Surgical Procedures

I didn't know that there were this many surgical procedures! I bet there are even more too!
SECTION 1: GENERAL SURGERY
Breast
111 Breast Biopsy With Frozen Section
129 Open Breast Biopsy - Bilateral
130 Open Breast Biopsy 3200
132 Breast Biopsy - Hook Wire 4360
134 Core biopsy of breast 330
135 Excision Accessary Breast Tissue 3260
140 Breast - Simple Mastectomy, Unilateral 6250
150 Breast - Simple Mastectomy, Bilateral
160 Breast, Male - Unilateral Mastectomy (related to Breast cancer)
170 Breast, Male - Bilateral Mastectomy (related to Breast cancer)
175 Sentinel Node Biopsy
176 Partial Mastectomy With Sentinel Node Biopsy 6870
177 Partial Mastectomy 4220
178 Correction Of Nipple Inversion - Unilateral
179 Correction Of Nipple Inversion - Bilateral
180 Wide Local Excision With Axillary Dissection, Breast - Unilateral 6990
182 Extended Simple Mastectomy With Axillary Dissection - Unilateral 8540
185 Wide Local Excision With Axillary Dissection, Breasts - Bilateral
186 Extended Simple Mastectomy With Axillary Dissection - Bilateral
187 Breast Reconstruction - Transfer Tram Microsurgical (following eligible
mastectomy)
188 Breast Reconstruction - Transfer Tram Pedicled (following eligible mastectomy)
189 Breast Reconstruction - Delay Procedure (prelim Tram Flap procedure) (following
eligible mastectomy)
6100
192 Breast Reconstruction- Insertion of Tissue expander or implant - Unilateral
(following eligible mastectomy)
193 Breast Reconstruction- Insertion of Tissue expander or implant - Bilateral (following
eligible mastectomy)
194 Breast Reconstruction- Removal of tissue expander and replacement with implant,
size and adjust - Unilateral (following eligible mastectomy)
195 Breast Reconstruction- Removal of tissue expander and replacement with implant,
size and adjust - Bilateral (following eligible mastectomy)
200 Breast Reconstruction - Latissimus Dorsi Muscle Transposition, Autogenous or with
expander or Implant - Unilateral (following eligible mastectomy)
22360
202 Breast Reconstruction- Removal of tissue expander and replacement with implant,
+ Nipple reconstruction - Unilateral (following eligible mastectomy)
203 Breast Reconstruction- Removal of tissue expander and replacement with implant,
+ Nipple reconstruction - Bilateral (following eligible mastectomy)
204 Nipple reconstruction post mastectomy (separate procedure) Unilateral (following
eligible mastectomy)
206 Nipple Areolar Tattoo (following eligible mastectomy)
207 Nipple Areola Reconstruction with full thickness graft (following eligible
mastectomy)
208 Breast Microdochotomy 4020
Effective Date: 1 July 2008
All figures include GST
Page 4
SX Code Description of Surgical Procedure Median Total
Price ($)
209 Nipple reconstruction post mastectomy (separate procedure) Bilateral (following
eligible mastectomy)
310 Axillary Node Dissection 5380
Gastrointestinal
31 Anal Sphincterotomy 2770
40 Simple Repair Of Anal Fistula 2950
50 Complicated Repair Of Anal Fistula 3710
60 Anal Dilatation
90 Abdominal Paracentesis Or Pleural Tap
440 Haemorrhoids - External 2770
445 Infrared Coagulation of Haemorrhoids
451 Haemorrhoidectomy Including Sigmoidoscopy 4620
460 Injection Of Haemorrhoids 140
461 Injection Of Haemorrhoids And Sigmoidoscopy 260
470 Banding Of Haemorrhoids 210
471 Excision Of Anal Skin Tag 430
620 Pilonidal Abscess, Including Drainage
631 Excision Of Pilonidal Sinus 4290
650 Sigmoidoscopy Including Consultation 190
660 Sigmoidoscopy With Biopsy 880
661 Sigmoidoscopy And Anal Fistula 3300
681 Examination Of Colon Up To Splenic Fixture (Short Colonoscopy With Biospy) 960
690 Colonoscopy 1280
691 Screening Colonoscopy 1280
700 Colonoscopy With Biopsy 1400
710 Colonoscopy With Removal Of Polyps 1660
940 Freeing Of Minor Abdominal Adhesions
945 Laparoscopic Freeing Of Minor Abdominal Adhesions 5420
950 Freeing Of Major Abdominal Adhesions
955 Laparoscopic Freeing Of Major Abdominal Adhesions 7000
969 Botulinum toxin type 4 injection for anal fissure (rooms only)
971 Appendicectomy
974 Laparoscopic Appendicectomy 5940
976 Anal Or Perineal Graciloplasty
978 Sphincteroplasty
979 Rectosigmoidectomy With Formation Of Stoma
982 Right Hemicolectomy - With Formation Of Stoma
983 Left Hemicolectomy - With Formation Of Stoma
984 Laparoscopic Hemicolectomy - With Formation Of Stoma
985 Left Hemicolectomy - With Anastomosis 12160
986 Right Hemicolectomy - With Anastomosis 12580
987 Laparoscopic Hemicolectomy - With Anastomosis 14930
991 Sigmoidcolectomy With Anastomosis 15400
992 Sigmoidcolectomy With Formation of Stoma
995 Colectomy - Total With Ileo-Rectal Anastomosis 13790
996 Laparoscopic Colectomy - Total With Ileo-Rectal Anastomosis
1010 Colostomy - Formation
1011 Colostomy - Closure 8930
1012 Revision Colostomy
1013 Ileostomy Formation
1014 Ileostomy Closure 7960
1015 Ileostomy Revision
1020 Colotomy - For Polyp Or Wedge Resection Of Colon For Polyp
1030 Cholecystectomy
1040 Cholecystectomy With Operative Cholangiogram
1042 Laparoscopic Cholecystectomy 6870
1044 Laparoscopic Cholecystectomy With Operative Cholangiogram 7810
1045 Laparoscopic Cholecystectomy Converted To Open With Operative Cholangiogram
1046 Laparoscopic Cholecystectomy And Nissen Repair or Wrap
1047 Laparoscopic Cholecystectomy Converted To Open 9370
1050 Cholecystectomy And Choledochotomy Including Any Choledonchoscopy
1084 Insertion of peritoneal shunt
1085 Insertion Of Oesaphageal Stent
1110 Gastrectomy - Partial
1120 Gastrectomy - Total (Abdominal, Thoracic, Or Combined Approach)
1125 Total Gastrectomy And Oesaphagectomy By Abdominal Transthoracic Mobilisation
1148 Gastroscopy And Colonoscopy with biopsy 2130
1152 E.R.C.P. 4480
1153 Gastroscopy And Colonoscopy 1860
1154 Gastroscopy (With Or Without Biopsy) 930
1155 E.R.C.P. And Sphincterotomy Or Stenting 5330
1156 Gastroscopy and Colonoscopy With Removal Of Polyps 2190
1159 Toupet Fundoplication - Adult - Open
1160 Hiatus Hernia Repair
1161 Toupet Fundoplication - Adult - Laparoscopic 9200
1163 Oesophagael Dilation With Gastroscopy 1410
1164 Oesophageal Manometry Test 580
1165 Toupet Fundoplication - Paediatric
1166 Oesophageal 24Ph Monitoring 640
1167 Non-endoscopic Dilation Of Oesophagus
1168 Anorectal Physiology Study 420
1169 Gastric Emptying study
1170 Laparoscopic Hiatus Hernia Repair 9910
1174 Needle Biopsy Of Liver (separate procedure) 1140
1180 Laparotomy 7760
1181 Laparotomy Including Appendicectomy
1182 Repair Of Sphincter Of Oddi
1183 Repair Of Pancreatic Duct Sphincter
1184 Choledocho-jejunostomy or choledoco-duodenostomy
1185 Small Bowel Resection
1186 Laparoscopic Small Bowel Resection
1188 Biopsy of Liver open, incidental
1189 Biopsy of Liver - With Ultrasound Guidance (Separate procedure) 1050
1191 Hepatic Cryotherapy
1192 Liver Lobectomy (Right Or Left)
1193 Hepatectomy
1194 Radio frequency ablation of the liver
1220 Oesophagectomy - One Stage
1221 Oesophagectomy By Abdominal And Transthoracic Mobilisation, With Thoracic
Oesophagogastric Anastomosis
1230 Oesophagus - Hellers Operation
1240 Pancreas - Total Excision Of, Or Pancreatico-Duodenectomy
1241 Excision Of Pancreatic Tumour
