
66 |
1,085.04 |
66 |
1,085.04 |
3 |
230.43 +T+M |
||||
3.3.2 |
Post-amputation reconstruction |
|
|||||||||
0706 |
Post-amputation reconstruction: Skin flap taken from a site remote from the injured finger or in cases of an advanced flap e g. Cutler Note: If not performed on thumb or index finger it must be motivated |
75 |
1,233.00 |
75 |
1,233.00 |
3 |
230.43 +T+M |
||||
0707 |
Post-amputation reconstruction: |
206 |
3,386.64 |
164.8 |
2,709.31 |
3 |
230.43 +T+M |
||||
0709 |
Post-amputation reconstruction. Metacarpal transfer |
192 |
3,156.48 |
153.6 |
2,525.18 |
3 |
230.43 +T+M |
||||
0711 |
Post-amputation reconstruction: Pollicisation of the finger (Prior permission must be obtained from the Commissioner at all times) |
282 |
4,636.08 |
225.6 |
3,708.86 |
3 |
230.43 +T+M |
||||
0712 |
Post-amputation reconstruction: Toe to thumb transfer (Prior permission must be obtained from the Commissioner at all times) |
800 |
13,152.00 |
640 |
10,521.60 |
3 |
230.43 +T+M |
||||
3.4 |
Muscles, tendons and fascias |
|
|||||||||
3.4.1 |
Investigations |
|
|||||||||
0713 |
Electromyography |
75 |
1,233.00 |
75 |
1,233.00 |
3 |
230.43 +T |
||||
0714 |
Electro-my graphic neuro-muscular junctional study, including edrophonium response (not to be used with item 2730) |
57 |
937.08 |
57 |
937.08 |
3 |
230.43 +T |
||||
0715 |
Strength duration curve per session |
10.5 |
172.62 |
10.5 |
172.62 |
3 |
230.43 +T |
||||
0717 |
Electrical examination of single nerve or muscle |
9 |
147.96 |
9 |
147.96 |
3 |
230.43 +T |
||||
0721 |
Voltage integration during isometric contraction |
12 |
197.28 |
12 |
197.28 |
3 |
230.43 +T |
||||
0723 |
Tonometry with edrophonium |
8 |
131.52 |
8 |
131.52 |
3 |
230.43 +T |
||||
0725 |
Isometric tension studies with edrophonium |
10 |
164.40 |
10 |
164.40 |
3 |
230.43 +T |
||||
0727 |
Crantal reflex study (both early and late responses) supra occulofacial, corneofacial or flabellofacial: Unilateral |
8 |
131.52 |
8 |
131.52 |
3 |
230.43 +T |
||||
0728 |
Cranial reflex study(both early and late responses) supra occulofacial, corneofacial or flabellofacial: Bilateral |
14 |
230.16 |
14 |
230.16 |
3 |
230.43 +T |
||||
0729 |
Tendon reflex time |
7 |
115.08 |
7 |
115.08 |
3 |
230.43 +T |
||||
0730 |
Limb-brain somatosensory studies (per limb) |
49 |
805.56 |
49 |
805.56 |
3 |
230.43 +T |
||||
0731 |
Vision and audiosensory studies |
49 |
805.56 |
49 |
805.56 |
|
|
||||
0733 |
Motor nerve conduction studies (single nerve) |
26 |
427.44 |
26 |
427.44 |
|
|
||||
0735 |
Examinations of sensory nerve conduction by sweep averages single nerve) |
31 |
509.64 |
31 |
509.64 |
3 |
230.43 +T |
||||
0737 |
Biopsy for motor nerve terminals and end plates |
20 |
328.80 |
20 |
328.80 |
3 |
230.43 +T |
||||
0739 |
Combined muscle biopsy with end plates and nerve terminal |
34 |
558.96 |
34 |
558.96 |
8 |
614.48 +T |
||||
0740 |
Muscle fatigue studies |
20 |
328.80 |
20 |
328.80 |
3 |
230.43 +T |
||||
0741 |
Muscle biopsy |
20 |
328.80 |
20 |
328.80 |
8 |
614.48 +T |
||||
0742 |
