Keeping Health Care Providers informed of payment, policy or program changes

To: All Providers
Published by: Claims Services Branch, Ministry of Health
Date Issued: April 15, 2020

Introduction

The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to implement physician compensation increases in accordance with the 2019 Kaplan Board of Arbitration Award.

This will be achieved through amendments to physician compensation under contracts and to regulations under the Health Insurance Act, including the Schedule of Benefits for Physician Services.

Delisted fee schedule codes with end date of March 31, 2020

Fee Schedule Code Description
S205

Appendectomy

S206 With gross perforation and peritonitis
C267 Subsequent visits-7th to 13th week inclusive
C269 Subsequent visits-after 13th week
G602 Neonatal intensive care-31st day onwards
Z819 Ventriculoscopy-External ventricular drainage

New fee schedule codes effective April 1, 2020

Fee Schedule Code Description Fee Assist Units Anaes. Units
E032C Anaesthesia service for Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499, Z555 or Z580 - - 4
S207 Appendectomy with or without perforation $458.60 6 7
E515 Incision of abscess or hematoma when performed as sole procedure under general anaesthetic in an operating room but not in an emergency department or emergency department equivalent. To Z102, Z172, Z105, Z107-increase the procedural fee(s) by. 100% - -
S152 Bowel lengthening procedure in a paediatric patient $1700.00 9 10
E084 Saturday, Sunday or Holiday Subsequent visit by the MRP, to subsequent visits and C122, C123, C124, C142, C143, C882 or C982-add 45% - -
K229 Complex genetic test interpretation $65.85 - -
A/C/W682 Extended special neurological consultation $401.30 - -
G496 Electroencephalography (EEG) with time locked video recording $120.00 - -
E060 Post renal transplant assessment premium-add 25% - -
A631 Nuclear medicine minor assessment-cancellation or deferral $17.75 - -
A632 Nuclear medicine minor assessment-advisability of nuclear medicine procedure $17.75 - -
R766 In-situ saphenous vein arterial bypass-tibial-first vascular surgeon $1303.00 10 17
R767 In-situ saphenous vein arterial bypass-tibial-second vascular surgeon $1303.00 nil nil
E986 Suprarenal or supraceliac aortic cross clamp, to R802, R817, R877, R783, R784, R785, R858 or R859-add $250.00 - -

R731

Tricuspid valvuloplasty

$770.55

18

28

A/C384 Consultation and Management for Acute Cerebral Vascular Syndrome (ACVS) $200.00 - -
K181 Management of Acute Cerebral Vascular Syndrome, after first 30 minutes, must include intravenous thrombolysis therapy and monitoring, per 30 minute unit (or major part thereof) $90.00 - -
A633 Nuclear medicine specific assessment $60.00    

Revised fee schedule codes effective April 1, 2020

Fee Schedule Code Description
E100C Attendance at delivery. Allow 4 base units plus time units
S117 Pyloromyotomy-Allow only for newborns and infants

C262

Can be billed daily. All other conditions continue to apply
G601 Level A neonatal intensive care 2nd day onwards
E386 Extradural decompression-spinal cord or cauda equina, tumour or infection-Increase add-on percentage from 40% to 42%
E683 Lungs and pleura-excision-when performed thorascopically or by VATS-Increase add-on percentage from 25% to 28%
E023C Anaesthesia service-Allow only with E137, E138, E139, E140, E141, E143, E144, E145, E146, E147, E149, Z432, Z606 or Z607
E676A/B Obesity Premium-Add the following codes that E676A/B can be billed with: S089A, S090A, S207, M142A, M143A, M144A
G412 Nephrological component of renal transplantatation-1st day –only after kidney transplant
G408 Nephrological component of renal transplantatation-2nd to 10th day inclusive –only after kidney transplant
G409 Nephrological component of renal transplantatation-11th to 21st day inclusive –only after kidney transplant
E638 With transbronchial lung biopsy with or without image intensification , to Z327-add
S329 S329 may only be claimed for nonelective surgery admitted through the Emergency department
E525 After localization with mammographic wire or radioactive seeds, to R107-add
G804, G805 Hyperbaric oxygen therapy for idiopathic sudden sensorneural hearing loss-change treatment initiation time period from 14 to 30 days

Technical services changes effective April 1, 2020

  • All technical services will receive a fee increase of 3.5400% with the exception of technical services performed in hospital
  • Technical services performed in hospital are defined as those with a Service Location Indicator of HED (hospital emergency department), HOP (hospital out patient), HDS (hospital day surgery), HRP (hospital referred patient)
  • Note that HIP (hospital in-patient) technical fees are disallowed

New premiums effective April 1, 2020

Hospitalist premium

Physicians submitting claims with speciality 00 (General and Family Practice) and 13 (Internal Medicine) and practicing as a Hospitalist will be eligible for a premium of 17% for core services listed below, with the exception of E082, based on service encounters and with minimum of 1,500 core services billed on at least 110 distinct days in the previous fiscal year (April 1-March 31). Premium will be for core services provided on or after April 1, 2020. Payments will be made periodically until a system solution is implemented. More details will follow in a future communication.

The Hospitalist Premium and Internal Medicine Office Assessment Premium payments will be reported on the Remittance Advice (RA) under Premium Payments, Hospitalist and Internal Medicine.

Core services

  • A933A-On-call admission assessment
  • C933A-On-call admission assessment
  • C002A-Subsequent visit-first five weeks
  • C007A-Subsequent visit-6th to13th weeks
  • C009A-Subsequent visit-after 13th week
  • C122A-Subsequent visit by MRP-day following hospital admission assessment
  • C123A-Subsequent visit by MRP-second day following the hospital assessment
  • C124A-Subsequent visit by MRP-day of discharge
  • C132A-Subsequent visit-first five weeks
  • C137A-Subsequent visit-6th to13th week
  • C139A-Subsequent visit-after 13th week
  • C142A-First subsequent visit by MRP following transfer from an Intensive Care area
  • C143A-Second subsequent visit by MRP following transfer from an Intensive Care area
  • C882A-Palliative care-GP
  • C982A-Palliative care-all other specialties
  • E082A-Admission assessment by the Most Responsible Physician premium

Internal medicine office assessment premium

Physicians who submitted claims solely with the Internal Medicine specialty (13) in the previous fiscal year (April 1-March 31) will be eligible for a premium of 12% of the fee approved amount on the following fee schedule codes:

  • A133A-Medical specific assessment
  • A134A-Medical specific re-assessment
  • A131A-Complex medical specific re-assessment
  • A138A-Partial assessment

The Hospitalist Premium and Internal Medicine Office Assessment Premium payments will be reported on the Remittance Advice (RA) under Premium Payments, Hospitalist and Internal Medicine.

General Practice (GP) psychotherapy premium

The General Practice (GP) Psychotherapy Premium will be increased to 17% effective April 1, 2020.

Unit fee increases

The Assistant Unit Fee will be increased to $12.25.
The Anaesthesiologist Unit Fee will be increased to $15.29.

Assistant base unit increases

Fee Schedule Code Description Current Units New Units

R240B

Arthroplasty-revision total arthroscopy shoulder

8

9

R241B

Arthroscopy-revision total arthroscopy hip

8

9

N500B

Anterior spine decompression-disc excision

9

10

N501B

Anterior spine decompression-vertebrectomy

9

11

N177B

Sciatic nerve in buttock

6

7

N189B

Peripheral nerves-nerve graft-ulnar nerve

6

7

N190B

Peripheral nerves-nerve graft-exploration

6

7

N283B

Peripheral nerves-exploration, decompression

6

7

N285B

Decompression/denervation-major nerve

6

7

N286B

Tumour or neuroma-major nerve

6

7

N287B

Nerve suture-major

6

7

N289B

Nerve suture-minor

6

7

Z823B

Implantation or revision of stimulation pack

6

8

Appendix A - Fee schedule code price changes

The following fee changes are effective April 1, 2020.

Fee Schedule Code Description Current Fee April 1, 2020 fee
A001 GP/FP-Minor assessment $21.70 $23.75
A003 GP/FP-General assessment $77.20 $84.45
A005 GP/FP-Consultation $77.20 $84.45
A007 GP/FP-Intermediate assessment/well baby care $33.70 $36.85
A015 Anaesthesia-Consultation $106.80 $107.25
A020 Complex dermatology assessment $49.95 $60.00
A023 Dermatology-Specific assessment $38.70 $43.00
A034 General Surgery-Partial assessment $24.10 $26.85
A070 Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient $185.00 $203.30
A071 Complex medical specific re-assessment $70.90 $84.35
A073 Medical specific assessment $79.85 $90.45
A074 Medical specific re-assessment $61.25 $72.90
A075 Consultation $175.00 $183.30
A078 Partial assessment $38.05 $45.30
A083 Plastic Surgery-Specific assessment $41.55 $44.95
A084 Plastic Surgery-Partial assessment $26.55 $28.70
A085 Plastic Surgery-Consultation $81.10 $87.70
A086 Plastic Surgery-Repeat consultation $47.95 $51.85
A113 Complex neuromuscular assessment $89.85 $91.00
A151 Endocrinology & Metabolism (15)-Complex medical specific re-assessment $70.90 $73.45
A153 Endocrinology & Metabolism (15)-Medical specific assessment $79.85 $82.75
A154 Endocrinology & Metabolism (15)-Medical specific re-assessment $61.25 $61.85
A155 Endocrinology & Metabolism (15)-Consultation $157.00 $162.65
A158 Endocrinology & Metabolism (15)-Partial assessment $38.05 $38.45
A161 Nephrology (16)-Complex medical specific re-assessment $70.90 $71.85
A163 Nephrology (16)-Medical specific assessment $79.85 $80.95
A164 Nephrology (16)-Medical specific re-assessment $61.25 $62.10
A165 Nephrology (16)-Nephrology-Consultation $157.00 $162.90
A168 Nephrology (16)-Partial assessment $38.05 $38.55
A181 Complex medical specific re-assessment $71.90 $72.85
A183 Medical specific assessment $78.80 $79.80
A184 Medical specific re-assessment $62.10 $62.90
A185 Consultation $176.35 $178.60
A188 Partial assessment $37.65 $38.15
A191 Consultative interview with caregiver(s) of a patient at least 65 years of age, or a patient less than 65 years of age with a diagnosis of dementia $212.65 $230.00
A192 Consultative interview with patient at least 65 years of age, or a patient less than 65 years of age with a diagnosis of dementia $212.65 $230.00
A193 Specific assessment $79.85 $86.35
A194 Partial assessment $38.05 $41.15
A195 Consultation $199.40 $215.65
A197 Consultative interview with parent(s) or patient representative(s) of patient less than age 22 $212.65 $230.00
A198 Consultative interview with patient less than age 22 $212.65 $230.00
A203 OB/GYN-Specific assessment $47.45 $52.15
A204 OB/GYN-Partial assessment $26.35 $33.70
A205 OB/GYN-Consultation $101.70 $111.70
A206 OB/GYN-Repeat consultation $54.10 $59.45
A223 Extended special genetic consultation $395.65 $401.30
A225 Consultation $165.00 $167.35
A235 Ophthalmology-Consultation $82.30 $82.20
A244 Otolaryngology-Partial assessment $24.55 $25.70
A245 Otolaryngology-Consultation $77.90 $79.90
A253 Ophthalmology-Optometrist-Requested Assessment (ORA) $82.30 $82.20
A262 Paediatrics-Level 2-Paediatric assessment $42.15 $43.45
A263 Paediatrics-Medical specific assessment $77.70 $80.05
A264 Paediatrics-Medical specific re-assessment $59.45 $61.25
A265 Paediatrics-Consultation $167.00 $175.40
A268 Paediatrics-Enhanced 18 month well baby visit $62.40 $64.30
A315 Physical Medicine and Rehabilitation-Consultation $172.85 $189.20
A348 Radiation Oncology-Partial assessment $37.05 $36.25
A353 Urology-Specific assessment $45.00 $45.55
A354 Urology-Partial assessment $26.00 $26.70
A355 Urology-Consultation $80.00 $83.15
A356 Urology-Repeat consultation $55.75 $56.40
A461 Infectious Disease (46)-Complex medical specific re-assessment $70.90 $80.70
A463 Infectious Disease (46)-Medical specific assessment $79.85 $90.85
A464 Infectious Disease (46)-Medical specific re-assessment $61.25 $69.70
A465 Infectious Disease (46)-Consultation $157.00 $178.65
A468 Infectious Disease (46)-Partial assessment $38.05 $43.30
A471 Respiratory Disease (47)-Complex medical specific re-assessment $70.90 $73.75
A473 Respiratory Disease (47)-Medical specific assessment $79.85 $84.65
A474 Respiratory Disease (47)-Medical specific re-assessment $61.25 $63.70
A475 Respiratory Disease (47)-Consultation $157.00 $169.65
A478 Respiratory Disease (47)-Partial assessment $38.05 $38.25
A480 Rheumatology (48)-Complex rheumatology assessment $89.85 $92.20
A481 Rheumatology (48)-Complex medical specific re-assessment $70.90 $72.65
A483 Rheumatology (48)-Medical specific assessment $79.85 $81.70
A484 Rheumatology (48)-Medical specific re-assessment $61.25 $62.60
A485 Rheumatology (48)-Consultation $157.00 $170.10
A486 Rheumatology (48)-Repeat consultation $105.25 $109.35
A488 Rheumatology (48)-Partial assessment $38.05 $39.10
A511 Physical Medicine and Rehabilitation-Complex physiatry assessment $89.85 $98.35
A585 Laboratory medicine-Diagnostic consultation $64.70 $68.60
A595 Rheumatology (48)-Limited consultation $105.25 $109.35
A611 Haematology (61)-Complex medical specific re-assessment $70.90 $76.20
A613 Haematology (61)-Medical specific assessment $79.85 $85.80
A614 Haematology (61)-Medical specific re-assessment $61.25 $65.85
A615 Haematology (61)-Consultation $157.00 $168.75
A621 Clinical Immunology (62)-Complex medical specific re-assessment $70.90 $71.80
A623 Clinical Immunology (62)-Medical specific assessment $79.85 $80.90
A624 Clinical Immunology (62)-Medical specific re-assessment $61.25 $62.05
A625 Clinical Immunology (62)-Consultation $157.00 $159.00
A628 Clinical Immunology (62)-Partial assessment $38.05 $38.55
A635 Nuclear Medicine-Consultation $82.40 $157.00
A636 Repeat consultation $57.25 $70.00
A638 Partial assessment $35.35 $40.00
A645 General Thoracic Surgery (64)-Consultation $90.30 $98.55
A661 Paediatrics-Complex medical specific re-assessment $68.80 $72.25
A662 Paediatrics-Extended special paediatric consultation $395.65 $401.30
A665 Paediatrics-Prenatal consultation $91.35 $100.55
A667 Paediatrics-Neurodevelopmental consultation $395.65 $401.30
A695 Neurodevelopmental consultation $395.65 $401.30
A735 Nuclear Medicine-Diagnostic consultation $33.70 $67.40
A760 Endocrinology & Metabolism (15)-Complex endocrine neoplastic disease assessment $89.85 $90.75
A770 Extended comprehensive geriatric consultation $395.65 $401.30
A777 GP/FP-Intermediate assessment-Pronouncement of death $33.70 $36.85
A800 Midwife-requested genetic assessment $165.00 $167.35
A802 Extended midwife-requested genetic assessment $395.65 $401.30
A813 GP/FP-Midwife-Requested Assessment (MRA)