1242 Whipples Procedure
1248 Transanal Excision Of Rectal Tumour 4050
1249 Transanal Endoscopic Microsurgery (TEM)
1250 Resection Of Rectum - Abdominoperineal
1260 Anterior Resection Of Rectum - Low With Coloanal Anastomosis 15590
1261 Anterior Resection Of Rectum - Ultra Low With Coloanal Anastomosis
1262 Anterior Resection Of Rectum - Low With Extraperitoneal Anastomosis
1263 Anterior Resection Of Rectum - High With Intraperitoneal Anastomosis
1264 Laparoscopic Anterior Resection Of Rectum - Low With Coloanal Anastomosis 21280
1265 Laparoscopic Anterior Resection Of Rectum - Ultra Low With Coloanal Anastomosis
1266 Laparoscopic Anterior Resection Of Rectum - Low With Extraperitoneal
Anastomosis
1267 Laparoscopic Anterior Resection Of Rectum - High With Intraperitoneal
Anastomosis
1270 Prolapse Of Rectum - Abdominal Rectopexy 5790
1271 Prolapse Of Rectum - Excision Of Rectal Mucosa (Including Sigmoidoscopy)
1272 Implantation Of Inflatable Sphincter -Anal
1274 Formalin Treatment for Radiation Proctitis
1275 Dynamic Graciloplasty
1280 Prolapse Of Rectum - Laparoscopic Rectopexy
1290 Splenectomy
1291 Laparoscopic Splenectomy
1175 Highly Selected Vagotomy
45 Insertion of Seton Tube
1016 Insertion of gastrostomy
1187 Laparoscopic Liver Biopsy
972 Laparoscopic reversal of Hartmann's procedure
973 Reversal of Hartmann’s procedure
Head and Neck
210 Branchial Fistula
305 Sublingual gland excision
306 Simple Lymph Node Dissection of Neck 3440
320 Glands - Supra Hyoid Dissection Of Neck (Selective - Supra hyoid)
584 Radical Neck Dissection
585 Superficial Parotidectomy 6780
590 Total Parotidectomy (Including Superficial)
591 Partial parotidectomy
592 Subtotal parotidectomy
593 Radical parotidectomy
600 Parathyroidectomy 6660
720 Excision Of Sub-Mandibular Gland 5480
740 Excision Of Thyroglossal Cyst Or Fistula 5270
745 Thyroplasty
781 Total Thyroid Lobectomy 7390
785 Total (Or Sub-Total) Thyroidectomy 7390
791 Thyroidectomy Including Para-Thyroid Transplant 9560
800 Tongue - Partial Removal, Hemi-Glossectomy
801 Biopsy Of Tongue 570
9600 Salivary Gland - Intra Oral Removal Duct Calculus 950
Lymph Nodes
306 Nodal excision 3440
584 Radical Neck Dissection
586 Selective neck dissection I-IV
587 Modified radical neck dissection
588 Extended radical neck dissection
Hernia
330 Repair Of Umbilical Hernia - Under 10 Years 2880
340 Repair Of Minor Umbilical Hernia - Adult 3650
350 Repair Of Major Umbilical Hernia - Adult 4260
355 Repair Of Epigastric Hernia 4150
361 Repair Of Incisional Hernia 5550
370 Repair Of Complicated Incisional Hernia 8400
381 Unilateral Hernia - Femoral Repair 3680
382 Unilateral Hernia - Inguinal Repair 4160
383 Spigelian Hernia
385 Unilateral Laparoscopic Hernia - Inguinal Repair 5650
386 Unilateral Laparoscopic Hernia - Femoral Repair
387 Repair Of Laparoscopic Incisional Hernia
390 Bilateral Hernia - Inguinal Repair 5950
391 Bilateral Hernia - Femoral Repair
395 Bilateral Laparoscopic Hernia - Inguinal 6810
396 Bilateral Laparoscopic Hernia - Femoral
411 Inguinal Herniotomy - Under 3 Years 3060
420 Bilateral Inguinal Herniotomies - Under 3 Years
430 Hernia - Under 3 Years - Strangulated
Skin and Superficial Structures
10 Abscess - Small, Or Cellulitis Requiring Incision And Drainage With Local
Anaesthetic
150
20 Abscess - Large, Or Extensive Cellulitis Requiring Incision Or Drainage 2060
100 Aspiration Of Cyst / Needle Biopsy (Breast) 170
101 Fine Needle Aspiration 170
238 Biopsy Of Skin And Subcutaneous Tissue 150
239 Cryosurgery 90
242 Electrosurgery, Hyfrecation 160
280 Removal of Foreign Body (simple)
292 Excision Of Ganglion - Other 2680
293 Excision Of Ganglion - Wrist / Hand 2480
500 Aspiration Of Small Haematoma 160
6701 <2.5cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under local
anaesthetic)
6702 2.5-7.5cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
local anaesthetic)
6703 7.5-12.5cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
local anaesthetic)
6704 12.5-20cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
local anaesthetic)
6705 20-30cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under local
anaesthetic)
6706 31+cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under local
anaesthetic)
6707 2.5-7.5cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under local
anaesthetic)
6708 7.5-12.5cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under
local anaesthetic)
6709 12.5-20cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under local
anaesthetic)
6710 20-30cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under local
anaesthetic)
6711 31+cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under local
anaesthetic)
6712 <2.5cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under local
anaesthetic)
6713 2.5-7.5cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under local
anaesthetic)
6714 7.5-12.5cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
local anaesthetic)
6715 12.5-20cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
local anaesthetic)
6716 20-30cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under local
anaesthetic)
6717 31+cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under local
anaesthetic)
6718 <2.5cm Skin Lesion Excision with Direct Closure on Face (under local anaesthetic)
6719 2.5-5cm Skin Lesion Excision with Direct Closure on Face (under local anaesthetic)
6720 5-7.5cm Skin Lesion Excision with Direct Closure on Face (under local anaesthetic)
6721 7.5-12.5cm Skin Lesion Excision with Direct Closure on Face (under local
anaesthetic)
6722 12.5-20cm Skin Lesion Excision with Direct Closure on Face (under local
anaesthetic)
6723 21+cm Skin Lesion Excision with Direct Closure on Face (under local anaesthetic)
6724 <2.5cm Skin Lesion Excision with Flap Closure on Face (under local anaesthetic)
6725 2.5-5cm Skin Lesion Excision with Flap Closure on Face (under local anaesthetic)
6726 5-7.5cm Skin Lesion Excision with Flap Closure on Face (under local anaesthetic)
6727 7.5-12.5cm Skin Lesion Excision with Flap Closure on Face (under local
anaesthetic)
6728 12.5-20cm Skin Lesion Excision with Flap Closure on Face (under local
anaesthetic)
6729 21+cm Skin Lesion Excision with Flap Closure on Face (under local anaesthetic)
6730 <2.5cm Skin Lesion Excision with Graft Closure on Face (under local anaesthetic)
6731 2.5-5cm Skin Lesion Excision with Graft Closure on Face (under local anaesthetic)
6732 5-7.5cm Skin Lesion Excision with Graft Closure on Face (under local anaesthetic)
6733 7.5-12.5cm Skin Lesion Excision with Graft Closure on Face (under local
anaesthetic)
6734 12.5-20cm Skin Lesion Excision with Graft Closure on Face (under local
anaesthetic)
6735 21+cm Skin Lesion Excision with Graft Closure on Face (under local anaesthetic)
