Copy of Edit of MEH Primary Price List

Coding Procedure Hospice Per
Code Description Contracted Contracted Hospital

System Category Day
Procedure Fee Anaesthetist Fee Consumables
SIMPLE INVESTIGATIONS AND PROCEDURES AND GENERAL PROCEDURES
DRG 1
DRG 1.1 INVESTIGATIONS
DRG 1.12011 ECG (INCLUDING REPORTING) 10 0
DRG 1.12015 PATCH TESTING (INCLUSIVE OF APPLICATION, READING & REPORTING) 15 0
DRG 1.12021 PURE TONE AUDIOGRAM (AIR CONDUCTION) - INCLUDING MASKING 20 0
DRG 1.12022 PURE TONE AUDIOGRAM (AIR AND BONE CONDUCTION) - INCLUDING
MASKING 20 0
DRG 1.12023 IMPEDANCE AUDIOGRAM 20 0
DRG 1.12024 IMPEDANCE AUDIOGRAM AS PART OF OTHER PROCEDURE 15 0
DRG 1.2 SIMPLE PROCEDURES
DRG 1.220141 CONTINUOUS AMBULATORY ECG FOR UP TO 24 HOURS (INCLUDING 50 0
REPORTING)
DRG 1.225 INCISION AND DRAINAGE (NOT ELSEWHERE COVERED) 25 0 50
DRG 1.225022 STELLATE GANGLION BLOCK (LOCAL ANAESTHETIC) 100 50 50
DRG 1.2H2510 RIGID SIGMOIDOSCOPY INCLUDING PROCTOSCOPY AND BIOPSY 100 0 50
DRG 1.2H5230 INJECTION OF SCLEROSING SUBSTANCE INTO HAEMORRHOIDS 100 50 75
DRG 1.2H5240 BANDING OF HAEMORRHOIDS 75 50 75
DRG 1.2H5260 LOW VOLTAGE TREATMENT OF INTERNAL HAEMORRHOIDS 75 0 50
DRG 1.2L8600 UNILATERAL VARICOSE VEIN INJECTION SCLEROTHERAPY 75 0 75
CURETTAGE/CRYOTHERAPY OF LESION OF SKIN INCLUDING
DRG 1.2S1110
CAUTERISATION - UP TO THREE 75 0 50
DRG 1.2S1500 BIOPSY OF SKIN OR SUBCUTANEOUS TISSUE 75 0 50
DRG 1.2S1510 NEEDLE/TRU-CUT BIOPSY OF MUSCLE 75 0 50
DRG 1.2S4780 ASPIRATION OF SUBCUTANEOUS HAEMATOMA 75 0 50
INJECTION INTO SUBCUTANEOUS TISSUE/PAINFUL TRIGGER POINT
DRG 1.2S5210
(INCLUDING LOCAL ANAESTHETIC AND STEROID) 75 50 50
DRG 1.2X3520 IV SEDATION ADMINISTERED BY ANAESTHETIST 0 75 50
INJECTION(S) +/- ASPIRATION, INTO JOINT, CYST, BURSA OR SOFT TISSUE
DRG 1.2W9040
75 0 50
JOINT FLUID EXAMINATION (EG POLARISING MICROSCOPY) PERFORMED BY
DRG 1.2W9282
CONSULTANT INCLUDING ASPIRATION OF FLUID 100 75 50
DRG 1.2X4810 CHANGE OF CAST WITHOUT GENERAL ANAESTHETIC 50 0 25
DRG 1.3 GENERAL PROCEDURES
DRG 1.32013 EXERCISE ECG (INCLUDING BASE LINE 12 LEAD ECG AND REPORTING) 25 0
EXERCISE OR DOBUTAMINE STRESS ECHOCARDIOGRAPHY (INCLUDING ECG
DRG 1.320132
AND REPORTING) 100 0
INSERTION OF IMPLANTABLE ECG LOOP RECORDER (INCLUDING
DRG 1.320142
REPORTING) 200 0
REMOVAL OF IMPLANTABLE ECG LOOP RECORDER (INCLUDING REPORTING)
DRG 1.320143
150 0
ROUTINE ELECTROENCEPHALOGRAPHY (EEG) IN ADULT OR CHILD AGED
DRG 1.322
OVER 5 (INCLUDING REPORTING) 75 0
PARAVERTEBRAL BLOCK UP TO TWO LEVELS (WITHOUT X-RAY CONTROL)
DRG 1.32501
150 0
DRG 1.3643 ECHOCARDIOGRAPHY 75 0
AURAL TOILET- INCLUDING MICROSUCTION AND/OR SUCTION OF
DRG 1.3D0702
EXTERIORISED MASTOID CAVITY 25 0
System Category Day
ENDOSCOPIC LARYNGO-PHARYNGOSCOPY AS SOLE OUTPATIENT
DRG 1.3E3680
PROCEDURE +/- STROBOSCOPY 100 0
DRG 1.3P2730 COLPOSCOPY (+/- BIOPSY, POLYPECTOMY OR VULVOSCOPY) 100 75
DRG 1.3Q1280 INTRODUCTION OF A MIRENA COIL 50 75
DRG 1.3Q2020 ENDOMETRIAL BIOPSY OR ASPIRATION 75 0
DRG 1.3S4760 FINE NEEDLE ASPIRATION CYTOLOGY 75 0
MANIPULATION OF SPINE WITHOUT GA/IV SEDATION (AS SOLE PROCEDURE)
DRG 1.3V5003
25 0
CPT 82948 GLUCOMETER(BLOOD SUGAR) 2 0
CPT 36450 BLOOD TRANSFUSION NEWBORN; CROSSMATCHING 30 0
CPT 36460 BLOOD TRANSFUSION NEWBORN; PRBC /UNIT 30 0
CPT 92595 NEWBORN BABY HEARING TEST (BERA) 15 0
CPT 96567 PHOTOTHERAPY; SINGLE 35 0
CPT 96568 PHOTOTHERAPY; DOUBLE 60 0
DRG 1.4 CONSULTATIONS AND PHYSICIANS’ FEES
DRG 1.4203 INITIAL OUT-PATIENT CONSULTATION-SURGEON & PHYSICIAN 20
DRG 1.4204 INITIAL OUT-PATIENT CONSULTATION-PSYCHIATRIST 25