$101.70

$111.70
A835 Nuclear Medicine-Special Nuclear Medicine consultation $180.00 $300.70
A888 GP/FP-ED equivalent-Partial assessment $33.70 $36.85
A895 Consultation in association with special visit to a hospital $232.70 $251.70
A905 GP/FP-Limited consultation $65.90 $72.10
A917 GP/FP-Focused Practice Assessment (FPA)-Sport medicine FPA $33.70 $36.85
A921 Obstetrics-Medical management of early or ectopic pregnancy-Follow-Up visit $33.70 $36.85
A927 GP/FP-Focused Practice Assessment (FPA)-Allergy FPA $33.70 $36.85
A937 GP/FP-Focused Practice Assessment (FPA)-Pain management FPA $33.70 $36.85
A945 GP/FP-Special palliative care consultation $144.75 $159.20
A947 GP/FP-Focused Practice Assessment (FPA)-Sleep medicine FPA $33.70 $36.85
A957 GP/FP-Focused Practice Assessment (FPA)-Addiction medicine FPA $33.70 $36.85
A967 GP/FP-Care of the elderly FPA $33.70 $36.85
B400 Community Palliative On-Call Program $471.23 $487.93
C002 family & general practice-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit $31.00 $34.10
C003 GP/FP-Non-emergency hospital in-patient services-General assessment $77.20 $84.45
C005 GP/FP-Non-emergency hospital in-patient services-Consultation $77.20 $84.45
C015 Anaesthesia-Non-emergency hospital in-patient services-Consultation $106.80 $107.25
C020 Complex dermatology assessment $49.95 $60.00
C023 Dermatology-Non-emergency hospital in-patient services-Specific assessment $38.70 $43.00
C034 Specific re-assessment $25.95 $28.90
C071 Complex medical specific re-assessment $70.90 $84.35
C072 geriatrics-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit $31.00 $34.10
C073 Medical specific assessment $79.85 $90.45
C074 Medical specific re-assessment $61.25 $72.90
C075 Consultation $185.00 $203.30
C077 Geriatrics-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit $31.00 $34.10
C078 Geriatrics-non-emergency hospital in-patient services-concurrent care, per visit $31.00 $34.10
C079 Geriatrics-non-emergency hospital in-patient services-subsequent visits-after 13th wk (max. of 6/mth)-per visit $31.00 $34.10
C083 Plastic Surgery-Non-emergency hospital in-patient services-Specific assessment $41.55 $44.95
C084 Plastic Surgery-Non-emergency hospital in-patient services-Specific re-assessment $27.80 $28.80
C085 Plastic Surgery-Non-emergency hospital in-patient services-Consultation $81.10 $87.70
C086 Plastic Surgery-Non-emergency hospital in-patient services-Repeat consultation $47.95 $51.85
C113 Complex neuromuscular assessment $89.85 $91.00
C122 Subsequent visits-MRP-day following hospital admission assessment $58.80 $61.15
C123 Subsequent visits-MRP-second day following hospital assessment $58.80 $61.15
C124 Subsequent visits-MRP-day of discharge $58.80 $61.15
C132 Internal medicine-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit $31.00 $32.65
C137 Internal medicine-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit $31.00 $32.65
C138 Internal medicine-non-emergency hospital in-patient services-concurrent care, per visit $31.00 $32.65
C139 Internal medicine-non-emergency hospital in-patient services-subsequent visits-after 13th week (max. of 6/mth)-per visit $31.00 $32.65
C142 Subsequent visit-MRP-first subsequent visit following transfer from IC $58.80 $61.15
C143 Subsequent visit-MRP-second subsequent visit following transfer from IC $58.80 $61.15
C151 Endocrinology & Metabolism (15)-Complex medical specific re-assessment $70.90 $73.45
C153 Endocrinology & Metabolism (15)-Medical specific assessment $79.85 $82.75
C154 Endocrinology & Metabolism (15)-Medical specific re-assessment $61.25 $61.85
C155 Endocrinology & Metabolism (15)-Consultation $157.00 $162.65
C161 Nephrology (16)-Complex medical specific re-assessment $70.90 $71.85
C162 Nephrology-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit $31.00 $33.95
C163 Nephrology (16)-Medical specific assessment $79.85 $80.95
C164 Nephrology (16)-Medical specific re-assessment $61.25 $62.10
C165 Nephrology (16)-Consultation $157.00 $162.90
C167 Nephrology-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit $31.00 $33.95
C169 Nephrology-non-emergency hospital in-patient services-subsequent visits-after 13th week (max. of 6/mth)-per visit $31.00 $33.95
C181 Complex medical specific re-assessment $71.90 $72.85
C183 Medical specific assessment $78.80 $79.80
C184 Medical specific re-assessment $62.10 $62.90
C185 Consultation $176.35 $178.60
C193 Specific assessment $79.85 $86.35
C194 Specific re-assessment $61.25 $66.25
C203 OB/GYN-Specific assessment $47.45 $52.15
C204 OB/GYN-Specific re-assessment $29.65 $36.85
C205 OB/GYN-Consultation $101.70 $111.70
C206 OB/GYN-Repeat consultation $54.10 $59.45
C223 Extended special genetic consultation $395.65 $401.30
C225 Consultation $165.00 $167.35
C235 Ophthalmology-Non-emergency hospital in-patient services-Consultation $82.30 $82.20
C245 Otolaryngology-Consultation $77.90 $79.90
C263 Paediatrics-Medical specific assessment $77.70 $80.05
C264 Paediatrics-Medical specific re-assessment $59.45 $61.25
C265 Paediatrics-Consultation $167.00 $175.40
C315 Physical Medicine and Rehabilitation-Non-emergency hospital in-patient services-Consultation $182.85 $200.15
C352 Urology-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit $31.00 $31.60
C353 Urology-Specific assessment $45.00 $45.55
C354 Urology-Specific re-assessment $26.00 $26.70
C355 Urology-Consultation $80.00 $83.15
C356 Urology-Repeat consultation $55.75 $56.40
C357 Urology-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit $31.00 $31.60
C358 Urology-non-emergency hospital in-patient services-concurrent care-per visit $31.00 $31.60
C359 Urology-non-emergency hospital in-patient services-subsequent visits-after 13th week (max. of 6/mth)-per visit $31.00 $31.60
C461 Infectious Disease (46)-Complex medical specific re-assessment $70.90 $80.70
C463 Infectious Disease (46)-Medical specific assessment $79.85 $90.85
C464 Infectious Disease (46)-Medical specific re-assessment $61.25 $69.70
C465 Infectious Disease (46)-Consultation $157.00 $178.65
C471 Respiratory Disease (47)-Complex medical specific re-assessment $70.90 $73.75
C472 Respiratory disease-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit $31.00 $33.30
C473 Respiratory Disease (47)-Medical specific assessment $79.85 $84.65
C474 Respiratory Disease (47)-Medical specific re-assessment $61.25 $63.70
C475 Respiratory Disease (47)-Consultation $157.00 $169.65
C477 Respiratory disease-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit $31.00 $33.30
C478 Respiratory disease-non-emergency hospital in-patient services-concurrent care, per visit $31.00 $34.10
C479 Respiratory disease-non-emergency hospital in-patient services-subsequent visits-after 13th wk (max. of 6/mth)-per visit $31.00 $34.10
C480 Rheumatology (48)-Complex rheumatology assessment $89.85 $92.20
C481 Rheumatology (48)-Complex medical specific re-assessment $70.90 $72.65
C483 Rheumatology (48)-Medical specific assessment $79.85 $81.70
C484 Rheumatology (48)-Complex medical specific re-assessment $61.25 $62.60
C485 Rheumatology (48)-Consultation $157.00 $170.10
C486 Rheumatology (48)-Repeat consultation $105.25 $109.35
C511 Physical Medicine and Rehabilitation-Non-emergency hospital in-patient services-Complex physiatry assessment $89.85 $98.35
C595 Rheumatology (48)-Limited consultation $105.25 $109.35
C611 Haematology (61)-Complex medical specific re-assessment $70.90 $76.20
C613 Haematology (61)-Medical specific assessment. $79.85 $85.80
C614 Haematology (61)-Medical specific re-assessment $61.25 $65.85
C615 Haematology (61)-Consultation $157.00 $168.75
C621 Clinical Immunology (62)-Complex medical specific re-assessment $70.90 $71.80
C623 Clinical Immunology (62)-Medical specific assessment $79.85 $80.90
C624 Clinical Immunology (62)-Medical specific re-assessment $61.25 $62.05
C625 Clinical Immunology (62)-Consultation $157.00 $159.00
C635 Nuclear Medicine-Non-emergency hospital in-patient services-Consultation $82.40 $157.00
C636 Repeat consultation $57.25 $70.00
C645 General Thoracic Surgery-Non-emergency hospital in-patient services-Consultation $90.30 $98.55
C661 Paediatrics-Complex medical specific re-assessment $68.80 $72.25
C662 Paediatrics-Extended special paediatric consultation-Subject to the same conditions as A662 $395.65 $401.30
C665 Paediatrics-Prenatal consultation $91.35 $100.55
C667 Paediatrics-Neurodevelopmental consultation $395.65 $401.30
C695 Neurodevelopmental consultation $395.65 $401.30
C735 Nuclear Medicine-Non-emergency hospital in-patient services-Diagnostic consultation $33.70 $67.40
C760 Endocrinology & Metabolism (15)-Complex endocrine neoplastic disease assessment $89.85 $90.75
C770 Extended comprehensive geriatric consultation $395.65 $401.30
C777 GP/FP-Non-emergency hospital in-patient services-Intermediate assessment-Pronouncement of death $33.70 $36.85
C800 Midwife-requested genetic assessment $165.00 $167.35
C802 Extended midwife-requested genetic assessment $395.65 $401.30
C813 GP/FP-Midwife-Requested Assessment $101.70 $111.70
C835 Nuclear Medicine-Non-emergency hospital in-patient services-Special Nuclear Medicine consultation $180.00 $300.70
C895 Consultation $232.70 $251.70
C905 GP/FP-Non-emergency hospital in-patient services-Limited consultation $65.90 $72.10
C945 GP/FP-Special palliative care consultation $144.75 $159.20
C983B Surgical Assistant-SVP-Saturdays, Sundays or Holidays, daytime and evenings (07:00h-24:00h), first patient seen $75.00 $85.60
C998B Surgical Assistant-SVP-Evenings (17:00h-24:00h) Monday to Friday, first patient seen $60.00 $67.05
C999B Surgical Assistant-SVP-Nights (00:00h-07:00h), first patient seen $100.00 $117.65
D028 Foot and Ankle-Reduction-Dislocations-Tarso-Metatarsal-Open reduction, one joint $300.00 $388.20
E079 GP/FP-Initial discussion with patient, to eligible services add $15.40 $15.55
E080 Assessments-First visit by Primary Care Physician after hospital discharge premium, to other service listed in payment rule 5, add $25.00 $25.25
E430 When Papanicolaou smear is performed outside of hospital, to G365,add $11.55 $11.95
E431 When Papanicolaou smear is performed outside of hospital, to G394, add $11.55 $11.95
E497 Hand and Wrist-Reconstruction-Bone-Pseudoarthrosis/non-union/avascular necrosis-Pedicled vascularized bone graft, to R322 or R345 add $350.00 $526.40
E525 Operations of the Breast-Excision-After mammographic wire localization, to R107 R111 add $41.55 $48.05
E542 When performed outside hospital, to G328, G378, G367, G370, R040, R041, R048, R049, R050, R094, R160, R161, R162, R163, R164, R165, S003, S006, Z080, Z081, Z082, Z083, Z084, Z085, Z096,Z101, Z103, Z104, Z106, Z114, Z116, Z122, Z123, Z124, Z125, Z126, Z127, Z128, Z129, Z173, Z174, Z130, Z131, Z141, Z154, Z156, Z157, Z158, Z162, Z163, Z164, Z $11.15 $11.55
E545 Vasectomy-when performed outside hospital add $11.15 $11.55
E608 Lungs and Pleura-each additional wedge resection of lung (to a maximum of 3), add $75.00 $84.15
E645 Heart and Pericardium-Coronary artery repair-Off pump coronary artery bypass grafting, to R742or R743 add $366.50 $371.00
E650 Heart and Pericardium-Pump bypass-Includes cannulating and decannulating heart or major vein, major artery, supervision of pump and pump run add $366.50 $371.00
E652 Heart and Pericardium-Coronary artery repair-Use of Internal mammary or epigastric or radial artery for construction of bypass graft, to R742 or R743 add $186.70 $187.85
