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 CodeDescription
S205Appendectomy
S206With gross perforation and peritonitis
C267Subsequent visits-7th to 13th week inclusive
C269Subsequent visits-after 13th week
G602Neonatal intensive care-31st day onwards
Z819Ventriculoscopy-External ventricular drainage

New Fee Schedule Codes effective April 1, 2020

Fee Schedule CodeDescriptionFeeAssist UnitsAnaes. Units
E032CAnaesthesia service for Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499, Z555 or Z580  4
S207Appendectomy with or without perforation$458.6067
E515Incision 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%  
S152Bowel lengthening procedure in a paediatric patient$1700.00910
E084Saturday, Sunday or Holiday Subsequent visit by the MRP, to subsequent visits and C122, C123, C124, C142, C143, C882 or C982-add45%  
K229Complex genetic test interpretation$65.85  
A/C/W682Extended special neurological consultation$401.30  
G496Electroencephalography (EEG) with time locked video recording$120.00  
E060Post renal transplant assessment premium-add25%  
A631Nuclear medicine minor assessment-cancellation or deferral$17.75  
A632Nuclear medicine minor assessment-advisability of nuclear medicine procedure$17.75  
R766In-situ saphenous vein arterial bypass-tibial-first vascular surgeon$1303.001017
R767In-situ saphenous vein arterial bypass-tibial-second vascular surgeon$1303.00nilnil
E986Suprarenal or supraceliac aortic cross clamp, to R802, R817, R877, R783, R784, R785, R858 or R859-add$250.00  
R731Tricuspid valvuloplasty$770.551828
A/C384Consultation and Management for Acute Cerebral Vascular Syndrome (ACVS)$200.00  
K181Management 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  
A633Nuclear medicine specific assessment$60.00  

Revised Fee Schedule Codes effective April 1, 2020

Fee Schedule CodeDescription
E100CAttendance at delivery. Allow 4 base units plus time units
S117Pyloromyotomy-Allow only for newborns and infants
C262Can be billed daily. All other conditions continue to apply
G601Level A neonatal intensive care 2nd day onwards
E386Extradural decompression-spinal cord or cauda equina, tumour or infection-Increase add-on percentage from 40% to 42%
E683Lungs and pleura-excision-when performed thorascopically or by VATS-Increase add-on percentage from 25% to 28%
E023CAnaesthesia service-Allow only with E137, E138, E139, E140, E141, E143, E144, E145, E146, E147, E149, Z432, Z606 or Z607
E676A/BObesity Premium-Add the following codes that E676A/B can be billed with: S089A, S090A, S207, M142A, M143A, M144A
G412Nephrological component of renal transplantatation-1st day –only after kidney transplant
G408Nephrological component of renal transplantatation-2nd to 10th day inclusive –only after kidney transplant
G409Nephrological component of renal transplantatation-11th to 21st day inclusive –only after kidney transplant
E638With transbronchial lung biopsy with or without image intensification , to Z327-add
S329S329 may only be claimed for nonelective surgery admitted through the Emergency department
E525After localization with mammographic wire or radioactive seeds, to R107-add
G804, G805Hyperbaric 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 CodeDescriptionCurrent UnitsNew Units
R240BArthroplasty-revision total arthroscopy shoulder89
R241BArthroscopy-revision total arthroscopy hip89
N500BAnterior spine decompression-disc excision910
N501BAnterior spine decompression-vertebrectomy911
N177BSciatic nerve in buttock67
N189BPeripheral nerves-nerve graft-ulnar nerve67
N190BPeripheral nerves-nerve graft-exploration67
N283BPeripheral nerves-exploration, decompression67
N285BDecompression/denervation-major nerve67
N286BTumour or neuroma-major nerve67
N287BNerve suture-major67
N289BNerve suture-minor67
Z823BImplantation or revision of stimulation pack68

Appendix A-Fee Schedule Code Price Changes

The following fee changes are effective April 1, 2020.

Fee Schedule CodeDescriptionCurrent FeeApril 1, 2020 fee
A001GP/FP-Minor assessment$21.70$23.75
A003GP/FP-General assessment$77.20$84.45
A005GP/FP-Consultation$77.20$84.45
A007GP/FP-Intermediate assessment/well baby care$33.70$36.85
A015Anaesthesia-Consultation$106.80$107.25
A020Complex dermatology assessment$49.95$60.00
A023Dermatology-Specific assessment$38.70$43.00
A034General Surgery-Partial assessment$24.10$26.85
A070Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient$185.00$203.30
A071Complex medical specific re-assessment$70.90$84.35
A073Medical specific assessment$79.85$90.45
A074Medical specific re-assessment$61.25$72.90
A075Consultation$175.00$183.30
A078Partial assessment$38.05$45.30
A083Plastic Surgery-Specific assessment$41.55$44.95
A084Plastic Surgery-Partial assessment$26.55$28.70
A085Plastic Surgery-Consultation$81.10$87.70
A086Plastic Surgery-Repeat consultation$47.95$51.85
A113Complex neuromuscular assessment$89.85$91.00
A151Endocrinology & Metabolism (15)-Complex medical specific re-assessment$70.90$73.45
A153Endocrinology & Metabolism (15)-Medical specific assessment$79.85$82.75
A154Endocrinology & Metabolism (15)-Medical specific re-assessment$61.25$61.85
A155Endocrinology & Metabolism (15)-Consultation$157.00$162.65
A158Endocrinology & Metabolism (15)-Partial assessment$38.05$38.45
A161Nephrology (16)-Complex medical specific re-assessment$70.90$71.85
A163Nephrology (16)-Medical specific assessment$79.85$80.95
A164Nephrology (16)-Medical specific re-assessment$61.25$62.10
A165Nephrology (16)-Nephrology-Consultation$157.00$162.90
A168Nephrology (16)-Partial assessment$38.05$38.55
A181Complex medical specific re-assessment$71.90$72.85
A183Medical specific assessment$78.80$79.80
A184Medical specific re-assessment$62.10$62.90
A185Consultation$176.35$178.60
A188Partial assessment$37.65$38.15
A191Consultative 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
A192Consultative 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
A193Specific assessment$79.85$86.35
A194Partial assessment$38.05$41.15
A195Consultation$199.40$215.65
A197Consultative interview with parent(s) or patient representative(s) of patient less than age 22$212.65$230.00
A198Consultative interview with patient less than age 22$212.65$230.00
A203OB/GYN-Specific assessment$47.45$52.15
A204OB/GYN-Partial assessment$26.35$33.70
A205OB/GYN-Consultation$101.70$111.70
A206OB/GYN-Repeat consultation$54.10$59.45
A223Extended special genetic consultation$395.65$401.30
A225Consultation$165.00$167.35
A235Ophthalmology-Consultation$82.30$82.20
A244Otolaryngology-Partial assessment$24.55$25.70
A245Otolaryngology-Consultation$77.90$79.90
A253Ophthalmology-Optometrist-Requested Assessment (ORA)$82.30$82.20
A262Paediatrics-Level 2-Paediatric assessment$42.15$43.45
A263Paediatrics-Medical specific assessment$77.70$80.05
A264Paediatrics-Medical specific re-assessment$59.45$61.25
A265Paediatrics-Consultation$167.00$175.40
A268Paediatrics-Enhanced 18 month well baby visit$62.40$64.30
A315Physical Medicine and Rehabilitation-Consultation$172.85$189.20
A348Radiation Oncology-Partial assessment$37.05$36.25
A353Urology-Specific assessment$45.00$45.55
A354Urology-Partial assessment$26.00$26.70
A355Urology-Consultation$80.00$83.15
A356Urology-Repeat consultation$55.75$56.40
A461Infectious Disease (46)-Complex medical specific re-assessment$70.90$80.70
A463Infectious Disease (46)-Medical specific assessment$79.85$90.85
A464Infectious Disease (46)-Medical specific re-assessment$61.25$69.70
A465Infectious Disease (46)-Consultation$157.00$178.65
A468Infectious Disease (46)-Partial assessment$38.05$43.30
A471Respiratory Disease (47)-Complex medical specific re-assessment$70.90$73.75
A473Respiratory Disease (47)-Medical specific assessment$79.85$84.65
A474Respiratory Disease (47)-Medical specific re-assessment$61.25$63.70
A475Respiratory Disease (47)-Consultation$157.00$169.65
A478Respiratory Disease (47)-Partial assessment$38.05$38.25
A480Rheumatology (48)-Complex rheumatology assessment$89.85$92.20
A481Rheumatology (48)-Complex medical specific re-assessment$70.90$72.65
A483Rheumatology (48)-Medical specific assessment$79.85$81.70
A484Rheumatology (48)-Medical specific re-assessment$61.25$62.60
A485Rheumatology (48)-Consultation$157.00$170.10
A486Rheumatology (48)-Repeat consultation$105.25$109.35
A488Rheumatology (48)-Partial assessment$38.05$39.10
A511Physical Medicine and Rehabilitation-Complex physiatry assessment$89.85$98.35
A585Laboratory medicine-Diagnostic consultation$64.70$68.60
A595Rheumatology (48)-Limited consultation$105.25$109.35
A611Haematology (61)-Complex medical specific re-assessment$70.90$76.20
A613Haematology (61)-Medical specific assessment$79.85$85.80
A614Haematology (61)-Medical specific re-assessment$61.25$65.85
A615Haematology (61)-Consultation$157.00$168.75
A621Clinical Immunology (62)-Complex medical specific re-assessment$70.90$71.80
A623Clinical Immunology (62)-Medical specific assessment$79.85$80.90
A624Clinical Immunology (62)-Medical specific re-assessment$61.25$62.05
A625Clinical Immunology (62)-Consultation$157.00$159.00
A628Clinical Immunology (62)-Partial assessment$38.05$38.55
