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Annual Increase in Medical Tariffs for Medical Service Providers, Pharmacies and Hospital Groups - 2012

Part III : Procedures

3. Musculo-skeletal system

 



Specialist

General Practitioner

Anaesthetic

 

U/E

R

U/E

R

U/E

R T/M

3.

3.1

Bones


3.1.1

Fractures


0383

Fracture (reduction under general anaesthetic) Scapula

 

 

 

 

3

230.43

+T+M

0387

Fracture (reduction under general anaesthetic): Clavicle

77

1,265.88

77

1,265.88

3

230.43

+T+M

0388

Percutaneous pinning supracondylar fracture elbow - stand alone procedure

175.70

2,888.51

140.58

2,310.81

3

230.43

+T+M

0389

Fracture (reduction under general anaesthetic): Humerus

111.60

1,834.70

111.60

1,834.70

3

230.43

+T+M

0391

Fracture (reduction under general anaesthetic):· Radius and/or ulna

77

1,265.88

77

1,265.88

3

230.43

+T+M

0392

Open reduction of both radius and ulna Modifier 0051 not applicable)

210

3,452.40

168

2,761.92

3

230.43

+T+M

0402

Fracture (reduction under general anaesthetic): Carpal bone

64

1,052.16

64

1,052.16

3

230.43

+T+M

0403

Bennett's fracture-dislocation

51

838.44

51

838.44

3

230.43

+T+M

0405

Fracture reduction under general anaesthetic - Open treatment of Metacarpal: Simple

118.3

1,944.85

118.3

1,944.85

3

230.43

+T+M

0409

Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Simple

 

 

 

 

3

230.43

+T+M

0411

Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Compound (open)

52

854.88

52

854.88

3

230.43

+T+M

0413

Fracture (reduction under general anaesthetic): Finger phalanx: Proximal or middle: Simple

48

789.12

48

789.12

3

230.43 +T

0415

Fracture (reduction under general anaesthetic): Finger phalanx: Proximal or middle: Compound (open)

102

1,676.88

102

1,676.88

3

230.43

+T+M

0417

Fracture (reduction under general anaesthetic): Pelvis fracture: Closed (modifier 0051 is applicable)

 

 

 

 

3

230,43 +T

0419

Fracture (reduction under general anaesthetic): Pelvis: Operative reduction and fixation

320

5,260.60

256

4,206.64

3

230.43

+T+M

0421

Fracture (reduction under general anaesthetic): Femur: Neck or Shaft

237

3,898.28

189.6

3,117.02

3

230.43

+T+M

0425

Fracture (reduction under general anaesthetic): Patella

51

838.44

51

838.44

3

230.43

+T+M

0429

Fracture (reduction under general anaesthetic): Tibia with or without Fibula

128

2,104.32

120

1,972.80

3

230.43

+T+M

0433

Fracture (reduction under general anaesthetic): Fibula shaft

 

 

 

 

3

230.43

+T+M

0435

Fracture (reduction under general anaesthetic): Malleolus of ankle

58

953.52

58

953.52

3

230.43

+T+M

0437

Fracture-dislocation of ankle

128

2,104.32

120

1,972.80

3

230.43

+T+M

0438

Open reduction: Talus fracture (Modifier 0051 not applicable)

198.7

3,266.63

158.96

2,613.30

3

230.43

+T+M

0439

Fracture (reduction under general anaesthetic): Tarsal bones (excluding talus and calcaneus)

64

1,052.16

64

1,052,16

3

230.43

+T+M

0440

Open reduction Calcaneus fracture (Modifier 0051 not applicable)

403.50

6,633.54

322.5

5,301.90

3

230.43

+T+M

0441

Fracture (reduction under general anaesthetic): Metatarsal

41.8

687.19

41.8

687.19

3

230.43

+T+M

0443

Fracture (reduction under general anaesthetic): Toe phalanx: Distal Simple

 

 

 

 

3

230.43

+T

0445

Fracture (reduction under general anaesthetic): Toe phalanx: Compound

32

526.08

32

526.08

3

230.43

+T+M

0447

Fracture (reduction under general anaesthetic): Other: Simple

26

427.44

26

427.44

3

230.43

+T

0449

Fracture (reduction under general anaesthetic): Other: Compound

52

854.88

52

854.88

3

230.43

+T+M

0451

Fracture (reduction under general anaesthetic): Sternum and/or ribs: Closed

 

 

 

 

3

230.43

+T

0452

Fracture (reduction under general anaesthetic): Sternum and/or ribs. Open reduction and fixation of multiple fractured ribs for flail chest.