DRG 1.4205 INITIAL OUT-PATIENT CONSULTATION-NEUROSURGEON /NEUROLOGIST 30
DRG 1.4207 INITIAL OUT-PATIENT CONSULTATION- SPECIALIST 15
DRG 1.4206 INITIAL OUT-PATIENT CONSULTATION-GENERAL PARCTITIONER 10
DRG 1.42031 FOLLOW-UP OUT-PATIENT CONSULTATION-SURGEON & PHYSICIAN 15
DRG 1.42032 FOLLOW-UP OUT-PATIENT CONSULTATION-PSYCHIATRIST 25
FOLLOW-UP OUT-PATIENT CONSULTATION-NEUROSURGEON/NEUROLOGIST
DRG 1.42033
30
DRG 1.42034 FOLLOW-UP OUT-PATIENT CONSULTATION-SPECIALIST 10
DRG 1.42035 FOLLOW-UP OUT-PATIENT CONSULTATION-GENERAL PRACTITIONER 5
DRG 1.401 IN-PATIENT CARE
DRG 1.401 Room Charges
DRG 1.402 ICU PER DAY 250
CPT 99031 SINGLE PRIVATE ROOM PER DAY 60
CPT 99032 ISOLATION ROOM PER DAY 110
CPT 99033 SUITE ROOM PER DAY 120
CPT 99034 ROOM UPGRADING PER DAY 50
CPT 99035 GRAND SUITE PER DAY 300
CPT 99039 DAY CARE ROOM UTILIZATION/DAY 40
CPT 99040 GEANRAL WARD PER DAY 40
CPT 99062 ER PATIENT STAY MORE THAN 2 HOURS 10
CPT 99103 NEONATAL INTENSIVE CARE UNIT/DAY 80
DRG 1.5 PRACTITIONERS’ FEES PER SESSION TREATMENT
DRG 1.501 ORTHOPTIST 25
DRG 1.502 ACUPUNCTURIST 30
DRG 1.503 HOMEOPATH 30
DRG 1.504 NURSE PRACTITIONER 20
DRG 1.505 PSYCHOLOGIST 50
DRG 1.506 NEUROPSYCHOLOGIST 50
DRG 1.507 PSYCHOTHERAPIST 50
DRG 1.508 SPEECH THERAPIST 30
DRG 1.509 DIETICIAN 25
System Category Day
DRG 1.510 NEUROPSYCHOLOGICAL AND NEUROPSYCHIATRIC ASSESSMENT WHEN
AVAILABLE
DRG 2 BRAIN, CRANIUM AND INTRACRANIAL ORGANS
DRG 2.1 BRAIN
DRG 2.1A0110 HEMISPHEROTOMY Complex 1000 150 950
DRG 2.1A0180 EXCISION OF ABSCESS OF BRAIN Complex 1000 150 950
DRG 2.1A0200 EXCISION OF LESION OF TISSUE OF BRAIN Complex 1000 150 950
AWAKE CRANIOTOMY WITH ABLATION OF LESION OF BRAIN WITH OR
DRG 2.1A0280 Complex
WITHOUT CORTICAL MAPPING/STEREOTAXY 1000 150 950
DRG 2.1A0300 STEREOTACTIC ABLATION OF TISSUE OF BRAIN Complex 1000 150 950
DRG 2.1A0310 STEREOTACTIC BIOPSY OF LESION OR TISSUE OF BRAIN Complex 1000 150 950
STEREOTACTIC RADIOTHERAPY (SRT) USING GAMMAKNIFE OR SIMILAR SRT
TECHNOLOGY 1000 150 950
BIOPSY OF LESION OF TISSUE OF BRAIN (INCLUDING VIA A BURR HOLE OR
STEALTH GUIDED) 1000 150 950
DRG 2.1A0900 IMPLANTATION OF NEUROSTIMULATOR TO BRAIN Major 500 100 450
DRG 2.1A0980 DEEP BRAIN STIMULATION Complex 1000 150 950
DRG 2.1A1220 CREATION OF VENTRICULOVASCULAR ANASTOMOSIS Major 500 100 450
DRG 2.1A1240 CREATION OF VENTRICULOPERITONEAL SHUNT Major 500 100 450
DRG 2.1A1250 CREATION OF SUBCUTANEOUS CEREBROSPINAL FLUID RESERVOIR Major 500 100 450
DRG 2.1A1300 MAINTENANCE OF CEREBROVENTRICULAR SHUNT Major 500 100 450
DRG 2.1A1430 REMOVAL OF CEREBROVENTRICULAR SHUNT Intermediate 250 50 300
DRG 2.1A1440 IRRIGATION OF CEREBROVENTRICULAR SHUNT Minor 100 20 155
THERAPEUTIC ENDOSCOPIC OPERATIONS ON VENTRICLE OF BRAIN
DRG 2.1A1700 Xmajor
(INCLUDING EXAMINATION AND BIOPSY OF LESION) 600 120 730
DRG 2.1A2080 VENTRICULAR PUNCTURE (AS SOLE PROCEDURE) Minor 100 20 155
DRG 2.1A2220 PUNCTURE OF CISTERN OF BRAIN Minor 100 20 155
DRG 2.2 CRANIUM
DRG 2.2A4280 INTRACRANIAL INFECTION: BURR HOLE Xmajor 600 120 730
DRG 2.2V0110 RECONSTRUCTIVE CRANIOPLASTY Xmajor 600 120 730
DRG 2.2V0130 SURGERY FOR CRANIOSTENOSIS (SINGLE SUTURE) Major 500 100 450
DRG 2.2V0180 SURGERY FOR CRANIOSTENOSIS (MORE THAN ONE SUTURE) Xmajor 600 120 730
DRG 2.2V0310 EXPLORATORY OPEN CRANIOTOMY Xmajor 600 120 730
DRG 2.2V0330 EXPLORATORY BURR HOLE OF CRANIUM Major 500 100 450
DRG 2.2V0382 TOTAL PETROSECTOMY (FOR TUMOUR) Complex 1000 150 950
DRG 2.2V0383 LATERAL PETROSECTOMY (FOR TUMOUR) Complex 1000 150 950
DRG 2.2V0390 FORAMEN MAGNUM DECOMPRESSION Complex 1000 150 950