E654 Heart and Pericardium-Coronary artery repair-Each additional add $187.70 $188.85
E671 Heart and Pericardium-Re-operation involving open heart procedures with pump-Following previous sternotomy add $337.00 $543.60
E691 Abdomen, Peritoneum and Omentum-Repair-Omphalocele and gastroschisis-requiring mobilization of abdominal wall musculature, to S348 add $100.00 $178.40
E705 Intestines (except rectum)-Into terminal ileum, to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add $30.50 $30.30
E730 Total thoracic oesophageal resection-with reconstruction, add $678.85 $740.95
E740 Intestines (except rectum)-Colonoscopy-To splenic flexure, to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add $51.95 $51.75
E741 Intestines (except rectum)-Colonoscopy-To hepatic flexure, to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add $31.40 $31.15
E747 Intestines (except rectum)-Endoscopy/Colonoscopy-To cecum add to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add $31.40 $31.15
E755 Male Genital-Penis-Repair-Hypospadias or Epispadia-With inflatable prosthesis add $55.15 $69.30
E756 Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Umbilical-With resection of strangulated contents add $111.45 $24.50
E764 Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Umbilical hernia repair when done in conjunction with other abdominal surgery, to other surgery add $96.85 $24.20
E889 Skull Base Surgery-Resection of Lesion(s)-Endonasal Approach-Complex endonasal endoscopic resection of pituitary and non-pituitary lesion(s)-complex endonasal endoscopic resection from cranial nerves, to N114 or N116, add $800.00 $520.00
E890 Skull Base Surgery-Resection of Lesion(s)-Endonasal Approach-Complex endonasal endoscopic resection of pituitary and non-pituitary lesion(s)-complex endonasal endoscopic resection from cavernous sinuses, to N114 or N116, add $800.00 $520.00
E891 Skull Base Surgery-Resection of Lesion(s)-Endonasal Approach-Complex endonasal endoscopic resection of pituitary and non-pituitary lesion(s)-complex endonasal endoscopic resection from frontal or temporal lobe or brainstem, to N114 or N116, add $800.00 $520.00
E898 Neurosurgery-Open Surgical Approach-Intracranial aneurysm repair-lesion greater than 2.5 cm, to N105 or N154, add $229.55 $283.80
E919 Cranial-intracranial duroplasty (greater than 2 cm diameter) to any intracranial procedure, add $244.80 $254.45
E921 Cranial-repeat cranial procedure-payable in addition to any intracranial procedure and N111, N114 and N116 but excluding N127, add $252.20 $262.15
F023 Elbow and Forearm-Reduction-Fractures-Radius and ulna-Monteggia-Open reduction of ulna plus closed reduction radial head $242.25 $416.65
F026 Elbow and Forearm-Reduction-Fractures-Radius and ulnar shaft-Open reduction $368.40 $528.55
F030 Elbow and Forearm-Reduction-Fractures-Radius-Distal, e.g. Colles', Smith's, or Barton's fracture-Open reduction $420.00 $499.40
F033 Elbow and Forearm-Reduction-Fractures-Radius or ulna-Open reduction $274.00 $438.05
F036 Elbow and Forearm-Reduction-Fractures-Olecranon-Open reduction $224.55 $414.60
F041 Elbow and Forearm-Reduction-Fractures-Transcondylar/condylar-open reduction $375.80 $600.00
F044 Shoulder, Arm and Chest-Reduction-Fractures-Shaft-Open reduction $323.05 $655.50
F052 Shoulder, Arm and Chest-Reduction-Fractures-Neck with dislocation of head-open reduction $385.15 $521.75
F055 Shoulder, Arm and Chest-Reduction-Fractures-Neck without dislocation of head-Open reduction $327.55 $514.95
F072 Foot and Ankle-Reduction-Fractures-Os calcis-Open reduction-With repair of both the subtalar and calcaneocuboid joints $500.00 $588.20
F076 Foot and Ankle-Reduction-Fractures-Ankle-Open reduction-One malleolus $237.50 $283.80
F077 Foot and Ankle-Reduction-Fractures-Ankle-Open reduction-Multiple malleoli or ligaments $400.00 $523.50
F080 Fibula and Tibia-Reduction-Fractures-Tibia with or without fibula-Open reduction-Shaft $356.40 $553.60
F081 Fibula and Tibia-Reduction-Fractures-Intramedullary nail with distal and proximal locking screws-Medial or lateral tibial plateau $394.45 $558.10
F096 Femur-Reconstruction-Fractures-Closed reduction-Open reduction $493.80 $613.95
F100 Pelvis and Hip-Reduction-Fractures-Femoral neck trochanteric, subtrochanteric-Open reduction-Pin and plate/screws (cannulated included) $498.95 $614.55
F101 Pelvis and Hip-Reduction-Fractures-Femoral neck trochanteric, subtrochanteric open reduction-Primary prosthesis, Femur only (includes Moore, Thompson, Unipolar, Bipolar) $490.95 $613.60
F108 Foot and Ankle-Reduction-Fractures-Ankle fracture with tibial Plafond burst-Open reduction $362.95 $616.15
F118 Shoulder, Arm and Chest-Reduction-Fractures-Clavicle-Open reduction $300.00 $458.75
F121 Shoulder, Arm and Chest-Reduction-Fractures-Scapula-Open reduction $242.25 $381.40
G001 Laboratory Medicine-Miscellaneous-Cholesterol, total $5.50 $5.70
G002 Laboratory Medicine-Miscellaneous-Glucose, quantitative or semi-quantitative $2.18 $2.26
G004 Laboratory Medicine-Miscellaneous-Occult blood $1.53 $1.58
G009 Laboratory Medicine-Miscellaneous-Urinalysis, routine (includes microscopic examination of centrifuged specimen plus any of SG, pH, protein, sugar, haemoglobin, ketones, urobilinogen, bilirubin) $4.30 $4.45
G010 Laboratory Medicine-one or more parts of above without microscopy $2.07 $2.14
G011 Laboratory Medicine-Miscellaneous-Fungus culture including KOH preparation and smear $12.60 $13.05
G012 Laboratory Medicine-Miscellaneous-Wet preparation (for fungus, trichomonas, parasites) $1.86 $1.93
G014 Laboratory Medicine-Miscellaneous-Rapid streptococcal test $5.50 $5.70
G031 Laboratory Medicine-Miscellaneous-Prothrombin time $6.20 $6.40
G112 ECG-Stress Testing-Dipyramidole Thallium stress test-professional component $75.00 $74.25
G197 Skin testing-professional component $0.19 $0.21
G208 Allergy-Provocation testing per unit $15.00 $16.85
G262 Cardiovascular-Angiography-Transluminal coronary angioplasty-Each additional major vessel add $212.45 $210.40
G263 Cardiovascular-Angiography-Selective coronary catheterization-With other drug interventional studies add $97.40 $96.45
G297 Cardiovascular-Angiography-Angiography-Angiograms (only two angiograms may be billed-One per right heart catheterization and one per left heart catheterization) irrespective of the number of chambers injected. $118.70 $117.55
G319 ECG-Stress Testing-Maximal stress ECG-professional component $62.65 $62.05
G365 Gynaecology-Papanicolaou Smear-Periodic $6.75 $8.65
G378 Gynaecology-Insertion of intrauterine contraceptive device $25.50 $31.10
G382 Chemotherapy-Monthly telephone supervision-Supervision of chemotherapy (pharmacologic therapy of malignancy or autoimmune disease) by telephone, monthly $13.30 $13.80
G388 Injections or Infusions-Management of special oral chemotherapy, for malignant disease $20.50 $25.75
G394 Gynaecology-Additional-for follow-Up of abnormal or inadequate smears/annually in a patient who is immunocompromised, e.g. HIV-Positive or taking long-Term immunosuppressants; or a patient with a history of oncogenic HPV-Typing; or-Where the physician is of the opinion that the patient is a member of a vulnerable group that may have difficulty accessing the services within the specified time period $6.75 $8.65
G405 Critical Care-Ventilatory support (ICA) physician-in-charge-1st day $193.45 $183.80
G406 Critical Care-Ventilatory support (ICA) physician-in-charge- 2nd to 30th day, inclusive per diem $101.55 $96.45
G407 Critical Care-Ventilatory support (ICA) physician-in-charge-31st day onwards per diem $67.60 $64.20
G408 Nephrology-Nephrological component of renal transplantation-2nd to 10th day, inclusive per diem $121.45 $139.65
G409 Nephrology-Nephrological component of renal transplantation-11th to 21st day, inclusive per diem $60.70 $69.80
G412 Nephrology-Nephrological component of renal transplantation-1st day following transplantation $242.90 $279.35
G418 Neurology-Routine EEG-professional component (16-21 channel EEG) $50.00 $62.50
G420 Otolaryngology-Ear syringing and/or extensive curetting or debridement unilateral or bilateral $11.25 $11.35
G473 Physical Medicine-Schedule C-professional component $191.00 $275.00
G478 diagnostic & therapeutic procedures-physical medicine-psychiatry-electroconvulsive therapy (ect) cerebral-single or multiple-in-patient $80.30 $86.85
G479 diagnostic & therapeutic procedures-physical medicine-psychiatry-electroconvulsive therapy (ect) cerebral-single or multiple-out-patient $92.60 $100.15
G481 Laboratory Medicine-Miscellaneous-Haemoglobin screen and/or haematocrit (any method or instrument) $1.32 $1.37
G512 Palliative Care-Palliative Care case management fee $62.75 $67.75
G526 Otolaryngology-Basic diagnostic hearing tests-Pure tone threshold audiometry (with or without bone conduction) and speech reception threshold and/or speech discrimination scores-professional component $15.70 $16.45
G538 Immunization-Other immunizing agents not listed above $4.50 $4.95
G543 Neurology-Electroencephalography-Sleep-deprived/induced EEG-professional component $60.00 $120.00
G557 Critical Care-Comprehensive Care (Intensive Care Area)-Physician-in-charge-1st day $325.40 $374.35
G558 Critical Care-Comprehensive Care (Intensive Care Area)-Physician-in-charge-2nd to 30th day, inclusive per diem $213.50 $223.50
G559 Critical Care-Comprehensive Care (Intensive Care Area)-Physician-in-charge-31st day onwards per diem $85.35 $113.00
G590 Immunization-Influenza agent $4.50 $4.95
G600 Critical Care-Neonatal intensive care-Level A-1st day $358.00 $376.05
G601 Critical Care-Neonatal intensive care-Level A-2nd to 30th day, inclusive per diem $178.95 $187.95
G603 Critical Care-Neonatal intensive care-Level A-Neonatal low volume intensive care-Payable in lieu of G600 or G604 if sole newborn to maximum of 25 services per physician per fiscal year $536.95 $564.00
G610 Critical Care-Neonatal intensive care-Level B-1st day $245.65 $258.05
G611 Critical Care-Neonatal intensive care-Level B-2nd day onwards, per diem $122.80 $129.00
G620 Critical Care-Neonatal intensive care-Level C-1st day $155.20 $162.95
G621 Critical Care-Neonatal intensive care-Level C-2nd day onwards, per diem $77.60 $81.50
G700 Basic fee-Per-Visit premium for procedures marked (+) $5.10 $5.60
G840 Injections and Infusions-Immunization-Diphtheria, Tetanus, and acellular Pertussis vaccine/ Inactivated Poliovirus vaccine (DTaP/IPV)-Paediatric $4.50 $5.40
G841 Injections and Infusions-Immunization-Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenza type b (DTaP-IPV-Hib)-Paediatric $4.50 $5.40
G842 Injections and Infusions-Immunization-Hepatitis B (HB) $4.50 $5.40
G843 Injections and Infusions-Immunization-Human Papillomavirus (HPV) $4.50 $5.40
G844 Injections and Infusions-Immunization-Meningococcal C Conjugate (Men-C) $4.50 $5.40
G845 Injections and Infusions-Immunization-Measles, mumps, rubella (MMR) $4.50 $5.40
G846 Injections and Infusions-Immunization-Pneumococcal conjugate $4.50 $5.40
G847 Injections and Infusions-Immunization-Diphtheria, Tetanus, acellular Pertussis (Tdap)-Adult $4.50 $5.40
G848 Injections and Infusions-Immunization-Varicella (VAR) $4.50 $5.40
H055 GP/FP-Emergency Medicine-ED-Physician on Duty-Consultation $97.60 $106.80
H065 GP/FP-Consultation in Emergency Medicine $74.25 $81.25
H101 GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Minor assessment $15.00 $16.55