6736 <2.5cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6737 2.5-7.5cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6738 7.5-12.5cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6739 12.5-20cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6740 20-30cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6741 31+cm Skin Lesion Excision with Direct Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6742 2.5-7.5cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6743 7.5-12.5cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6744 12.5-20cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6745 20-30cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6746 31+cm Skin Lesion Excision with Flap Closure on Trunk/Extremities (under general
anaesthetic or in an approved facility)
6747 <2.5cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6748 2.5-7.5cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6749 7.5-12.5cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6750 12.5-20cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6751 20-30cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under
general anaesthetic or in an approved facility)
6752 31+cm Skin Lesion Excision with Graft Closure on Trunk/Extremities (under general
anaesthetic or in an approved facility)
6753 <2.5cm Skin Lesion Excision with Direct Closure on Face (under general
anaesthetic or in an approved facility)
6754 2.5-5cm Skin Lesion Excision with Direct Closure on Face (under general
anaesthetic or in an approved facility)
6755 5-7.5cm Skin Lesion Excision with Direct Closure on Face (under general
anaesthetic or in an approved facility)
6756 7.5-12.5cm Skin Lesion Excision with Direct Closure on Face (under general
anaesthetic or in an approved facility)
6757 12.5-20cm Skin Lesion Excision with Direct Closure on Face (under general
anaesthetic or in an approved facility)
6758 21+cm Skin Lesion Excision with Direct Closure on Face (under general
anaesthetic or in an approved facility)
6759 <2.5cm Skin Lesion Excision with Flap Closure on Face (under general anaesthetic
or in an approved facility)
6760 2.5-5cm Skin Lesion Excision with Flap Closure on Face (under general anaesthetic
or in an approved facility)
6761 5-7.5cm Skin Lesion Excision with Flap Closure on Face (under general anaesthetic
or in an approved facility)
6762 7.5-12.5cm Skin Lesion Excision with Flap Closure on Face (under general
anaesthetic or in an approved facility)
6763 12.5-20cm Skin Lesion Excision with Flap Closure on Face (under general
anaesthetic or in an approved facility)
6764 21+cm Skin Lesion Excision with Flap Closure on Face (under general anaesthetic
or in an approved facility)
6765 <2.5cm Skin Lesion Excision with Graft Closure on Face (under general anaesthetic
or in an approved facility)
6766 2.5-5cm Skin Lesion Excision with Graft Closure on Face (under general
anaesthetic or in an approved facility)
6767 5-7.5cm Skin Lesion Excision with Graft Closure on Face (under general
anaesthetic or in an approved facility)
6768 7.5-12.5cm Skin Lesion Excision with Graft Closure on Face (under general
anaesthetic or in an approved facility)
6769 12.5-20cm Skin Lesion Excision with Graft Closure on Face (under general
anaesthetic or in an approved facility)
6770 21+cm Skin Lesion Excision with Graft Closure on Face (under general anaesthetic
or in an approved facility)
25 Debridement of infected wound area & closure
26 Debridement of infected wound/fistula/sinus
6650 MoHs surgery 1 specimen (excision and microscopy) 2310
6651 MoHs surgery 2 specimens (excision and microscopy)
6652 MoHs surgery 3+ specimens (excision and microscopy)
Lung/chest
1200 Lung, Lobectomy
1201 Lung Biopsy - Percutaneous
1202 Lung Biopsy - Open
1203 Lung Exploration
1204 Lung Biopsy - Bronchoscopic 1720
1205 Lung Biopsy - Bronchoscopic - Fibreoptic
1206 Chest Biopsy, Thoracotomy
1207 Mediastenoscopy
1208 Thorascopic Pleurodesis Stapling Bullae
1209 Excision Thymoma With Sternotomy
1212 Chest Biopsy, Needle
Miscellaneous
1301 Insertion Of Port-A-Cath 5570
1302 Central Vein Catheterisation
1303 Percutaneous Central Vein Catheterisation
1304 Removal Of Port-A-Cath
SECTION 2: OTOLARYNGOLOGY
Throat
800 Hemiglossectomy
801 Partial glossectomy per-oral
803 Partial glossectomy drop through
804 Subtotal glossectomy
805 Total glossectomy
1701 Tonsillectomy Alone - Adult 3010
1706 Tonsillectomy And Adenoidectomy - Child 2850
1707 Tonsillectomy And Adenoidectomy (adult) 3240
1710 Tonsillectomy Alone - Child 2780
1711 Tonsillectomy, Grommets With Cautery Of Turbinates
1712 Tonsillectomy, Grommets (Bilat) With Cautery Of Turbinates - Child
1713 Tonsillectomy, Grommets (Unilat) With Cautery Of Turbinates - Child
1714 Adenotonsillectomy, Grommets (Bilat) With Cautery Of Turbinates - Child
1715 Adenotonsillectomy, Grommets (Unilat) With Cautery Of Turbinates - Child
1717 Tonsillectomy With Grommet Insertion - Unilateral - Child
1718 Tonsillectomy With Grommet Insertion - Bilateral - Child 2880
1719 Adenotonsillectomy With Grommet Insertion - Unilateral - Child 3020
1720 Adenotonsillectomy With Grommet Insertion - Bilateral - Child 3170
1721 Tonsillectomy With Septoplasty
1722 Partial pharyngectomy
1723 Tonsillectomy, Adenoidectomy, Grommets With Antral Lavage
1724 Adenotonsillectomy, Grommets (Bilat) With Antral Lavage - Child
1725 Tonsillectomy With Antral Lavage - Adult
1726 Tonsillectomy With Antral Lavage - Child
1727 Tonsillectomy With Cautery Of Turbinates - Adult
1728 Tonsillectomy With Cautery Of Turbinates - Child
1729 Adenotonsillectomy, Grommets (Unilat) With Antral Lavage - Child
1730 Adenoidectomy
1735 Adenoidectomy And Cautery Of Turbinates 2550
1741 Adenoidectomy With Bilateral Grommet Insertion 2370
1744 Fixation mandibular reconstruction plate
1745 Segmental mandibulectomy
1746 Marginal mandibulectomy
1747 Hemi-mandibulectomy
1748 Condylectomy
1749 Coronoidectomy
1750 Uvulopalatopharyngoplasty (Uppp) 5110
1755 Uvulopalatopharyngoplasty & Septoplasty
1756 Uvulopalatopharngoplasty, Septoplasty And Reduction Of Turbinates
1757 Tracheostomy
1758 Floor of mouth excision
Hypopharynx and Larynx
1760 Pharyngoscopy
1770 Pharyngoscopy With Biopsy
1775 Excision of Malignant Tumour of Upper Aerodigestive Tract
1780 Removal Of Pharyngeal Pouch
1781 Excision and stapling Hypopharyngeal Diverticulum, Cricopharyngeal Myotomy
1790 Laryngoscopy - With Or Without Biopsy
1800 Micro-Laryngoscopy With Or Without Biopsy
1805 Partial laryngectomy
1806 Total laryngectomy
1785 Dohlman’s procedure
Trachea, Bronchi and Oesophagus
1830 Bronchoscopy - Fibreoptic
1840 Bronchoscopy With Removal Of Foreign Body
1860 Oesophagoscopy
1861 Oesophagoscopy - With Biopsy
1870 Pan-Endoscopy - Including Laryngoscopy, Pharyngoscopy, Oesophagoscopy &
E.U.A Nasopharynx
1875 Tracheal resection
Ears
2010 Pinnectomy
2015 Lateral temporal bone resection
2020 Foreign Body Ear - Surgical Removal
2030 Removal Solitary Osteoma Ear Canal
2040 Removal Of Multiple Exostoses - Ear Canal 6260
2050 Meatoplasty
2060 Myringotomy
2080 Unilateral Grommet Insertion (Including Myringotomy) 300
2082 Bilateral Grommet Insertion (Including Myringotomy) 1240
2085 Removal Of Grommets 1170
2090 Tympanotomy - Unilateral
2100 Tympanotomy - Plus Division Of Nerves Or Adhesions
2110 Tympanotomy Plus Ossiculoplasty 6500
2120 Myringoplasty - Transcanal 4650
2130 Tympanoplasty (Myringoplasty Postaural Or Endaural) 5300
2140 Tympanoplasty plus Ossiculoplasty