230

3,781.20

184

3,024.96

3

230.43

+T+M

0455

Fracture (reduction under general anaesthetic): Spine: with or without paralysis: Cervical

 

 

 

 

3

230.43

+T+M

0456

Fracture (reduction under general anaesthetic): Spine: with or without paralysis: Rest

 

 

 

 

3

230.43

+T+M

0459

DELETED 2009: Open reduction and internal fixation for fracture and/or dislocation of spit>

 

 

 

 

3

230.43

+T+M

0461

Fracture (reduction under general anaesthetic): Compression fracture: Cervical

 

 

 

 

3

230.43

+T+M

0462

Fracture (reduction under general anaesthetic) Compression fracture: Rest

 

 

 

 

3

230.43

+T+M

0463

Fracture (reduction under general anaesthetic): Spinous or transverse processes: Cervical

 

 

 

 

3

230.43

+T+M

0464

Fracture (reduction under general anaesthetic): Spinous or transverse processes: Rest

 

 

 

 

3

230.43

+T+M

3.1.1.1

Operations for fractures

 

0465

Fractures involving large joints (includes the item for the relative bone). This item may not be used as a modifier)

288

4,734.72

230.4

3,787.78

3

230.43

+T+M

0473

Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pin. (Not subject to rule G) (Modifier 0005 not applicable)

43

706.92

43

706.92

3

230.43

+T 

0475

Bone grafting or internal fixation for malunion or non-union: femur, tibia, Humerus, Radius and Ulna.

282

4,636.08

225.6

3,708.86

3

230.43

+T+M

0479

Bone grafting or internal fixation for malunion or non-union: Other bones (not applicable to fingers and toes)

154

2,531.76

123.2

2,025.41

3

230.43

+T+M

3.1.2

Bony operations

 

3.1.2.1

Bone grafting

 

0497

Resection of bone with or without grafting (benign)

282

4,836.08

225.6

3,708.85

3

230.43

+T+M

0498

Resection of bone or tumour (malignant) with or without grafting (does not include digits)

340

5,589.60

272

4,471.68

3

230.43

+T+M

0499

Grafts to cysts: Large bones

192

3,156.48

153.6

2,525.18

3

230.43

+T+M

0501

Grafts to cysts: Small bones

128

2,104.32

120

1,972.80

3

230.43

+T+M

0503

Grafts to cysts: Cartilage graft

206

3,386.64

164.8

2,709.31

3

230.43

+T+M

0505

Grafts to cysts: Inter-metacarpal bone graft

147

2,416.68

120

1,972.80

3

230.43

+T+M

0507

Removal of autogenous bone for grafting (not subject to modifier 0005)

50

822.00

50

822.00

3

230.43

+T+M

3.1.2.2

Acute/chronic osteomyelitis

 

0509

Conservative treatment

 

 

 

 

 

 

0511

Operation Tariff which would be applicable for compound (open) fracture of the bone involved, including six weeks post-operative care.

 

 

 

 

 

 

0512

Sternum sequestrectomy and drainage, including six weeks after-care

128

2,104.32

120

1,972.80

3

230.43

+T+M

3.1.2.3

Osteotomy

 

0514

Osteotomy: Sternum: Repair of pectus-excavatum

330

5,.425.20

254

4,340.16

3

230.43

+T+M

0515

Osteotomy: Sternum: Repair of pectus carinatum

330

5,425.20

264

4,340.16

3

230.43

+T+M

0518

Osteotomy: Pelvic

320

5,280.80

256

4,208.84

3

230.43

+T+M

0521

Osteotomy: Femoral: Proximal (Modifier 0051 is applicable)

320

5,260.80

256

4,208.84

3

230.43

+T+M

0527

Osteotomy: Knee region (Modifier 0051 is applicable)

320

5,280.80

256

4,208.64

3

230.43

+T+M

0528

Osteotomy: Os Calcis (Dwyer operation) (Modifier 0051 is applicable)

115

1,890.60

115

1,890.60

3

230.43

+T+M

0530

Osteotomy: Metacarpal and phalanx: Corrective for mal-union or rotation (Modifier 0051 is applicable)

120

1,972.80

120

1,972.80

3

230.43

+T+M

0531

Rotational osteotomy tibia and fibula - stand alone procedure

278.90

4,585.12

223.12

3,668.09

3

230.43

+T+M

0532

Rotation osteotomy of the Radius, Ulna or Humerus (modifier 0051 is applicable)

160

2,630.40

128

2,104.32

3

230.43

+T+M

0533

Osteotomy single metatarsal (modifier 0051 is applicable)

60

986.40

60

986.40

3

230.43

+T+M

0534

Multiple metatarsal osteotomies (modifier 0051 is applicable)

150

2,466.00

120

1,972.80

3

230.43

+T+M

3.1.2.4

Exostosis

 

0535

Exostosis: Excision: Readily accessible sites

60

986.40

60

986.40

3

230.43 +T+M

0537

Exostosis: Excision: Less accessible sites

96

1,578.24

96

1,578.24

3

230.43 +T+M

3.1.2.5

Biopsy

 

0539

Needle Biopsy: Spine (no after-care). Modifier 0005 not applicable

50

822.00

50

822.00

4

307.24 +T

0541

Needle Biopsy: Other sites (no after-care). Modifier 0005 not applicable

32

526.08

32

526.06

4

307.24 +T

0543

Biopsy: Open (modifier 0005 is not applicable): Readily accessible site

64

1,052.18

64

1,052.18

 

As per bone

0545

Biopsy: Open (modifier 0005 is not applicable): Less accessible site

96

1,578.24

96

1,578.24

 

As per bone

3.2

Joints

 

3.2.1

Dislocations

 