H102 GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Comprehensive assessment and care $37.20 $41.65
H103 GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Multiple systems assessment $35.65 $39.35
H104 GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Re-assessment $15.00 $16.55
H112 GP/FP-Nights (00:00h to 08:00h) $34.20 $35.15
H113 GP/FP-Daytime and evenings (08:00h to 24:00h) on Saturdays, Sundays or Holidays $19.80 $20.35
H121 GP/FP-Nights (00:00h to 08:00h)-Minor assessment $29.80 $30.60
H122 GP/FP-Nights (00:00h to 08:00h)-Comprehensive assessment and care $73.90 $76.70
H123 GP/FP-Nights (00:00h to 08:00h)-Multiple systems assessment $65.95 $67.75
H124 GP/FP-Nights (00:00h to 08:00h)-Re-assessment $29.80 $30.60
H131 GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Minor assessment $18.70 $20.65
H132 GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Comprehensive assessment and care $46.30 $51.85
H133 GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Multiple systems assessment $42.40 $46.80
H134 GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Re-assessment $18.70 $20.65
H151 GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Minor assessment $25.50 $26.20
H152 GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Comprehensive assessment and care $63.30 $65.70
H153 GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Multiple systems assessment $56.95 $58.50
H154 GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Re-assessment $25.50 $26.20
H261 Paediatrics-Newborn care in hospital or home $57.90 $60.80
H312 -first twelve weeks per visit $39.00 $42.70
H313 Physical Medicine and Rehabilitation-Rehabilitation counselling-Per unit $76.95 $84.20
H317 -From thirteenth to twenty-sixth week (maximum) $39.00 $42.70
H319 -Twenty-seventh week onwards (maximum 6 per $39.00 $42.70
J135 Diagnostic Ultrasound-Thorax, abdomen and retroperitoneum-Abdominal scan-Complete $26.55 $26.45
J138 Diagnostic Ultrasound-Pelvis-Intracavitary ultrasound* (e.g. transrectal, transvaginal) $26.55 $26.50
J304 Pulmonary Function Studies-Flow volume loop-Volume versus flow study-From which an expiratory limb, and inspiratory limb if indicated, are generated. A flow volume loop may include derivation of FEV1, VC, V50, V25 $10.75 $11.30
J306 Pulmonary Function Studies-Functional residual capacity-Airways resistance by plethysmography or estimated using oesophageal catheter $16.05 $16.85
J307 Pulmonary Function Studies-Functional residual capacity-By body plethysmography $17.85 $18.75
J310 Pulmonary Function Studies-Functional residual capacity-Carbon monoxide diffusing capacity by single breath method $18.00 $18.90
J311 Pulmonary Function Studies-Functional residual capacity-By gas dilution method $17.55 $18.45
J327 Pulmonary Function Studies-Flow volume loop-Repeat after bronchodilator $6.45 $6.75
J332 Pulmonary Function Studies-Oxygen saturation-By oximetry at rest and exercise, or during sleep with or without O2 $10.80 $11.35
J333 Pulmonary Function Studies-Oxygen saturation-Non-Specific bronchial provocative test (histamine, methacholine, thermal challenge) $34.70 $36.45
J334 Pulmonary Function Studies-Oxygen saturation-J332 with at least two levels of supplemental O2 $16.05 $16.85
J336 Pulmonary Function Studies-Oxygen saturation-With single blind assessment of exercise on room air and with supplemental oxygen $16.05 $16.85
J802 Nuclear Medicine-IN VIVO-Cardiovascular system-Venography-Peripheral and superior vena cava $38.70 $40.30
J804 Nuclear Medicine-IN VIVO-Cardiovascular system-First transit-Without blood pool images $15.90 $16.55
J815 Nuclear Medicine-IN VIVO-Cardiovascular system-Myocardial wall motion-Detection of venous thrombosis using radioiodinated fibrinogen up to ten days $38.70 $40.30
J816 Nuclear Medicine-IN VIVO-Endocrine system-Adrenal scintigraphy-With iodocholesterol $38.70 $40.30
J817 Nuclear Medicine-IN VIVO-Endocrine system-Thyroid-Uptake $17.50 $18.25
J818 Nuclear Medicine-IN VIVO-Endocrine system-Thyroid scintigraphy with Tc99m or I-131 $38.70 $40.30
J819 Nuclear Medicine-IN VIVO-Musculoskeletal system-Application of Tomography (SPECT)-Where each SPECT image represents a different organ or body area, to J852, J652, maximum 3 images per examination add $23.65 $24.65
J820 Nuclear Medicine-IN VIVO-Endocrine system-Parathyroid scintigraphy-Dual isotope technique with T1201 and Tc99m Iodine $53.10 $55.30
J824 Nuclear Medicine-IN VIVO-Gastrointestinal system-Malabsorption test-With C14 substrate $9.95 $10.35
J827 Nuclear Medicine-IN VIVO-Gastrointestinal system-Calcium absorption-Oesophageal motility studies-one or more $38.70 $40.30
J829 Nuclear Medicine-IN VIVO-Gastrointestinal system-Gastrointestinal-Transit $38.70 $40.30
J830 Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Tc99m sulphur colloid or Tc04 $38.70 $40.30
J831 Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Biliary scintigraphy $38.70 $40.30
J832 Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Liver/spleen scintigraphy $38.70 $40.30
J833 Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Salivary gland scintigraphy $38.70 $40.30
J834 Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Dynamic renal imaging $31.30 $32.60
J835 Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Includes first transit $55.50 $57.80
J836 Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Static renal scintigraphy $38.70 $40.30
J837 Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-ERPF by blood sample method $9.95 $10.35
J838 Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-GFR by blood sample method $9.95 $10.35
J839 Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Cystography for vesicoureteric reflux $38.70 $40.30
J840 Nuclear Medicine-IN VIVO-Genitourinary system-Testicular and scrotal scintigraphy-Includes first transit $38.70 $40.30
J841 Nuclear Medicine-IN VIVO-Hematopoietic system-Plasma volume $11.40 $11.85
J843 Nuclear Medicine-IN VIVO-Hematopoietic system-Red cell volume $11.40 $11.85
J850 Nuclear Medicine-IN VIVO-Musculoskeletal system-Bone scintigraphy-General survey $47.70 $49.70
J851 Nuclear Medicine-IN VIVO-Musculoskeletal system-Bone scintigraphy-Single site $38.70 $40.30
J852 Nuclear Medicine-IN VIVO-Musculoskeletal system-Gallium scintigraphy-General survey $51.70 $49.70
J853 Nuclear Medicine-IN VIVO-Musculoskeletal system-Gallium scintigraphy-Single survey $38.70 $40.30
J857 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-With Tc99m or I-131 HSA $43.95 $45.75
J858 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-Brain scintigraphy $38.70 $40.30
J859 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-Respiratory system-Perfusion lung scintigraphy $34.60 $36.05
J860 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-Respiratory system-Perfusion and ventilation scintigraphy-Same day $47.70 $49.70
J861 Nuclear Medicine-IN VIVO-Miscellaneous-Radionuclide lymphangiogram $52.60 $54.80
J863 Nuclear Medicine-IN VIVO-Miscellaneous-Scintimammography-Unilateral or bilateral $38.70 $40.30
J864 Nuclear Medicine-IN VIVO-Miscellaneous-Tear duct scintigraphy $41.25 $42.95
J865 Nuclear Medicine-IN VIVO-Miscellaneous-Total body counting $38.70 $49.70
J867 Nuclear Medicine-IN VIVO-Cardiovascular system-First transit-With blood pool images $22.30 $23.25
J869 Nuclear Medicine-IN VIVO-Endocrine system-Adrenal scintigraphy-With MIBG $44.45 $49.70
J870 Nuclear Medicine-IN VIVO-Endocrine system-Thyroid-Repeat $10.30 $10.75
J871 Nuclear Medicine-IN VIVO-Endocrine system-Thyroid scintigraphy-With I-123 $38.70 $40.30
J872 Nuclear Medicine-IN VIVO-Endocrine system-Parathyroid scintigraphy-Metastatic survey with I-131 $44.45 $49.70
J876 Nuclear Medicine-IN VIVO-Gastrointestinal system-Gastro-oesophageal-reflux $38.70 $40.30
J877 Nuclear Medicine-IN VIVO-Gastrointestinal system-Gastro-oesophageal-Aspiration $38.70 $40.30
J878 Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Labelled RBCs $38.70 $40.30
J880 Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Repeat after pharmacological intervention $17.10 $17.80
J881 Nuclear Medicine-IN VIVO-Hematopoietic system-Bone marrow scintigraphy-Whole body $47.70 $49.70
J882 Nuclear Medicine-IN VIVO-Hematopoietic system-Bone marrow scintigraphy-Single site $38.70 $40.30
J883 Nuclear Medicine-IN VIVO-Hematopoietic system-In-111 leukocyte scintigraphy-Whole body $46.75 $49.70
J884 Nuclear Medicine-IN VIVO-Hematopoietic system-In-111 leukocyte scintigraphy-Single site $38.70 $40.30
J885 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-With In-111 $43.95 $45.75
J886 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-Via shunt puncture $42.70 $44.45
J887 Nuclear Medicine-IN VIVO-Nervous system and respiratory system-Respiratory system-Ventilation lung scintigraphy $34.60 $36.05
K002 Interviews-with relatives or a person who is authorized to make a treatment decision on behalf of the patient in accordance with the health care consent act, conducted for a purpose other than to obtain consent $62.75 $67.75
K003 Interviews-interviews with C.A.S. or legal guardian or a person who is authorized to make a treatment decision on behalf of the patient in accordance with the health care consent act, conducted for a purpose other than to obtain consent $62.75 $67.75
K004 Psychotherapy-family-2 or more family members in attendance at the same time-per ½ hour or major part thereof $68.10 $73.55
K005 Primary mental health care-individual care-per ½ hour or major part thereof $62.75 $67.75
K006 Hypnotherapy-individual-per ½ hour or major part thereof $62.75 $67.75
K007 Psychotherapy-individual care-per ½ hour or major part thereof $62.75 $67.75
K008 Interviews-diagnostic interview and/or counselling with child and/or parent-for psychological problem or for learning disabilities-per ½ hour or major part thereof $62.75 $67.75
K010 Psychotherapy-group-per ½ hour or major part thereof-per member (seventh hour onward per day to a maximum of six services) $10.00 $10.80
K012 Psychotherapy-group-per ½ hour or major part thereof-per member (up to six hours per day)-four people $15.80 $17.05
K013 Counselling-individual care-per ½ hour or major part thereof $62.75 $67.75
K014 Counselling-counselling for transplant recipients, donors or families of recipients and donors-one or more persons-per ½ hour or major part thereof $62.75 $67.75
K015 Counselling relatives on behalf of catastrophically or terminally ill patient-1 or more persons-per ½ hour or major part thereof $62.75 $67.75
K019 Psychotherapy-group-2 people $31.40 $33.90
K020 Psychotherapy-group-3 people $20.90 $22.55
K022 HIV primary care-primary care of patients infected with hiv-time-based all-inclusive visit fee per patient per day-per unit (½ hour or major part thereof) $62.75 $67.75
K023 Palliative care support-time-based all-inclusive visit fee per patient per day for the purpose of providing pain and symptom management, emotional support and counselling to patients with terminal disease in the final year of $62.75 $72.15
K024 Psychotherapy-group-per ½ hour or major part thereof-per member (up to six hours per day)-five people $13.00 $14.05
K025 Psychotherapy-group-per ½ hour or major part thereof-per member (up to six hours per day)-six to twelve people $11.05 $11.95
K028 Sexually Transmitted Disease (STD) management-per ½ hour or major part thereof $62.75 $67.75
K029 Insulin therapy support (its)-per ½ hour or major part thereof $62.75 $67.75
K030 GP/FP-Diabetic Management Assessment $39.20 $40.55