2150 Stapedectomy 5820
2180 Tympanotomy Plus Repair Of Perilymph Fistula
2190 Endolympatic Sac, Decompression (With Or Without Shunt Insertion)
2210 Cortical Mastoidectomy Or Atticotomy
2220 Cortical Mastoidectomy Or Atticotomy Plus Myringoplasty
2230 Atticotomy Plus Tympanoplasty
2231 Cortical Mastoidectomy Plus Tympanoplasty
2240 Modified Radical Mastoidectomy Or Mastoidectomy With Posterior Tympanotomy
(Cat)
7910
2260 Modified Radical Mastoidectomy Or Cat Plus Tympanoplasty 8730
2261 Cochlear Implant Surgery (Excluding The Cost Of The Appliance)
Nose & Paranasal Sinuses
1880 Bilateral Antral Lavage 250
1920 Nasal Polyp Or Polypi - Unilateral 1850
1930 Nasal Polyp Or Polypi - Bilateral
1940 Transnasal Ethmoidectomy
1945 Endoscopic Maxillary Antrostomy
1946 Endoscopic Maxillary Antrostomy - bilateral
1950 Radical Antrostomy (Caldwell Luc)
1960 Radical Antrostomy - With Trans-Antral Ethmoidectomy (Jansen Horgan)
1968 Endoscopic Powered Turbinoplasty
1969 Sinoscopy
1970 Endoscopic Sinus Surgery 4620
1972 Endoscopic Sinus Surgery - Bilateral 5780
1976 Endoscopic Sinus Surgery - Bilateral And Septoplasty 6980
1980 Endoscopic Modified Lothrop
1990 External Fronto-Ethmoidectomy
2000 Radical Fronto-Ethmoidectomy
2270 Reduction Of Nasal Fracture
2280 Foreign Body In Nose - Removal Of, Other Than Simple Probing
2290 Cautery Of Septum Or Turbinates 130
2300 Cautery Of Turbinates With Outfracture 2140
2310 Trimming Of Turbinates - Total - Bilateral 2940
2320 Septoplasty 4220
2321 Crural J flap (bilateral)
2330 Septoplasty With Cautery Or Diathermy Of Turbinates, With Or Without Outfracture 4000
2336 Conchal Cartilage Graft
2337 Septoplasty With Trimming Of Turbinates 4570
2340 Septo-Rhinoplasty 6260
2350 External Septo Rhinoplasty 8980
2355 Rhinectomy
2360 Excision maxillary tuberosity
2361 Posterior maxillectomy
2362 Medial maxillectomy
2363 Subtotal maxillectomy
2364 Total maxillectomy
2365 Extended total maxillectomy
2370 Orbital exenteration
2371 External ethmoidectomy
2375 Inferior craniofacial resection
2380 Nasendoscopy 70
2390 Examination Of Nasopharynx And Biopsy
SECTION 3: UROLOGY
Kidney
2554 Biopsy of Kidney - Ultrasound Guided 1050
2555 Closed Biopsy of Kidney
2560 Nephrectomy - Simple
2570 Nephrectomy - Partial 13520
2580 Nephrectomy - Radical 11740
2581 Open/Laparoscopic Adrenalectomy
2585 Laparoscopic nephrectomy
2586 Laparoscopic partial nephrectomy
2590 Nephroureterectomy
2610 Pyelolithotomy
2620 Nephrolithotomy - Major More Than 120 Minutes
2630 Nephrostomy - Open
2640 Nephrostomy - Percutaneous
2641 Nephrostomy Tract Establishment By Urologist
2642 Percutaneous Nephroscopy and Lithotomy Less Than 90 Minutes
2644 Percutaneous Nephroscopy and Lithotomy - More Than 90 Minutes
2650 Pyeloplasty
2662 Endopyelotomy - Retrograde
2664 Endopyelotomy - Antegrade
2680 Percutaneous Pyelolithotomy
2652 Laparoscopic Pyeloplasty
Ureter
2682 Insertion Of Double J Stent
2690 Ureteroscopy With Minor Additional Procedure 4910
2692 Ureteroscopy With Major Additional Procedure 7220
2700 Reimplantation Ureter - Unilateral
2710 Reimplantation Ureter - Bilateral
2720 Ureterolithotomy
2770 Ureterolysis
2780 Reduction Ureteroplasty And Reimplant - 1st Stage
2790 Reduction Ureteroplasty And Reimplant - 2nd Stage
Bladder
2442 Colposuspension - Open
2444 Needle Colposuspension, Endoscopic Bladder Neck Suspension Or Similar
2850 Cystoscopy and urethroscopy
2851 Cystoscopy - With Biopsy, Ureteric Catheterization, Urethral Dilatation, Removal
Stent, Or Other Minor Procedure
2852 Flexible Cystourethroscopy Under Local Anaesthetic
2853 Flexible Cystourethroscopy Under Local Anaesthetic - With Biopsy, Ureteric
Catheterization, Urethral Dilatation, Removal Stent, Or Other Minor Procedure
2854 Cystoscopy and Transrectal Ultrasound and Biopsy (TRUS)
2855 Cystourethroscopy - With Bladder Neck Incision Or Major Visual Urethrotomy
2856 Retrograde pyelogram
2900 Transurethral Resection Bladder Tumour -Minor <30Min
2910 Transurethral Resection Bladder Tumour -Major >30Min
2920 Cystoscopy - Removal Ureteric Calculus Or Foreign Body
2930 Cystoscopic Destruction And Removal Bladder Calculus / Litholopaxy
2940 Incision Of Bladder Neck
2950 Total Or Radical Cystectomy With Ileal Conduit Diversion
2951 Total Or Radical Cystectomy With Replacement Cystoplasty Ectopic With Continent
Stoma
2952 Cystectomy Plus Bladder Reconstruction
2953 Total Or Radical Cystectomy With Replacement Cystoplasty Orthotopic
2960 Bladder - Repair Of Rupture
2970 Bladder Tumours, Suprapubic Diathermy Of
2981 Cystoscopic Destruction And Removal Bladder Calculus - Minor Less Than 30
Minutes
2982 Cystoscopic Destruction And Removal Bladder Calculus - Major More Than 30
Minutes
2983 Laser Resection Of Bladder Tumour - Minor
2984 Laser Resection Of Bladder Tumour - Major
2985 Cystolithotomy
2990 Diverticulum Of Bladder, Excision Or Obliteration Of
3030 Cystoplasty
3322 Laparoscopic Colposuspension
3670 Ventro-Suspension
3040 Partial Cystectomy
Prostate
315 Inguinal Node Dissection 7210
2800 Open Enucleation Prostate
2810 Transurethral Resection Prostate 6130
2811 TURP Including Cystoscopy 6680
2815 Laser Resection Prostate including Cystoscopy 8190
2816 Transurethral Needle Ablation Of Prostate
2825 Perineal Prostatectomy
2829 Radical Retropubic Prostatectomy 11040
2830 Radical Retropubic Prostatectomy -With Synchronous Node Dissection 14940
2832 Pelvic Node Dissection
2833 Laparoscopic Pelvic Node Dissection
2840 Prostate - Needle Biopsy 650
Brachytherapy - NB: Only covered through an Affiliated Provider (Policy limits will
Incontinence
2420 Pubo-Vaginal Sling Operation For Incontinence 6240
2425 TVT Sling Revision
2440 Implantation Artificial Urinary Sphincter
2446 Male Sling operation
Urethra
2400 Caruncle - Cauterisation
2430 Incontinence - Peri-Urethral Injection
2460 Urethrectomy
2470 Urethroplasty - Stage 1
2480 Urethroplasty - Stage 2
2490 Urethroplasty Including Stricture Repair, Urethral Diverticulum - Minor
2491 Urethroplasty Including Stricture Repair, Urethral Diverticulum Major
2500 Urethroplasty - One Stage Trans Pubic
2510 Urethroplasty - Revision For Recurrent Stricture
2520 Meatoplasty (Urethra)
2530 Urethral Calculus
2540 Urethrotomy - Internal 3310
2550 Urethral Diverticulum
Scrotum
560 Orchidectomy - High Ligation 4280
571 Orchidopexy - Unilateral 3680
580 Orchidopexy - Bilateral 3820
820 Varicocele Repair- Inguinal
825 Varicocele Repair- Laparaoscopic
3073 Excision of Epididymal Cyst Spermatocele, or Epididymectomy - Unilateral 3480
3074 Excision of Epididymal Cysts Spermatocele, or Epididymectomy - Bilateral
3075 Hydrocele Repair - Unilateral 3390
3076 Hydrocele Repair - Bilateral 4320
3100 Testicular Biopsy
3111 Undescended Testis - Laparoscopy For
3115 Bilateral Scrotal Orchidectomies 3730
3120 Radical Orchidectomy 3940
3125 Testicular Prosthesis Insertion
Penis
231 Circumcision 2770
3077 Dorsal Slit 1990
3079 Penile Biopsy
3080 Penis - Amputation
3090 Penile Plication For Peyronies 6400
3140 Penile Prosthesis - Semi Rigid
3150 Penile Prosthesis - Inflatable
3151 Priapism - Aspiration And Irrigation