Global fee for all muscle studies, including histochemical studies |
262 |
4,307.28 |
|
|
|
|
||||
4701 |
Biochemical estimations on muscle biopsy specimens: Creatine |
20.25 |
332.91 |
|
|
|
|
||||
4703 |
Biochemical estimations on muscle biopsy specimens: Adenylate kinase |
33.3 |
547.46 |
|
|
|
|
||||
4705 |
Biochemical estimations on muscle biopsy specimens: Pyruvate kinase |
5.7 |
93.71 |
|
|
|
|
||||
4707 |
Biochemical estimations on muscle biopsy specimens: Lactate dehydrogenase |
1.6 |
26.30 |
|
|
|
|
||||
4709 |
Biochemical estimations on muscle biopsy specimens: Adenylate deaminase |
9.9 |
162.76 |
|
|
|
|
||||
4711 |
Biochemical estimations on muscle biopsy specimens: Phosphoglycerate kinase |
13.7 |
225.23 |
|
|
|
|
||||
4713 |
Biochemical estimations on muscle biopsy specimens: Phosphoglycerate mutase |
25.9 |
425.80 |
|
|
|
|
||||
4715 |
Biochemical estimations on muscle biopsy specimens· Enolase |
32.7 |
537.59 |
|
|
|
|
||||
4717 |
Biochemical estimations on muscle biopsy specimens: Phosphofructokinase |
37.7 |
619.79 |
|
|
|
|
||||
4719 |
Biochemical estimations on muscle biopsy specimens: Aldolase |
15 75 |
258.93 |
|
|
|
|
||||
4721 |
Biochemical estimations on muscle biopsy specimens: Glyceraldehyde 3 Phosphate Dehydrogenase |
11.06 |
181.83 |
|
|
|
|
||||
4723 |
Biochemical estimations on muscle biopsy specimens: Phosphorylasa |
34.7 |
570.47 |
|
|
|
|
||||
4725 |
Biochemical estimations on muscle biopsy specimens: Phosphoglucomutase |
40.3 |
662.53 |
|
|
|
|
||||
4727 |
Biochemical estimations on muscle biopsy specimens: Phosphohexose isomerase |
28.8 |
473.47 |
|
|
|
|
||||
3.4.2 |
Decompression Operations |
|
|||||||||
0743 |
Major Compartemental Decompression |
132 |
2,170.08 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0744 |
Decompression operation: Fasciotomy only |
60 |
986.40 |
60 |
986.40 |
3 |
230.43 +T |
||||
3.4.3 |
Muscle and tendon repair |
|
|||||||||
0745 |
Muscle and tendon repair: Biceps humeri |
109 |
1,791,96 |
109 |
1,791,96 |
3 |
230.43 +T |
||||
0746 |
Muscle and tendon repair: Removal of calcification in Rotator cuff |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 |
||||
0747 |
Muscle and tendon repair: Rotator cuff |
134 |
2,202.98 |
120 |
1,972.80 |
.4 |
307.24 +T |
||||
0748 |
Muscle and tendon repair: Debridement rotator cuff |
139.7 |
2,296.67 |
120 |
1,972.80 |
.4 |
307.24 +T |
||||
0749 |
Muscle and tendon repair: Scapulopexy - stand alone procedure |
271.90 |
4,470.04 |
217.52 |
3,576.03 |
4 |
307.24 +T |
||||
0755 |
Muscle and tendon repair: lnfrapatellar or quadriceps tendon |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0757 |
Muscle and tendon repair:· Achilles tendon repair |
197.6 |
3,248.54 |
158.08 |
2,598.84 |
4 |
307.24 +T |
||||
0759 |
Muscle and tendon repair: Other single tendon |
77 |
1,265.88 |
77 |
1,265.88 |
3 |
230.43 +T |
||||
0763 |
Muscle and tendon repair: Tendon or ligament injection |
9 |
147.96 |
9 |
147.96 |
3 |
230.43 +T |
||||
0767 |