DRG 2.2V0510 EXCISION OF LESION OF CRANIUM Major 500 100 450
DRG 2.2V0530 ELEVATION OF DEPRESSED FRACTURE OF CRANIUM Major 500 100 450
DRG 2.2V0580 REPAIR OF COMPOUND FRACTURE OF CRANIUM Xmajor 600 120 730
CPT 20612-01 Aspiration of scalp smelly 25
DRG 2.3 MENINGES
DRG 2.3A2210 DRAINAGE OF SUBARACHNOID SPACE OF BRAIN Major 500 100 450
DRG 2.3A3810 EXCISION OF LESION OF MENINGES OF BRAIN Complex 1000 150 950
DRG 2.3A3830 OPERATION FOR ARACHNOIDAL CYST Xmajor 600 120 730
DRG 2.3A3900 REPAIR OF DURA Complex 1000 150 950
DRG 2.3A4010 EVACUATION OF EXTRADURAL HAEMATOMA Complex 1000 150 950
DRG 2.3A4110 EVACUATION OF SUBDURAL HAEMATOMA OR ABSCESS Complex 1000 150 950
DRG 2.3A4180 SUBDURAL HAEMORRHAGE – TAP Minor 100 20 155
System Category Day
DRG 2.4 Nerves
DRG 2.4A2500 INTRACRANIAL TRANSECTION OF CRANIAL NERVE Complex 1000 150 950
DRG 2.4A2600 OTHER INTRACRANIAL DESTRUCTION OF CRANIAL NERVE Complex 1000 150 950
DRG 2.4A2900 EXCISION OF LESION OF CRANIAL NERVE (INTRACRANIAL) Complex 1000 150 950
EXCISON OF ACOUSTIC NEUROMA (VESTIBULAR SCHWANNOMA) - TUMOURS
LESS THAN 2.5CM (PERFORMED BY SINGLE SURGEON) 1000 150 950
EXCISION OF ACOUSTIC NEUROMA (VESTIBULAR SCHWANNOMA) -
DRG 2.4A2953 TUMOURS MORE THAN 2.5CM OR COMPRESSING BRAIN STEM (PERFORMED Complex
BY SINGLE SURGEON) 1000 150 950
DRG 2.4A2954 TUMOURS MANAGED BY COMBINED OTO-NEUROSURGICAL TEAM Complex
IRRESPECTIVE OF TUMOUR SIZE 1000 150 950
DRG 2.4A3000 REPAIR OF CRANIAL NERVE (INTRACRANIAL) Complex 1000 150 950
DRG 2.4A3200 DECOMPRESSION OF CRANIAL NERVE (CRANIOTOMY) Complex 1000 150 950
DRG 2.4A3300 IMPLANTATION OF NEUROSTIMULATOR TO CRANIAL NERVE Major 500 100 450
DRG 2.4A3330 REMOVAL OF NEUROSTIMULATOR FROM CRANIAL NERVE Major 500 100 450
DRG 2.4A3680 EXCISION OF CEREBELLO-PONTINE ANGLE TUMOUR Complex 1000 150 950
DRG 2.5 VESSELS
EXCISION OF ARTERIOVENOUS MALFORMATION FROM VESSELS OF BRAIN
1000 150 950
DRG 2.5A4080 CRANIOTOMY – POST-OPERATIVE HAEMORRHAGE Xmajor 600 120 730
DRG 2.5L3320 CLIPPING OF CEREBRAL ARTERY ANEURYSM Complex 1000 150 950
DRG 2.5L3380 REINFORCEMENT OF ANEURYSM OF CEREBRAL ARTERY Complex 1000 150 950
DRG 2.5L3400 OPEN OPERATIONS ON CEREBRAL ARTERY Complex 1000 150 950
DRG 2.6 OTHER
DRG 2.6A8300 ELECTRO-CONVULSIVE THERAPY Minor 100 20 155
DRG 2.6B0100 OPEN HYPOPHYSECTOMY (INCLUDING TOTAL) Complex 1000 150 950
DRG 2.6B0210 CRYOTHERAPY TO PITUITARY GLAND Xmajor 600 120 730
DRG 2.6B0410 TRANSSPHENOIDAL HYPOPHYSECTOMY (INCLUDING TOTAL) Complex 1000 150 950
DRG 2.6B0610 EXCISION OF PINEAL GLAND Complex 1000 150 950
DRG 3 SPINE, SPINAL CORD AND PERIPHERAL NERVES
SPINAL COLUMN (INCLUDING INTERVERTEBRAL DISCS) CERVICAL REGION
DRG 3.100
POSTERIOR DECOMPRESSION +/- FORAMINOTOMY - CERVICAL REGION (1
DRG 3.100V2200 Complex
OR 2 LEVELS) 1000 150 950
PROSTHETIC INTERVERTEBRAL DISC REPLACEMENT - CERVICAL REGION (1
OR 2 LEVELS) 1000 150 950
REVISIONAL POSTERIOR DECOMPRESSION +/– FORAMINOTOMY (CERVICAL
REGION) 1000 150 950
DRG 3.100V2990 OPEN DOOR LAMINOPLASTY OF THE CERVICAL REGION (HIROBYASHI) Complex 1000 150 950
POSTERIOR FUSION +/- INSTRUMENTATION - CERVICAL REGION (1 OR 2
DRG 3.100V3720 Xmajor
LEVELS) 600 120 730
DRG 3.100V2900 ANTERIOR DISCECTOMY - CERVICAL REGION (1 OR 2 LEVELS) Xmajor 600 120 730
DRG 3.100V2902 REVISIONAL ANTERIOR DISCECTOMY (CERVICAL REGION) Complex 1000 150 950
ANTERIOR DISCECTOMY, DECOMPRESSION AND FUSION (INCLUDING BONE
GRAFTING) - CERVICAL REGION (1 OR 2 LEVELS) 1000 150 950
DRG 3.100V2980 COMBINED ANTERIOR AND POSTERIOR FUSION OF CERVICAL SPINE Complex 1000 150 950