0547

Joint: Dislocation: Clavicle: either end

38

624.72

38

624.72

3

230.43

+T+M

0549

Joint: Dislocation: Shoulder

51

838.44

51

838.44

3

230.43

+T+M

0551

Joint Dislocation: Elbow

51

838.44

51

838.44

3

230.43

+T+M

0552

Joint: Dislocation: Wrist

77

1,265.88

77

1,265.88

3

230.43

+T+M

0553

Joint: Dislocation: Perilunar transscaphoid fracture dislocation

130

2,137.20

120

1,972.80

3

230.43

+T+M

0555

Joint: Dislocation: Lunate

77

1,265.88

77

1,265.88

3

230.43

+T+M

0556

Joint: Dislocation: Carpo-metacarpo dislocation

51

838.44

51

838.44

3

230.43

+T+M

0557

Joint: Dislocation Metacarpo-phalangeal or interphalangeal joints (hand)

26

427.44

26

427.44

3

230.43

+T+M

0559

Joint: Dislocation. Hip

109

1,791.96

109

1,791.96

3

230.43

+T+M

0561

Joint: Dislocation. Knee

96

1,578.24

96

1,578.24

3

230.43

+T+M

0563

Joint: Dislocation: Patella

32

526.08

32

526.08

3

230.43

+T+M

0565

Joint: Dislocation: Ankle

90

1,479.60

90

1,479.60

3

230.43

+T+M

0567

Joint: Dislocation: Sub-Talar dislocation

90

1,479.60

90

1,479.60

3

230.43

+T+M

0569

Joint: Dislocation: lntertarsal or Tarsometatarsal or Mid-tarsal

77

1,265.88

77

1,265.88

3

230.43

+T+M

0571

Joint: Dislocation: Meta-tarsophalangeal or Interphalangeal Joints (foot)

14

230.16

14

230.16

3

230.43

+T+M

0573

Joint: Dislocation Spine with or without paralysis

 

 

 

 

 

 

3.2.2

Operations for dislocations

 

0578

Recurrent dislocation of shoulder

200

3,288.00

160

2,630.40

3

230.43

+T+M

0579

Recurrent dislocation of large joints

161

2,646.84

128.8

2,117.47

3

230.43

+T+M

3.2.3

Capsular operations

 

0582

Capsulotomy or arthrotomy or biopsy or drainage of joint: Small joint (Including three weeks after-care)

51

838.44

51

838.44

3

230.43

+T+M

0583

Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint (including three weeks after-care)

95

1,578.24

96

1,578.24

3

230.43

+T+M

0585

Capsulotomy or arthrotomy or biopsy or drainage of joint: Capsulectomy digital joint

64

1,052.16

64

1,052.16

3

230.43

+T+M

0586

Multiple percutaneous capsulotomies of metacarpo-phalangeal joints

90

1,479.80

90

1,479.60

3

230.43

+T+M

0587

Release of digital joint contracture

128

2,104.32

120

1,972.80

3

230.43

+T+M

3.2.4

Synovectomy

 

0589

Synovectomy: Digital joint

77

1,265.88

77

1,265.88

3

230.43

+T+M

0592

Synovectomy· Large joint

160

2,630.40

128

2,104.32

3

230.43

+T+M

0593

Tendon synovectomy

203.7

3,348.83

162.96

2 679.08

3

230.43

+T+M

3.2.5

Arthrodesis

 

0597

Arthrodesis: Shoulder

224

3,682.58

179.2

2,946.05

3

230.43

+T+M

0598

Arthrodesis: Elbow

180

2.959.20

144

2,367.36

3

230.43

+T+M

0599

Arthrodesis: Wrist

180

2,959.20

144

2,367.36

3

230.43

+T+M

0600

Arthrodesis: Digital joint

128

2,104.32

120

1,972.80

3

230.43

+T+M

0601

Arthrodesis: Hip

320

5,260.80

256

4,208.64

3

230.43

+T+M

0602

Arthrodesis: Knee

180

2,959.20

144

2,367.36

3

230.43

+T+M

0603

Arthrodesis· Ankle

180

2,959.20

144

2,367.36

3

230.43

+T+M

0604

Arthrodesis: Sub-talar

130

2,137.20

120

1,972.60

3

230.43

+T+M

0605

Arthrodesis: Stabilisation of foot (triple-arthrodeses)

180

2,959.20

144

2,367.36

3

230.43

+T+M

0607

Arthrodesis: Mid-tarsal wedge resection

180

2,959.20

144

2,367.36

3

230.43

+T+M

3.2.6

Arthroplasty

 