A635Nuclear Medicine-Consultation$82.40$157.00
A636Repeat consultation$57.25$70.00
A638Partial assessment$35.35$40.00
A645General Thoracic Surgery (64)-Consultation$90.30$98.55
A661Paediatrics-Complex medical specific re-assessment$68.80$72.25
A662Paediatrics-Extended special paediatric consultation$395.65$401.30
A665Paediatrics-Prenatal consultation$91.35$100.55
A667Paediatrics-Neurodevelopmental consultation$395.65$401.30
A695Neurodevelopmental consultation$395.65$401.30
A735Nuclear Medicine-Diagnostic consultation$33.70$67.40
A760Endocrinology & Metabolism (15)-Complex endocrine neoplastic disease assessment$89.85$90.75
A770Extended comprehensive geriatric consultation$395.65$401.30
A777GP/FP-Intermediate assessment-Pronouncement of death$33.70$36.85
A800Midwife-requested genetic assessment$165.00$167.35
A802Extended midwife-requested genetic assessment$395.65$401.30
A813GP/FP-Midwife-Requested Assessment (MRA)$101.70$111.70
A835Nuclear Medicine-Special Nuclear Medicine consultation$180.00$300.70
A888GP/FP-ED equivalent-Partial assessment$33.70$36.85
A895Consultation in association with special visit to a hospital$232.70$251.70
A905GP/FP-Limited consultation$65.90$72.10
A917GP/FP-Focused Practice Assessment (FPA)-Sport medicine FPA$33.70$36.85
A921Obstetrics-Medical management of early or ectopic pregnancy-Follow-Up visit$33.70$36.85
A927GP/FP-Focused Practice Assessment (FPA)-Allergy FPA$33.70$36.85
A937GP/FP-Focused Practice Assessment (FPA)-Pain management FPA$33.70$36.85
A945GP/FP-Special palliative care consultation$144.75$159.20
A947GP/FP-Focused Practice Assessment (FPA)-Sleep medicine FPA$33.70$36.85
A957GP/FP-Focused Practice Assessment (FPA)-Addiction medicine FPA$33.70$36.85
A967GP/FP-Care of the elderly FPA$33.70$36.85
B400Community Palliative On-Call Program$471.23$487.93
C002family & general practice-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit$31.00$34.10
C003GP/FP-Non-emergency hospital in-patient services-General assessment$77.20$84.45
C005GP/FP-Non-emergency hospital in-patient services-Consultation$77.20$84.45
C015Anaesthesia-Non-emergency hospital in-patient services-Consultation$106.80$107.25
C020Complex dermatology assessment$49.95$60.00
C023Dermatology-Non-emergency hospital in-patient services-Specific assessment$38.70$43.00
C034Specific re-assessment$25.95$28.90
C071Complex medical specific re-assessment$70.90$84.35
C072geriatrics-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit$31.00$34.10
C073Medical specific assessment$79.85$90.45
C074Medical specific re-assessment$61.25$72.90
C075Consultation$185.00$203.30
C077Geriatrics-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit$31.00$34.10
C078Geriatrics-non-emergency hospital in-patient services-concurrent care, per visit$31.00$34.10
C079Geriatrics-non-emergency hospital in-patient services-subsequent visits-after 13th wk (max. of 6/mth)-per visit$31.00$34.10
C083Plastic Surgery-Non-emergency hospital in-patient services-Specific assessment$41.55$44.95
C084Plastic Surgery-Non-emergency hospital in-patient services-Specific re-assessment$27.80$28.80
C085Plastic Surgery-Non-emergency hospital in-patient services-Consultation$81.10$87.70
C086Plastic Surgery-Non-emergency hospital in-patient services-Repeat consultation$47.95$51.85
C113Complex neuromuscular assessment$89.85$91.00
C122Subsequent visits-MRP-day following hospital admission assessment$58.80$61.15
C123Subsequent visits-MRP-second day following hospital assessment$58.80$61.15
C124Subsequent visits-MRP-day of discharge$58.80$61.15
C132Internal medicine-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit$31.00$32.65
C137Internal medicine-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit$31.00$32.65
C138Internal medicine-non-emergency hospital in-patient services-concurrent care, per visit$31.00$32.65
C139Internal medicine-non-emergency hospital in-patient services-subsequent visits-after 13th week (max. of 6/mth)-per visit$31.00$32.65
C142Subsequent visit-MRP-first subsequent visit following transfer from IC$58.80$61.15
C143Subsequent visit-MRP-second subsequent visit following transfer from IC$58.80$61.15
C151Endocrinology & Metabolism (15)-Complex medical specific re-assessment$70.90$73.45
C153Endocrinology & Metabolism (15)-Medical specific assessment$79.85$82.75
C154Endocrinology & Metabolism (15)-Medical specific re-assessment$61.25$61.85
C155Endocrinology & Metabolism (15)-Consultation$157.00$162.65
C161Nephrology (16)-Complex medical specific re-assessment$70.90$71.85
C162Nephrology-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit$31.00$33.95
C163Nephrology (16)-Medical specific assessment$79.85$80.95
C164Nephrology (16)-Medical specific re-assessment$61.25$62.10
C165Nephrology (16)-Consultation$157.00$162.90
C167Nephrology-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit$31.00$33.95
C169Nephrology-non-emergency hospital in-patient services-subsequent visits-after 13th week (max. of 6/mth)-per visit$31.00$33.95
C181Complex medical specific re-assessment$71.90$72.85
C183Medical specific assessment$78.80$79.80
C184Medical specific re-assessment$62.10$62.90
C185Consultation$176.35$178.60
C193Specific assessment$79.85$86.35
C194Specific re-assessment$61.25$66.25
C203OB/GYN-Specific assessment$47.45$52.15
C204OB/GYN-Specific re-assessment$29.65$36.85
C205OB/GYN-Consultation$101.70$111.70
C206OB/GYN-Repeat consultation$54.10$59.45
C223Extended special genetic consultation$395.65$401.30
C225Consultation$165.00$167.35
C235Ophthalmology-Non-emergency hospital in-patient services-Consultation$82.30$82.20
C245Otolaryngology-Consultation$77.90$79.90
C263Paediatrics-Medical specific assessment$77.70$80.05
C264Paediatrics-Medical specific re-assessment$59.45$61.25
C265Paediatrics-Consultation$167.00$175.40
C315Physical Medicine and Rehabilitation-Non-emergency hospital in-patient services-Consultation$182.85$200.15
C352Urology-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit$31.00$31.60
C353Urology-Specific assessment$45.00$45.55
C354Urology-Specific re-assessment$26.00$26.70
C355Urology-Consultation$80.00$83.15
C356Urology-Repeat consultation$55.75$56.40
C357Urology-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit$31.00$31.60
C358Urology-non-emergency hospital in-patient services-concurrent care-per visit$31.00$31.60
C359Urology-non-emergency hospital in-patient services-subsequent visits-after 13th week (max. of 6/mth)-per visit$31.00$31.60
C461Infectious Disease (46)-Complex medical specific re-assessment$70.90$80.70
C463Infectious Disease (46)-Medical specific assessment$79.85$90.85
C464Infectious Disease (46)-Medical specific re-assessment$61.25$69.70
C465Infectious Disease (46)-Consultation$157.00$178.65
C471Respiratory Disease (47)-Complex medical specific re-assessment$70.90$73.75
C472Respiratory disease-non-emergency hospital in-patient services-subsequent visits-up to five weeks-per visit$31.00$33.30
C473Respiratory Disease (47)-Medical specific assessment$79.85$84.65
C474Respiratory Disease (47)-Medical specific re-assessment$61.25$63.70
C475Respiratory Disease (47)-Consultation$157.00$169.65
C477Respiratory disease-non-emergency hospital in-patient services-subsequent visits-6th-13th wks inclusive (max. of 3/wk)-per visit$31.00$33.30
C478Respiratory disease-non-emergency hospital in-patient services-concurrent care, per visit$31.00$34.10
C479Respiratory disease-non-emergency hospital in-patient services-subsequent visits-after 13th wk (max. of 6/mth)-per visit$31.00$34.10
C480Rheumatology (48)-Complex rheumatology assessment$89.85$92.20
C481Rheumatology (48)-Complex medical specific re-assessment$70.90$72.65
C483Rheumatology (48)-Medical specific assessment$79.85$81.70
C484Rheumatology (48)-Complex medical specific re-assessment$61.25$62.60
C485Rheumatology (48)-Consultation$157.00$170.10
C486Rheumatology (48)-Repeat consultation$105.25$109.35
C511Physical Medicine and Rehabilitation-Non-emergency hospital in-patient services-Complex physiatry assessment$89.85$98.35
C595Rheumatology (48)-Limited consultation$105.25$109.35
C611Haematology (61)-Complex medical specific re-assessment$70.90$76.20
C613Haematology (61)-Medical specific assessment.$79.85$85.80
C614Haematology (61)-Medical specific re-assessment$61.25$65.85
C615Haematology (61)-Consultation$157.00$168.75
C621Clinical Immunology (62)-Complex medical specific re-assessment$70.90$71.80
C623Clinical Immunology (62)-Medical specific assessment$79.85$80.90
C624Clinical Immunology (62)-Medical specific re-assessment$61.25$62.05
C625Clinical Immunology (62)-Consultation$157.00$159.00
C635Nuclear Medicine-Non-emergency hospital in-patient services-Consultation$82.40$157.00
C636Repeat consultation$57.25$70.00
C645General Thoracic Surgery-Non-emergency hospital in-patient services-Consultation$90.30$98.55
C661Paediatrics-Complex medical specific re-assessment$68.80$72.25
C662Paediatrics-Extended special paediatric consultation-Subject to the same conditions as A662$395.65$401.30
C665Paediatrics-Prenatal consultation$91.35$100.55
C667Paediatrics-Neurodevelopmental consultation$395.65$401.30