DRG 3.100V3730 TRANS ORAL SURGERY INCLUDING POSTERIOR FIXATION Complex 1000 150 950
System Category Day
POSTERIOR FUSION +/- INSTRUMENTATION - CERVICAL REGION (3 OR MORE
LEVELS) 600 120 730
DRG 3.100V2901 ANTERIOR DISCECTOMY - CERVICAL REGION (3 OR MORE LEVELS) Xmajor 600 120 730
POSTERIOR DECOMPRESSION +/- FORAMINOTOMY - CERVICAL REGION (3
OR MORE LEVELS) 1000 150 950
PROSTHETIC INTERVERTEBRAL DISC REPLACEMENT - CERVICAL REGION (3
ANTERIOR DISCECTOMY, DECOMPRESSION AND FUSION (INCLUDING BONE
GRAFTING) - CERVICAL REGION (3 OR MORE LEVELS) 1000 150 950
DRG 3.101 THORACIC REGION
DRG 3.101V2402 POSTERIOR DECOMPRESSION (THORACIC REGION) Xmajor 600 120 730
DRG 3.101V2400 POSTERIOR DECOMPRESSION WITH FUSION (THORACIC REGION) Complex 1000 150 950
REVISIONAL POSTERIOR DECOMPRESSION WITH FUSION (THORACIC
REGION) 1000 150 950
TRANSTHORACIC/ANTERO-LATERAL EXCISION OF INTERVERTEBRAL DISC
+/– FUSION 1000 150 950
REVISIONAL TRANSTHORACIC/ANTERO-LATERAL EXCISION OF
INTERVERTEBRAL DISC +/– FUSION 1000 150 950
DRG 3.101V3140 VATS PERCUTANEOUS DISCECTOMY +/– FUSION (THORACIC REGION) Xmajor 600 120 730
COMBINED ANTERIOR DISCECTOMY AND POSTERIOR FUSION (THORACIC
REGION) 1000 150 950
REVISIONAL COMBINED ANTERIOR DISCECTOMY AND POSTERIOR FUSION
(THORACIC REGION) 1000 150 950
PROSTHETIC INTERVERTEBRAL DISC REPLACEMENT IN THE THORACIC
SPINE 1000 150 950
DRG 3.102 LUMBAR REGION
POSTERIOR EXCISION OF DISC PROLAPSE (INCLUDING MICRODISCECTOMY
+/- DECOMPRESSION) - LUMBAR REGION (1 OR 2 LEVELS) 600 120 730
REVISION OF POSTERIOR EXCISION OF DISC PROLAPSE (LUMBAR REGION)
1000 150 950
POSTERIOR EXCISION OF DISC PROLAPSE WITH UNDERCUTTING
FACETECTOMY +/- DECOMPRESSION - LUMBAR REGION (1 OR 2 LEVELS) 600 120 730
REVISION OF POSTERIOR EXCISION OF DISC PROLAPSE WITH
UNDERCUTTING FACETECTOMY (LUMBAR REGION) 1000 150 950
DECOMPRESSION FOR CENTRAL SPINAL STENOSIS (ONE OR TWO LEVELS)
600 120 730
DECOMPRESSION FOR CENTRAL SPINAL STENOSIS (THREE OR MORE
LEVELS) 1000 150 950
DRG 3.102A5410 EPIDURAL BLOOD PATCH Minor 150 0 50
DRG 3.102A5290 TRANSFORAMINAL EPIDURAL Intermediate 250 50 300
MOBILISATION OF THE LUMBAR/THORACIC VESSELS TO PROVIDE SPINAL
DRG 3.102V3345 Major
SURGICAL ACCESS (BY VASCULAR SURGEON) 500 100 450
PROSTHETIC INTERVERTEBRAL DISC REPLACEMENT - LUMBAR REGION (3
PRIMARY ANTERIOR DISCECTOMY, DECOMPRESSION AND ANTERIOR
FUSION +/- INSTRUMENTATION - LUMBAR REGION (3 OR MORE LEVELS) 600 120 730
System Category Day
PRIMARY POSTERIOR FUSION +/- DECOMPRESSION +/- DISCECTOMY -
LUMBAR REGION (3 OR MORE LEVELS) 1000 150 950
POSTERIOR EXCISION OF DISC PROLAPSE WITH UNDERCUTTING
DRG 3.102V2546 FACETECTOMY +/- DECOMPRESSION - LUMBAR REGION (3 OR MORE Xmajor
LEVELS) 600 120 730
POSTERIOR EXCISION OF DISC PROLAPSE (INCLUDING MICRODISCECTOMY
+/- DECOMPRESSION) - LUMBAR REGION (3 OR MORE LEVELS) 600 120 730
DRG 3.102V2570 PERCUTANEOUS VERTEBROPLASTY Xmajor 600 120 730
DRG 3.102V2660 REVISION OF DECOMPRESSION FOR CENTRAL SPINAL STENOSIS Complex 1000 150 950
PRIMARY POSTERIOR FUSION +/- DECOMPRESSION +/- DISCECTOMY -
LUMBAR REGION (1 OR 2 LEVELS) 1000 150 950
PRIMARY POSTERIOR FUSION WITH INSTRUMENTATION +/-
DRG 3.102V3362 DECOMPRESSION +/- DISCECTOMY (INCLUDING GRAF STABILISATION AND Complex
ALL FUSION APPROACHES) (LUMBAR REGION) 1000 150 950
DRG 3.102V2652 REVISION POSTERIOR FUSION +/– INSTRUMENTATION (LUMBAR REGION) Complex 1000 150 950
PRIMARY ANTERIOR DISCECTOMY, DECOMPRESSION AND ANTERIOR
FUSION +/- INSTRUMENTATION - LUMBAR REGION (1 OR 2 LEVELS) 600 120 730
COMBINED ANTERIOR APPROACH DISCECTOMY, DECOMPRESSION AND