0614

Arthroplasty: Debridement large joints

160

2,630.40

128

2,104.32

3

230.43

+T+M

0615

Arthroplasty: Excision medial or lateral end of clavicle

116

1,907.04

116

1,907.04

3

230.43

+T+M

0617

Shoulder: Acromioplasty

192

3,156.46

153.6

2,525.18

3

230.43

+T+M

0619

Shoulder: Partial replacement

277

4,553.88

221.5

3,643.10

5

384.05

+T+M

0620

Shoulder Total replacement

416

6,839.04

332.8

5,471.23

5

384.05

+T+M

0621

Elbow: Excision head of radius

96

1,578.24

96

1,578.24

3

230.43

+T+M

0622

Elbow: Excision

192

3,156.48

153.6

2,525.18

3

230.43

+T+M

0623

Elbow: Partial replacement

188

3,090.72

150.4

2,472.58

3

230.43

+T+M

0624

Elbow: Total replacement

282

4,636.08

225.6

3,706.86

3

230.43

+T+M

0625

Wrist: Excision distal end of ulna

96

1,578.24

96

1,578.24

3

230.43

+T+M

0626

Wrist: Excision single bone

110

1,808.40

110

1,808.40

3

230.43

+T+M

0627

Wrist: Excision proximal row

166

2,729.04

132.8

2,183.23

3

230.43

+T+M

0631

Wrist: Total replacement

249

4,093.56

199.2

3,274.85

3

230.43

+T+M

0635

Digital joint: Total replacement

192

3,156.46

153.6

2,525.18

3

230.43

+T+M

0637

Hip: Total replacement

415

6,839.04

332.8

5,471.23

3

230.43

+T+M

0641

Hip: Prosthetic replacement of femoral head

288

4,734.72

230.4

3,787.78

3

230.43

+T+M

0643

Hip:· Girdlestone

320

5,260.80

256

4,208.64

3

230.43

+T+M

0645

Knee: Partial replacement

277

4,553.88

221.5

3,643.10

3

230.43

+T+M

0646

Knee: Total replacement

416

6,839.04

332.8

5,471.23

3

230.43

+T+M

0649

Ankle: Total replacement

290.4

4,774.18

232.32

3,819.34

3

230.43

+T+M

0650

Ankle: : Astragalectomy

154

2,531.76

123.2

2,025.41

3

230.43

+T+M

3.2.7

Miscellaneous (Joints)

 

0661

Aspiration of joint or intra-articular injection (not subject to rule G). (Modifier 0005 not applicable)

9

147.96

9

147.96

3

230.43

+T+M

0667

Arthroscopy (excluding after-care), modifiers 0005 and 0013 not applicable

60

986.40

60

986.40

3

230.43

+T+M

0669

Manipulation large joint under general anaesthetic(not subject to rule G) (Modifier 0005 not applicable)

14

230.16

14

230,16

4

 

3

307.24

Hip+T

230.43

Knee/

Shoulder

+T

0670

Only the consultation fee should be charged when manipulation of a large joint is performed with or without local anaesthetic

 

 

 

 

4

 

3

307.24

Hip+T

230.43

Knee/

Shoulder

+T

0673

Menisectomy or operation for other internal derangement of knee

109

1,791.96

109

1,791.96

3

230.43

+T+M

3.2.8

Joint ligament reconstruction or suture

 

0675

Joint ligament reconstruction or suture: Ankle: Collateral

160

2,630.40

128

2,104.32

3

230.43

+T+M

0677

Joint ligament reconstruction or suture: Knee: Collateral

160

2,630.40

128

2,104.32

3

230.43

+T+M

0678

Joint ligament reconstruction or suture: Knee: Cruciate

160

2,630.40

128

2,104.32

3

230.43

+T+M

0679

Joint ligament reconstruction or suture: Ligament augmentation procedure of knee

280

4,603.20

224

3,682.56

3

230.43

+T+M

0680

Joint ligament reconstruction or suture: Digital joint ligament

165

2,712.60

132

2,170.08

3

230.43

+T+M

3.3

Amputations

 

3.3.1

Specific amputations

 

0682

Amputation: Fore-quarter amputation

294

4,833.36

235.2

3,865.59

9

691.29

+T+M

0683

Amputation: Through shoulder

148

2,433.12

120

1,972.80

5

384.05

+T+M

0685

Amputation: Upper arm or fore-arm

116

1,907.04

116

1,907.04

3

230.43

+T+M

0687

Partial amputation of the hand: One ray

102

1,676.88

102

1,676.88

3

230.43

+T+M

0691

Amputation: Whole or part of finger (skin flap included)

116 8

1,920.19

116 80

1,920.19

3

230.43

+T+M

0693

Hindquarter amputation

420

6,904.80

336

5,523.84

6

460.86

+T+M

0695

Amputation: Through hip joint region

192

3,156.48

153.6

2,525.18

6

460.86

+T+M

0697

Amputation: Through thigh

205

3,370.20

164

2,696.16

6

460.86

+T+M

0699

Amputation· Below knee. through Knee/Syme

194

3,189.36

155.2

2,551.49

5

384.05

+T+M

0701

Amputation: Trans-metatarsal or trans-tarsal

142

2,334.48

120

1,972.80

3

230.43

+T+M

0703

Amputation: Foot: One ray

97

1,594.68

97

1,594.68

3

230.43

+T+M

0705

Amputation: Toe (skin flap included)

66

1,085.04

66

1,085.04

3

230.43

+T+M

3.3.2

Post-amputation reconstruction

 

0706

Post-amputation reconstruction: Skin flap taken from a site remote from the injured finger or in cases of an advanced flap e g. Cutler

Note: If not performed on thumb or index finger it must be motivated

75

1,233.00

75

1,233.00

3

230.43

+T+M

0707

Post-amputation reconstruction:

206

3,386.64

164.8

2,709.31

3

230.43

+T+M

0709

Post-amputation reconstruction. Metacarpal transfer

192

3,156.48

153.6

2,525.18

3

230.43

+T+M

0711

Post-amputation reconstruction: Pollicisation of the finger (Prior permission must be obtained from the Commissioner at all times)

282

4,636.08

225.6

3,708.86

3

230.43

+T+M

0712

Post-amputation reconstruction: Toe to thumb transfer (Prior permission must be obtained from the Commissioner at all times)

800

13,152.00

640

10,521.60

3

230.43

+T+M

3.4

Muscles, tendons and fascias

 

3.4.1

Investigations

 

0713

Electromyography

75

1,233.00

75

1,233.00

3

230.43 +T

0714

Electro-my graphic neuro-muscular junctional study, including edrophonium response (not to be used with item 2730)

57

937.08

57

937.08

3

230.43 +T

0715

Strength duration curve per session

10.5

172.62

10.5

172.62

3

230.43 +T

0717

Electrical examination of single nerve or muscle

9

147.96

9

147.96

3

230.43 +T

0721

Voltage integration during isometric contraction

12

197.28

12

197.28

3

230.43 +T

0723

Tonometry with edrophonium

8

131.52

8

131.52

3

230.43 +T

0725

Isometric tension studies with edrophonium

10

164.40

10

164.40

3

230.43 +T

0727

Crantal reflex study (both early and late responses) supra occulofacial, corneofacial or flabellofacial: Unilateral

8

131.52

8

131.52

3

230.43 +T

0728

Cranial reflex study(both early and late responses) supra occulofacial, corneofacial or flabellofacial: Bilateral

14

230.16

14

230.16

3

230.43 +T

0729

Tendon reflex time

7

115.08

7

115.08

3

230.43 +T

0730

Limb-brain somatosensory studies (per limb)

49

805.56

49

805.56

3

230.43 +T

0731

Vision and audiosensory studies

49

805.56

49

805.56

 

 

0733

Motor nerve conduction studies (single nerve)

26

427.44

26

427.44

 

 

0735

Examinations of sensory nerve conduction by sweep averages single nerve)

31

509.64

31

509.64

3

230.43 +T

0737

Biopsy for motor nerve terminals and end plates

20

328.80

20

328.80

3

230.43 +T

0739

Combined muscle biopsy with end plates and nerve terminal

34

558.96

34

558.96

8

614.48 +T

0740

Muscle fatigue studies

20

328.80

20

328.80

3

230.43 +T

0741

Muscle biopsy

20

328.80

20

328.80

8

614.48 +T

0742

Global fee for all muscle studies, including histochemical studies

262

4,307.28

 

 

 

 

4701

Biochemical estimations on muscle biopsy specimens: Creatine

20.25

332.91

 

 

 

 

4703

Biochemical estimations on muscle biopsy specimens: Adenylate kinase

33.3

547.46

 

 

 

 

4705

Biochemical estimations on muscle biopsy specimens: Pyruvate kinase

5.7

93.71

 

 

 

 

4707

Biochemical estimations on muscle biopsy specimens: Lactate dehydrogenase

1.6

26.30

 

 

 

 

4709

Biochemical estimations on muscle biopsy specimens: Adenylate deaminase

9.9

162.76

 

 

 

 

4711

Biochemical estimations on muscle biopsy specimens: Phosphoglycerate kinase

13.7

225.23

 

 

 

 

4713

Biochemical estimations on muscle biopsy specimens: Phosphoglycerate mutase

25.9

425.80

 

 

 

 

4715

Biochemical estimations on muscle biopsy specimens· Enolase

32.7

537.59

 

 

 

 

4717

Biochemical estimations on muscle biopsy specimens: Phosphofructokinase

37.7

619.79

 

 

 

 

4719

Biochemical estimations on muscle biopsy specimens: Aldolase

15 75

258.93

 

 

 

 

4721

Biochemical estimations on muscle biopsy specimens: Glyceraldehyde 3 Phosphate Dehydrogenase

11.06

181.83

 

 

 

 

4723

Biochemical estimations on muscle biopsy specimens: Phosphorylasa

34.7

570.47

 

 

 

 

4725

Biochemical estimations on muscle biopsy specimens: Phosphoglucomutase

40.3

662.53

 

 

 

 

4727

Biochemical estimations on muscle biopsy specimens: Phosphohexose isomerase

28.8

473.47

 

 

 

 

3.4.2

Decompression Operations

 

0743

Major Compartemental Decompression

132

2,170.08

120

1,972.80

3

230.43 +T

0744

Decompression operation: Fasciotomy only

60

986.40

60

986.40

3

230.43 +T

3.4.3

Muscle and tendon repair

 