C695Neurodevelopmental consultation$395.65$401.30
C735Nuclear Medicine-Non-emergency hospital in-patient services-Diagnostic consultation$33.70$67.40
C760Endocrinology & Metabolism (15)-Complex endocrine neoplastic disease assessment$89.85$90.75
C770Extended comprehensive geriatric consultation$395.65$401.30
C777GP/FP-Non-emergency hospital in-patient services-Intermediate assessment-Pronouncement of death$33.70$36.85
C800Midwife-requested genetic assessment$165.00$167.35
C802Extended midwife-requested genetic assessment$395.65$401.30
C813GP/FP-Midwife-Requested Assessment$101.70$111.70
C835Nuclear Medicine-Non-emergency hospital in-patient services-Special Nuclear Medicine consultation$180.00$300.70
C895Consultation$232.70$251.70
C905GP/FP-Non-emergency hospital in-patient services-Limited consultation$65.90$72.10
C945GP/FP-Special palliative care consultation$144.75$159.20
C983BSurgical Assistant-SVP-Saturdays, Sundays or Holidays, daytime and evenings (07:00h-24:00h), first patient seen$75.00$85.60
C998BSurgical Assistant-SVP-Evenings (17:00h-24:00h) Monday to Friday, first patient seen$60.00$67.05
C999BSurgical Assistant-SVP-Nights (00:00h-07:00h), first patient seen$100.00$117.65
D028Foot and Ankle-Reduction-Dislocations-Tarso-Metatarsal-Open reduction, one joint$300.00$388.20
E079GP/FP-Initial discussion with patient, to eligible services add$15.40$15.55
E080Assessments-First visit by Primary Care Physician after hospital discharge premium, to other service listed in payment rule 5, add$25.00$25.25
E430When Papanicolaou smear is performed outside of hospital, to G365,add$11.55$11.95
E431When Papanicolaou smear is performed outside of hospital, to G394, add$11.55$11.95
E497Hand and Wrist-Reconstruction-Bone-Pseudoarthrosis/non-union/avascular necrosis-Pedicled vascularized bone graft, to R322 or R345 add$350.00$526.40
E525Operations of the Breast-Excision-After mammographic wire localization, to R107 R111 add$41.55$48.05
E542When 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
E545Vasectomy-when performed outside hospital add$11.15$11.55
E608Lungs and Pleura-each additional wedge resection of lung (to a maximum of 3), add$75.00$84.15
E645Heart and Pericardium-Coronary artery repair-Off pump coronary artery bypass grafting, to R742or R743 add$366.50$371.00
E650Heart 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
E652Heart 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
E654Heart and Pericardium-Coronary artery repair-Each additional add$187.70$188.85
E671Heart and Pericardium-Re-operation involving open heart procedures with pump-Following previous sternotomy add$337.00$543.60
E691Abdomen, Peritoneum and Omentum-Repair-Omphalocele and gastroschisis-requiring mobilization of abdominal wall musculature, to S348 add$100.00$178.40
E705Intestines (except rectum)-Into terminal ileum, to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add$30.50$30.30
E730Total thoracic oesophageal resection-with reconstruction, add$678.85$740.95
E740Intestines (except rectum)-Colonoscopy-To splenic flexure, to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add$51.95$51.75
E741Intestines (except rectum)-Colonoscopy-To hepatic flexure, to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add$31.40$31.15
E747Intestines (except rectum)-Endoscopy/Colonoscopy-To cecum add to Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add$31.40$31.15
E755Male Genital-Penis-Repair-Hypospadias or Epispadia-With inflatable prosthesis add$55.15$69.30
E756Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Umbilical-With resection of strangulated contents add$111.45$24.50
E764Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Umbilical hernia repair when done in conjunction with other abdominal surgery, to other surgery add$96.85$24.20
E889Skull 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
E890Skull 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
E891Skull 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
E898Neurosurgery-Open Surgical Approach-Intracranial aneurysm repair-lesion greater than 2.5 cm, to N105 or N154, add$229.55$283.80
E919Cranial-intracranial duroplasty (greater than 2 cm diameter) to any intracranial procedure, add$244.80$254.45
E921Cranial-repeat cranial procedure-payable in addition to any intracranial procedure and N111, N114 and N116 but excluding N127, add$252.20$262.15
F023Elbow and Forearm-Reduction-Fractures-Radius and ulna-Monteggia-Open reduction of ulna plus closed reduction radial head$242.25$416.65
F026Elbow and Forearm-Reduction-Fractures-Radius and ulnar shaft-Open reduction$368.40$528.55
F030Elbow and Forearm-Reduction-Fractures-Radius-Distal, e.g. Colles', Smith's, or Barton's fracture-Open reduction$420.00$499.40
F033Elbow and Forearm-Reduction-Fractures-Radius or ulna-Open reduction$274.00$438.05
F036Elbow and Forearm-Reduction-Fractures-Olecranon-Open reduction$224.55$414.60
F041Elbow and Forearm-Reduction-Fractures-Transcondylar/condylar-open reduction$375.80$600.00
F044Shoulder, Arm and Chest-Reduction-Fractures-Shaft-Open reduction$323.05$655.50
F052Shoulder, Arm and Chest-Reduction-Fractures-Neck with dislocation of head-open reduction$385.15$521.75
F055Shoulder, Arm and Chest-Reduction-Fractures-Neck without dislocation of head-Open reduction$327.55$514.95
F072Foot and Ankle-Reduction-Fractures-Os calcis-Open reduction-With repair of both the subtalar and calcaneocuboid joints$500.00$588.20
F076Foot and Ankle-Reduction-Fractures-Ankle-Open reduction-One malleolus$237.50$283.80
F077Foot and Ankle-Reduction-Fractures-Ankle-Open reduction-Multiple malleoli or ligaments$400.00$523.50
F080Fibula and Tibia-Reduction-Fractures-Tibia with or without fibula-Open reduction-Shaft$356.40$553.60
F081Fibula and Tibia-Reduction-Fractures-Intramedullary nail with distal and proximal locking screws-Medial or lateral tibial plateau$394.45$558.10
F096Femur-Reconstruction-Fractures-Closed reduction-Open reduction$493.80$613.95
F100Pelvis and Hip-Reduction-Fractures-Femoral neck trochanteric, subtrochanteric-Open reduction-Pin and plate/screws (cannulated included)$498.95$614.55
F101Pelvis and Hip-Reduction-Fractures-Femoral neck trochanteric, subtrochanteric open reduction-Primary prosthesis, Femur only (includes Moore, Thompson, Unipolar, Bipolar)$490.95$613.60
F108Foot and Ankle-Reduction-Fractures-Ankle fracture with tibial Plafond burst-Open reduction$362.95$616.15
F118Shoulder, Arm and Chest-Reduction-Fractures-Clavicle-Open reduction$300.00$458.75
F121Shoulder, Arm and Chest-Reduction-Fractures-Scapula-Open reduction$242.25$381.40
G001Laboratory Medicine-Miscellaneous-Cholesterol, total$5.50$5.70
G002Laboratory Medicine-Miscellaneous-Glucose, quantitative or semi-quantitative$2.18$2.26
G004Laboratory Medicine-Miscellaneous-Occult blood$1.53$1.58
G009Laboratory 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
G010Laboratory Medicine-one or more parts of above without microscopy$2.07$2.14
G011Laboratory Medicine-Miscellaneous-Fungus culture including KOH preparation and smear$12.60$13.05
G012Laboratory Medicine-Miscellaneous-Wet preparation (for fungus, trichomonas, parasites)$1.86$1.93
G014Laboratory Medicine-Miscellaneous-Rapid streptococcal test$5.50$5.70
G031Laboratory Medicine-Miscellaneous-Prothrombin time$6.20$6.40
G112ECG-Stress Testing-Dipyramidole Thallium stress test-professional component$75.00$74.25
G197Skin testing-professional component$0.19$0.21
G208Allergy-Provocation testing per unit$15.00$16.85
G262Cardiovascular-Angiography-Transluminal coronary angioplasty-Each additional major vessel add$212.45$210.40
G263Cardiovascular-Angiography-Selective coronary catheterization-With other drug interventional studies add$97.40$96.45
G297Cardiovascular-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
G319ECG-Stress Testing-Maximal stress ECG-professional component$62.65$62.05
G365Gynaecology-Papanicolaou Smear-Periodic$6.75$8.65
G378Gynaecology-Insertion of intrauterine contraceptive device$25.50$31.10
G382Chemotherapy-Monthly telephone supervision-Supervision of chemotherapy (pharmacologic therapy of malignancy or autoimmune disease) by telephone, monthly$13.30$13.80
G388Injections or Infusions-Management of special oral chemotherapy, for malignant disease$20.50$25.75
G394Gynaecology-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
G405Critical Care-Ventilatory support (ICA) physician-in-charge-1st day$193.45$183.80
G406Critical Care-Ventilatory support (ICA) physician-in-charge- 2nd to 30th day, inclusive per diem$101.55$96.45
G407Critical Care-Ventilatory support (ICA) physician-in-charge-31st day onwards per diem$67.60$64.20
G408Nephrology-Nephrological component of renal transplantation-2nd to 10th day, inclusive per diem$121.45$139.65
G409Nephrology-Nephrological component of renal transplantation-11th to 21st day, inclusive per diem$60.70$69.80
G412Nephrology-Nephrological component of renal transplantation-1st day following transplantation$242.90$279.35
G418Neurology-Routine EEG-professional component (16-21 channel EEG)$50.00$62.50
G420Otolaryngology-Ear syringing and/or extensive curetting or debridement unilateral or bilateral$11.25$11.35