FUSION AND POSTERIOR FUSION (LUMBAR REGION) 1000 150 950
PROSTHETIC INTERVERTEBRAL DISC REPLACEMENT - LUMBAR REGION (1
OR 2 LEVELS) 1000 150 950
DRG 3.102V4140 REMOVAL OF POSTERIOR SPINAL IMPLANT Major 500 100 450
DRG 3.102V4740 IMAGE GUIDED PERCUTANEOUS SPINAL BIOPSY Major 500 100 450
OPEN BIOPSY OF LESION OF SPINE WHERE NO OTHER OPERATIVE
PROCEDURE ON THE SPINE IS PERFORMED. 500 100 450
DRG 3.102V5210 CHEMONUCLEOSIS (MULTIPLE LEVELS) Xmajor 600 120 730
DRG 3.102W0660 COCCYGECTOMY (MULTIPLE LEVELS) Intermediate 250 50 300
DISCOGRAM/DIAGNOSTIC VERTEBRAL DISC INJECTION UNDER X-RAY
DRG 3.102V5230 Minor
CONTROL 100 20 155
DRG 3.102V5002 MANIPULATION OF SPINE UNDER GA/IV SEDATION (SOLE PROCEDURE) Minor 100 20 155
MANIPULATION OF SPINE WITHOUT GA/IV SEDATION (AS SOLE PROCEDURE)
DRG 3.102V5003
50 0
REVISION ANTERIOR DECOMPRESSION WITH FUSION AND
INSTRUMENTATION (LUMBAR REGION) 1000 150 950
SCOLIOSIS (INCLUDING KYPHOSIS, FRACTURES, TUMOURS AND
DRG 3.103
INFECTIONS) 1000 150 950
POSTERIOR CORRECTION OF IDIOPATHIC JUVENILE SCOLIOSIS WITH
INSTRUMENTATION, +/- FUSION (INCLUDING SPINAL CORD MONITORING) 1000 150 950
ANTERIOR CORRECTION OF IDIOPATHIC JUVENILE SCOLIOSIS WITH
COMBINED ANTERIOR AND POSTERIOR CORRECTION AND
DRG 3.103V4000 INSTRUMENTATION, +/- FUSION OF IDIOPATHIC JUVENILE SCOLIOSIS Complex
(INCLUDING SPINAL MONITORING) 1000 150 950
CORRECTION OF DEGENERATIVE SCOLIOSIS INCLUDING DECOMPRESSION
+/- FUSION 1000 150 950
POSTERIOR CORRECTION OF IDIOPATHIC JUVENILE KYPHOSIS WITH
System Category Day
ANTERIOR CORRECTION OF IDIOPATHIC JUVENILE KYPHOSIS WITH
POSTERIOR CORRECTION OF DEGENERATIVE ADULT KYPHOSIS WITH
ANTERIOR CORRECTION OF DEGENERATIVE ADULT KYPHOSIS WITH
DRG 3.103V4300 ANTERIOR VERTEBRECTOMY WITH DECOMPRESSION AND IMPLANT Complex 1000 150 950
COMBINED ANTERIOR VERTEBRECTOMY WITH POSTERIOR FUSION AND
INSTRUMENTATION 1000 150 950
REMOVAL OF POSTERIOR SCOLIOSIS INSTRUMENTATION (AS SOLE
PROCEDURE) 500 100 450
DRG 3.103W2912 APPLICATION OF HALO (AS SOLE PROCEDURE) Intermediate 250 50 300
DRG 3.103V4451 BALLOON KYPHOPLASTY – SINGLE LEVEL Major 500 100 450
DRG 3.103V4452 BALLOON KYPHOPLASTY - TWO LEVEL Xmajor 600 120 730
DRG 3.103V4453 BALLOON KYPHOPLASTY - GREATER THAN TWO LEVELS Xmajor 600 120 730
DRG 3.2 SPINAL CORD
DRG 3.2A4400 PARTIAL EXCISION OF SPINAL CORD Complex 1000 150 950
DRG 3.2A4500 OPEN OPERATIONS ON SPINAL CORD Complex 1000 150 950
DRG 3.2A4730 PERCUTANEOUS CORDOTOMY OF SPINAL CORD Xmajor 600 120 730
DRG 3.2A4850 IMPLANTATION/REMOVAL OF INTRATHECAL DRUG DELIVERY SYSTEM Major 500 100 450
DRG 3.2A4860 IMPLANTATION/REMOVAL OF EPIDURAL DELIVERY SYSTEM Major 500 100 450
DRG 3.2A4900 REPAIR OF SPINAL MYELOMENINGOCELE Complex 1000 150 950
DRG 3.2A5110 EXCISION OF INTRADURAL LESION Complex 1000 150 950
DRG 3.2A5300 DRAINAGE OF SPINAL CANAL (INCLUDING INSERTION OF SHUNT) Xmajor 600 120 730
DRG 3.2A5530 LUMBAR PUNCTURE (INCLUDING SPINAL MANOMETRY) Minor 100 20 155
CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC 90
CPT 62272 SPINAL PUNCTURE, LUMBAR, THERAPEUTIC 75
DRG 3.2A5580 CSF INFUSION STUDIES Intermediate 250 50 300
DRG 3.2V4980 EXCISION OF INTRAMEDULLARY TUMOUR Complex 1000 150 950
DRG 3.3 PARASPINAL INJECTIONS
PARAVERTEBRAL BLOCK UP TO TWO LEVELS (WITHOUT X-RAY CONTROL)
DRG 3.32501
150 0
DRG 3.325011 PARAVERTEBRAL BLOCK UP TO TWO LEVELS (UNDER X-RAY CONTROL) Minor 100 20 155
DRG 3.325012 SACRAL ROOT BLOCK (UNDER X-RAY CONTROL) Minor 100 20 155
INTRAVENOUS REGIONAL SYMPATHETIC BLOCK (GUANETHIDINE BLOCK) - 1
DRG 3.32502 Minor