K032 Specific neurocognitive assessment-diagnosis of dementia $62.75 $67.75
K033 Counselling-individual care-additional units per patient per provider per year, per ½ hour or major part thereof $38.15 $47.70
K037 Fibromyalgia/chronic fatigue syndrome care-Fibromyalgia/chronic fatigue syndrome care $62.75 $67.75
K040 Group counselling-two or more persons-where no group members have received more than 3 units of any counselling paid under codes k013 and k040 combined per provider per year, per unit $62.75 $67.75
K041 Group counselling-two or more persons-additional units where any group member has received 3 or more units of any counselling paid under codes k013 and k040 combined per provider per year, per unit $38.80 $48.50
K077 Geriatrics-Geriatric telephone support per unit $35.45 $40.05
K119 Paediatrics-Paediatric developmental assessment incentive $100.00 $115.10
K122 Developmental and/or behavioural care-individual developmental and/or behavioural care $80.30 $86.85
K123 Developmental and/or behavioural care-family developmental and/or behavioural care $91.10 $98.55
K131 GP/FP-Periodic health visit-Adult age 18 to 64 inclusive $50.00 $54.00
K140 Chronic disease shared appointment-per patient-maximum 8 units per patient per day-2 patients-per unit $31.40 $33.90
K141 Chronic disease shared appointment-per patient-maximum 8 units per patient per day-3 patients-per unit $20.90 $22.55
K142 Chronic disease shared appointment-per patient-maximum 8 units per patient per day-4 patients-per unit $15.80 $17.05
K143 Chronic disease shared appointment-per patient-maximum 8 units per patient per day-5 patients-per unit $13.00 $14.05
K144 Chronic disease shared appointment-per patient-maximum 8 units per patient per day 6 to 12 patients-per unit $11.05 $11.95
K189 Urgent community psychiatric follow-up, to A190, A195, A695 or A795 add $200.00 $216.30
K190 Psychiatry-office/clinic-individual in-patient psychotherapy (including aversive conditioning, narcoanalysis, psychoanalysis)-per ½ hour or major part thereof $84.15 $91.00
K191 Psychiatry-family psychiatric care, in-patient, per ½ hour or major part thereof $105.10 $113.70
K192 Psychiatry-hypnotherapy-individual-per ½ hour or major part thereof $80.30 $86.85
K193 Psychiatry-family psychotherapy-in-patients (two or more family members) per ½ hour or major part thereof $95.45 $103.25
K194 Psychiatry-hypnotherapy-group-for induction and training for hypnosis (up to eight people) per ½ hour or major part thereof-per member $14.60 $15.80
K195 Psychiatry-family psychotherapy-out-patients (two or more family members) per ½ hour or major part thereof $91.10 $98.55
K196 Psychiatry-family psychiatric care, out-patient, per ½ hour or major part thereof $91.10 $98.55
K197 Psychiatry-office/clinic-individual out-patient psychotherapy (including aversive conditioning, narcoanalysis, psychoanalysis)-per ½ hour or major part thereof $80.30 $86.85
K198 Psychiatry-psychiatric care, out-patient, per ½ hour or major part thereof $80.30 $86.85
K199 Psychiatry-psychiatric care, in-patient, per ½ hour or major part thereof $92.60 $100.15
K200 Psychiatry-group psychotherapy, in-patients-per member, per ½ hour or major part thereof-up to six hours per day-4 people $21.00 $22.70
K201 Psychiatry-group psychotherapy-in-patients-per member-per unit (½ hr or major part thereof-first 12 units per day)-5 people $16.80 $18.15
K202 Psychiatry-group psychotherapy-in-patients-per member-per unit (½ hr or major part thereof-first 12 units per day)-6 to 12 people $15.15 $16.40
K203 Psychiatry-group psychotherapy-out-patients-per member-per unit (½ hr or major part thereof-first 12 units per day)-4 people $20.10 $21.75
K204 Psychiatry-group psychotherapy-out-patients-per member-per unit (½ hr or major part thereof-first 12 units per day)-5 people $16.05 $17.35
K205 Psychiatry-group psychotherapy-out-patients-per member-per unit (½ hr or major part thereof-first 12 units per day)-6 to 12 people $14.45 $15.65
K206 Psychiatry-group psychotherapy, out-patients-per member, per ½ hour-(seventh hour onward, to a maximum of 3 hours) $12.85 $13.90
K207 Outpatient psychotherapy-group-add'l units $12.85 $13.90
K208 Psychiatry-Psychotherapy, Family Psychotherapy, Hypnotherapy and Psychiatric Care-Group psychotherapy, out-patients-per member-first 12 units per day $40.15 $43.45
K209 Psychiatry (19)-Group psychotherapy, out-patients-per member-first 12 units per day- 3 people…per unit $26.75 $28.95
K210 Psychiatry (19)-Group psychotherapy, in-patients-per member-first 12 units per day-2 people…per unit $42.10 $45.55
K211 Psychiatry (19)-Group psychotherapy, in-patients-per member-first 12 units per day-3 people…per unit $28.05 $30.35
K222 Genetic care, patient or family, per unit $74.70 $75.75
K223 Clinical interpretation by a geneticist $37.65 $38.20
K224 Clinical interpretation requested by a midwife $37.65 $38.20
K620 Psychiatry-assessments under the mental health act-consultation for involuntary psychiatric treatment (as mandated by section 35a (2) of the mental health act)-per ½ hour or major part thereof $85.00 $91.95
K623 Family & general practice-assessments under the mental health act-application for psychiatric assessment-form 1 $104.80 $113.35
K624 Family & general practice-assessments under the mental health act-certification of involuntary admission-form 3 $129.05 $139.60
K629 Family & general practice-assessments under the mental health act-all other re-certification(s) of involuntary admission including completion of appropriate forms $38.25 $41.35
K630 Psychiatry-Psychiatric consultation extension-per unit $105.10 $113.70
K680 Substance abuse-extended assessment $62.75 $67.75
K887 Family & general practice-community treatment order (CTO)-CTO initiation-including completion of the CTO form and all preceding CTO services directly related to CTO initiation-per unit $84.70 $91.60
K888 Family & general practice-community treatment order (CTO)-CTO supervision-including all associated CTO services except those related to initiation or renewal-per unit $84.70 $91.60
K889 Family & general practice-community treatment order (CTO)-CTO renewal-including completion of the CTO form and all preceding CTO services directly related to CTO renewal-per unit $84.70 $91.60
L800 Laboratory Medicine-Haematopathology-Blood film interpretation (Romanowsky stain) $20.85 $21.70
L805 Laboratory Medicine-Anatomic Pathology-Cytopathology-Aspiration biopsy e.g. Lung, breast, thyroid, prostate $79.00 $81.20
L806 Laboratory Medicine-Anatomic Pathology-Bronchial, oesophageal, gastric, endometrial or other brushings and washings $35.45 $35.80
L810 Laboratory Medicine-Anatomic Pathology-Cytopathology-Fluids e.g. pleural, ascitic cyst, pericardial, C.S.F., urine and joint $22.05 $23.40
L820 Laboratory Medicine-Anatomic Pathology-Cytopathology-Smear for spermatozoa $6.05 $7.00
L826 Laboratory Medicine-Haematopathology-Blood film interpretation (special stain) $11.85 $13.35
L829 Laboratory Medicine-Haematopathology-Haemoglobinopathy interpretation (payable for abnormal results only) $12.90 $13.70
L834 Laboratory Medicine-Special Procedures and Interpretation-Histology or Cytology-Histochemistry of muscle-1 to 3 enzymes $11.85 $13.35
L835 Laboratory Medicine-Special Procedures and Interpretation-Each additional enzyme, add $11.85 $13.35
L841 Laboratory Medicine-Special Procedures and Interpretation-Enzyme histochemistry and interpretation-Per enzyme $11.85 $13.35
L843 Laboratory Medicine-Special Procedures and Interpretation-Special microscopy of tissues including polarization, interference phase contrast, dark field, autofluorescence or other microscopy and interpretation $19.80 $21.50
L844 Laboratory Medicine-Special Procedures and Interpretation-Special microscopy of fluids (polarization, interference, phase contrast, dark field, autofluorescence or other microscopy and interpretation) $12.80 $13.60
L846 Laboratory Medicine-Special Procedures and Interpretation-Flow cell cytometry and interpretation-Per marker $11.85 $12.20
L849 Laboratory Medicine-Special Procedures and Interpretation-Interpretation and handling of decalcified tissue $12.80 $13.90
M135 Major decortication of lung for empyema or tumour $800.00 $848.80
M142 Pneumonectomy, may include radical mediastinal node dissection, sampling or pericardial resection requiring repair $1,400.00 $1,485.40
M143 Lobectomy, may include radical mediastinal node dissection or sampling $1,285.00 $1,402.60
M144 Segmental resection, including segmental bronchus and artery $1,285.00 $1,441.75
M145 Wedge resection of lung $818.45 $843.40
N102 Meningioma and other tumourous lesions, including pituitary tumours-supratentorial $1,726.80 $1,862.85
N103 Craniotomy plus excision-Astrocytoma, oligodendroglioma, glioblastoma or metastatic tumour-supratentorial $1,562.90 $1,686.05
N104 Spontaneous Intracerebral Haemorrhage-Craniotomy plus removal-supratentorial $1,100.00 $1,230.00
N105 Neurosurgery-Open Surgical Approach-Intracranial aneurysm repair-Craniotomy approaches-Carotid circulation-per vessel $2,140.15 $2,477.45
N106 Neurosurgery-Open Surgical Approach-Cerebral vascular malformation-Craniotomy-supratentorial $1,622.50 $2,006.05
N113 Intracranial Abscess-Craniotomy for brain Biopsy (other than for tumour) $774.90 $1,019.15
N119 Intracranial Abscess-Functional stereotaxy-Intracranial implantation of chronic surface electrodes $901.25 $1,185.30
N123 Intracranial Abscess-Stereotaxis-intracranial (to include ventriculography) $538.40 $559.60
N124 Intracranial Abscess-Functional stereotaxy $1,551.20 $2,040.15
N128 Intracranial Abscess-Repair of encephalocoele $798.80 $924.70
N129 Intracranial Abscess-Posterior fossa decompression for Arnold Chiari malformation $1,110.00 $1,284.95
N140 Cranial-Reduction of skull fracture-compound $773.15 $895.00
N143 Cranial-Extracerebral haematoma and/or hygroma-Drainage by burr hole(s)-unilateral $559.60 $647.80
N144 Cranial-Extracerebral haematoma and/or hygroma-Drainage and/or removal by craniotomy $863.25 $999.30
N148 Cranial-Removal of intracerebral haematoma and/or debridement of traumatized brain (includes management of any skull fracture) $1,040.65 $1,204.65
N151 Craniotomy plus excision-Astrocytoma, oligodendroglioma, glioblastoma or metastatic tumour-infratentorial $1,726.80 $1,862.85
N153 Meningioma and other tumourous lesions, including pituitary tumours-infratentorial or basal $2,345.00 $2,529.80
N154 Neurosurgery-Open Surgical Approach-Intracranial aneurysm repair-Craniotomy approaches-Vertebrobasilar circulation, including aneurysm of vein of Galen $2,140.15 $2,477.45
N155 Neurosurgery-Open Surgical Approach-Cerebral vascular malformation-Craniotomy-infratentorial $1,532.10 $2,015.00
N157 Spontaneous Intracerebral Haemorrhage-Craniotomy plus removal-infratentorial $1,241.65 $1,388.40
N174 Cranial-Conversion of shunt (e.g. ventriculoperitoneal to ventriculoatrial)-includes removal of existing shunt $420.30 $585.90
N200 Cranial-Decompressive craniectomy (frontal, sub-temporal) $638.05 $738.60
N218 Neurosurgery-Open Surgical Approach-Extracranial-intracranial microvascular anastomosis superficial temporal artery $1,178.35 $1,364.05
N230 Cranial-CSF shunting procedures-all types $737.00 $1,027.40
N245 Cranial-Revision of CSF shunt-operative-all types $420.70 $585.90
N249 Cranial-Conversion of shunt (e.g. ventriculoperitoneal to ventriculoatrial)-Third ventriculostomy $777.80 $1,084.25