G473Physical Medicine-Schedule C-professional component$191.00$275.00
G478diagnostic & therapeutic procedures-physical medicine-psychiatry-electroconvulsive therapy (ect) cerebral-single or multiple-in-patient$80.30$86.85
G479diagnostic & therapeutic procedures-physical medicine-psychiatry-electroconvulsive therapy (ect) cerebral-single or multiple-out-patient$92.60$100.15
G481Laboratory Medicine-Miscellaneous-Haemoglobin screen and/or haematocrit (any method or instrument)$1.32$1.37
G512Palliative Care-Palliative Care case management fee$62.75$67.75
G526Otolaryngology-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
G538Immunization-Other immunizing agents not listed above$4.50$4.95
G543Neurology-Electroencephalography-Sleep-deprived/induced EEG-professional component$60.00$120.00
G557Critical Care-Comprehensive Care (Intensive Care Area)-Physician-in-charge-1st day$325.40$374.35
G558Critical Care-Comprehensive Care (Intensive Care Area)-Physician-in-charge-2nd to 30th day, inclusive per diem$213.50$223.50
G559Critical Care-Comprehensive Care (Intensive Care Area)-Physician-in-charge-31st day onwards per diem$85.35$113.00
G590Immunization-Influenza agent$4.50$4.95
G600Critical Care-Neonatal intensive care-Level A-1st day$358.00$376.05
G601Critical Care-Neonatal intensive care-Level A-2nd to 30th day, inclusive per diem$178.95$187.95
G603Critical 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
G610Critical Care-Neonatal intensive care-Level B-1st day$245.65$258.05
G611Critical Care-Neonatal intensive care-Level B-2nd day onwards, per diem$122.80$129.00
G620Critical Care-Neonatal intensive care-Level C-1st day$155.20$162.95
G621Critical Care-Neonatal intensive care-Level C-2nd day onwards, per diem$77.60$81.50
G700Basic fee-Per-Visit premium for procedures marked (+)$5.10$5.60
G840Injections and Infusions-Immunization-Diphtheria, Tetanus, and acellular Pertussis vaccine/ Inactivated Poliovirus vaccine (DTaP/IPV)-Paediatric$4.50$5.40
G841Injections and Infusions-Immunization-Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenza type b (DTaP-IPV-Hib)-Paediatric$4.50$5.40
G842Injections and Infusions-Immunization-Hepatitis B (HB)$4.50$5.40
G843Injections and Infusions-Immunization-Human Papillomavirus (HPV)$4.50$5.40
G844Injections and Infusions-Immunization-Meningococcal C Conjugate (Men-C)$4.50$5.40
G845Injections and Infusions-Immunization-Measles, mumps, rubella (MMR)$4.50$5.40
G846Injections and Infusions-Immunization-Pneumococcal conjugate$4.50$5.40
G847Injections and Infusions-Immunization-Diphtheria, Tetanus, acellular Pertussis (Tdap)-Adult$4.50$5.40
G848Injections and Infusions-Immunization-Varicella (VAR)$4.50$5.40
H055GP/FP-Emergency Medicine-ED-Physician on Duty-Consultation$97.60$106.80
H065GP/FP-Consultation in Emergency Medicine$74.25$81.25
H101GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Minor assessment$15.00$16.55
H102GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Comprehensive assessment and care$37.20$41.65
H103GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Multiple systems assessment$35.65$39.35
H104GP/FP-Monday to Friday-Daytime (08:00h to 17:00h)-Re-assessment$15.00$16.55
H112GP/FP-Nights (00:00h to 08:00h)$34.20$35.15
H113GP/FP-Daytime and evenings (08:00h to 24:00h) on Saturdays, Sundays or Holidays$19.80$20.35
H121GP/FP-Nights (00:00h to 08:00h)-Minor assessment$29.80$30.60
H122GP/FP-Nights (00:00h to 08:00h)-Comprehensive assessment and care$73.90$76.70
H123GP/FP-Nights (00:00h to 08:00h)-Multiple systems assessment$65.95$67.75
H124GP/FP-Nights (00:00h to 08:00h)-Re-assessment$29.80$30.60
H131GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Minor assessment$18.70$20.65
H132GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Comprehensive assessment and care$46.30$51.85
H133GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Multiple systems assessment$42.40$46.80
H134GP/FP-Monday to Friday-Evenings (17:00h to 24:00h)-Re-assessment$18.70$20.65
H151GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Minor assessment$25.50$26.20
H152GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Comprehensive assessment and care$63.30$65.70
H153GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Multiple systems assessment$56.95$58.50
H154GP/FP-Saturdays, Sundays and Holidays-Daytime and Evenings (08:00h to 24:00h)-Re-assessment$25.50$26.20
H261Paediatrics-Newborn care in hospital or home$57.90$60.80
H312-first twelve weeks per visit$39.00$42.70
H313Physical 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
J135Diagnostic Ultrasound-Thorax, abdomen and retroperitoneum-Abdominal scan-Complete$26.55$26.45
J138Diagnostic Ultrasound-Pelvis-Intracavitary ultrasound* (e.g. transrectal, transvaginal)$26.55$26.50
J304Pulmonary 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
J306Pulmonary Function Studies-Functional residual capacity-Airways resistance by plethysmography or estimated using oesophageal catheter$16.05$16.85
J307Pulmonary Function Studies-Functional residual capacity-By body plethysmography$17.85$18.75
J310Pulmonary Function Studies-Functional residual capacity-Carbon monoxide diffusing capacity by single breath method$18.00$18.90
J311Pulmonary Function Studies-Functional residual capacity-By gas dilution method$17.55$18.45
J327Pulmonary Function Studies-Flow volume loop-Repeat after bronchodilator$6.45$6.75
J332Pulmonary Function Studies-Oxygen saturation-By oximetry at rest and exercise, or during sleep with or without O2$10.80$11.35
J333Pulmonary Function Studies-Oxygen saturation-Non-Specific bronchial provocative test (histamine, methacholine, thermal challenge)$34.70$36.45
J334Pulmonary Function Studies-Oxygen saturation-J332 with at least two levels of supplemental O2$16.05$16.85
J336Pulmonary Function Studies-Oxygen saturation-With single blind assessment of exercise on room air and with supplemental oxygen$16.05$16.85
J802Nuclear Medicine-IN VIVO-Cardiovascular system-Venography-Peripheral and superior vena cava$38.70$40.30
J804Nuclear Medicine-IN VIVO-Cardiovascular system-First transit-Without blood pool images$15.90$16.55
J815Nuclear Medicine-IN VIVO-Cardiovascular system-Myocardial wall motion-Detection of venous thrombosis using radioiodinated fibrinogen up to ten days$38.70$40.30
J816Nuclear Medicine-IN VIVO-Endocrine system-Adrenal scintigraphy-With iodocholesterol$38.70$40.30
J817Nuclear Medicine-IN VIVO-Endocrine system-Thyroid-Uptake$17.50$18.25
J818Nuclear Medicine-IN VIVO-Endocrine system-Thyroid scintigraphy with Tc99m or I-131$38.70$40.30
J819Nuclear 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
J820Nuclear Medicine-IN VIVO-Endocrine system-Parathyroid scintigraphy-Dual isotope technique with T1201 and Tc99m Iodine$53.10$55.30
J824Nuclear Medicine-IN VIVO-Gastrointestinal system-Malabsorption test-With C14 substrate$9.95$10.35
J827Nuclear Medicine-IN VIVO-Gastrointestinal system-Calcium absorption-Oesophageal motility studies-one or more$38.70$40.30
J829Nuclear Medicine-IN VIVO-Gastrointestinal system-Gastrointestinal-Transit$38.70$40.30
J830Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Tc99m sulphur colloid or Tc04$38.70$40.30
J831Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Biliary scintigraphy$38.70$40.30
J832Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Liver/spleen scintigraphy$38.70$40.30
J833Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Salivary gland scintigraphy$38.70$40.30
J834Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Dynamic renal imaging$31.30$32.60
J835Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Includes first transit$55.50$57.80
J836Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Static renal scintigraphy$38.70$40.30
J837Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-ERPF by blood sample method$9.95$10.35
J838Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-GFR by blood sample method$9.95$10.35
J839Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Cystography for vesicoureteric reflux$38.70$40.30
J840Nuclear Medicine-IN VIVO-Genitourinary system-Testicular and scrotal scintigraphy-Includes first transit$38.70$40.30
J841Nuclear Medicine-IN VIVO-Hematopoietic system-Plasma volume$11.40$11.85
J843Nuclear Medicine-IN VIVO-Hematopoietic system-Red cell volume$11.40$11.85
J850Nuclear Medicine-IN VIVO-Musculoskeletal system-Bone scintigraphy-General survey$47.70$49.70
J851Nuclear Medicine-IN VIVO-Musculoskeletal system-Bone scintigraphy-Single site$38.70$40.30
J852Nuclear Medicine-IN VIVO-Musculoskeletal system-Gallium scintigraphy-General survey$51.70$49.70
J853Nuclear Medicine-IN VIVO-Musculoskeletal system-Gallium scintigraphy-Single survey$38.70$40.30
J857Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-With Tc99m or I-131 HSA$43.95$45.75
J858Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-Brain scintigraphy$38.70$40.30
J859Nuclear Medicine-IN VIVO-Nervous system and respiratory system-Respiratory system-Perfusion lung scintigraphy$34.60$36.05