Hand: Flexor tendon suture: Primary (per tendon, Modifier 0005 not applicable) |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0769 |
Hand: Flexor tendon suture: Secondary (per tendon. Modifier 0005 not applicable) |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T |
||||
0771 |
Extensor tendon suture: Primary (per tendon. Modifier 0005 not applicable) |
129.7 |
2,132.27 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0773 |
Extensor tendon suture: Secondary (per tendon, Modifier 0005 not applicable) |
80 |
1,315.20 |
80 |
1,315.20 |
3 |
230.43 +T |
||||
0774 |
Repair of Boutonniere deformity or Mallet finger with graft |
183.7 |
3,020.03 |
146.96 |
2,416.02 |
3 |
230.43 +T |
||||
3.4.4 |
Tendon graft |
|
|||||||||
0775 |
Free tendon graft |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T |
||||
0776 |
Reconstruction of pulley for flexor tendon |
50 |
822.00 |
50 |
822.00 |
3 |
230.43 +T |
||||
0777 |
Tendon graft: Finger: Flexor |
192 |
3,156.46 |
153.6 |
2,525.18 |
3 |
230.43 +T |
||||
0779 |
Tendon graft: Finger. Extensor |
122 |
2,005.68 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0780 |
Two stage flexor tendon graft using silastic rod |
240 |
3,945.60 |
192 |
3,156.46 |
3 |
230.43 +T |
||||
3.4.5 |
Tenolysis |
|
|||||||||
0781 |
Tendon freeing operation, except where specified elsewhere |
64 |
1,052.16 |
64 |
1,052.16 |
3 |
230.43 +T |
||||
0782 |
Carpal tunnel syndrome |
98.7 |
1,622.63 |
98.7 |
1,622.63 |
3 |
230.43 +T |
||||
0783 |
Tenolysis: De Quervain |
38 |
624.72 |
38 |
624.72 |
3 |
230.43 +T |
||||
0784 |
Trigger finger |
38 |
624.72 |
38 |
624.72 |
3 |
230.43 +T |
||||
0785 |
Flexor tendon freeing operation following free tendon graft or suture |
186.8 |
3,070.99 |
149.44 |
2,456.79 |
3 |
230.43 +T |
||||
0787 |
Extensor tendon freeing operation following graft or suture in finger, hand or forearm |
180.9 |
2,974.00 |
144.72 |
2,379.20 |
3 |
230.43 +T |
||||
0788 |
Intrinsic tendon release per finger |
64 |
1,052.16 |
64 |
1,052.16 |
3 |
230.43 +T |
||||
0789 |
Central tendon tenotomy for Boutonniere deformity |
64 |
1,052.16 |
64 |
1,052.16 |
3 |
230.43 +T |
||||
3.4.6 |
Tenodesis |
|
|||||||||
0790 |
Tenodesis: Digital joint |
90 |
1,479.60 |
90 |
1,479.60 |
3 |
230.43 +T |
||||
3.4.7 |
Muscle, tendon and fascia transfer |
|
|||||||||
0791 |
Single tendon transfer |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T |
||||
0792 |
Multiple tendon transfer |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0793 |
Hamstring to quadriceps transfer |
141 |
2,318.04 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0794 |
Pectoralis major or Latissimus dorsi transfer to biceps tendon |
320 |
5,260.80 |
256 |
4,208.64 |
5 |
384.05 +T |
||||
0795 |
Tendon transfer at elbow |
116 |
1,907.04 |
116 |
1,907.04 |
3 |
230.43 +T |
||||
0803 |
Hand tendons: Single tendon transfer |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T |
||||
0809 |
Hand tendons· Substitution for intrinsic paralysis of hand |
224 |
3,682.56 |
179.2 |
2,946.05 |
3 |
230.43 +T |