3152 Priapism - Winter's Procedure
3153 Priapism - Intrapenile Shunts
3154 Priapism - Caverno-Femoral Shunt Or Similar
Clinic Procedures
2450 Catheterisation 190
2451 Catheterisation - With Instillation Drugs 200
2452 Urethral Dilatation 120
2881 Cystoscopy With Urodynamic Assessment
3078 Diathermy Penile Warts Or Minor Genital Skin Lesion Excision
3155 Vasectomy (NB: Loyalty Benefit) 450
3157 Vasectomy (GP) (NB: Loyalty Benefit)
6405 Transrectal Ultrasound And Biopsy of Prostate 660
SECTION 4: GYNAECOLOGY
Vulva
3180 Bartholins Cyst / Abscess Surgery 2500
3420 Incision Of Hymen
3421 Separation Of Labial Fusion
3480 Fenton's Procedure 3440
3490 Simple Excision Vulval Lesion - Unilateral (including excision varicocele) 2250
3491 Simple Excision Vulval Lesion - Bilateral
3500 Vulva - Radical Excision Of, With Glands
3510 Simple Vulvectomy
3520 Warts - Vulval, Cauterisation Or Laser 2210
3529 Vulval Biopsy - Office 170
3530 Multiple Vulval Biopsy 2100
Vagina
3270 Anterior Colporrhaphy 4550
3275 Vaginal Anterior Mesh Repair 8590
3276 Minor Revision Mesh Repair
3280 Colporrhaphy - Anterior And Amputation Of Cervix
3290 Anterior And Posterior Colporrhaphy 5960
3300 Posterior Colporrhaphy 4700
3305 Vaginal Posterior Mesh Repair 8480
3310 Posterior Colporrhaphy And Enterocele
3311 Repair of enterocele, vaginal approach (separate procedure)
3315 Vault Repair, i.e. Sacrospinous Fixation
3325 Open Sacrocolpopexy, Levatoplasty 8240
3410 Examination Under Anaesthetic 2040
3460 Recto-Vaginal Fistula - Repair Of
3470 Vesico-Vaginal Fistula - Repair Of
3485 Excision Of Vaginal Lesion 2520
3595 Laparoscopic Pelvic Floor Repair
3596 Vaginal reconstruction disease related
3285 Vaginoplasty
Cervix
3220 Cervix - Amputation Or Reconstruction
3230 Cervix - Biopsy Under Anaesthetic
3240 Cryotherapy of cervix
3250 Cervix Cauterisation Of - With Anaesthesia
3261 Revision of Episiotomy Scar (not cosmetic)
3330 Colposcopy With Biopsy 200
3375 Cervical Polypectomy
3405 Lletz Loop 1550
3406 Laser Cone Biopsy and or ablation 1440
3407 Laser Ablation
3408 Cone Biopsy 2530
Uterus
3170 Abscess - Pelvic, Drainage Of, Via Fornices
3340 D & C With Reuben's Test
3350 D & C With Biopsy Of Cervix
3360 D&C With Cone Biopsy Of Cervix 2930
3370 D&C With Removal Of Polyp - Uterus
3371 D&C With Removal Of Polyp - Cervix 2400
3380 D&C After Miscarriage 2220
3390 Endometrial Biopsy (Pipelle) 140
3455 Laparoscopic Uterine Nerve Ablation
3540 Hysteroscopy D&C 2590
3542 Hysteroscopy And Removal Of Submucous Fibroid With D&C 3850
3543 Hysteroscopy And Removal Of Endometrial Polyp With D&C 2860
3544 Insert Intra-Uterine Device 610
3545 Uterine Ablation therapy
3560 Pelvic Glands - Radical Dissection Of
3570 Abdominal Hysterectomy 7420
3571 Abdominal Hysterectomy With BSO 8000
3575 Endometrial Resection / Ablation 4650
3576 Hysteroscopy and Radiofrequency endometrial ablation
3577 Hysteroscopy and Microwave endometrial ablation 5130
3580 Hysterectomy - Total And Marshall Marchetti Procedure
3585 Total Abdominal Hysterectomy & Bilateral Salpingo-Oophorectomy & Omentectomy
+/- Nodes
12630
3590 Vaginal Hysterectomy With Pelvic Repair 7380
3600 Vaginal Hysterectomy 6100
3610 Wertheims Hysterectomy
3613 Subtotal lap hysterectomy
3614 Laparoscopically Assisted Vaginal Hysterectomy 10240
3615 Laparoscopically Assisted Vaginal Hysterectomy With BSO 11260
3616 Laparoscopically assisted Vaginal Hysterectomy With Division Of Adhesions 10570
3630 Abdominal Myomectomy
3632 Laparoscopic Myomectomy
Fallopian tubes - Ovaries
3160 Laparoscopic Sterilisation (NB Loyalty Benefit) 4310
3162 Essure - Sterilisation (NB Loyalty Benefit)
3440 Diagnostic Laparoscopy 3920
3445 Laparoscopy With Dye Study 4270
3450 Laparoscopy With D & C
3451 Laparoscopy with Hysteroscopy and D&C and Dye Study
3550 Ectopic Pregnancy - Removal Of
3552 Laparoscopic Removal Of Ectopic Pregnancy
3554 Laparoscopy with Hysteroscopy and D&C 4600
3650 Open Oophorectomy - Unilateral
3651 Open Oophorectomy - Bilateral
3652 Laparoscopic Oophorectomy - Unilateral 7000
3653 Laparoscopic Oophorectomy - Bilateral 7280
3654 Unilateral Oophorectomy With Bilateral Salpingectomy
3655 Laparoscopic Unilateral Oophorectomy With Bilateral Salpingectomy
3660 Open Ovarian Cystectomy - Unilateral
3661 Open Ovarian Cystectomy - Bilateral
3662 Laparoscopic Ovarian Cystectomy - Unilateral 5780
3663 Laparoscopic Ovarian Cystectomy - Bilateral
3665 P.C.O.S. Laparoscopic Drilling Of Ovaries
3666 Laparoscopic Division Of Adhesions To Ovaries
3667 Microsurgery and Reanastomosis of Tubes and Ovaries
3689 Biopsy Of Ovary
3690 Open Salpingectomy
3691 Open Laparotomy
3692 Laparoscopic Salpingectomy unilateral
3700 Open Salpingo-Oophorectomy unilateral
3701 Open Salpingo-Oophorectomy bilateral
3702 Laparoscopic Salpingo-Oophorectomy Unilateral 7710
3703 Laparoscopic Salpingo-Oophorectomy, Bilateral 8450
3710 Salpingo Or Salpingolysis
3712 Salpingostomy - Laparoscopic
3720 Tubal Anastomosis (Unilateral Or Bilateral, Not After Tubal Ligation)
3730 Laparoscopic Diathermy To Endometriosis 4000
3731 Laparoscopic Endometriosis Surgery - Mild 5830
3732 Laparoscopic Endometriosis Surgery - Moderate 7610
3733 Laparoscopic Endometriosis Surgery - Severe 9120
3734 Endometriosis Surgery - Severe (Laparotomy)
SECTION 5: OPHTHALMOLOGY
Lids and Adnexa
251 Xanthelasma
3825 Removal Of Tarsal Cyst 250
3830 Entropion / Ectropion - Repair 1030
3831 Entropion / Ectropion - Repair - Bilateral 1200
3835 Correction Of Ptosis 2700
3837 Correction Of Ptosis - Bilateral 4720
3840 Lacrimal Passage - Probing Of 190
3841 Lacrimal Passage - Probing Of - Bilateral 250
3842 Lacrimal Intubation - Unilateral
3845 Dacryocystorhinostomy 4850
3850 Minor Eyelid Surgery 250
3855 Intermediate Eyelid Surgery 840
3860 Major Eyelid Surgery
3861 Blepharoplasty for dermatochalasis Bilateral
3862 Blepharoplasty for dermatochalasis Unilateral
3870 Autogenous Grafts - Major
3871 Autogenous Grafts - Minor
Strabismus Surgery
3880 Extraocular Muscles - Strabismus - One Or Two Muscles 3400
3882 Strabismus - One Or Two Muscles - Reoperation 3540
3893 Extraocular Muscles - Strabismus - Three Or More Muscles
3894 Strabismus - Three Or More Muscles - Reoperation
3895 Extraocular muscles -strabismus and placement Of Adjustable Suture During
Strabismus Surgery (Including Post-Operative Adjustments)
Extraocular Operations on Globe
3920 Excision Of Pterygium 1730
3921 Excision Of Pterygium - Bilateral
3930 Excision Of Pterygium And Conjunctival Graft 2270
3940 Excision Of Pinguecula 1270
Cataract
3950 Lens Extraction
3952 Phacoemulsification Cataract Extraction With Insertion Of Artificial Lens (Monofocal
only)
3430
3955 Phacoemulsification Cataract Extraction With Insertion Of Artificial Lens (Monofocal
only) (Includes Axial Length Ultrasonography)
3580
3959 Extracapsular Cataract Extraction With Insertion Of Artificial Lens (Monofocal only)
3960 Secondary Iol Implant (Monofocal only)
3961 Cataract Extraction And Iol With Anterior Vitrectomy (Monofocal only)
3965 Iol Implant With Anterior Vitrectomy (Monofocal only)
3970 Yag Laser Capsulotomy 340
3971 Yag Laser Capsulotomy - Bilateral 600