INJECTION 100 20 155
DRG 3.32503 STELLATE GANGLION BLOCK (NEUROLYTIC) Minor 100 20 155
COELIAC PLEXUS BLOCK, SPLANCHNIC NERVE BLOCK, HYPOGASTRIC
DRG 3.3251 Intermediate
BLOCK - DIAGNOSTIC 250 50 300
BLOCK - THERAPEUTIC 250 50 300
DORSAL ROOT GANGLION BLOCK (LOCAL ANAESTHETIC OR NEUROLYTIC)
250 50 300
DRG 3.32513 DORSAL ROOT GANGLION BLOCK (RADIOFREQUENCY) Major 600 120 730
DRG 3.32514 INTRATHECAL NEUROLYSIS Intermediate 250 50 300
TRIGEMINAL GANGLION INJECTION (LOCAL ANAESTHETIC UNDER X-RAY
CONTROL) 250 50 300
System Category Day
TRIGEMINAL GANGLION RADIOFREQUENCY LESION (UNDER X-RAY
DRG 3.32516 Major
CONTROL) 600 120 730
DRG 3.3A5200 EPIDURAL INJECTION (CERVICAL) Intermediate 250 50 300
DRG 3.3A5210 EPIDURAL INJECTION (LUMBAR) Minor 100 20 155
DRG 3.3A5220 EPIDURAL INJECTION (THORACIC) Intermediate 250 50 300
DRG 3.3A5230 EPIDUROGRAM Minor 100 20 155
DRG 3.3A5240 EPIDUROPLASTY (RACZ CATHETER OR EQUIVALENT) Intermediate 250 50 300
DRG 3.3A5420 INJECTION OF THERAPEUTIC SUBSTANCE INTO CSF Minor 100 20 155
FACET OR SACROILIAC JOINT (RF) RADIOFREQUENCY
DRG 3.3A5720 THERMOCOAGULATION INCLUDING RHIZOLYSIS (UNDER X-RAY CONTROL) - Intermediate
UP TO 3 JOINTS 250 50 300
FACET OR SACROILIAC JOINT (RF) RADIOFREQUENCY
DRG 3.3A5730 THERMOCOAGULATION INCLUDING RHIZOLYSIS (UNDER X-RAY CONTROL ) - Major
4 TO 6 JOINTS. 500 100 450
CPT 64623 INJECTION FACET JOINT (X-RAY GUIDED) 120 0 0
CPT 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) 30
CPT 20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s) 60
DRG 3.3A5750 MEDIAL BRANCH BLOCK OR FACET JOINT INJECTION (UNDER X-RAY Intermediate 250 50 300
CONTROL) - UP TO 2 JOINTS
DRG 3.3A5760 MEDIAL BRANCH BLOCK OR FACET JOINT INJECTION (UNDER X-RAY Intermediate 250 50 300
CONTROL)
MEDIAL BRANCH - 3 TO BLOCK
4 JOINTSFACET JOINT INJECTION (UNDER X-RAY CONTROL) -
DRG 3.3A5770 Intermediate
5 TO 6 JOINTS 250 50 300
SACROILIAC JOINT INJECTION UNDER IMAGE GUIDANCE (AND BILATERAL)
DRG 3.3A5790 Minor
100 20 155
DRG 3.3A5211 EPIDURAL INJECTION (CAUDAL) Minor 100 20 155
DESTRUCTION OF BRANCH OF TRIGEMINAL NERVE
DRG 3.3AA460 Intermediate
(NEUROLYTIC/RF/CRYOPROBE) 250 50 300
DRG 3.4 NERVE ROOTS
DRG 3.4A5780 RHIZOLYSIS Xmajor 600 120 730
DRG 3.5 SYMPATHETIC NERVES
INTRAVENOUS REGIONAL SYMPATHETIC BLOCK (GUANETHIDINE BLOCK) - 1
DRG 3.52502 Minor
INJECTION 100 20 155
DRG 3.525022 STELLATE GANGLION BLOCK (LOCAL ANAESTHETIC) Minor 100 20 155
DRG 3.52503 STELLATE GANGLION BLOCK (NEUROLYTIC) Minor 100 20 155
BLOCK - DIAGNOSTIC 250 50 300
BLOCK - THERAPEUTIC 250 50 300
LUMBAR SYMPATHECTOMY DIAGNOSTIC (LOCAL ANAESTHETIC UNDER X-
RAY CONTROL) 250 50 300
DRG 3.5A7510 THORASCOPIC CERVICAL SYMPATHECTOMY Xmajor 600 120 730
THORACIC SYMPATHECTOMY DIAGNOSTIC (LOCAL ANAESTHETIC UNDER X-
RAY CONTROL) 250 50 300
DRG 3.5A7530 LAPAROSCOPIC LUMBAR SYMPATHECTOMY Major 500 100 450
LUMBAR SYMPATHECTOMY THERAPEUTIC (NEUROLYTIC UNDER X-RAY
CONTROL) 250 50 300
THORACIC SYMPATHECTOMY THERAPEUTIC (NEUROLYTIC UNDER X-RAY
DRG 3.5A7620 Major
CONTROL) 500 100 450
DRG 3.5A7682 PRESACRAL SYMPATHECTOMY - DIAGNOSTIC Major 500 100 450
System Category Day
DRG 3.5A7683 PRESACRAL SYMPATHECTOMY - THERAPEUTIC Major 500 100 450
SACRAL NERVE STIMULATION FOR FAECAL/URINARY INCONTINENCE OR
DRG 3.5A7085 Major
CONSTIPATION 500 100 450
DRG 3.6 PERIPHERAL NERVES
DRG 3.6A6030 TRANSECTION OF PERIPHERAL NERVE FOR NEUROMA Intermediate 250 50 300
DRG 3.6A6080 NEURECTOMY (MAJOR NERVE) Intermediate 250 50 300
DRG 3.6A6110 EXCISION OF LESION OF PERIPHERAL NERVE (EG NEURILEMOMA) Intermediate 250 50 300