||||
0811 |
Hand tendons: Opponens tendon transfer (including obtaining of graft) |
220.6 |
3,526.66 |
176.48 |
2,901,33 |
3 |
230.43 +T |
||||
3.4.8 |
Muscle slide operations and tendon lengthening |
|
|||||||||
0812 |
Percutaneous Tenotomy: All sites |
38 |
624.72 |
38 |
624.72 |
3 |
230.43 +T |
||||
0813 |
Torticollis |
96 |
1,578.24 |
96 |
1,578.24 |
5 |
384.05 +T |
||||
0815 |
Scalenotomy |
132 |
2,170.08 |
120 |
1,972.80 |
5 |
384.05 +T |
||||
0817 |
Scalenotomy with excision of first rib |
190 |
3,123.60 |
152 |
2,498.86 |
3 |
230.43 +T+M |
||||
0822 |
Open release elbow (Mitals) -stand alone procedure |
278.20 |
4,573.81 |
222.56 |
3,658,89 |
3 |
230.43 +T+M |
||||
0823 |
Excision or slide for Volksmann’s Contracture |
192 |
3,156.48 |
153.6 |
2,525.18 |
3 |
230.43 +T |
||||
0825 |
Hip: Open muscle release |
116 |
1,907.04 |
116 |
1,907.04 |
7 |
537.67 +T |
||||
0829 |
Knee: Quadriceps plasty |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T |
||||
0831 |
Knee, Open tenotomy |
141 |
2,318.04 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0835 |
Calf |
96 |
1,578.24 |
96 |
1,578.24 |
4 |
307.24 +T |
||||
0837 |
Open Elongation Tendon Achilles |
96 |
1,578.24 |
96 |
1,578.24 |
4 |
307.24 +T |
||||
0838 |
Percutaneous "Hoke" elongation tendoachilles -stand alone procedure |
79.30 |
1,303.69 |
79.30 |
1,303.69 |
4 |
307.24 +T |
||||
0845 |
Foot: Plantar fasciotomy |
70 |
1,150.80 |
70 |
1,150.80 |
3 |
230.43 +T |
||||
3.5 |
Bursae and ganglia |
|
|||||||||
0847 |
Excision: Semi-membranosus |
90 |
1,479.80 |
90 |
1,479.80 |
4 |
307.24 +T |
||||
0849 |
Excision: Prepatellar |
45 |
739.60 |
45 |
739.60 |
3 |
230.43 +T |
||||
0851 |
Excision: Olecranon |
81.8 |
1,344.79 |
81.8 |
1,344.79 |
3 |
230.43 +T |
||||
0853 |
Excision: Small bursa or ganglion |
80.9 |
1,330.00 |
80.9 |
1,330.00 |
3 |
230.43 +T |
||||
0855 |
Excision:· Compound palmar ganglion or synovectomy |
128 |
2,104.32 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
0857 |
Bursae and ganglia: Aspiration or injection (not subject to rule G). (Modifier 0005 not applicable) |
9 |
147.96 |
9 |
147.96 |
3 |
230.43 +T |
||||
3.6 |
Musculo-skeletal system: Miscellaneous |
|
|||||||||
3.6.1 |
Leg lengthening |
|
|||||||||
0861 |
Leg lengthening |
416 |
6,839.04 |
332.8 |
5,471.23 |
3 |
230.43 +T+M |
||||
3.6.2 |
Removal of internal fixatives or prosthesis |
|
|||||||||
0863 |
Readily accessible |
36.6 |
601.70 |
36.6 |
601.70 |
|
As per bone |
||||
0864 |
Less accessible |
75.5 |
1,241.22 |
75.5 |
1,241.22 |
|
+M |
||||
0865 |
Removal of prosthesis for infection soon after operation |
128 |
2,104.32 |
120 |
1,972.80 |
|
As per bone +M |
||||
0866 |
Late removal of infected or not infected total joint replacement prosthesis (including six weeks after-care). ADD to the item for total joint replacement of the specific joint |
+ 4 |
1,052.16 |
64 |
1,052.16 |
6 |
460.66 +T+M |
||||
3.7 |
Plasters (not subject to rule G)
Note: The initial application of a plaster cast is included in the scheduled fee.