0745

Muscle and tendon repair: Biceps humeri

109

1,791,96

109

1,791,96

3

230.43 +T

0746

Muscle and tendon repair: Removal of calcification in Rotator cuff

96

1,578.24

96

1,578.24

3

230.43
+T+M

0747

Muscle and tendon repair: Rotator cuff

134

2,202.98

120

1,972.80

.4

307.24 +T

0748

Muscle and tendon repair: Debridement rotator cuff

139.7

2,296.67

120

1,972.80

.4

307.24 +T

0749

Muscle and tendon repair: Scapulopexy - stand alone procedure

271.90

4,470.04

217.52

3,576.03

4

307.24 +T

0755

Muscle and tendon repair: lnfrapatellar or quadriceps tendon

128

2,104.32

120

1,972.80

3

230.43 +T

0757

Muscle and tendon repair:· Achilles tendon repair

197.6

3,248.54

158.08

2,598.84

4

307.24 +T

0759

Muscle and tendon repair: Other single tendon

77

1,265.88

77

1,265.88

3

230.43 +T

0763

Muscle and tendon repair: Tendon or ligament injection

9

147.96

9

147.96

3

230.43 +T

0767

Hand: Flexor tendon suture: Primary (per tendon, Modifier 0005 not applicable)

128

2,104.32

120

1,972.80

3

230.43 +T

0769

Hand: Flexor tendon suture: Secondary (per tendon. Modifier 0005 not applicable)

160

2,630.40

128

2,104.32

3

230.43 +T

0771

Extensor tendon suture: Primary (per tendon. Modifier 0005 not applicable)

129.7

2,132.27

120

1,972.80

3

230.43 +T

0773

Extensor tendon suture: Secondary (per tendon, Modifier 0005 not applicable)

80

1,315.20

80

1,315.20

3

230.43 +T

0774

Repair of Boutonniere deformity or Mallet finger with graft

183.7

3,020.03

146.96

2,416.02

3

230.43 +T

3.4.4

Tendon graft

 

0775

Free tendon graft

160

2,630.40

128

2,104.32

3

230.43 +T

0776

Reconstruction of pulley for flexor tendon

50

822.00

50

822.00

3

230.43 +T

0777

Tendon graft: Finger: Flexor

192

3,156.46

153.6

2,525.18

3

230.43 +T

0779

Tendon graft: Finger. Extensor

122

2,005.68

120

1,972.80

3

230.43 +T

0780

Two stage flexor tendon graft using silastic rod

240

3,945.60

192

3,156.46

3

230.43 +T

3.4.5

Tenolysis

 

0781

Tendon freeing operation, except where specified elsewhere

64

1,052.16

64

1,052.16

3

230.43 +T

0782

Carpal tunnel syndrome

98.7

1,622.63

98.7

1,622.63

3

230.43 +T

0783

Tenolysis: De Quervain

38

624.72

38

624.72

3

230.43 +T

0784

Trigger finger

38

624.72

38

624.72

3

230.43 +T

0785

Flexor tendon freeing operation following free tendon graft or suture

186.8

3,070.99

149.44

2,456.79

3

230.43 +T

0787

Extensor tendon freeing operation following graft or suture in finger, hand or forearm

180.9

2,974.00

144.72

2,379.20

3

230.43 +T

0788

Intrinsic tendon release per finger

64

1,052.16

64

1,052.16

3

230.43 +T

0789

Central tendon tenotomy for Boutonniere deformity

64

1,052.16

64

1,052.16

3

230.43 +T

3.4.6

Tenodesis

 

0790

Tenodesis: Digital joint

90

1,479.60

90

1,479.60

3

230.43 +T

3.4.7

Muscle, tendon and fascia transfer

 

0791

Single tendon transfer

96

1,578.24

96

1,578.24

3

230.43 +T

0792

Multiple tendon transfer

128

2,104.32

120

1,972.80

3

230.43 +T

0793

Hamstring to quadriceps transfer

141

2,318.04

120

1,972.80

3

230.43 +T

0794

Pectoralis major or Latissimus dorsi transfer to biceps tendon

320

5,260.80

256

4,208.64

5

384.05 +T

0795

Tendon transfer at elbow

116

1,907.04

116

1,907.04

3

230.43 +T

0803

Hand tendons: Single tendon transfer

96

1,578.24

96

1,578.24

3

230.43 +T

0809

Hand tendons· Substitution for intrinsic paralysis of hand

224

3,682.56

179.2

2,946.05

3

230.43 +T

0811

Hand tendons: Opponens tendon transfer (including obtaining of graft)

220.6

3,526.66

176.48

2,901,33

3

230.43 +T

3.4.8

Muscle slide operations and tendon lengthening

 

0812

Percutaneous Tenotomy: All sites

38

624.72

38

624.72

3

230.43 +T

0813

Torticollis

96

1,578.24

96

1,578.24

5

384.05 +T

0815

Scalenotomy

132

2,170.08

120

1,972.80

5

384.05 +T

0817

Scalenotomy with excision of first rib

190

3,123.60

152

2,498.86

3

230.43 +T+M

0822

Open release elbow (Mitals) -stand alone procedure

278.20

4,573.81

222.56

3,658,89

3

230.43 +T+M

0823

Excision or slide for Volksmann’s Contracture

192

3,156.48

153.6

2,525.18

3

230.43 +T

0825

Hip: Open muscle release

116

1,907.04

116

1,907.04

7

537.67 +T

0829

Knee: Quadriceps plasty

160

2,630.40

128

2,104.32

3

230.43 +T

0831

Knee, Open tenotomy

141

2,318.04

120

1,972.80

3

230.43 +T

0835

Calf

96

1,578.24

96

1,578.24

4

307.24 +T

0837

Open Elongation Tendon Achilles

96

1,578.24

96

1,578.24

4

307.24 +T

0838

Percutaneous "Hoke" elongation tendoachilles -stand alone procedure

79.30

1,303.69

79.30

1,303.69

4

307.24 +T

0845

Foot: Plantar fasciotomy

70

1,150.80

70

1,150.80

3

230.43 +T

3.5

Bursae and ganglia

 