J860Nuclear Medicine-IN VIVO-Nervous system and respiratory system-Respiratory system-Perfusion and ventilation scintigraphy-Same day$47.70$49.70
J861Nuclear Medicine-IN VIVO-Miscellaneous-Radionuclide lymphangiogram$52.60$54.80
J863Nuclear Medicine-IN VIVO-Miscellaneous-Scintimammography-Unilateral or bilateral$38.70$40.30
J864Nuclear Medicine-IN VIVO-Miscellaneous-Tear duct scintigraphy$41.25$42.95
J865Nuclear Medicine-IN VIVO-Miscellaneous-Total body counting$38.70$49.70
J867Nuclear Medicine-IN VIVO-Cardiovascular system-First transit-With blood pool images$22.30$23.25
J869Nuclear Medicine-IN VIVO-Endocrine system-Adrenal scintigraphy-With MIBG$44.45$49.70
J870Nuclear Medicine-IN VIVO-Endocrine system-Thyroid-Repeat$10.30$10.75
J871Nuclear Medicine-IN VIVO-Endocrine system-Thyroid scintigraphy-With I-123$38.70$40.30
J872Nuclear Medicine-IN VIVO-Endocrine system-Parathyroid scintigraphy-Metastatic survey with I-131$44.45$49.70
J876Nuclear Medicine-IN VIVO-Gastrointestinal system-Gastro-oesophageal-reflux$38.70$40.30
J877Nuclear Medicine-IN VIVO-Gastrointestinal system-Gastro-oesophageal-Aspiration$38.70$40.30
J878Nuclear Medicine-IN VIVO-Gastrointestinal system-Abdominal scintigraphy for gastrointestinal bleed-Labelled RBCs$38.70$40.30
J880Nuclear Medicine-IN VIVO-Genitourinary system-Computer assessed renal function-Repeat after pharmacological intervention$17.10$17.80
J881Nuclear Medicine-IN VIVO-Hematopoietic system-Bone marrow scintigraphy-Whole body$47.70$49.70
J882Nuclear Medicine-IN VIVO-Hematopoietic system-Bone marrow scintigraphy-Single site$38.70$40.30
J883Nuclear Medicine-IN VIVO-Hematopoietic system-In-111 leukocyte scintigraphy-Whole body$46.75$49.70
J884Nuclear Medicine-IN VIVO-Hematopoietic system-In-111 leukocyte scintigraphy-Single site$38.70$40.30
J885Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-With In-111$43.95$45.75
J886Nuclear Medicine-IN VIVO-Nervous system and respiratory system-CSF circulation-Via shunt puncture$42.70$44.45
J887Nuclear Medicine-IN VIVO-Nervous system and respiratory system-Respiratory system-Ventilation lung scintigraphy$34.60$36.05
K002Interviews-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
K003Interviews-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
K004Psychotherapy-family-2 or more family members in attendance at the same time-per ½ hour or major part thereof$68.10$73.55
K005Primary mental health care-individual care-per ½ hour or major part thereof$62.75$67.75
K006Hypnotherapy-individual-per ½ hour or major part thereof$62.75$67.75
K007Psychotherapy-individual care-per ½ hour or major part thereof$62.75$67.75
K008Interviews-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
K010Psychotherapy-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
K012Psychotherapy-group-per ½ hour or major part thereof-per member (up to six hours per day)-four people$15.80$17.05
K013Counselling-individual care-per ½ hour or major part thereof$62.75$67.75
K014Counselling-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
K015Counselling relatives on behalf of catastrophically or terminally ill patient-1 or more persons-per ½ hour or major part thereof$62.75$67.75
K019Psychotherapy-group-2 people$31.40$33.90
K020Psychotherapy-group-3 people$20.90$22.55
K022HIV 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
K023Palliative 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
K024Psychotherapy-group-per ½ hour or major part thereof-per member (up to six hours per day)-five people$13.00$14.05
K025Psychotherapy-group-per ½ hour or major part thereof-per member (up to six hours per day)-six to twelve people$11.05$11.95
K028Sexually Transmitted Disease (STD) management-per ½ hour or major part thereof$62.75$67.75
K029Insulin therapy support (its)-per ½ hour or major part thereof$62.75$67.75
K030GP/FP-Diabetic Management Assessment$39.20$40.55
K032Specific neurocognitive assessment-diagnosis of dementia$62.75$67.75
K033Counselling-individual care-additional units per patient per provider per year, per ½ hour or major part thereof$38.15$47.70
K037Fibromyalgia/chronic fatigue syndrome care-Fibromyalgia/chronic fatigue syndrome care$62.75$67.75
K040Group 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
K041Group 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
K077Geriatrics-Geriatric telephone support per unit$35.45$40.05
K119Paediatrics-Paediatric developmental assessment incentive$100.00$115.10
K122Developmental and/or behavioural care-individual developmental and/or behavioural care$80.30$86.85
K123Developmental and/or behavioural care-family developmental and/or behavioural care$91.10$98.55
K131GP/FP-Periodic health visit-Adult age 18 to 64 inclusive$50.00$54.00
K140Chronic disease shared appointment-per patient-maximum 8 units per patient per day-2 patients-per unit$31.40$33.90
K141Chronic disease shared appointment-per patient-maximum 8 units per patient per day-3 patients-per unit$20.90$22.55
K142Chronic disease shared appointment-per patient-maximum 8 units per patient per day-4 patients-per unit$15.80$17.05
K143Chronic disease shared appointment-per patient-maximum 8 units per patient per day-5 patients-per unit$13.00$14.05
K144Chronic disease shared appointment-per patient-maximum 8 units per patient per day 6 to 12 patients-per unit$11.05$11.95
K189Urgent community psychiatric follow-up, to A190, A195, A695 or A795 add$200.00$216.30
K190Psychiatry-office/clinic-individual in-patient psychotherapy (including aversive conditioning, narcoanalysis, psychoanalysis)-per ½ hour or major part thereof$84.15$91.00
K191Psychiatry-family psychiatric care, in-patient, per ½ hour or major part thereof$105.10$113.70
K192Psychiatry-hypnotherapy-individual-per ½ hour or major part thereof$80.30$86.85
K193Psychiatry-family psychotherapy-in-patients (two or more family members) per ½ hour or major part thereof$95.45$103.25
K194Psychiatry-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
K195Psychiatry-family psychotherapy-out-patients (two or more family members) per ½ hour or major part thereof$91.10$98.55
K196Psychiatry-family psychiatric care, out-patient, per ½ hour or major part thereof$91.10$98.55
K197Psychiatry-office/clinic-individual out-patient psychotherapy (including aversive conditioning, narcoanalysis, psychoanalysis)-per ½ hour or major part thereof$80.30$86.85
K198Psychiatry-psychiatric care, out-patient, per ½ hour or major part thereof$80.30$86.85
K199Psychiatry-psychiatric care, in-patient, per ½ hour or major part thereof$92.60$100.15
K200Psychiatry-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
K201Psychiatry-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
K202Psychiatry-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
K203Psychiatry-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
K204Psychiatry-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
K205Psychiatry-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
K206Psychiatry-group psychotherapy, out-patients-per member, per ½ hour-(seventh hour onward, to a maximum of 3 hours)$12.85$13.90
K207Outpatient psychotherapy-group-add'l units$12.85$13.90
K208Psychiatry-Psychotherapy, Family Psychotherapy, Hypnotherapy and Psychiatric Care-Group psychotherapy, out-patients-per member-first 12 units per day$40.15$43.45
K209Psychiatry (19)-Group psychotherapy, out-patients-per member-first 12 units per day- 3 people…per unit$26.75$28.95
K210Psychiatry (19)-Group psychotherapy, in-patients-per member-first 12 units per day-2 people…per unit$42.10$45.55
K211Psychiatry (19)-Group psychotherapy, in-patients-per member-first 12 units per day-3 people…per unit$28.05$30.35
K222Genetic care, patient or family, per unit$74.70$75.75
K223Clinical interpretation by a geneticist$37.65$38.20
K224Clinical interpretation requested by a midwife$37.65$38.20
K620Psychiatry-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
K623Family & general practice-assessments under the mental health act-application for psychiatric assessment-form 1$104.80$113.35
K624Family & general practice-assessments under the mental health act-certification of involuntary admission-form 3$129.05$139.60
K629Family & 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
K630Psychiatry-Psychiatric consultation extension-per unit$105.10$113.70
K680Substance abuse-extended assessment$62.75$67.75
K887Family & 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
K888Family & 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
K889Family & 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
L800Laboratory Medicine-Haematopathology-Blood film interpretation (Romanowsky stain)$20.85$21.70
L805Laboratory Medicine-Anatomic Pathology-Cytopathology-Aspiration biopsy e.g. Lung, breast, thyroid, prostate$79.00$81.20
L806Laboratory Medicine-Anatomic Pathology-Bronchial, oesophageal, gastric, endometrial or other brushings and washings$35.45$35.80
L810Laboratory Medicine-Anatomic Pathology-Cytopathology-Fluids e.g. pleural, ascitic cyst, pericardial, C.S.F., urine and joint$22.05$23.40
L820Laboratory Medicine-Anatomic Pathology-Cytopathology-Smear for spermatozoa$6.05$7.00