Note: The Commissioner will only consider payment i.r.o splinting material (Scotschcast, Dynacast. etc.) in the following cases (not applicable when Plaster of Paris is used). Where extremity splints are applied for at least five weeks: A maximum of one application for an upper extremity injury. A maximum of two applications for a lower extremity injury. |
|
|||||||||
0887 |
Long limb cast (excluding after-care). (Modifier 0005 not applicable) |
13 |
213.72 |
13 |
213.72 |
3 |
230.43 +T |
||||
0888 |
Short limb cast (excluding after-care) (modifier 0005 not applicable) |
6.6 |
108.50 |
6.6 |
108.50 |
3 |
230.43 +T |
||||
0889 |
Spica, plaster jacket or hinged cast brace (excluding aftercare) |
32 |
526.08 |
32 |
526.08 |
4 |
307.24 +T |
||||
3.8 |
Specific areas |
|
|||||||||
3.8.1 |
Foot and ankle |
|
|||||||||
0900 |
Excision tarsal coalition - stand alone procedure |
141,5 |
2,326.26 |
120.00 |
1,912.80 |
3 |
230.4 +T+M |
||||
0901 |
Tenotomy single tendon |
63.3 |
1,040.65 |
63.3 |
1,040.65 |
3 |
230.43 +T+M |
||||
0903 |
Hammertoe: one toe |
99.5 |
1,635.78 |
99.5 |
1,635.78 |
3 |
230.43 +T+M |
||||
0905 |
Fillet of toe or Ruiz-Mora procedure |
99.5 |
1,635.78 |
99.5 |
1,635.78 |
3 |
230.43 +T+M |
||||
0906 |
Arthrodesis Hallux |
148 |
2,433.12 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0909 |
Excision arthroplasty |
145.2 |
2,387.09 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
0910 |
Cheilectomy or metatarsophangeal implant Hallux |
183 |
3,008.52 |
146.4 |
2,406.82 |
3 |
230,43 +T+M |
||||
0911 |
Metatarsal osteotomy or Lapidus or similar or Chevron - stand alone procedure |
189.2 |
3,110.45 |
151.36 |
2,488.36 |
3 |
230.43 +T+M |
||||
5730 |
Hallux valgus double osteotomy etc |
182.60 |
3,001.94 |
146.08 |
2,401.56 |
3 |
230.43 +T+M |
||||
5731 |
Distal soft tissue procedure for Hallux Valgus |
173.6 |
2,853.98 |
138.88 |
2,283.19 |
3 |
230.43 +T+M |
||||
5732 |
Aitkin procedure or similar |
166.8 |
2,742.19 |
133.44 |
2,193.75 |
3 |
230.43 +T+M |
||||
5734 |
Removal bony prominence foot (bunionette not applicable to COlD) |
91 |
1,496.04 |
91 |
1,496.04 |
3 |
230.43 +T+M |
||||
5735 |
Repair angular deformity toe (lesser toes) |
97.2 |
1.597.97 |
97 2 |
1,597.97 |
3 |
230.43 +T+M |
||||
5736 |
Sesamoidectomy |
97.8 |
1,607.83 |
97.8 |
1,607.83 |
3 |
230.43 +T+M |
||||
5737 |
Repair major foot tendons e.g. Tib Post |
147.30 |
2,421.61 |
120 |
1,972.80 |
3 |
230.43 +T |
||||
5738 |
Repair of dislocating peroneal tendons |
173.2 |
2,847.41 |
138,56 |
2,277.93 |
3 |
230.43 +T |
||||
5740 |
Steindler strip – plantar fascia |
97.2 |
1,597.97 |
97.2 |
1,597.97 |
3 |
230.43 +T |
||||
5742 |
Tendon transfer foot |
172 |
2,827.68 |
137.6 |
2,262.14 |
3 |
230.43 +T |
||||
5743 |
Capsulotomy metatarsophalangeal joints –foot |
86.8 |
1,426.99 |
86.8 |
1,426.99 |
3 |
230.43 +T |
||||
3.8.3 |
Replantation |
|
|||||||||
0912 |
Replantation of amputated upper limb proximal to wrist joint |
730 |
12,001.20 |
584 |
9,600.96 |
3 |
230.43 +T+M |
||||
0913 |
Replantation of thumb |
670 |
11,014.80 |
536 |
8,811.84 |
3 |
230.43 +T+M |
||||
0914 |
Replantation of a single digit (to be motivated), for multiple digits modifier 0005 applicable |
580 |
9,535.20 |
464 |
7,628.16 |
3 |
230.43 +T+M |
||||
0915 |
Replantation operation through the palm |
1270 |