3972 Cataract Extraction With Iol With Trabeculectomy (Monofocal only) (Including First 5
Post-Op Visits)
Glaucoma
3805 Bleb needling
3975 Trabeculectomy (Including First 5 Post-Op Visits) 4980
3980 Trabeculectomy With Cytotoxic Agent (Including First 5 Post-Op Visits) 4710
3985 Drainage (Glaucoma), Molteno Drain Or Similar Procedure 7520
3990 Iridectomy Or Iridotomy
4010 Laser Iridotomy 770
4011 Laser Iridotomy - Bilateral 1150
4015 Laser Trabeculoplasty 1310
4016 Laser Trabeculoplasty - Bilateral 1780
Corneal Surgery
3801 Anterior Stromal Puncture
3910 Cornea Or Sclera - Removal Of Foreign Body
4020 Keratectomy
4030 Penetrating Keratoplasty Or Similar 7690
4040 Phototherapeutic Keratectomy - NB: On application to the Chief Medical Officer
4026 Intrasomal corneal ring segment implantation for Kerataconus
Vitreo-Retinal Surgery
4043 Intravitreal injection 950
4045 Repair Of Detached Retina - Cryotherapy Or Diathermy
4046 Retinal Detachment Repair With Scleral Buckle
4054 Vitrectomy 6020
4056 Vitrectomy With Retinal Detachment Repair 9180
4057 Vitrectomy With Macular Hole Surgery
4058 Removal Of Silicone Oil
4059 Macula Hole Eye Surgery
4060 Complex Vitrectomy
4064 Vitrectomy With Macular Epiretinal Membrane Peel 7640
4065 Retinal Membrane Peeling
4070 Retinal Cryotherapy 1170
4075 Photocoagulation Of Retina (Macular degeneration) 890
4076 Photocoagulation Of Retina - Bilateral 2050
4080 Pan Retinal Laser 1350
4082 Transpupillary Thermotherapy (TTT)
Orbit
4085 Evisceration Of Globe
4086 Evisceration Of Globe - With Implant
4090 Enucleation Of Eye
4091 Enucleation Of Eye With Implant
4100 Orbitotomy
SECTION 6: ORTHOPAEDIC SURGERY
Ankle/foot
4250 Repair Of Foot Tendon - Primary Suture (Flexor Or Extensor)
4251 Repair Of Foot Tendon - Secondary Suture (Flexor Or Extensor)
4260 Repair Ruptured Achilles Tendon - Open, Primary
4261 Achilles Tendon Reconstruction (Tenotomy, Percutaneous, Achilles Tendon)
4270 Repair Ruptured Achilles Tendon - Secondary
4280 Achilles - Elongation
4290 Incision Of Tendon Sheath
4310 Tendon Reconstruction - Ankle
4355 Neurectomy Of Leg / Foot Not Elsewhere Classified
4540 Ingrown Toenail - Radical Excision / Wedge Resection - Unilateral 1640
4550 Ingrown Toenail - Radical Excision / Wedge Resection - Bilateral 2680
4580 Amputation Of Toe - MTP Joint
4581 Amputation Of Toe - IP Joint 2800
5380 Arthrotomy - Ankle
5385 Arthroscopy - Ankle
5386 Arthroscopy Ankle And Therapeutic Procedure 4240
5387 Tarsal Tunnel Release
5390 Ankle Ligament Reconstruction
5400 Arthrodesis - Ankle 8290
5401 Ankle Triple Arthodesis
5402 Subtalar Arthrodesis
5403 Tarsometatarsal Arthrodesis
5404 Talo-Navicular Arthrodesis 5140
5410 Hind Foot Correction
5420 Soft Tissue Correction Of Foot
5430 Bone Correction - Tarsectomy Triple
5431 Complex midfoot correction
5440 Hallux Valgus - Unilateral 3650
5450 Hallux Valgus - Bilateral 5590
5460 Arthrodesis - Great Toe 4620
5461 Arthrodesis - Great Toe - Bilateral
5470 Hallux Rigidus - Bilateral 3520
5480 Hallux Rigidus With Silastic Implant - Single
5490 Hallux Rigidus With Silastic Implant - Bilateral
5500 Hammer Toe Repair 2950
5501 Tenotomy - Toe
5520 Correction Of Hallux Valgus By Osteotomy - First Metatarsal, Unilateral 3890
5522 Osteotomy - Lesser Metatarsal 3290
5530 Correction Of Hallux Valgus By Osteotomy - First Metatarsal, Bilateral 5230
5535 Ankle Replacement 19780
5465 Hallux Rigidus - Unilateral
Elbow
4340 Tendon Transfer - Hand
4390 Transposition Of Ulna Nerve 3540
4391 Open Neurolysis of peripheral nerve, not elsewhere classified 3100
4392 Cubital Tunnel Syndrome
4500 Epicondylitis Release (Epicondylitis Debridement) 2940
5030 Elbow Replacement Arthroplasty
5040 Supracondylar Osteotomy
5050 Arthrotomy & Removal Of Loose Bodies - Elbow
5051 Arthrotomy - Elbow
5061 Arthroscopy Elbow
5062 Arthroscopy Elbow With Procedure 4920
5063 Release Of Elbow Contracture
6030 Radial Head Excision
General
4255 Decompression Fasciotomy (Compartment Syndrome)
4257 Decompression Fasciotomy (Compartment Syndrome) - Bilateral 5000
4380 Nerve Graft
4420 Acute Osteomyelitis - Drainage Small Bone
4430 Acute Osteomyelitis - Drainage Large Bone
4440 Sub-Acute Or Chronic Osteomyelitis - Exploration
4445 Excision Bursa 3190
4446 Bone Graft - Any Area, Minor Or Small
4450 Excision Exostosis - Superficial 2850
4460 Excision Of Exostosis - Deep Bone 3710
4541 Excision of nail and nail matrix, partial or complete - Unilateral 530
4551 Excision of nail and nail matrix, partial or complete - Bilateral
4678 Soft Tissue Injection 50
4679 Joint Injection (Unspecified) 40
4465 Removal of Sesamoid Bone
Hip/Upper Leg
5156 Subcutaneous Tenotomy, Not Elsewhere Classified
5157 Neurectomy Of Leg Nerve
5158 Decompression Fasciotomy - Thigh / Knee
5159 Surgical Dislocation of Hip vs Hip Arthroscopy (Chondroplasty)
5160 Arthroplasty Hemi Or Cup
5161 Hip Arthroscopy 6030
5162 Hip Arthroscopy With Therapeutic Procedure
5163 Ganz Osteotomy
5165 Bone Graft To Femur
5170 Total Hip Replacement 18060
5171 Total Hip Replacement - Bilateral 33580
5175 Removal Of Hip Prosthesis For Infection (Without Revision)
5180 Revision Hip Replacement
5190 Osteotomy - Distal Femur
5620 Hip - Closed Reduction
6155 Removal Of Intra Medullary Rod
6160 Femur - Slipped Epiphysis - Pinning
6165 Femur Osteotomy
6166 Open hip joint biopsy
Knee
4620 Amputation - Above Or Below Knee
5220 Arthrotomy For Loose Body Or Pinning
5240 Repair Collateral Ligament - Knee
5250 Synovectomy Of Knee
5260 Repair Cruciate Ligament - Knee arthroscopic or open
5261 Repair Of Patellar Tendon - Primary
5262 Repair Of Patellar Tendon - Secondary
5284 Arthroscopy Knee - Diagnostic - Bilateral
5285 Arthroscopy Knee - Diagnostic 3700
5286 Arthroscopy Knee And Arthroscopic Procedure 3990
5287 Arthroscopy And Meniscectomy - Bilateral 5110
5289 Arthroscopy And Meniscectomy 3610
5291 Arthroscopic Chondroplasty Of Knee 3860
5293 Debridement Of Knee Joint 3840
5294 Chondroplasty of Knee
5295 Arthroscopic Anterior Cruciate Ligament Repair And / Or Reconstruction - Knee
5300 Patellectomy
5310 Repair Recurrent Dislocating Patella
5330 Knee - Osteotomy
5350 Arthrodesis Of Knee
5360 Partial Knee Replacement 15450
5365 Partial Knee Replacement - Bilateral
5370 Total Knee Replacement 18980
5371 Total Knee Replacement - Bilateral 33340
5375 Revision Knee Replacement
Lower leg
4252 Repair Flexor Tendon Leg - Secondary
4253 Repair Extensor Tendon Leg - Primary
4254 Repair Extensor Tendon Leg - Secondary
4256 Repair Flexor Tendon Leg - Primary
4275 Tendon Lengthening
4300 Tibialis Anterior Transfer
5340 Osteotomy - Proximal Tibia 7840
Nervous System
4350 Suture Of Nerve Requiring Extensive Mobilisation
4360 Primary Suture Nerves
4361 Suture Of Major Peripheral Nerves - Arm/Leg
4362 Suture Of Digital Nerve - Hand / Foot
4370 Secondary Repair Of Nerve
4410 Excision of Neuroma
4411 Lateral Popliteal Nerve Decompression
4412 Excision Of Neuroma - Major Peripheral Nerves
4510 Post Interoseous Nerve Release
4666 Intra-Spinal Injection
4668 Peripheral Nerve Block
4670 Epidural Injection Anaesthetic - Lumbar / Caudal 550
4671 Iv Guanethidine Block Or Similar