N259 Cranial-V-Decompression or rhizotomy (partial or complete) trigeminal nerve $481.90 $671.75
N267 Cranial-Occipital and/or suboccipital craniectomy for compression, decompression or section of cranial nerves $1,232.35 $1,280.90
N501 Anterior Spinal Decompression-Cervical-Vertebrectomy (removal of vertebral body and excision of adjacent discs) $1,020.00 $1,100.40
N523 AV malformation of cord-excision/obliteration $1,530.00 $1,891.70
N530 Implantation of spinal cord stimulating electrode by laminectomy $816.00 $1,008.90
N536 Repair of myelomeningocoele (one surgeon) $765.00 $1,217.10
N538 Repair of myelomeningocoele (two surgeons)-reconstructive surgeon $632.40 $881.55
N555 Insertion / revision of implantable infusion pump $510.00 $590.40
N560 Intradural extramedullary spinal tumour(s)-partial or total removal $1,530.00 $2,132.80
N561 Intradural intramedullary spinal tumour(s)-partial or total removal $1,765.75 $2,461.45
N565 Repair of lipomeningocoele including release of tethered cord $1,020.00 $1,622.80
N577 Intradural rhizotomy anterior/posterior (uni/bilateral)-any number of roots. $714.00 $1,276.65
P004 Obstetrics-Prenatal care-Minor prenatal assessment $33.70 $36.85
P008 Obstetrics-Labour-Delivery-Postnatal care in office $33.70 $36.85
R261 Elbow and Forearm-Reconstruction-Bone-Deformity-Osteotomy-radius with or without ulna $411.20 $577.70
R322 Hand and Wrist-Reconstruction-Bone-Pseudoarthrosis/non-Union/avascular necrosis-Scaphoid $500.00 $588.20
R352 Chest Wall and Mediastinum-Repair-Chest wall-Pleura-Pectus excavatum or carinatum repair (by reconstruction, not implant) $750.00 $832.30
R401 Shoulder, Arm and Chest-Reduction-Dislocations-Glenohumeral joint-Open reduction, recurrent $379.50 $419.65
R421 Elbow and Forearm-Excision-Joint contents-Synovectomy/capsulectomy/debridement, etc. $311.85 $407.25
R465 Hand and Wrist-Arthrodesis-Finger-Thumb $256.15 $321.30
R466 Hand and Wrist/Elbow and Forearm/Foot and Ankle-Arthrodesis-Wrist/Elbow/Ankle $400.00 $461.75
R475 Foot and Ankle-Arthrodesis-Pan-Talar, one stage $626.45 $779.50
R477 Foot and Ankle-Arthrodesis-Metatarsophalangeal $247.25 $302.60
R485 Hand and Wrist-Arthroplasty-Wrist-Total $426.90 $667.75
R486 Elbow and Forearm-Arthroplasty-Complete arthroplasty replacement $619.90 $911.05
R487 Shoulder, Arm and Chest-Arthroplasty-Total prosthesis $695.10 $770.00
R695 Foot and Ankle-Arthrodesis-Subtalar $450.00 $599.95
R720 Heart and Pericardium-Repair-Total repair Tetralogy of Fallot-With or without previous arterial shunt $1,261.80 $1,285.00
R721 Heart and Pericardium-Repair-Arterial repair of transposition $1,687.50 $1,739.20
R722 Heart and Pericardium-Repair-Total anomalous pulmonary venous drainage $1,124.70 $1,152.30
R723 Heart and Pericardium-Repair-Total correction transposition of great vessels $1,124.70 $1,152.30
R727 Valves-Tricuspid annuloplasty $662.55 $678.80
R728 Valves-Tricuspid valve replacement $758.80 $777.40
R734 Valves-Mitral annuloplasty $770.70 $789.60
R735 Valves-Mitral replacement $948.70 $960.35
R738 Valves-Mitral valve reconstruction-Aortic valve replacement $1,036.50 $1,049.20
R743 Heart and Pericardium-Excision-Coronary artery repair-Two $1,255.00 $1,278.10
R758 Heart and Pericardium-Resection coarctation-Adolescent or adult $967.00 $984.90
R759 Heart and Pericardium-Resection coarctation-Congenital heart procedures-E.g. Blalock, Glenn, Potts, Waterston or Central $755.80 $774.35
R770 Heart and Pericardium-Repair-Correction of cor triatriatum $864.40 $885.60
R773 Valves-Mitral valve reconstruction-Simple (includes annuloplasty) $1,618.50 $1,648.25
R774 Valves-Mitral valve reconstruction-Complex (includes annuloplasty and repair of both the anterior and posterior leaflets) $2,021.05 $2,058.20
R785 Arteries-Aorto-Iliac repair-Plus bilateral common femoral repair $2,202.00 $2,327.50
R787 Arteries-Femoro-Anterior/posterial tibial/peroneal bypass graft-With saphenous vein $1,006.75 $1,265.00
R791 Arteries-Femoro-Popliteal-With saphenous vein $857.35 $1,077.25
R799 Arteries-Thoracic aorta aneurysm-Repair or excision with graft-Ascending $1,455.30 $1,473.15
R800 Arteries-Thoracic aorta aneurysm-Repair or excision with graft-Arch $1,807.10 $1,840.35
R802 Arteries-Abdominal aorta-Repair or excision with graft-Aneurysm repair alone or including unilateral common femoral repair $1,500.00 $1,585.50
R803 Arteries-Thoracic aorta aneurysm-Repair or excision with graft-Thoraco-Abdominal aneurysm $2,566.70 $2,859.30
R817 Arteries-Abdominal aorta-Repair or excision with graft-Aneurysm repair and bilateral common femoral repair $2,202.00 $2,327.50
R827 Diagnostic and Therapeutic Procedures/Cardiovascular-Dialysis/veins-Revision of Scribner shunt/Anastomosis-Spleno-renal-Creation of A.V. fistula $440.00 $490.15
R840 Dialysis-Bypass graft for haemodialysis-Autogenous vein $424.10 $496.60
R851 Dialysis-Bypass graft for haemodialysis-Synthetic $444.70 $482.70
R852 Dialysis-Peritoneal dialysis-Insertion of peritoneal cannula by laparotomy or laparoscopy $256.10 $352.50
R863 Valves-Mitral valve reconstruction-Replacement of aortic valve, replacement of ascending aorta, and reimplantation of coronary Arteries (Modified Bentall) $2,021.05 $2,070.60
R874 Heart and Pericardium-Percutaneous transluminal catheter assisted closure for Secundum arterial septal defect-Cardiopulmonary transplantation $2,534.25 $2,565.30
R876 Valves-Mitral valve reconstruction-Valve sparing aortic root replacement or remodelling $2,021.05 $2,144.95
R877 Arteries-Abdominal aorta-Repair or excision with graft-Aneurysm with repair of iliac artery aneurysm (unilateral or bilateral) $2,002.75 $2,116.90
R923 Heart and Pericardium-Repair-Double outlet-Right/left ventricle $1,480.40 $1,516.70
R924 Heart and Pericardium-Repair-Double outlet ventricle with transposition $1,687.50 $1,728.90
R925 Heart and Pericardium-Repair-Truncus arteriosus $1,687.50 $1,718.55
R926 Heart and Pericardium-Repair-Interrupted aortic arch $1,480.40 $1,516.70
R927 Heart and Pericardium-Repair-Aorto-Pulmonary window $948.75 $960.40
S089 Partial oesophageal resection and reconstruction (including intestinal transposition) $1,081.55 $1,180.50
S090 Total thoracic oesophageal resection $1,465.35 $1,912.30
S096 Ruptured oesophagus, suture and drainage $507.00 $661.65
S104 Oesophagus-Suture-Repair of esophageal atresia with or without tracheal fistula $1,153.85 $2,203.20
S117 Stomach-Incision-Gastrotomy-Pyloromyotomy (Ramstedt's) $314.80 $536.90
S118 Stomach-Incision-Gastrostomy-Gastrostomy $345.85 $467.85
S139 Stomach-Suture-Gastrorrhaphy (for perforated gastric or duodenal ulcer or wound) $503.15 $672.75
S149 Intestines (except rectum) Incision-Enterotomy-Ileostomy $406.85 $470.65
S157 Intestines (except rectum) Incision-Enterotomy-Colostomy $406.85 $470.65
S160 Intestines (except rectum) Incision-Enterotomy-Entero-enterostomy $406.85 $470.65
S164 Intestines (except rectum) Excision-Resection with anastomosis-Small intestine-Duodenum $746.10 $1,015.15
S165 Intestines (except rectum) Excision-Resection with anastomosis-Small intestine-Other $687.55 $741.45
S166 Intestines (except rectum) Excision-Resection with anastomosis-Small and large intestine terminal ileum, cecum and ascending colon (right hemicolectomy) $799.55 $899.85
S167 Intestines (except rectum) Excision-Resection with anastomosis-Large intestine-any portion $799.55 $877.95
S168 Intestines (except rectum) Excision-Ileostomy-Subtotal colectomy $1,057.70 $1,260.40
S169 Intestines (except rectum) Excision-Resection with anastomosis-Total colectomy with ileo-rectal anastomosis $1,242.90 $1,313.65
S170 Intestines (except rectum) Ileostomy-Plus total colectomy plus abdomino-perineal resection $1,790.60 $2,183.65
S171 Intestines (except rectum) Excision-Resection with anastomosis-Left hemicolectomy with anterior resection or proctosigmoidectomy (anastomosis below peritoneal reflection & mobilization of splenic flexure) $1,082.95 $1,128.10
S173 Intestines (except rectum)-Ileostomy-Two-Surgeon team-Abdominal $1,632.80 $1,812.00
S174 Intestines (except rectum)-Ileostomy-Two-Surgeon team-Perineal $481.00 $533.80
S175 Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-Without resection $620.00 $712.35
S176 Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-With entero-enterostomy $748.00 $894.85
S177 Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-With resection $900.00 $1,055.25
S178 Intestines (except rectum)-Intestinal obstruction (mechanical)-Intestinal atresia (newborn) $682.90 $1,512.75
S179 Intestines (except rectum)-Intestinal obstruction (mechanical)-Meconium ileus $682.90 $1,512.75
S180 Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-With enterotomy $672.00 $824.80
S182 Intestines (except rectum)-Repair-Revision of ileostomy or colostomy-Full thickness $350.65 $467.90
S185 Intestines (except rectum)-Suture-Closure of colostomy or enterostomy-With or without resection and/or anastomosis $406.85 $504.70
S188 Intestines (except rectum)-Ileostomy-Bowel resection without anastomosis (colostomy and mucous fistula) $544.35 $770.55
S213 Rectum-Excision-Proctectomy-Anterior resection or proctosigmoidectomy (anastomosis below peritoneal reflection) $1,100.00 $1,204.50
S214 Rectum-Excision-Proctectomy-Abdomino-Perineal resection or pull through $1,300.00 $1,524.20
S215 Rectum-Excision-Two surgeon team-Abdominal surgeon $1,009.85 $1,107.50
S217 Rectum-Excision-Two surgeon team-Hartmann procedure $890.00 $1,063.60
S218 Rectum-Excision-Two surgeon team-Colon reconstruction following Hartmann procedure $1,030.00 $1,086.75
S222 Rectum-Excision-Two surgeon team-Presacral or trans-sacral proctotomy and excision of lesion $350.65 $474.35
S227 Rectum-Repair-Rectal prolapse-Abdominal approach $554.10 $688.75
S229 Rectum-Suture of rectum, trauma-External approach $239.20 $355.45
S249 Rectum-Excision-Local excision for malignancy $153.05 $291.05
S270 Liver-Excision-Hepatectomy-Formal anatomical resection-one or two liver segments $1,184.60 $1,426.05
S271 Liver-Excision-Hepatectomy-Formal anatomical resection-Five or more liver segments $1,784.60 $1,938.50
S300 Pancreas-Excision-Pancreatectomy-"Whipple type" procedure $1,785.45 $2,457.35
S312 Abdomen, Peritoneum and Omentum-Incision-Laparotomy, with or without biopsy or for Hirschsprung's disease (except biopsies of stomach, liver, pancreas and multiple para-Aortic lymph nodes $330.00 $485.25
S321 Abdomen, Peritoneum and Omentum-Incision-Laparotomy-for acute trauma $397.15 $587.10
S322 Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Inguinal and/or femoral-Infants $325.00 $487.50
S323 Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Inguinal and/or femoral-Adolescents and adults $331.80 $357.80
S326 Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Inguinal and/or femoral-Children $275.00 $412.50
S328 Unilateral with exploration of other side-infants and children $329.30 $458.40
S345 Massive sliding inguinal hernia $400.00 $431.35
S346 Abdomen, Peritoneum and Omentum-Repair-Congenital diaphragmatic hernia-Primary or first stage repair $576.90 $1,300.55
S347 Abdomen, Peritoneum and Omentum-Repair-Congenital diaphragmatic hernia-Second or subsequent stage repair $366.00 $472.15
S348 Abdomen, Peritoneum and Omentum-Repair-Omphalocele and gastroschisis-Primary or first stage repair $375.80 $1,112.35
S349 Abdomen, Peritoneum and Omentum-Repair-Omphalocele and gastroschisis-Second or subsequent stage repair $475.80 $1,408.35