20,878.80 |
1016 |
16,703.04 |
3 |
230.43 +T+M |
||||
3.8.4 |
Hands: (Note: Skin: See Integumentary system) |
|
|||||||||
0919 |
Tumours: Epidermiod cysts |
35 |
575.40 |
35 |
575.40 |
3 |
230.43 +T+M |
||||
0922 |
Removal of foreign bodies requiring incision: Under local anaesthetic |
19 |
312.36 |
19 |
312.36 |
3 |
230.43 +T+M |
||||
0923 |
Removal of foreign bodies requiring incision: Under general or regional anaesthetic |
32 |
526.08 |
32 |
526.08 |
3 |
230.43 +T+M |
||||
0924 |
Crushed hand injuries: Initial extensive soft tissue toilet under general anaesthetic (sliding scale) |
37 to 110 |
608.28 #VALUE! 1,808.40 |
37 to 110 |
608.28 #VALUE! 1,808.40 |
3 |
230.43 +T+M |
||||
0925 |
Crushed hand injuries: Subsequent dressing changes under general anaesthetic |
16 |
263.04 |
16 |
263.04 |
3 |
230.43 +T+M |
||||
0926 |
Initial treatment of fractures, tendons, nerves, loss of skin and blood vessels. including removal of dead tissue under general anaesthesia and six weeks after-care |
269 |
4,422.36 |
215.2 |
3,537.89 |
3 |
230.43 +T+M |
||||
3.8.5 |
Spine |
|
|||||||||
0927 |
Excision of one vertebral body, for a lesion within the body (no decompression) |
207 |
3,403.08 |
165.6 |
2,722.46 |
3 |
230.43 +T+M |
||||
0928 |
Excision of each additional vertebral segment for a lesion within the body (no decompression) |
+ 42 |
690.48 |
42 |
690.48 |
3 |
230.43 +T+M |
||||
0929 |
Manipulation of spine with anaesthetic (no after-care), modifier 0005 not applicable |
14 |
230.16 |
14 |
230.16 |
5 |
384.05 +T+M |
||||
0930 |
Postenor osteotomy of spine: One vertebral segment |
339 |
5,573.18 |
271.2 |
4,458.53 |
3 |
230.43 +T+M |
||||
0931 |
Postenor spinal fusion: One level |
385 |
6,329.40 |
308 |
5,063.52 |
3 |
230.43 +T+M |
||||
0932 |
Posterior osteotomy of spine: Each additional vertebral segment |
+ 103 |
1,693.32 |
103 |
1,693.32 |
3 |
230.43 +T+M |
||||
0933 |
Anterior spinal osteotomy with disc removal: One vertebral segment |
315 |
5,178.60 |
252 |
4,142.88 |
3 |
230.43 +T+M |
||||
0936 |
Anterior spinal osteotomy with disc removal: Each additional vertebral segment |
+ -103 |
1,693.32 |
-103 |
1,693.32 |
3 |
230.43 +T+M |
||||
0938 |
Anterior fusion base of skull to C2 |
449 |
7,361.56 |
359.2 |
5,905.25 |
4 |
307.24 +T+M |
||||
0939 |
Trans-abdominal anterior exposure of the spine for spinal-fusion only if done by a second surgeon |
160 |
2,630.40 |
128 |
2,104.32 |
3 |
230.43 +T+M |
||||
0940 |
Transthoracic anterior exposure of the spine if done by a second surgeon |
160 |
2,630.40 |
128 |
2.104.32 |
3 |
230.43 +T+M |
||||
0941 |
Anterior interbody fusion: One level |
360 |
5,918.40 |
288 |
4,734.72 |
3 |
230.43 +T+M |
||||
0942 |
Anterior interbody fusion: Each additional level |
+ 102 |
1.676.88 |
+102 |
1,676.88 |
3 |
230.43 +T+M |
||||
0943 |
Laminectomy with decompression of nerve roots and disc removal: One level |
240 |
3,945.60 |
192 |
3,156.46 |
3 |
230.43 +T+M |
||||
0944 |
Posterior fusion: Occiput to C2 |
390 |
6,411.60 |
312 |
5,129.28 |
4 |
307,24 +T+M |
||||
0946 |
Posterior spinal fusion: Each additional level |
+ +111 |
1,824.84 |
+111 |
1,824.84 |
3 |
230.43 +T+M |
||||
0948 |
Posterior interbody lumbar fusion: One level |
364 |
5,984.16 |
291.2 |
4,787.33 |
3 |
230.43 +T+M |
||||
0950 |
Posterior interbody lumbar fusion: Each additional interspace |