L826Laboratory Medicine-Haematopathology-Blood film interpretation (special stain)$11.85$13.35
L829Laboratory Medicine-Haematopathology-Haemoglobinopathy interpretation (payable for abnormal results only)$12.90$13.70
L834Laboratory Medicine-Special Procedures and Interpretation-Histology or Cytology-Histochemistry of muscle-1 to 3 enzymes$11.85$13.35
L835Laboratory Medicine-Special Procedures and Interpretation-Each additional enzyme, add$11.85$13.35
L841Laboratory Medicine-Special Procedures and Interpretation-Enzyme histochemistry and interpretation-Per enzyme$11.85$13.35
L843Laboratory 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
L844Laboratory 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
L846Laboratory Medicine-Special Procedures and Interpretation-Flow cell cytometry and interpretation-Per marker$11.85$12.20
L849Laboratory Medicine-Special Procedures and Interpretation-Interpretation and handling of decalcified tissue$12.80$13.90
M135Major decortication of lung for empyema or tumour$800.00$848.80
M142Pneumonectomy, may include radical mediastinal node dissection, sampling or pericardial resection requiring repair$1,400.00$1,485.40
M143Lobectomy, may include radical mediastinal node dissection or sampling$1,285.00$1,402.60
M144Segmental resection, including segmental bronchus and artery$1,285.00$1,441.75
M145Wedge resection of lung$818.45$843.40
N102Meningioma and other tumourous lesions, including pituitary tumours-supratentorial$1,726.80$1,862.85
N103Craniotomy plus excision-Astrocytoma, oligodendroglioma, glioblastoma or metastatic tumour-supratentorial$1,562.90$1,686.05
N104Spontaneous Intracerebral Haemorrhage-Craniotomy plus removal-supratentorial$1,100.00$1,230.00
N105Neurosurgery-Open Surgical Approach-Intracranial aneurysm repair-Craniotomy approaches-Carotid circulation-per vessel$2,140.15$2,477.45
N106Neurosurgery-Open Surgical Approach-Cerebral vascular malformation-Craniotomy-supratentorial$1,622.50$2,006.05
N113Intracranial Abscess-Craniotomy for brain Biopsy (other than for tumour)$774.90$1,019.15
N119Intracranial Abscess-Functional stereotaxy-Intracranial implantation of chronic surface electrodes$901.25$1,185.30
N123Intracranial Abscess-Stereotaxis-intracranial (to include ventriculography)$538.40$559.60
N124Intracranial Abscess-Functional stereotaxy$1,551.20$2,040.15
N128Intracranial Abscess-Repair of encephalocoele$798.80$924.70
N129Intracranial Abscess-Posterior fossa decompression for Arnold Chiari malformation$1,110.00$1,284.95
N140Cranial-Reduction of skull fracture-compound$773.15$895.00
N143Cranial-Extracerebral haematoma and/or hygroma-Drainage by burr hole(s)-unilateral$559.60$647.80
N144Cranial-Extracerebral haematoma and/or hygroma-Drainage and/or removal by craniotomy$863.25$999.30
N148Cranial-Removal of intracerebral haematoma and/or debridement of traumatized brain (includes management of any skull fracture)$1,040.65$1,204.65
N151Craniotomy plus excision-Astrocytoma, oligodendroglioma, glioblastoma or metastatic tumour-infratentorial$1,726.80$1,862.85
N153Meningioma and other tumourous lesions, including pituitary tumours-infratentorial or basal$2,345.00$2,529.80
N154Neurosurgery-Open Surgical Approach-Intracranial aneurysm repair-Craniotomy approaches-Vertebrobasilar circulation, including aneurysm of vein of Galen$2,140.15$2,477.45
N155Neurosurgery-Open Surgical Approach-Cerebral vascular malformation-Craniotomy-infratentorial$1,532.10$2,015.00
N157Spontaneous Intracerebral Haemorrhage-Craniotomy plus removal-infratentorial$1,241.65$1,388.40
N174Cranial-Conversion of shunt (e.g. ventriculoperitoneal to ventriculoatrial)-includes removal of existing shunt$420.30$585.90
N200Cranial-Decompressive craniectomy (frontal, sub-temporal)$638.05$738.60
N218Neurosurgery-Open Surgical Approach-Extracranial-intracranial microvascular anastomosis superficial temporal artery$1,178.35$1,364.05
N230Cranial-CSF shunting procedures-all types$737.00$1,027.40
N245Cranial-Revision of CSF shunt-operative-all types$420.70$585.90
N249Cranial-Conversion of shunt (e.g. ventriculoperitoneal to ventriculoatrial)-Third ventriculostomy$777.80$1,084.25
N259Cranial-V-Decompression or rhizotomy (partial or complete) trigeminal nerve$481.90$671.75
N267Cranial-Occipital and/or suboccipital craniectomy for compression, decompression or section of cranial nerves$1,232.35$1,280.90
N501Anterior Spinal Decompression-Cervical-Vertebrectomy (removal of vertebral body and excision of adjacent discs)$1,020.00$1,100.40
N523AV malformation of cord-excision/obliteration$1,530.00$1,891.70
N530Implantation of spinal cord stimulating electrode by laminectomy$816.00$1,008.90
N536Repair of myelomeningocoele (one surgeon)$765.00$1,217.10
N538Repair of myelomeningocoele (two surgeons)-reconstructive surgeon$632.40$881.55
N555Insertion / revision of implantable infusion pump$510.00$590.40
N560Intradural extramedullary spinal tumour(s)-partial or total removal$1,530.00$2,132.80
N561Intradural intramedullary spinal tumour(s)-partial or total removal$1,765.75$2,461.45
N565Repair of lipomeningocoele including release of tethered cord$1,020.00$1,622.80
N577Intradural rhizotomy anterior/posterior (uni/bilateral)-any number of roots.$714.00$1,276.65
P004Obstetrics-Prenatal care-Minor prenatal assessment$33.70$36.85
P008Obstetrics-Labour-Delivery-Postnatal care in office$33.70$36.85
R261Elbow and Forearm-Reconstruction-Bone-Deformity-Osteotomy-radius with or without ulna$411.20$577.70
R322Hand and Wrist-Reconstruction-Bone-Pseudoarthrosis/non-Union/avascular necrosis-Scaphoid$500.00$588.20
R352Chest Wall and Mediastinum-Repair-Chest wall-Pleura-Pectus excavatum or carinatum repair (by reconstruction, not implant)$750.00$832.30
R401Shoulder, Arm and Chest-Reduction-Dislocations-Glenohumeral joint-Open reduction, recurrent$379.50$419.65
R421Elbow and Forearm-Excision-Joint contents-Synovectomy/capsulectomy/debridement, etc.$311.85$407.25
R465Hand and Wrist-Arthrodesis-Finger-Thumb$256.15$321.30
R466Hand and Wrist/Elbow and Forearm/Foot and Ankle-Arthrodesis-Wrist/Elbow/Ankle$400.00$461.75
R475Foot and Ankle-Arthrodesis-Pan-Talar, one stage$626.45$779.50
R477Foot and Ankle-Arthrodesis-Metatarsophalangeal$247.25$302.60
R485Hand and Wrist-Arthroplasty-Wrist-Total$426.90$667.75
R486Elbow and Forearm-Arthroplasty-Complete arthroplasty replacement$619.90$911.05
R487Shoulder, Arm and Chest-Arthroplasty-Total prosthesis$695.10$770.00
R695Foot and Ankle-Arthrodesis-Subtalar$450.00$599.95
R720Heart and Pericardium-Repair-Total repair Tetralogy of Fallot-With or without previous arterial shunt$1,261.80$1,285.00
R721Heart and Pericardium-Repair-Arterial repair of transposition$1,687.50$1,739.20
R722Heart and Pericardium-Repair-Total anomalous pulmonary venous drainage$1,124.70$1,152.30
R723Heart and Pericardium-Repair-Total correction transposition of great vessels$1,124.70$1,152.30
R727Valves-Tricuspid annuloplasty$662.55$678.80
R728Valves-Tricuspid valve replacement$758.80$777.40
R734Valves-Mitral annuloplasty$770.70$789.60
R735Valves-Mitral replacement$948.70$960.35
R738Valves-Mitral valve reconstruction-Aortic valve replacement$1,036.50$1,049.20
R743Heart and Pericardium-Excision-Coronary artery repair-Two$1,255.00$1,278.10
R758Heart and Pericardium-Resection coarctation-Adolescent or adult$967.00$984.90
R759Heart and Pericardium-Resection coarctation-Congenital heart procedures-E.g. Blalock, Glenn, Potts, Waterston or Central$755.80$774.35
R770Heart and Pericardium-Repair-Correction of cor triatriatum$864.40$885.60
R773Valves-Mitral valve reconstruction-Simple (includes annuloplasty)$1,618.50$1,648.25
R774Valves-Mitral valve reconstruction-Complex (includes annuloplasty and repair of both the anterior and posterior leaflets)$2,021.05$2,058.20
R785Arteries-Aorto-Iliac repair-Plus bilateral common femoral repair$2,202.00$2,327.50
R787Arteries-Femoro-Anterior/posterial tibial/peroneal bypass graft-With saphenous vein$1,006.75$1,265.00
R791Arteries-Femoro-Popliteal-With saphenous vein$857.35$1,077.25
R799Arteries-Thoracic aorta aneurysm-Repair or excision with graft-Ascending$1,455.30$1,473.15
R800Arteries-Thoracic aorta aneurysm-Repair or excision with graft-Arch$1,807.10$1,840.35
R802Arteries-Abdominal aorta-Repair or excision with graft-Aneurysm repair alone or including unilateral common femoral repair$1,500.00$1,585.50
R803Arteries-Thoracic aorta aneurysm-Repair or excision with graft-Thoraco-Abdominal aneurysm$2,566.70$2,859.30
R817Arteries-Abdominal aorta-Repair or excision with graft-Aneurysm repair and bilateral common femoral repair$2,202.00$2,327.50
R827Diagnostic and Therapeutic Procedures/Cardiovascular-Dialysis/veins-Revision of Scribner shunt/Anastomosis-Spleno-renal-Creation of A.V. fistula$440.00$490.15
R840Dialysis-Bypass graft for haemodialysis-Autogenous vein$424.10$496.60
R851Dialysis-Bypass graft for haemodialysis-Synthetic$444.70$482.70
R852Dialysis-Peritoneal dialysis-Insertion of peritoneal cannula by laparotomy or laparoscopy$256.10$352.50
R863Valves-Mitral valve reconstruction-Replacement of aortic valve, replacement of ascending aorta, and reimplantation of coronary Arteries (Modified Bentall)$2,021.05$2,070.60