4672 Coeliac Plexus Block
4674 Nerve Root Injection (Trans-Foraminal) 1080
4675 Stellate Ganglion Block
Shoulder
4330 Biceps Tendon Release Or Tenodesis
4960 Removal Of Calcaneous Deposits Of Shoulder
4970 Acromioplasty/ Acromionectomy 5720
4972 Rotator Cuff Repair With Acromioplasty 6990
4973 Arthroscopy & Stabilisation Of Shoulder
4974 Arthroscopy, Decompression & Partial Acromioplasty 5610
4975 Rotator Cuff Repair - Simple
4976 Shoulder Arthroscopy, Decompression And Rotator Cuff Repair 6870
4980 Excision Outer End Of Clavicle
4983 Open Reduction Fracture of Clavicle
4985 Arthroscopy- Shoulder, Diagnostic
4986 Arthroscopy Shoulder And Other Arthroscopic Procedure 5930
4990 Arthrodesis Of Shoulder
5000 Hemi Replacement Of Shoulder 13760
5010 Total Replacement Of Shoulder 19440
5020 Arthroplasty Excision
5550 Acromio-Clavicular - Open Reduction And Repair - Chronic
5570 Manipulation Of Shoulder Joint
5590 Repair Of Recurrent Dislocation
Spine
4676 Facet Joint Injection 410
4677 Intra-Discal Injection 1100
4680 Discography 1 Level
4690 Discography 2 Or More Levels
4700 Anterior Cervical Fusion, 1 Level (Dowel Or Similar), Lumbar - Sacral Fusion
4701 Occipital Cervical Fusion
4702 Anterior Cervical Discectomy + Fusion (1 Level) Including Foramen Decompression 15240
4710 Anterior Cervical Fusion, 2 Or More Levels
4711 Anterior Cervical Discectomy + Fusion (2+ Level) Including Foramen
Decompression
16990
4720 Anterior Cervical Fusion With Internal Fixation
4730 Posterior C1-C2 Fusion
4731 Posterior Fusion - C Spine (Excl C1-2)
4740 Anterior Cervical Discectomy
4750 Lumbar Discectomy 2 Or More Levels
4760 Corporectomy With Fusion
4770 Cervical Rib Excision
4780 Trans Thoracic Fusion 1 Level
4790 Trans Thoracic Fusion 2 Or More Levels With Or Without Instrumentation
4800 Posterior Thoracic Fusion 1-2 Levels
4810 Posterior Thoracic Fusion 3+ Levels With Instrumentation
4820 Lumbar Discectomy 7720
4821 Anterior Lumbar Discectomy With Fusion 1 Level
4822 Anterior Lumbar Discectomy With Fusion 2 Or More Levels
4823 Thoracic Discectomy
4825 Anterior Endoscopic Spinal Fusion
4830 Anterior Lumbar Decompression / Interbody Fusion 1 Level 16240
4840 Posterior / Posterolateral Fusion - Lumbar -Without Instrumentation, 2+ Level
4850 Anterior Lumbar Decompression / Interbody Fusion 2+ levels 18690
4860 Posterior / Posterolateral Fusion - Lumbar -Without Instrumentation, 1 Level
4870 Posterior / Posterolateral Fusion - Lumbar -With Instrumentation 1 Level 19850
4880 Posterior / Posterolateral Fusion - Lumbar - With Instrumentation 2+ Levels
4890 Posterior Interbody Fusion With Disc Implant
4900 Corporectomy
4910 Vertebra Excision / Replacement
4920 Spinal Stenosis Decompression - 1 Level 9420
4925 Spinal Stenosis Decompression - 2+ Level 10950
4930 Decompression With Intertransverse Fusion 14500
4940 Decompression and Instumented Fusion 1 level 19570
4950 Coccygectomy
6170 Spine - Vertebral Bodies With Cord Involvement
Wrist/Hand
4200 Primary Repair Of Flexor Tendon - Hand
4210 Secondary Repair Flexor Tendon - Wrist / Forearm
4211 Secondary Repair Flexor Tendon - Hand
4220 Extensor Tendon Repair - Hand
4221 Extensor Tendon Repair - Finger
4222 Tenolysis Extensor Tendon - Hand / Finger
4223 Tenolysis Flexor Tendon - Finger / Palm
4224 Tenolysis Flexor Or Extensor Tendon - Wrist / Forearm
4225 Repair Of Mallet Finger
4230 Secondary Repair Extensor Tendon - Wrist / Forearm
4239 Tendon Transfer - Palm
4240 Tendon Transfer - Opponensplasty
4241 Tendon Transfer - Hand
4242 Open Tenotomy, Not Elsewhere Classified
4243 Tenotomy - Hand / Finger (e.g. For Trigger Finger) 2300
4244 Synovectomy - MCP Joint
4245 Tenotomy - Hand / Finger - Bilateral
4400 Excision Of Neuroma - Cutaneous Nerve 3120
4470 Minor Dupuytrens Contracture Release - Unilateral 3690
4471 Minor Dupuytrens Contracture Release - Bilateral
4480 Major Dupuytrens Contracture Release - Unilateral 5080
4490 Volkman's Contracture
4560 Carpal Tunnel Release 1890
4564 Endoscopic Release Of Carpal Tunnel 2820
4570 Bilateral Carpal Tunnel 2740
4582 Amputation - Finger Or Thumb, Any Joint
5070 Arthrodesis - Wrist With Bone Graft 6140
5071 Arthroscopy - Wrist
5072 Proximal Row Carpectomy removal of bones
5080 Total Replacement - Wrist Joint
5090 Replacement - Interphalyngeal Joint
5100 Replacement MCP Joint
5110 Replacement Of CMC Joint
5120 Fusion - Thumb
5121 Fusion - MCP Joint
5130 Fusion - IP Joint 3510
5131 Fusion - IP Joint With Graft
5140 Fusion - CMC Joint To Thumb With Bone Graft
5141 Fusion - CMC Joint To Digits With Graft
5150 Replacement Arthroplasty In Thumb - Carpal Bones 4490
6010 Bone Graft - Metacarpals Or Phalanx
Other
4660 Manipulation Of Joint 2320
4665 Neurofasciotomy
5930 Upper Limb - Above Elbow - Plaster
5940 Upper Limb - Below Elbow - Plaster 30
5950 Lower Limb - Above Knee - Plaster
5960 Lower Limb - Below Knee - Plaster 160
5965 Debridement of Joint unspecified
6175 Removal Of Metal - Major 3640
6176 Excision benign bone tumour
6185 Removal Of Metal - Minor 2620
4448 Open Muscle Biopsy
SECTION 7: PERIPHERAL VASCULAR SURGERY
6200 Aorto-Iliac Endarterectomy
6201 Aorto-Iliac Bifurcation Graft (Occlusive Disease)
6210 Carotid Endarterectomy - Direct Closure 10430
6211 Carotid Endarterectomy - Patch Closure 12420
6220 Carotid Subclavian Graft
6225 Brachial Artery Bypass
6230 Cervical Or Axillary Sympathectomy - Unilateral
6232 Thoracoscopic Cervical Sympathectomy - Unilateral
6233 Thoracoscopic Cervical Sympathectomy - Bilateral 6840
6240 Cross-Over Graft (Fem - Fem)
6250 Embolectomy / Catheter Thrombectomy - Unilateral
6260 Femoral Endarterectomy
6270 Femoro-Popliteal Graft - Vein 13050
6271 Femoro-Popliteal Graft - Synthetic
6280 Femoro-Tibial Graft - Vein
6281 Femoro-Tibial Graft - Synthetic
6282 Temporal Artery Biopsy 1410
6310 Profundoplasty
6320 Abdominal Aortic Aneurysm Replacement - Infrarenal - With Tube Graft
6321 Abdominal Aortic Aneurysm Replacement - Infrarenal - With Bifurcation Graft To
Iliac Arteries
24320
6322 Abdominal Aortic Aneurysm Replacement - Infrarenal - With Bifurcation Graft To
Femoral Arteries
6323 Renal Artery Aneurism Surgery
6352 Femoral Artery Suturing
6324 Abdominal Aortic Aneurysm Endoluminal Stent-Graft Repair
6215 Carotid Sinus Denervation
SECTION 8: PLASTIC
70 Apocrinectomy - Bilateral 4190
271 Vermillionectomy 1290
6555 Revision Of Scar Of Other Site <= 7 Cms In Length (not cosmetic) 2870
6575 Reconstruction following major head and neck surgery at Chief Medical Officer’s
discretion
6578 Reconstructions other than breast, skin, head/neck at Chief Medical Officer’s
discretion
65 Apocrinectomy – Unilateral
SECTION 9: ORAL AND MAXILLOFACIAL
Removal of Teeth
9001 Removal Of Tooth - Forceps 260
9003 Removal Of Two Or More Teeth - Surgical 1360
9004 Full Dental Clearance 2750
9005 Removal Of One Tooth - Surgical 620
9006 Upper Clearance 1510
9007 Lower Clearance
9008 Third Molars - 2 Upper, 2 Lower 2560
9009 Third Molars - 2 Lower 1990
9011 Third Molars - 1 Upper, 1 Lower 1140
9012 Third Molars - 2 Upper 1080
9014 Third Molars - 2 Upper, 1 Lower 2240
Dental-aveolar surgery
9010 Apicectomy And Root/Fill Anterior Tooth X 1 1020