0847

Excision: Semi-membranosus

90

1,479.80

90

1,479.80

4

307.24 +T

0849

Excision: Prepatellar

45

739.60

45

739.60

3

230.43 +T

0851

Excision: Olecranon

81.8

1,344.79

81.8

1,344.79

3

230.43 +T

0853

Excision: Small bursa or ganglion

80.9

1,330.00

80.9

1,330.00

3

230.43 +T

0855

Excision:· Compound palmar ganglion or synovectomy

128

2,104.32

120

1,972.80

3

230.43 +T

0857

Bursae and ganglia: Aspiration or injection (not subject to rule G). (Modifier 0005 not applicable)

9

147.96

9

147.96

3

230.43 +T

3.6

Musculo-skeletal system: Miscellaneous

 

3.6.1

Leg lengthening

 

0861

Leg lengthening

416

6,839.04

332.8

5,471.23

3

230.43 +T+M

3.6.2

Removal of internal fixatives or prosthesis

 

0863

Readily accessible

36.6

601.70

36.6

601.70

 

As per bone

0864

Less accessible

75.5

1,241.22

75.5

1,241.22

 

+M

0865

Removal of prosthesis for infection soon after operation

128

2,104.32

120

1,972.80

 

As per bone +M

0866

Late removal of infected or not infected total joint replacement prosthesis (including six weeks after-care). ADD to the item for total joint replacement of the specific joint

+        4

1,052.16

64

1,052.16

6

460.66

+T+M

3.7

Plasters (not subject to rule G)

 

Note: The initial application of a plaster cast is included in the scheduled fee.

 

Note: The Commissioner will only consider payment i.r.o splinting material (Scotschcast, Dynacast. etc.) in the following cases (not applicable when Plaster of Paris is used).

Where extremity splints are applied for at least five weeks:

A maximum of one application for an upper extremity injury.

A maximum of two applications for a lower extremity injury.

 

0887

Long limb cast (excluding after-care). (Modifier 0005 not applicable)

13

213.72

13

213.72

3

230.43 +T

0888

Short limb cast (excluding after-care) (modifier 0005 not applicable)

6.6

108.50

6.6

108.50

3

230.43 +T

0889

Spica, plaster jacket or hinged cast brace (excluding aftercare)

32

526.08

32

526.08

4

307.24 +T

3.8

Specific areas

 

3.8.1

Foot and ankle

 

0900

Excision tarsal coalition - stand alone procedure

141,5

2,326.26

120.00

1,912.80

3

230.4

+T+M

0901

Tenotomy single tendon

63.3

1,040.65

63.3

1,040.65

3

230.43

+T+M

0903

Hammertoe: one toe

99.5

1,635.78

99.5

1,635.78

3

230.43

+T+M

0905

Fillet of toe or Ruiz-Mora procedure

99.5

1,635.78

99.5

1,635.78

3

230.43

+T+M

0906

Arthrodesis Hallux

148

2,433.12

120

1,972.80

3

230.43

+T+M

0909

Excision arthroplasty

145.2

2,387.09

120

1,972.80

3

230.43

+T+M

0910

Cheilectomy or metatarsophangeal implant Hallux

183

3,008.52

146.4

2,406.82

3

230,43

+T+M

0911

Metatarsal osteotomy or Lapidus or similar or Chevron - stand alone procedure

189.2

3,110.45

151.36

2,488.36

3

230.43

+T+M

5730

Hallux valgus double osteotomy etc

182.60

3,001.94

146.08

2,401.56

3

230.43

+T+M

5731

Distal soft tissue procedure for Hallux Valgus

173.6

2,853.98

138.88

2,283.19

3

230.43

+T+M

5732

Aitkin procedure or similar

166.8

2,742.19

133.44

2,193.75

3

230.43

+T+M

5734

Removal bony prominence foot (bunionette not applicable to COlD)

91

1,496.04

91

1,496.04

3

230.43

+T+M

5735

Repair angular deformity toe (lesser toes)

97.2

1.597.97

97 2

1,597.97

3

230.43

+T+M

5736

Sesamoidectomy

97.8

1,607.83

97.8

1,607.83

3

230.43

+T+M

5737

Repair major foot tendons e.g. Tib Post

147.30

2,421.61

120

1,972.80

3

230.43

+T

5738

Repair of dislocating peroneal tendons

173.2

2,847.41

138,56

2,277.93

3

230.43

+T

5740

Steindler strip – plantar fascia

97.2

1,597.97

97.2

1,597.97

3

230.43 +T

5742

Tendon transfer foot

172

2,827.68

137.6

2,262.14

3

230.43 +T

5743

Capsulotomy metatarsophalangeal joints –foot

86.8

1,426.99

86.8

1,426.99

3

230.43 +T

3.8.3

Replantation

 