+ +95 |
1,561.80 |
+95 |
1,561.80 |
3 |
230.43 +T+M |
||||
0959 |
Excision of coccyx |
96 |
1,578.24 |
96 |
1,578.24 |
3 |
230.43 +T+M |
||||
0960 |
Posterior non-segmental instrumentation |
167 |
2,745.46 |
133.6 |
2,196.38 |
5 |
384.05 +T+M |
||||
0961 |
Costo-transversectomy |
198 |
3,255.12 |
158.4 |
2,604.10 |
3 |
230.43 +T+M |
||||
0962 |
Posterior segmental instrumentation2 to 6 vertebrae |
176 |
2,893.44 |
140.8 |
2,314.75 |
5 |
384.05 +T+M |
||||
0963 |
Antero-lateral decompression of spinal cord or anterior debridement |
326 |
5,359.44 |
260.8 |
4,287.55 |
3 |
230.43 +T+M |
||||
0964 |
Posterior segmental instrumentation:- 7 to 12 vertebrae |
201 |
3,304.44 |
160.8 |
2,643.55 |
5 |
384.05 +T+M |
||||
0966 |
Posterior segmental instrumentation: 13 or more vertebrae |
245 |
4,027.80 |
196 |
3,222.24 |
5 |
384.05 +T+M |
||||
0968 |
Anterior instrumentation - 2 to 3 vertebrae |
159 |
2,613.96 |
127.2 |
2,091.17 |
5 |
384.05 +T+M |
||||
0969 |
Skull or skull·femoral traction including two weeks after-care |
64 |
1,052.16 |
64 |
1,052.16 |
- |
#VALUE! |
||||
0970 |
Anterior instrumentation: 4 to 7 vertebrae |
185 |
3,041.40 |
148 |
2,433.12 |
5 |
384.05 +T+M |
||||
0972 |
Anterior instrumentation: 8 or more vertebrae |
206 |
3,386.64 |
164.8 |
2,709.31 |
5 |
384.05 +T+M |
||||
0974 |
Additional pelvic fixation of instrumentation other than sacrum |
108 |
1,775.52 |
108 |
1,775.52 |
5 |
384.05 +T+M |
||||
5750 |
Reinsertion of instrumentation |
276 |
4,537.44 |
220.8 |
3,629.95 |
6 |
460.86 +T+M |
||||
5751 |
Removal of posterior non-segmental instrumentation |
173 |
2,844.12 |
138.4 |
2,275.30 |
6 |
460.86 +T+M |
||||
5752 |
Removal of posterior segmental instrumentation |
175 |
2,877.00 |
140 |
2,301.60 |
6 |
460.86 +T+M |
||||
5753 |
Removal of anterior instrumentation |
204 |
3,353.78 |
163.2 |
2,683.01 |
6 |
460.86 +T+M |
||||
5755 |
Laminectomy for spinal stenosis (exclude diskectomy, foraminotomy and spondylolisthesis): One or two levels |
295 |
4,849.60 |
236 |
3,879.84 |
3 |
230.43 +T+M |
||||
5756 |
Laminectomy with full decompression for spondylolisthesis (Gill procedure) |
304 |
4,997.76 |
243.2 |
3,998.21 |
3 |
230.43 +T+M |
||||
5757 |
Laminectomy for decompression without foraminotomy or diskectomy more than two levels |
321 |
5,277.24 |
256.8 |
4,221.79 |
3 |
230.43 +T+M |
||||
5758 |
Laminectomy with decompression of nerve roots and disc removal: Each additional level |
63 |
1,035.72 |
63 |
1,035.72 |
3 |
230.43 +T+M |
||||
5759 |
Laminectomy for decompression diskectomy etc., revision operation |
352 |
5,786.88 |
281.6 |
4,629.50 |
4 |
307.24 +T+M |
||||
5760 |
Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: One level |
301 |
4,948.44 |
240.8 |
3,958.75 |
3 |
230.43 +T+M |
||||
5761 |
Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: Each additional level |
68 |
1,117.92 |
68 |
1,117,92 |
3 |
230.43 +T+M |
||||
5763 |
Anterior disc removal and spinal decompression cervical. One level |
344 |
5,655.36 |
275.2 |
4,524.29 |
3 |
230.43 +T+M |
||||
5764 |
Anterior disc removal and spinal decompression cervical: Each additional level |
81 |
1,331.84 |
81 |
1,331.84 |
3 |
230.43 +T+M |
||||
5765 |
Vertebral corpectomy for spinal decompression: One level |
466 |
7,661.04 |
372.8 |
6,128.83 |
3 |
230.43 +T+M |
||||
5766 |