9020 Apicectomy And Root/Fill Anterior Tooth X 2 930
9030 Apicectomy And Root/Fill Posterior Tooth X 1 1200
9040 Apicectomy And Root/Fill Posterior Tooth X 2
9050 Exposure Of Unerupted Tooth X 1 - For Repositioning 1670
9051 Exposure Of Unerupted Tooth X 1 - For Stimulation And Packing 1320
9060 Exposure Of Unerupted Tooth X 2 - For Repositioning
9061 Exposure Of Unerupted Tooth X 2 - For Stimulation And Packing
9070 Pericision (Fibrotomy) 1-2 Quadrant 210
9080 Pericision (Fibrotomy) 3 Quadrant
9090 Pericision (Fibrotomy) 4 Quadrant 290
9101 Frenectomy 1200
9105 Removal Of Tooth Root From Sinus 400
9110 Removal Of Foreign Body From Antrum Via Alveolus
9120 Removal Of Foreign Body From Antrum Via Caldwell Luc
9130 Oro-Antral Fistula Closure - Buccal Sliding Flap 710
9131 Oro-Antral Fistula Closure - Buccal Fat Pad
Maxillofacial trauma
9180 Removal Foreign Bodies
9190 Salivary Fistula - Duct Relocation/Repair
9200 Open Neurolysis Of Peripheral Nerve, Not Elsewhere Classified
9210 Nerve Suture
9390 Removal Plates/Screws/Wires (Oral Surg)
9170 Scar Revision
Pathology
9480 Bone Graft - Intraoral Site
9481 Bone Graft - Remote Site
9510 Biopsy - Incisional (Oral Surg) 400
9520 Biopsy - Excisional (Oral Surg) 550
9530 Biopsy - Needle
9540 Cyst Enucleation - Periapical 1010
9550 Cyst Enucleation - Dentigerous
9560 Cyst Enucleation - Large Intra Bony 3040
9570 Cyst - Soft Tissue - Excision 560
9580 Infection - Drain Abscess - Cellulitis Intra Oral 670
9590 Infection - Drain Abscess - Cellulitis Extra Oral
9610 Excision Ranula - Sub-Lingual Gland
9620 Tumour - Benign Localised 1020
9630 Tumour - Benign Extensive Including Bone
9640 Tumour - Malignant - Local Excision
Pre-Prosthetic surgery
9650 Removal Hyperplasia - Localised
9660 Removal Hyperplasia - Extensive
9670 Sulcoplasty
9680 Sulcoplasty - With Skin Graft
9690 Reconstruction Of Alveolar Ridge/Grafting
9700 Cheiloplasty
9705 Gingival Reconstruction
9710 Removal Torus
Temporomandibular Joint
9740 Dislocation - Closed Reduction
9750 Internal Derangement - Conservative Management
9760 Internal Derangement - With Splint 410
9770 Arthroplasty - Meniscal Surgery
9780 Arthroplasty - Condylar Surgery
9790 Arthroscopy - Investigative
9800 Arthroscopy - With Surgery
9810 Arthrocentesis 1080
SECTION 10: CARDIAC
1197 Pericardiotomy
1198 Pericardiocentesis
1199 Drainage of Pericardial Effusion
1500 Coronary Artery By Pass, single vessel (using vein or artery)
1501 Coronary Artery By Pass, double vessel (using vein or artery)
1502 Coronary Artery By Pass, triple vessel (using vein or artery)
1503 Coronary Artery By Pass, quadruple vessel or more (using vein or artery)
1505 Valve Replacement
1506 Atrial Septal Defect (Open Closure)
1507 Valvuloplasty
1520 Pacemaker Surgery - Implantation (Excluding The Cost Of The Pacemaker)
1521 Removal Of Sternal Wire
1522 Maze Arrhythmia Surgery
1523 Removal & Rewiring of Sternal Wire
Percutaneous Atrial Septal Defect Closure - NB: Only covered through an Affiliated
Provider(Policy limits will apply. Prior to receiving treatment your Affiliated Provider
will advise the balance payable to you.)
Percutaneous Patent Foramen Ovale Closure - NB: Only covered through an
Affiliated Provider(Policy limits will apply. Prior to receiving treatment your Affiliated
Provider will advise the balance payable to you.)
SECTION 11: INTERVENTIONAL RADIOLOGY
6400 Fine Needle Aspiration (Other Than Breast) Under Ultrasound 330
6401 Ultrasound Breast Cyst Aspiration (Including Fine Needle) 240
6402 Core Biopsy With Ultrasound 420
6403 CT Guided Biopsy 950
6404 CT Guided Drainage
6406 Trans Perineal Prostate Biopsy 3170
6407 Lumbar Chemical Sympathectomy
6408 Chemical Sympathectomy
6409 Intradiscal / Verteb. Inject
6410 Fluoroscopy (in conjunction with surgical procedure)
6411 CT Guided Injections 1200
6415 Stereotactic Mammotome Breast Biopsy
6420 Brachytherapy grid guided prostate biopsy
3546 Embolisation of Fibroid
SECTION 12: NEUROSURGERY
1400 Micro Vascular Decompression Trigeminal Nerve, Trigeminal Neuralgia
1402 Craniotomy
1403 Acoustic Neuroma
1404 Translabrinthine Excision Of Tumour
1405 Craniectomy, Posterior Fossa Craniectomy 26770
1407 Pituitary Adenoma 20850
1408 Repair Of Encephalocele
1409 Spinal Rhizolysis
1410 Removal Of Spinal Intradural Lesion
SECTION 13: PROSTHESES
Additional Sundries
0001185 Prosthesis Bone Anchor. Includes Incontinence Sling Procedure hooks, Vesica
Percutaneous Coposuspension kit, MYA hook
0001200 Laparoscopic supplies
0001230 Endometrial Ablation Device
0001235 Wave length fibres for prostatectomy. Includes laser fee for Holium laser resection,
transurethral resection vapour probe.
0001245 Bone Graft
0001800 Mirena Interuterine
0001236 Wave length fibers- Urological, Includes Incision of Ureteroceis laser fibre fee
0001238 Coblation Wand
0001082 Maze Pen
Prostheses
0001130 Breast implants protheses
0001080 Prosthesis Heart Valve
0001085 Prosthesis Ankle
0001095 Wrist prosthesis - DEVICE ONLY, NOT INSERTION PROCEDURE
0001100 Lens prosthesis (as part of Cataract Surgery) (Monofocal only)
0001110 Shoulder Prostheses
0001120 Prosthesis Elbow
0001140 Spine Prostheses, Single level
0001141 Spine Prostheses, Two levels
0001142 Spine Prostheses, Three or more levels
0001150 Other prostheses devices
0001195 Prosthesis Lacrimal Tube
0001205 Prosthesis Arterial Graft
0001210 Prosthesis Screws and Plates
0001220 Prosthesis Tissue Expander
0001225 TVT tension free vaginal tape
0001250 Prosthesis Urological Stent
0001255 Prosthesis Hepatic Stent
0001275 Post Mastectomy Tissue Expander
0001280 Prosthesis Hip Revision
0001285 Prosthesis Knee Revision
0001290 Prosthesis Hip Primary
0001295 Prosthesis Knee Primary
0001650 Endoluminal Stent
0001655 Oesophageal Stent
0001108 Intrasomal corneal ring segment - prostheses
SECTION 14: TESTS
*Cardiac Tests
1170000 Resting ECG
1170800 Ambulatory NIBP
1171200 Exercise ECG
5528600 Echocardiogram
5511200 Stress Echocardiogram
5511800 Dobutamine Stress Echo/Transoesophageal Echo
1170900 Holter Monitoring
*Diagnostic Tests
4176400 Nasendoscopy (office based only)
4185500 Laryngoscopy (office based only)
0008011 Endometrial sampling
3681200 Flexible Cystoscopy (office based only)
0001804 Simple Urinary Flow Study
1150000 Spirometry
0008012 Overnight Pulse Oximetry
1150600 Pulse Oximeter / Sonography
0008013 Laboratory Sleep Study
1220300 Sleep Study
0008014 Home Sleep Study
1150000 Spirometry - Flow Vol Loops
1150311 Lung Diffusion Study
1150312 Lung Function
1150307 Lung Func Test
9601800 Vascular lab testing
1101200 Electromyography/Nerve conduction study
1100000 Electroencephalography
1190000 Full Urodynamic Assessment
1122100 Automated visual field test
4075 Retinal Photography
1121500 Fluoroscein Angiography
5505500 Axial Ultrasonography
1123500 Corneal Topography
1120600 Electroretinogram
1120601 Electro-oculogram
9201500 Visual Evoked Potential
0003815 Ocular Coherent Tomography
Hiedelberg Ret Tomography

THIS LIST BELONGS TO:
http://www.southerncross.co.nz/index.cfm?104CD0F7-ACE7-4C8D-B6CD-B6AE99A2B865

Later,
Hannah Marie
"Future RNFA, ARNP, PhD, MB, ChB"