S411 Kidney and Upper Urinary Tract-Excision-Partial or heminephrectomy $875.00 $890.80
S416 Kidney and Upper Urinary Tract-Excision-Nephrectomy-Thoraco-Abdominal or radical nephrectomy $875.00 $890.80
S422 Kidney and Upper Urinary Tract-Repair-Pyeloplasty (with or without nephropexy) $679.25 $890.80
S424 Kidney and Upper Urinary Tract-Excision-Nephrectomy-Extrophy-Plastic closure of bladder with closure of abdominal wall and urethral lengthening with closure of pelvic floor with or without reimplantation of ureters $939.70 $1,237.25
S428 Kidney and Upper Urinary Tract-Repair-Symphysiotomy for horseshoe kidney with or without nephropexy and associated procedures $437.20 $494.90
S449 Kidney and Upper Urinary Tract-Excision-Ureterectomy-Including ureterovesical junction $437.20 $445.40
S458 Kidney and Upper Urinary Tract-Repair-Ureterostomy-Cutaneous-Unilateral $260.85 $494.90
S484 Bladder-Cystectomy-Complete cystectomy, without transplant $657.75 $791.85
S512 Bladder-Repair of ruptured bladder $330.90 $346.45
S513 Bladder-Repair-Cystoplasty, using intestine $657.75 $692.85
S518 Bladder-Repair-Plastic repair of bladder neck-Child $331.70 $494.90
S523 Urogenital and Urinary Surgical Procedures-Bladder/Female Genital Surg Procedures-Vagina-Suture/Repair-Closure of fistula/Vesicovaginal-Vaginal approach $772.40 $791.85
S524 Bladder-Suture-Closure of fistula-Vesicovaginal-Transvesical approach (with or without omental flap) $467.00 $544.40
S535 Urethra-Repair-Urethroplasty-First stage-One stage repair and may include skin grafting $381.60 $445.40
S536 Urethra-Excision-Caruncle $85.30 $118.80
S537 Urethra-Excision-Urethral papilloma, single or multiple $85.30 $118.80
S543 Urethra-Excision-Prolapse urethra $85.30 $118.80
S544 Urethra-Excision-Urethrectomy-Radical $215.80 $296.95
S553 Urethra-Suture-Posterior urethra-Late repair $552.30 $643.35
S569 Penis-Incision-Slit of prepuce (complete care)-Adult or child $30.25 $39.60
S571 Penis-Repair-Hypospadias or Epispadia-One stage repair-With advancement of meatus into glans $383.50 $420.65
S572 Penis-Repair-Hypospadias or Epispadia-One stage repair-Into glans using island flap pedicle (penoscrotal) $662.45 $722.55
S573 Penis-Excision-Circumcision-for Physical symptomatology only-for patients aged one year or older $179.40 $188.05
S574 Penis-Excision-Amputation-Partial $170.65 $197.95
S577 Penis-Excision-Circumcision-for Physical symptomatology only-for infants less than one year of age $90.05 $188.05
S581 Penis-Repair-Hypospadias or Epispadia-Closure urethro-Cutaneous fistula $92.10 $296.95
S588 Penis-Repair-Hypospadias or Epispadia-Surgical removal of prosthesis $110.15 $148.45
S591 Testis-Repair-Orchidopexy-for undescended testis, any type, one or two stages to include hernia repair where required $331.70 $346.45
S593 Testis-Repair-Orchidopexy-Exploration for undescended testicle, without orchidopexy $260.85 $346.45
S595 Testis-Repair-Orchidopexy-Ruptured testicle $170.65 $247.45
S596 Testis-Repair-Orchidopexy-Insertion of testicular prosthesis $170.65 $197.95
S597 Penis-Repair-Hypospadias or Epispadia-Penile prosthesis for impotence $306.85 $395.90
S598 Testis-Biopsy-Radical orchidectomy for malignancy-Unilateral $235.35 $267.25
S600 Testis-Repair-Orchidopexy-Reduction of torsion of testis or appendix testis and orchidopexy (one or both sides) if required $235.35 $296.95
S601 Epididymis and Tunica Vaginalis-Epididymis-Spermatocele or spermatic granuloma excision $205.35 $207.85
S611 Epididymis and Tunica Vaginalis-Tunica Vaginalis-Hydrocele excision-Unilateral $205.35 $207.85
S616 Scrotum-Incision-Abscess or haematocele-And exploration-Unilateral $85.30 $99.00
S647 Prostate-Excision-Prostatectomy-Suprapubic-With or without removal of bladder stones $600.75 $643.35
S650 Prostate-Excision-Retropubic-With or without removal of bladder stones-Simple $600.75 $643.35
W075 Consultation $185.00 $203.30
W085 Plastic Surgery-Non-emergency LTC in-patient Services-Consultation $81.10 $87.70
W086 Plastic Surgery-Non-emergency hospital in-patient services-Repeat consultation $47.95 $51.85
W113 Complex neuromuscular assessment $89.85 $91.00
W155 Endocrinology & Metabolism (15) -Consultation $157.00 $162.65
W165 Nephrology (16)-Consultation $157.00 $162.90
W185 Consultation $176.35 $178.60
W223 Extended special genetic consultation $395.65 $401.30
W225 Consultation $165.00 $167.35
W265 Paediatrics-Consultation $167.00 $175.40
W305 OB/GYN-Consultation $101.70 $111.70
W306 OB/GYN-Repeat consultation $54.10 $59.45
W345 Otolaryngology-Non-emergency LTC in-patient Services-Consultation $77.90 $79.90
W355 Urology-Non-emergency LTC in-patient Services-Consultation $80.00 $83.15
W356 Urology-Non-emergency LTC in-patient Services-Repeat consultation $55.75 $56.40
W465 Infectious Disease (46)-Consultation $157.00 $178.65
W511 Physical Medicine and Rehabilitation-Non-emergency LTC in-patient Service-Complex physiatry assessment $89.85 $98.35
W515 Physical Medicine and Rehabilitation-Non-emergency LTC in-patient Service-Consultation $182.85 $200.15
W535 Ophthalmology-Non-emergency LTC in-patient Service-Consultation $82.30 $82.20
W645 General Thoracic Surgery-Non-emergency hospital in-patient services-Consultation $90.30 $98.55
W662 Paediatrics-Extended special paediatric consultation-Subject to the same conditions as A662 $395.65 $401.30
W667 Paediatrics-Neurodevelopmental consultation $395.65 $401.30
W695 Neurodevelopmental consultation $395.65 $401.30
W760 Endocrinology & Metabolism (15) -Complex endocrine neoplastic disease assessment $89.85 $90.75
W770 Extended comprehensive geriatric consultation $395.65 $401.30
W777 GP/FP-Non-emergency LTC in-patient Services-Admission assessment-Intermediate assessment-Pronouncement of death $33.70 $36.85
W895 Consultation $232.70 $251.70
X090 Diagnostic Radiology-Chest & Abdomen-Chest-Single view $6.40 $6.35
X091 Diagnostic Radiology-Chest & Abdomen-Chest-Two views $10.75 $10.70
X092 Diagnostic Radiology-Chest & Abdomen-Chest-Three or more views $12.45 $12.40
Y820 Nuclear Medicine-IN VIVO-Parathyroid scintigraphy-Dual isotope technique with T1201 and Tc99m Iodine $69.03 $71.89
Y827 Nuclear Medicine-IN VIVO-Calcium absorption-Oesophageal motility studies-one or more $50.31 $52.40
Y829 Nuclear Medicine-IN VIVO-Gastrointestinal-Transit $50.31 $52.40
Y831 Nuclear Medicine-IN VIVO-Abdominal scintigraphy-for gastrointestinal bleed-Biliary scintigraphy $50.31 $52.40
Y832 Nuclear Medicine-IN VIVO-Abdominal scintigraphy-for gastrointestinal bleed-Liver/spleen scintigraphy $50.31 $52.40
Y833 Nuclear Medicine-IN VIVO-Abdominal scintigraphy-for gastrointestinal bleed-Salivary gland scintigraphy $50.31 $52.40
Y836 Nuclear Medicine-IN VIVO-Computer assessed renal function-Static renal scintigraphy $50.31 $52.40
Y850 Nuclear Medicine-IN VIVO-Bone scintigraphy-General survey $62.01 $64.58
Y851 Nuclear Medicine-IN VIVO-Bone scintigraphy-Single site $50.31 $52.40
Y859 Nuclear Medicine-IN VIVO-Perfusion lung scintigraphy $44.98 $46.85
Y860 Nuclear Medicine-IN VIVO-Perfusion and ventilation scintigraphy-Same day $62.01 $64.58
Y876 Nuclear Medicine-IN VIVO-Gastroesophageal-Reflux $50.31 $52.40
Y877 Nuclear Medicine-IN VIVO-Gastro-Oesophageal-Aspiration $50.31 $52.40
Y887 Nuclear Medicine-IN VIVO-Ventilation lung scintigraphy $44.98 $46.85
Z296 Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With flexible endoscope-If only operative procedure performed $19.20 $20.10
Z335 Thoracoscopy (pleuroscopy) with or without pleural biopsy, suction, etc. $228.40 $242.35
Z341 Lungs and Pleura-Incision-Closed drainage effusion or pneumothorax $69.80 $76.80
Z403 Diagnostic and Therapeutic Procedures/Haematic and Lymphatic Surgical Procedures-Laboratory medicine/spleen and marrow-Incision//Haematopathology-Bone marrow aspiration $33.90 $42.40
Z408 Spleen and Marrow-Incision-Bone marrow core biopsy (with biopsy needle) $63.35 $79.20
Z434 Cardiovascular-Angiography-Transluminal coronary angioplasty-one or more sites on a single major vessel $471.60 $467.05
Z440 Cardiovascular-Haemodynamic/Flow/Metabolic Studies-Left heart-Retrograde aortic $210.55 $208.50
Z442 Cardiovascular-Angiography-Selective coronary catheterization-Both arteries $289.55 $286.75
Z604 Urethra-Incision-Urethrotomy-Meatotomy and Plastic repair $31.60 $39.60
Z621 Urethra-Manipulation-Dilatation of stricture-Male, local anaesthetic $13.65 $14.85
Z622 Urethra-Manipulation-Dilatation of urethra-Female $5.65 $9.90
Z627 Kidney and Upper Urinary Tract-Percutaneous procedures-Removal of renal calculi $167.85 $168.25
Z628 Kidney and Upper Urinary Tract-Endoscopic Procedures-Cystoscopy and diagnostic ureteroscopy-Above intramural $125.65 $125.70
Z702 Penis-Excision-Biopsy $23.55 $39.60
Z708 Epididymis and Tunica Vaginalis-Tunica Vaginalis-Hydrocele aspiration $16.25 $19.80
Z709 Scrotum-Incision-Abscess or haematocele-Local anaesthetic $20.10 $39.60
Z740 Operations of the Breast-Incision-Drainage of intramammary abscess or haematoma-Single or multiloculated-General anaesthetic $75.00 $133.80
Z768 Scrotum-Incision-Abscess or haematocele-General anaesthetic $55.15 $99.00
Z785 Rectum-Excision-Polyps or tumours of rectum or sigmoid-Excision and suture-Base over 5 cm $329.65 $582.95
Z804 Neurology-Lumbar puncture $67.60 $74.35
Z805 Neurology-Lumbar puncture-With instillation of medication or other therapeutic agent $75.10 $86.35
Z809 Cranial-Conversion of shunt (e.g. ventriculoperitoneal to ventriculoatrial)-Insertion of CSF reservoir (Ommaya) including burr holes $370.50 $428.90
Z813 Intracranial Abscess-Burr hole-plus needling of brain for biopsy $453.60 $560.85
Z820 Intracranial Abscess-Ventriculoscopy-Insertion of intracranial catheter or transducer for purposes of monitoring $317.85 $367.95
Z823 Neurological Surgical Procedures-Cranial/Peripheral Nerves-Functional stereotaxy-Implantation or revision of stimulation pack or leads (peripheral nerve, brain) $307.40 $404.30
Z825 Intracranial Abscess-Ventriculoscopy-to include burr hole $408.95 $731.20
Z943 Programming infusion pump or dorsal column stimulator $102.00 $142.20
K018 Sexual assault examination-female $308.70 $319.60
K021 Sexual assault examination-male $243.50 $252.10
K061 Taking of blood samples in a hospital setting at the request of a police officer $30.00 $31.05
K050 Health Status Report and Activities of Daily Living Index (amalgamated form) $100.00 $103.55
K051 Health Status Report (completed separately) $80.00 $82.85
K052 Activities of Daily Living Index (completed separately) $20.00 $20.70
K057 Medical Form Part A for Medical Review process $35.00 $36.25
K058 Medical Form Part B including both Health Status Report and Activities of Daily Living Index for Medical Review process $125.00 $129.40
K059 Health Status Report of Part B (completed separately) for Medical Review process $100.00 $103.55
K060 Activities of Daily Living Index of Part B (completed separately) for Medical Review process $25.00 $25.90
K054 Mandatory Special Necessities Benefit Request Form $25.00 $25.90
K055 Application for Special Diet Allowance $20.00 $20.70
K056 Application for Pregnancy/Breast-feeding Nutritional Allowance $20.00 $20.70
K053 A Limitation to Participation Form $15.00 $15.55
K065 Periodic Oculo-Visual Assessment-ODSP $48.90 $50.65
K066 Periodic Oculo-Visual Assessment-OW $48.90 $50.65
G153 Cortical evoked audiometry, technical component $9.75 $10.10
G154 Cortical evoked audiometry, professional component $40.30 $41.70