R874Heart and Pericardium-Percutaneous transluminal catheter assisted closure for Secundum arterial septal defect-Cardiopulmonary transplantation$2,534.25$2,565.30
R876Valves-Mitral valve reconstruction-Valve sparing aortic root replacement or remodelling$2,021.05$2,144.95
R877Arteries-Abdominal aorta-Repair or excision with graft-Aneurysm with repair of iliac artery aneurysm (unilateral or bilateral)$2,002.75$2,116.90
R923Heart and Pericardium-Repair-Double outlet-Right/left ventricle$1,480.40$1,516.70
R924Heart and Pericardium-Repair-Double outlet ventricle with transposition$1,687.50$1,728.90
R925Heart and Pericardium-Repair-Truncus arteriosus$1,687.50$1,718.55
R926Heart and Pericardium-Repair-Interrupted aortic arch$1,480.40$1,516.70
R927Heart and Pericardium-Repair-Aorto-Pulmonary window$948.75$960.40
S089Partial oesophageal resection and reconstruction (including intestinal transposition)$1,081.55$1,180.50
S090Total thoracic oesophageal resection$1,465.35$1,912.30
S096Ruptured oesophagus, suture and drainage$507.00$661.65
S104Oesophagus-Suture-Repair of esophageal atresia with or without tracheal fistula$1,153.85$2,203.20
S117Stomach-Incision-Gastrotomy-Pyloromyotomy (Ramstedt's)$314.80$536.90
S118Stomach-Incision-Gastrostomy-Gastrostomy$345.85$467.85
S139Stomach-Suture-Gastrorrhaphy (for perforated gastric or duodenal ulcer or wound)$503.15$672.75
S149Intestines (except rectum) Incision-Enterotomy-Ileostomy$406.85$470.65
S157Intestines (except rectum) Incision-Enterotomy-Colostomy$406.85$470.65
S160Intestines (except rectum) Incision-Enterotomy-Entero-enterostomy$406.85$470.65
S164Intestines (except rectum) Excision-Resection with anastomosis-Small intestine-Duodenum$746.10$1,015.15
S165Intestines (except rectum) Excision-Resection with anastomosis-Small intestine-Other$687.55$741.45
S166Intestines (except rectum) Excision-Resection with anastomosis-Small and large intestine terminal ileum, cecum and ascending colon (right hemicolectomy)$799.55$899.85
S167Intestines (except rectum) Excision-Resection with anastomosis-Large intestine-any portion$799.55$877.95
S168Intestines (except rectum) Excision-Ileostomy-Subtotal colectomy$1,057.70$1,260.40
S169Intestines (except rectum) Excision-Resection with anastomosis-Total colectomy with ileo-rectal anastomosis$1,242.90$1,313.65
S170Intestines (except rectum) Ileostomy-Plus total colectomy plus abdomino-perineal resection$1,790.60$2,183.65
S171Intestines (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
S173Intestines (except rectum)-Ileostomy-Two-Surgeon team-Abdominal$1,632.80$1,812.00
S174Intestines (except rectum)-Ileostomy-Two-Surgeon team-Perineal$481.00$533.80
S175Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-Without resection$620.00$712.35
S176Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-With entero-enterostomy$748.00$894.85
S177Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-With resection$900.00$1,055.25
S178Intestines (except rectum)-Intestinal obstruction (mechanical)-Intestinal atresia (newborn)$682.90$1,512.75
S179Intestines (except rectum)-Intestinal obstruction (mechanical)-Meconium ileus$682.90$1,512.75
S180Intestines (except rectum)-Intestinal obstruction (mechanical)-One stage-With enterotomy$672.00$824.80
S182Intestines (except rectum)-Repair-Revision of ileostomy or colostomy-Full thickness$350.65$467.90
S185Intestines (except rectum)-Suture-Closure of colostomy or enterostomy-With or without resection and/or anastomosis$406.85$504.70
S188Intestines (except rectum)-Ileostomy-Bowel resection without anastomosis (colostomy and mucous fistula)$544.35$770.55
S213Rectum-Excision-Proctectomy-Anterior resection or proctosigmoidectomy (anastomosis below peritoneal reflection)$1,100.00$1,204.50
S214Rectum-Excision-Proctectomy-Abdomino-Perineal resection or pull through$1,300.00$1,524.20
S215Rectum-Excision-Two surgeon team-Abdominal surgeon$1,009.85$1,107.50
S217Rectum-Excision-Two surgeon team-Hartmann procedure$890.00$1,063.60
S218Rectum-Excision-Two surgeon team-Colon reconstruction following Hartmann procedure$1,030.00$1,086.75
S222Rectum-Excision-Two surgeon team-Presacral or trans-sacral proctotomy and excision of lesion$350.65$474.35
S227Rectum-Repair-Rectal prolapse-Abdominal approach$554.10$688.75
S229Rectum-Suture of rectum, trauma-External approach$239.20$355.45
S249Rectum-Excision-Local excision for malignancy$153.05$291.05
S270Liver-Excision-Hepatectomy-Formal anatomical resection-one or two liver segments$1,184.60$1,426.05
S271Liver-Excision-Hepatectomy-Formal anatomical resection-Five or more liver segments$1,784.60$1,938.50
S300Pancreas-Excision-Pancreatectomy-"Whipple type" procedure$1,785.45$2,457.35
S312Abdomen, 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
S321Abdomen, Peritoneum and Omentum-Incision-Laparotomy-for acute trauma$397.15$587.10
S322Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Inguinal and/or femoral-Infants$325.00$487.50
S323Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Inguinal and/or femoral-Adolescents and adults$331.80$357.80
S326Abdomen, Peritoneum and Omentum-Repair-Herniotomy-Inguinal and/or femoral-Children$275.00$412.50
S328Unilateral with exploration of other side-infants and children$329.30$458.40
S345Massive sliding inguinal hernia$400.00$431.35
S346Abdomen, Peritoneum and Omentum-Repair-Congenital diaphragmatic hernia-Primary or first stage repair$576.90$1,300.55
S347Abdomen, Peritoneum and Omentum-Repair-Congenital diaphragmatic hernia-Second or subsequent stage repair$366.00$472.15
S348Abdomen, Peritoneum and Omentum-Repair-Omphalocele and gastroschisis-Primary or first stage repair$375.80$1,112.35
S349Abdomen, Peritoneum and Omentum-Repair-Omphalocele and gastroschisis-Second or subsequent stage repair$475.80$1,408.35
S411Kidney and Upper Urinary Tract-Excision-Partial or heminephrectomy$875.00$890.80
S416Kidney and Upper Urinary Tract-Excision-Nephrectomy-Thoraco-Abdominal or radical nephrectomy$875.00$890.80
S422Kidney and Upper Urinary Tract-Repair-Pyeloplasty (with or without nephropexy)$679.25$890.80
S424Kidney 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
S428Kidney and Upper Urinary Tract-Repair-Symphysiotomy for horseshoe kidney with or without nephropexy and associated procedures$437.20$494.90
S449Kidney and Upper Urinary Tract-Excision-Ureterectomy-Including ureterovesical junction$437.20$445.40
S458Kidney and Upper Urinary Tract-Repair-Ureterostomy-Cutaneous-Unilateral$260.85$494.90
S484Bladder-Cystectomy-Complete cystectomy, without transplant$657.75$791.85
S512Bladder-Repair of ruptured bladder$330.90$346.45
S513Bladder-Repair-Cystoplasty, using intestine$657.75$692.85
S518Bladder-Repair-Plastic repair of bladder neck-Child$331.70$494.90
S523Urogenital and Urinary Surgical Procedures-Bladder/Female Genital Surg Procedures-Vagina-Suture/Repair-Closure of fistula/Vesicovaginal-Vaginal approach$772.40$791.85
S524Bladder-Suture-Closure of fistula-Vesicovaginal-Transvesical approach (with or without omental flap)$467.00$544.40
S535Urethra-Repair-Urethroplasty-First stage-One stage repair and may include skin grafting$381.60$445.40
S536Urethra-Excision-Caruncle$85.30$118.80
S537Urethra-Excision-Urethral papilloma, single or multiple$85.30$118.80
S543Urethra-Excision-Prolapse urethra$85.30$118.80
S544Urethra-Excision-Urethrectomy-Radical$215.80$296.95
S553Urethra-Suture-Posterior urethra-Late repair$552.30$643.35
S569Penis-Incision-Slit of prepuce (complete care)-Adult or child$30.25$39.60
S571Penis-Repair-Hypospadias or Epispadia-One stage repair-With advancement of meatus into glans$383.50$420.65
S572Penis-Repair-Hypospadias or Epispadia-One stage repair-Into glans using island flap pedicle (penoscrotal)$662.45$722.55
S573Penis-Excision-Circumcision-for Physical symptomatology only-for patients aged one year or older$179.40$188.05
S574Penis-Excision-Amputation-Partial$170.65$197.95
S577Penis-Excision-Circumcision-for Physical symptomatology only-for infants less than one year of age$90.05$188.05
S581Penis-Repair-Hypospadias or Epispadia-Closure urethro-Cutaneous fistula$92.10$296.95
S588Penis-Repair-Hypospadias or Epispadia-Surgical removal of prosthesis$110.15$148.45
S591Testis-Repair-Orchidopexy-for undescended testis, any type, one or two stages to include hernia repair where required$331.70$346.45
S593Testis-Repair-Orchidopexy-Exploration for undescended testicle, without orchidopexy$260.85$346.45
S595Testis-Repair-Orchidopexy-Ruptured testicle$170.65$247.45
S596Testis-Repair-Orchidopexy-Insertion of testicular prosthesis$170.65$197.95
S597Penis-Repair-Hypospadias or Epispadia-Penile prosthesis for impotence$306.85$395.90
S598Testis-Biopsy-Radical orchidectomy for malignancy-Unilateral$235.35$267.25
S600Testis-Repair-Orchidopexy-Reduction of torsion of testis or appendix testis and orchidopexy (one or both sides) if required$235.35$296.95
S601Epididymis and Tunica Vaginalis-Epididymis-Spermatocele or spermatic granuloma excision$205.35$207.85
S611Epididymis and Tunica Vaginalis-Tunica Vaginalis-Hydrocele excision-Unilateral$205.35$207.85