Vertebral corpectomy for spinal decompression: Each additional level |
88 |
1,446,72 |
88 |
1,446.72 |
3 |
230.43 +T+M |
||||
5770 |
Use of microscope in spinal and intercranial procedures (modifier 0005 not applicable) |
71 |
1,167.24 |
71 |
1,167.24 |
|
|
||||
3.9 |
Facial bone procedures Please note: Modifiers 0046 to 0058 are not applicable to section 3 9 of the tariff. |
|
|||||||||
0987 |
Repair of orbital floor (blowout fracture) |
184.6 |
3,034.82 |
147.68 |
2,427.86 |
4 |
307.24 +T+M |
||||
0988 |
Genioplasty |
263 |
4,323.72 |
210.4 |
3,458.98 |
4 |
307.24 +T+M |
||||
0989 |
Open reduction and fixation of central mid-third facial fracture with |
202.2 |
3,324.17 |
161.76 |
2,659.33 |
4 |
307.24 +T+M |
||||
0990 |
Open reduction and fixation of central mid-third facial fracture with displacement: LeFort II |
302 |
4,964.68 |
241.6 |
3,971.90 |
4 |
307.24 +T+M |
||||
0991 |
Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort III |
433 |
7,118.52 |
346.4 |
5,694.82 |
4 |
307.24 +T+M |
||||
0992 |
Open reduction and fixation of central mid-third facial fracture with displacement: LeFort I Osteotomy |
970 |
15,946.80 |
776 |
12,757.44 |
4 |
307.24 +T+M |
||||
0993 |
Open reduction and fixation of central mid-third facial fracture with displacement: Palatal Osteotomy |
302 |
4,954.88 |
241.6 |
3,971.90 |
4 |
307.24 +T+M |
||||
0994 |
Open reduction and fixation of central mid-third facial fracture with displacement: LeFort II Osteotomy (team fee) |
1103 |
18,133.32 |
882.4 |
14,506.66 |
4 |
307.24 +T+M |
||||
0995 |
Open reduction and fixation of central mid-third facial fracture with displacement: Le Fort Ill Osteotomy (team fee) |
1654 |
27,191.76 |
1323.2 |
21,753.41 |
4 |
307.24 +T+M |
||||
0996 |
Open reduction and fixation of central mid-third facial fracture with displacement: Fracture of maxilla without displacement |
|
|
|
|
|
|
||||
0997 |
Mandible: Fractured nose and zygoma. Open reduction and fixation |
302 |
4,964.88 |
241.6 |
3,971.90 |
3 |
230.43 +T+M |
||||
0999 |
Mandible: Fractured nose and zygoma. Closed reduction by inter-maxillary fixation |
184 |
3,024.96 |
147.2 |
2,419.97 |
3 |
230.43 +T+M |
||||
1001 |
Temporo-mandibular joint: Reconstruction for dysfunction |
206 |
3,386.64 |
164.8 |
2,709.31 |
4 |
307.24 +T+M |
||||
1003 |
Manipulation, immobilisation and follow-up of fractured nose |
35 |
575.40 |
35 |
575.40 |
3 |
230.43 +T+M |
||||
1005 |
Nasal fracture without manipulation |
|
|
|
|
|
|
||||
1007 |
Mandibulectomy |
320 |
5,260.80 |
256 |
4,208.64 |
5 |
384.05 +T+M |
||||
1009 |
Maxillectomy |
382.5 |
6,288.30 |
306 |
5,030.64 |
4 |
307.24 +T+M |
||||
1011 |
Bone graft to mandible |
206 |
3,386.64 |
164.8 |
2,709.31 |
4 |
307.24 +T+M |
||||
1012 |
Adjustment of occlusion by ramisection |
227 |
3,731.88 |
181.6 |
2,985.50 |
4 |
307.24 +T+M |
||||
1013 |
Fracture of arch of zygoma without displacement |
|
|
|
|
|
|
||||
1015 |
Fracture of arch of zygoma with displacement requiring operative manipulation but not including associated fractures, recent fractures (within four weeks) |
131 |
2,153.94 |
120 |
1,972.80 |
3 |
230.43 +T+M |
||||
1017 |
Fracture of arch of zygoma with displacement requiring operative manipulation (not including associated fractures) (after four weeks) |
262 |
4,307.28 |
209.6 |
3,445.82 |
3 |
230.43 +T+M |