Appendix B - Relativity rates by physician specialty

Table 1 below provides a list of the Year 4 relativity rates by physician specialty code and specialty description.

The specialty rates noted in the table are based on the cumulative compounded increases for Years 1-4.

Table 1: Relativity rates by physician specialty

Specialty Code Specialty Description Relativity Rate
00 GP Group 1: Capitated harmonized models 2.4629%
00 GP Group 2: Comprehensive Care models with CCM fee 6.7646%
00 GP Group 3: FFS and Other 8.9897%
01 Anaesthesiology 0.4542%
02 Dermatology 1.8232%
03 General Surgery 2.4806%
04 Neurosurgery 2.8042%
05 Community Medicine 3.5446%
06 Orthopaedic Surgery 2.2551%
07 Geriatrics 5.3367%
08 Plastic Surgery 3.1374%
09 Cardiac Surgery 1.6189%
13 Internal and Occupational Medicine 3.8628%
15 Endocrinology 2.8045%
16 Nephrology 1.4123%
17 Vascular Surgery 1.2025%
18 Neurology 4.5901%
19 Psychiatry 7.5602%
20 Obstetrics & Gynaecology 4.7519%
22 Genetics 3.6546%
23 Ophthalmology 0.0000%
24 Otolaryngology 1.6817%
26 Paediatrics 4.0562%
31 Physical Medicine & Rehabilitation 5.2649%
33 Diagnostic Radiology 0.0000%
34 Radiation Oncology 0.0000%
35 Urology 1.6730%
41 Gastroenterology 0.0000%
44 Medical Oncology 2.4548%
46 Infectious Disease 9.2749%
47 Respiratory Disease 4.7734%
48 Rheumatology 3.6674%
60 Cardiology 0.0000%
61 Haematology 5.1865%
62 Clinical Immunology 1.3318%
63 Nuclear Medicine 1.6832%
64 General Thoracic Surgery 3.8604%
EM Emergency Medicine group 3.6198%
LM Laboratory Medicine group 2.2418%
GB Global 3.5446%

Medical Claims Adjustments (MADJ)

Due to staged implementations, Medical Claims Adjustments (MADJ) will be required. Further information will be provided in advance of any implementation of a Medical Claims Adjustment.

  • Please also note that during the MADJ process, the claims processing system selects an entire claim and reprocesses it.
  • A single claim can include multiple fee schedule codes and all codes will be reprocessed.
  • Claims that were reprocessed with no change in payment will appear on the Remittance Advice with explanatory code '55-This deduction is an adjustment on an earlier account' and '57-This payment is an adjustment on an earlier account'. These two transactions will net out to zero with no payment impact but will report on the Remittance Advice for reconciliation purposes.

Resources

For any further inquiries, please contact the Service Support Contact Centre at 1-800-262-6524.

The latest version of the Schedule of Benefits for Physician Services is available on the Ministry of Health website. Hard copies of the Schedule of Benefits for Physician Services will not be distributed. If you would like to order a paper copy or compact disk (CD) of the Schedule for a fee, please visit Publications Ontario. Physicians without access to the Internet can contact ServiceOntario at 1-800-668-9938.

This bulletin is a general summary provided for information purposes only. Physicians are directed to review the Health Insurance Act, Regulation 552, and the schedules under that regulation, for the complete text of the provisions. You can access this information at ontario.ca/laws. In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulations, the legislation and/or regulations prevail.