S616Scrotum-Incision-Abscess or haematocele-And exploration-Unilateral$85.30$99.00
S647Prostate-Excision-Prostatectomy-Suprapubic-With or without removal of bladder stones$600.75$643.35
S650Prostate-Excision-Retropubic-With or without removal of bladder stones-Simple$600.75$643.35
W075Consultation$185.00$203.30
W085Plastic Surgery-Non-emergency LTC in-patient Services-Consultation$81.10$87.70
W086Plastic Surgery-Non-emergency hospital in-patient services-Repeat consultation$47.95$51.85
W113Complex neuromuscular assessment$89.85$91.00
W155Endocrinology & Metabolism (15) -Consultation$157.00$162.65
W165Nephrology (16)-Consultation$157.00$162.90
W185Consultation$176.35$178.60
W223Extended special genetic consultation$395.65$401.30
W225Consultation$165.00$167.35
W265Paediatrics-Consultation$167.00$175.40
W305OB/GYN-Consultation$101.70$111.70
W306OB/GYN-Repeat consultation$54.10$59.45
W345Otolaryngology-Non-emergency LTC in-patient Services-Consultation$77.90$79.90
W355Urology-Non-emergency LTC in-patient Services-Consultation$80.00$83.15
W356Urology-Non-emergency LTC in-patient Services-Repeat consultation$55.75$56.40
W465Infectious Disease (46)-Consultation$157.00$178.65
W511Physical Medicine and Rehabilitation-Non-emergency LTC in-patient Service-Complex physiatry assessment$89.85$98.35
W515Physical Medicine and Rehabilitation-Non-emergency LTC in-patient Service-Consultation$182.85$200.15
W535Ophthalmology-Non-emergency LTC in-patient Service-Consultation$82.30$82.20
W645General Thoracic Surgery-Non-emergency hospital in-patient services-Consultation$90.30$98.55
W662Paediatrics-Extended special paediatric consultation-Subject to the same conditions as A662$395.65$401.30
W667Paediatrics-Neurodevelopmental consultation$395.65$401.30
W695Neurodevelopmental consultation$395.65$401.30
W760Endocrinology & Metabolism (15) -Complex endocrine neoplastic disease assessment$89.85$90.75
W770Extended comprehensive geriatric consultation$395.65$401.30
W777GP/FP-Non-emergency LTC in-patient Services-Admission assessment-Intermediate assessment-Pronouncement of death$33.70$36.85
W895Consultation$232.70$251.70
X090Diagnostic Radiology-Chest & Abdomen-Chest-Single view$6.40$6.35
X091Diagnostic Radiology-Chest & Abdomen-Chest-Two views$10.75$10.70
X092Diagnostic Radiology-Chest & Abdomen-Chest-Three or more views$12.45$12.40
Y820Nuclear Medicine-IN VIVO-Parathyroid scintigraphy-Dual isotope technique with T1201 and Tc99m Iodine$69.03$71.89
Y827Nuclear Medicine-IN VIVO-Calcium absorption-Oesophageal motility studies-one or more$50.31$52.40
Y829Nuclear Medicine-IN VIVO-Gastrointestinal-Transit$50.31$52.40
Y831Nuclear Medicine-IN VIVO-Abdominal scintigraphy-for gastrointestinal bleed-Biliary scintigraphy$50.31$52.40
Y832Nuclear Medicine-IN VIVO-Abdominal scintigraphy-for gastrointestinal bleed-Liver/spleen scintigraphy$50.31$52.40
Y833Nuclear Medicine-IN VIVO-Abdominal scintigraphy-for gastrointestinal bleed-Salivary gland scintigraphy$50.31$52.40
Y836Nuclear Medicine-IN VIVO-Computer assessed renal function-Static renal scintigraphy$50.31$52.40
Y850Nuclear Medicine-IN VIVO-Bone scintigraphy-General survey$62.01$64.58
Y851Nuclear Medicine-IN VIVO-Bone scintigraphy-Single site$50.31$52.40
Y859Nuclear Medicine-IN VIVO-Perfusion lung scintigraphy$44.98$46.85
Y860Nuclear Medicine-IN VIVO-Perfusion and ventilation scintigraphy-Same day$62.01$64.58
Y876Nuclear Medicine-IN VIVO-Gastroesophageal-Reflux$50.31$52.40
Y877Nuclear Medicine-IN VIVO-Gastro-Oesophageal-Aspiration$50.31$52.40
Y887Nuclear Medicine-IN VIVO-Ventilation lung scintigraphy$44.98$46.85
Z296Nose-Endoscopy-Fiberoptic endoscopy of upper airway (nose, hypopharynx or larynx) (IOP)-With flexible endoscope-If only operative procedure performed$19.20$20.10
Z335Thoracoscopy (pleuroscopy) with or without pleural biopsy, suction, etc.$228.40$242.35
Z341Lungs and Pleura-Incision-Closed drainage effusion or pneumothorax$69.80$76.80
Z403Diagnostic and Therapeutic Procedures/Haematic and Lymphatic Surgical Procedures-Laboratory medicine/spleen and marrow-Incision//Haematopathology-Bone marrow aspiration$33.90$42.40
Z408Spleen and Marrow-Incision-Bone marrow core biopsy (with biopsy needle)$63.35$79.20
Z434Cardiovascular-Angiography-Transluminal coronary angioplasty-one or more sites on a single major vessel$471.60$467.05
Z440Cardiovascular-Haemodynamic/Flow/Metabolic Studies-Left heart-Retrograde aortic$210.55$208.50
Z442Cardiovascular-Angiography-Selective coronary catheterization-Both arteries$289.55$286.75
Z604Urethra-Incision-Urethrotomy-Meatotomy and Plastic repair$31.60$39.60
Z621Urethra-Manipulation-Dilatation of stricture-Male, local anaesthetic$13.65$14.85
Z622Urethra-Manipulation-Dilatation of urethra-Female$5.65$9.90
Z627Kidney and Upper Urinary Tract-Percutaneous procedures-Removal of renal calculi$167.85$168.25
Z628Kidney and Upper Urinary Tract-Endoscopic Procedures-Cystoscopy and diagnostic ureteroscopy-Above intramural$125.65$125.70
Z702Penis-Excision-Biopsy$23.55$39.60
Z708Epididymis and Tunica Vaginalis-Tunica Vaginalis-Hydrocele aspiration$16.25$19.80
Z709Scrotum-Incision-Abscess or haematocele-Local anaesthetic$20.10$39.60
Z740Operations of the Breast-Incision-Drainage of intramammary abscess or haematoma-Single or multiloculated-General anaesthetic$75.00$133.80
Z768Scrotum-Incision-Abscess or haematocele-General anaesthetic$55.15$99.00
Z785Rectum-Excision-Polyps or tumours of rectum or sigmoid-Excision and suture-Base over 5 cm$329.65$582.95
Z804Neurology-Lumbar puncture$67.60$74.35
Z805Neurology-Lumbar puncture-With instillation of medication or other therapeutic agent$75.10$86.35
Z809Cranial-Conversion of shunt (e.g. ventriculoperitoneal to ventriculoatrial)-Insertion of CSF reservoir (Ommaya) including burr holes$370.50$428.90
Z813Intracranial Abscess-Burr hole-plus needling of brain for biopsy$453.60$560.85
Z820Intracranial Abscess-Ventriculoscopy-Insertion of intracranial catheter or transducer for purposes of monitoring$317.85$367.95
Z823Neurological Surgical Procedures-Cranial/Peripheral Nerves-Functional stereotaxy-Implantation or revision of stimulation pack or leads (peripheral nerve, brain)$307.40$404.30
Z825Intracranial Abscess-Ventriculoscopy-to include burr hole$408.95$731.20
Z943Programming infusion pump or dorsal column stimulator$102.00$142.20
K018Sexual assault examination-female$308.70$319.60
K021Sexual assault examination-male$243.50$252.10
K061Taking of blood samples in a hospital setting at the request of a police officer$30.00$31.05
K050Health Status Report and Activities of Daily Living Index (amalgamated form)$100.00$103.55
K051Health Status Report (completed separately)$80.00$82.85
K052Activities of Daily Living Index (completed separately)$20.00$20.70
K057Medical Form Part A for Medical Review process$35.00$36.25
K058Medical Form Part B including both Health Status Report and Activities of Daily Living Index for Medical Review process$125.00$129.40
K059Health Status Report of Part B (completed separately) for Medical Review process$100.00$103.55
K060Activities of Daily Living Index of Part B (completed separately) for Medical Review process$25.00$25.90
K054Mandatory Special Necessities Benefit Request Form$25.00$25.90
K055Application for Special Diet Allowance$20.00$20.70
K056Application for Pregnancy/Breast-feeding Nutritional Allowance$20.00$20.70
K053A Limitation to Participation Form$15.00$15.55
K065Periodic Oculo-Visual Assessment-ODSP$48.90$50.65
K066Periodic Oculo-Visual Assessment-OW$48.90$50.65
G153Cortical evoked audiometry, technical component$9.75$10.10
G154Cortical 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 CodeSpecialty DescriptionRelativity Rate
00GP Group 1: Capitated harmonized models2.4629%
00GP Group 2: Comprehensive Care models with CCM fee6.7646%
00GP Group 3: FFS and Other8.9897%
01Anaesthesiology0.4542%
02Dermatology1.8232%
03General Surgery2.4806%
04Neurosurgery2.8042%
05Community Medicine3.5446%
06Orthopaedic Surgery2.2551%
07Geriatrics5.3367%
08Plastic Surgery3.1374%
09Cardiac Surgery1.6189%
13Internal and Occupational Medicine3.8628%
15Endocrinology2.8045%
16Nephrology1.4123%
17Vascular Surgery1.2025%
18Neurology4.5901%
19Psychiatry7.5602%
20Obstetrics & Gynaecology4.7519%
22Genetics3.6546%
23Ophthalmology0.0000%
24Otolaryngology1.6817%
26Paediatrics4.0562%
31Physical Medicine & Rehabilitation5.2649%
33Diagnostic Radiology0.0000%
34Radiation Oncology0.0000%
35Urology1.6730%
41Gastroenterology0.0000%
44Medical Oncology2.4548%
46Infectious Disease9.2749%
47Respiratory Disease4.7734%
48Rheumatology3.6674%
60Cardiology0.0000%
61Haematology5.1865%
62Clinical Immunology1.3318%
63Nuclear Medicine1.6832%
64General Thoracic Surgery3.8604%
EMEmergency Medicine group3.6198%
LMLaboratory Medicine group2.2418%
GBGlobal3.5446%

Medical Claims Adjustments (MADJ)

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

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

Resources

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

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

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