0912

Replantation of amputated upper limb proximal to wrist joint

730

12,001.20

584

9,600.96

3

230.43

+T+M

0913

Replantation of thumb

670

11,014.80

536

8,811.84

3

230.43

+T+M

0914

Replantation of a single digit (to be motivated), for multiple digits modifier 0005 applicable

580

9,535.20

464

7,628.16

3

230.43

+T+M

0915

Replantation operation through the palm

1270

20,878.80

1016

16,703.04

3

230.43

+T+M

3.8.4

Hands: (Note: Skin: See Integumentary system)

 

0919

Tumours: Epidermiod cysts

35

575.40

35

575.40

3

230.43

+T+M

0922

Removal of foreign bodies requiring incision: Under local anaesthetic

19

312.36

19

312.36

3

230.43

+T+M

0923

Removal of foreign bodies requiring incision: Under general or regional anaesthetic

32

526.08

32

526.08

3

230.43

+T+M

0924

Crushed hand injuries: Initial extensive soft tissue toilet under general anaesthetic (sliding scale)

37

to

110

608.28

#VALUE!

1,808.40

37

to

110

608.28

#VALUE!

1,808.40

 

 

3

 

230.43

+T+M

0925

Crushed hand injuries: Subsequent dressing changes under general anaesthetic

16

263.04

16

263.04

3

230.43

+T+M

0926

Initial treatment of fractures, tendons, nerves, loss of skin and blood vessels. including removal of dead tissue under general anaesthesia and six weeks after-care

269

4,422.36

215.2

3,537.89

3

230.43

+T+M

3.8.5

Spine

 

0927

Excision of one vertebral body, for a lesion within the body (no decompression)

207

3,403.08

165.6

2,722.46

3

230.43

+T+M

0928

Excision of each additional vertebral segment for a lesion within the body (no decompression)

+           42

690.48

42

690.48

3

230.43

+T+M

0929

Manipulation of spine with anaesthetic (no after-care), modifier 0005 not applicable

14

230.16

14

230.16

5

384.05

+T+M

0930

Postenor osteotomy of spine: One vertebral segment

339

5,573.18

271.2

4,458.53

3

230.43

+T+M

0931

Postenor spinal fusion: One level

385

6,329.40

308

5,063.52

3

230.43

+T+M

0932

Posterior osteotomy of spine: Each additional vertebral segment

+           103

1,693.32

103

1,693.32

3

230.43

+T+M

0933

Anterior spinal osteotomy with disc removal: One vertebral segment

315

5,178.60

252

4,142.88

3

230.43

+T+M

0936

Anterior spinal osteotomy with disc removal: Each additional vertebral segment

+          -103

1,693.32

-103

1,693.32

3

230.43

+T+M

0938

Anterior fusion base of skull to C2

449

7,361.56

359.2

5,905.25

4

307.24

+T+M

0939

Trans-abdominal anterior exposure of the spine for spinal-fusion only if done by a second surgeon

160

2,630.40

128

2,104.32

3

230.43

+T+M

0940

Transthoracic anterior exposure of the spine if done by a second surgeon

160

2,630.40

128

2.104.32

3

230.43

+T+M

0941

Anterior interbody fusion: One level

360

5,918.40

288

4,734.72

3

230.43

+T+M

0942

Anterior interbody fusion: Each additional level

+          102

1.676.88

+102

1,676.88

3

230.43

+T+M

0943

Laminectomy with decompression of nerve roots and disc removal: One level

240

3,945.60

192

3,156.46

3

230.43

+T+M

0944

Posterior fusion: Occiput to C2

390

6,411.60

312

5,129.28

4

307,24

+T+M

0946

Posterior spinal fusion: Each additional level

+         +111

1,824.84

+111

1,824.84

3

230.43

+T+M

0948

Posterior interbody lumbar fusion: One level

364

5,984.16

291.2

4,787.33

3

230.43

+T+M

0950

Posterior interbody lumbar fusion: Each additional interspace

+           +95

1,561.80

+95

1,561.80

3

230.43

+T+M

0959

Excision of coccyx

96

1,578.24

96

1,578.24

3

230.43

+T+M

0960

Posterior non-segmental instrumentation

167

2,745.46

133.6

2,196.38

5

384.05

+T+M

0961

Costo-transversectomy

198

3,255.12

158.4

2,604.10

3

230.43

+T+M

0962

Posterior segmental instrumentation2 to 6 vertebrae

176

2,893.44

140.8

2,314.75

5

384.05

+T+M

0963

Antero-lateral decompression of spinal cord or anterior debridement

326

5,359.44

260.8

4,287.55

3

230.43 +T+M

0964

Posterior segmental instrumentation:- 7 to 12 vertebrae

201

3,304.44

160.8

2,643.55

5

384.05

+T+M

0966

Posterior segmental instrumentation: 13 or more vertebrae

245

4,027.80

196

3,222.24

5

384.05

+T+M

0968

Anterior instrumentation - 2 to 3 vertebrae

159

2,613.96

127.2

2,091.17

5

384.05

+T+M

0969

Skull or skull·femoral traction including two weeks after-care

64

1,052.16

64

1,052.16

-

#VALUE!