DRG 3.6A6180 EXCISION OF LESION OF MAJOR NERVE Intermediate 250 50 300
DRG 3.6A6300 GRAFT TO PERIPHERAL NERVE Xmajor 600 120 730
DRG 3.6A6302 GRAFT TO MAJOR NERVE Xmajor 600 120 730
DRG 3.6A6400 REPAIR OF PERIPHERAL NERVE Intermediate 250 50 300
DRG 3.6A6402 REPAIR OF MAJOR NERVE Major 500 100 450
DRG 3.6A6510 CARPAL TUNNEL RELEASE (OPEN) Intermediate 250 50 300
DRG 3.6A6580 CARPAL TUNNEL RELEASE (OPEN) - BILATERAL Intermediate 250 50 300
DRG 3.6A6600 RELEASE OF ENTRAPMENT OF DEEPLY PLACED PERIPHERAL NERVE Intermediate 250 50 300
DRG 3.6A6700 RELEASE OF ENTRAPMENT OF PERIPHERAL NERVE Intermediate 250 50 300
DRG 3.6A6710 CUBITAL TUNNEL RELEASE (OPEN) (WITHOUT TRANSPOSITION) Intermediate 250 50 300
CUBITAL TUNNEL RELEASE (OPEN) BILATERAL (WITHOUT TRANSPOSITION)
250 50 300
NEUROLYSIS AND TRANSPOSITION OF PERIPHERAL NERVE (EXCLUDES
CARPAL TUNNEL RELEASE) 250 50 300
DRG 3.6A6900 REVISION OF RELEASE OF PERIPHERAL NERVE Major 500 100 450
DRG 3.6A7010 IMPLANTATION OF NEUROSTIMULATOR INTO PERIPHERAL NERVE Major 500 100 450
TRIAL OF NEUROSTIMULATOR TO PERIPHERAL NERVE (AS SOLE
PROCEDURE) NOT AT TIME OF PERMANENT IMPLANT 250 50 300
DRG 3.6A6530 CARPAL TUNNEL RELEASE (ENDOSCOPIC) Intermediate 250 50 300
DRG 3.6A6570 CARPAL TUNNEL RELEASE (ENDOSCOPIC) - BILATERAL Intermediate 250 50 300
DRG 3.6A6740 CUBITAL TUNNEL RELEASE (ENDOSCOPIC) (WITHOUT TRANSPOSITION) Intermediate 250 50 300
CUBITAL TUNNEL RELEASE (ENDOSCOPIC) BILATERAL (WITHOUT
TRANSPOSITION) 250 50 300
DRG 3.6A7310 BIOPSY OF PERIPHERAL NERVE Intermediate 250 50 300
DRG 3.6A7340 EXPLORATION AND GRAFTING OF BRACHIAL PLEXUS Complex 1000 150 950
DRG 3.7 OTHER NERVE BLOCKS
TRIGEMINAL GANGLION INJECTION (LOCAL ANAESTHETIC UNDER X-RAY
CONTROL) 250 50 300
RADIOFREQUENCY (INCLUDING PULSED DENERVATION), CRYOPROBE OR
PHENOL FOR PERMANENT LESION OF MAJOR NERVE TRUNK 250 50 300
DRG 3.7A7302 CONTINUOUS NERVE BLOCK AS SOLE PROCEDURE Minor 150 0 50
IMAGE-GUIDED LOCAL ANAESTHETIC BLOCKADE OF NAMED MAJOR NERVE
DRG 3.7A7352 Minor
OR PLEXUS 150 0 50
DESTRUCTION OF BRANCH OF TRIGEMINAL NERVE
DRG 3.7AA460 Intermediate
(NEUROLYTIC/RF/CRYOPROBE) 250 50 300
DRG 3.8 OTHER PROCEDURES
TRIGEMINAL GANGLION RADIOFREQUENCY LESION (UNDER X-RAY
CONTROL) 250 50 300
DRG 3.8T6520 TENDON SHEATH INJECTION Minor 100 20 155
DRG 3.8T7290 TRIGGER POINT INJECTION/ENTHESIS - ONE INJECTION Minor 150 0 50
DRG 3.8T7292 TRIGGER POINT INJECTION/ENTHESIS - MORE THAN ONE INJECTION Minor 150 0 50
System Category Day
DRG 3.8V5484 INTERSPINOUS DYNAMIC STABILISATION PROCEDURE Xmajor 600 120 730
DRG 3.8X3750 BOTULINUS TOXIN INJECTIONS TO MUSCLE Minor 100 20 155
INTRAMUSCULAR INJECTION WITH X-RAY CONTROL (EG PIRIFORMIS BLOCK)
DRG 3.8X3770 Minor
100 20 155
DRG 3.8Y3800 INSERTION OF INDWELLING AXILLARY CATHETER Intermediate 250 50 300
DRG 3.8Y3810 INSERTION OF INDWELLING PLEURAL CATHETER Intermediate 250 50 300
DRG 3.8Y3820 INSERTION OF INDWELLING PSOAS CATHETER Intermediate 250 50 300
DRG 3.9 NEUROPHYSIOLOGICAL PROCEDURES
ROUTINE ELECTROENCEPHALOGRAPHY (EEG) IN ADULT OR CHILD AGED
DRG 3.922
OVER 5 (INCLUDING REPORTING) 75 0
ROUTINE ELECTROENCEPHALOGRAPHY (EEG) IN CHILD UNDER 5
DRG 3.922002 Minor
(INCLUDING REPORTING) 150 0 50
DRG 3.922003 SLEEP ELECTROENCEPHALOGRAPHY (EEG) Minor 150 0 50
24 HOUR AMBULATORY ELECTROENCEPHALOGRAPHY (EEG) (INCLUDING
DRG 3.922004 Minor
REPORTING) 150 0 50
24 HOUR VIDEO TELEMETRY ELECTROENCEPHALOGRAPHY (EEG)
DRG 3.922005 Minor
DRG 3.922011 RECORDING AND REPORTING ON EVOKED POTENTIAL STUDY Minor 150 0 50
RECORDING AND REPORTING ON ELECTROMYOGRAPHY AND NERVE
