Bulletin 4753 — Kaplan Board of Arbitration Award — April 1, 2020 Fee Schedule Code and Premium Changes
Keeping Health Care Providers informed of payment, policy or program changes
To: Providers
Published by: Claims Services Branch, Ministry of Health
Date Issued: April 14, 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
Hospitalist Premium
New Premiums effective April 1, 2020
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
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
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.
Updated: May 01, 2023
Published: May 01, 2023