DRG 3.922022 CONDUCTION STUDIES (EMG); CTS (BILATERAL UPPER LIMB ONLY) OR Minor
PERIPHERAL NEUROPATHY 150 0 50
DRG 3.922023 CONDUCTION STUDIES (EMG); MONONEUROPATHY (EG ULNAR), CX/LUMBAR Minor
RADICULOPATHY, MYOPATHY 150 0 50
CONDUCTION STUDIES (EMG); MONONEURITIS MULTIPLEX, MND-AHC,
DRG 3.922024 Minor
MULTIPLE MUSCLE MONITORING (EG TORTICOLLIS), MYAESTHENIA GRAVIS
(- SFEMG) 150 0 50
DRG 3.922025 Minor
CONDUCTION STUDIES (EMG); MYAESTHENIA GRAVIS (+ SFEMG) 150 0 50
DRG 3.922028 SLEEP STUDY (POLYSOMNOGRAPHY) INCLUDING REPORTING Minor 150 0 50
DRG 4 EYE AND ORBITAL CONTENTS
DRG 4.1 GLOBE AND ORBIT
DRG 4.1C0110 EXENTERATION OF ORBIT Major 500 100 450
DRG 4.1C0120 ENUCLEATION/EVISCERATION OF EYEBALL Major 500 100 450
DRG 4.1C0122 ENUCLEATION/EVISCERATION OF EYEBALL (WITH IMPLANT) Major 500 100 450
DRG 4.1C0212 EXCISION OF LESION OF ORBIT - ANTERIOR APPROACH Major 500 100 450
DRG 4.1C0213 EXCISION OF LESION OF ORBIT - LATERAL ORBITOMY Major 500 100 450
SIMPLE RECONSTRUCTION OF SOCKET (NOT INCLUDING IMPLANT OR
DRG 4.1C0512 Major
GRAFT) 500 100 450
DRG 4.1C0513 RECONSTRUCTION OF SOCKET WITH EITHER IMPLANT OR GRAFT Complex 1000 150 950
DRG 4.1C0514 RECONSTRUCTION OF SOCKET WITH IMPLANT AND GRAFT Complex 1000 150 950
DRG 4.1C0610 BIOPSY OF LESION OF ORBIT Intermediate 250 50 300
DRG 4.1C0620 DRAINAGE OF ORBIT Intermediate 250 50 300
DRG 4.1C0630 DECOMPRESSION OF ORBIT Major 500 100 450
DRG 4.1C0640 REMOVAL OF FOREIGN BODY FROM ORBIT Major 500 100 450
DRG 4.1C0650 EXPLORATION OF ORBIT (AS SOLE PROCEDURE) Major 500 100 450
DRG 4.1C0840 ORBITAL INJECTION Minor 100 20 155
System Category Day
DRG 4.2 EYEBROW AND LID
DRG 4.2C1010 EXCISION OF LESION OF EYEBROW Minor 100 20 155
DRG 4.2C1040 SUTURE OF EYEBROW Minor 100 20 155
DRG 4.2C1110 EXCISION OF LESION OF CANTHUS Intermediate 250 50 300
DRG 4.2C1130 CORRECTION OF EPICANTHUS Intermediate 250 50 300
DRG 4.2C1140 CORRECTION OF TELECANTHUS Intermediate 250 50 300
DRG 4.2C1150 GRAFT OF SKIN TO CANTHUS Intermediate 250 50 300
DRG 4.2C1160 CANTHOTOMY Minor 100 20 155
DRG 4.2C1210 EXCISION OF LESION OF EYELID Minor 100 20 155
DRG 4.2C1230 CURETTAGE/CRYOTHERAPY OF LESION OF EYELID Minor 100 20 155
DRG 4.2C1420 GRAFT OF SKIN TO EYELID Intermediate 250 50 300
DRG 4.2C1512 CORRECTION OF LOWER LID ECTROPION WITHOUT GRAFT/FLAP Intermediate 250 50 300
DRG 4.2C1513 CORRECTION OF LOWER LID ECTROPION WITH GRAFT/FLAP Intermediate 250 50 300
DRG 4.2C1522 CORRECTION OF ENTROPION - LOWER LID Intermediate 250 50 300
DRG 4.2C1818 REVERSE PTOSIS REPAIR OF EYELID Major 500 100 450
DRG 4.2C1523 CORRECTION OF ENTROPION - UPPER LID, INCLUDING GRAFT/FLAP Intermediate 250 50 300
CORRECTION OF TRICHIASIS BY
DRG 4.2C1532 Minor
ELECTROLYSIS/DIATHERMY/CRYOTHERAPY/LASER 100 20 155
SURGICAL CORRECTION OF TRICHIASIS/UPPER LID ENTROPION, INCLUDING
DRG 4.2C1540 Minor
GRAFT/FLAP 100 20 155
DRG 4.2C1640 TARSORRHAPHY Intermediate 250 50 300
DRG 4.2C1700 TOTAL RECONSTRUCTION OF EYELID - UNILATERAL Major 500 100 450
DRG 4.2C1710 SUTURE OF EYELID (LACERATION) (AS SOLE PROCEDURE) Minor 100 20 155
CORRECTION OF PTOSIS OF EYELID - SIMPLE, INCLUDING
DRG 4.2C1810 Major
TARSOMULLERECTOMY 500 100 450
DRG 4.2C1812 CORRECTION OF PTOSIS OF EYELID - COMPLEX Major 500 100 450
DRG 4.2C1813 CORRECTION OF PTOSIS OF EYELID WITH AUTOLOGOUS FASCIA LATA Major 500 100 450
DRG 4.2C2220 BIOPSY OF LESION OF EYELID Minor 100 20 155
DRG 4.3 LACRIMAL SYSTEM
DACRYOCYSTORHINOSTOMY (INCLUDING INSERTION AND LATER REMOVAL
DRG 4.3C2540 Major
OF TUBE) 500 100 450
DACRYOCYSTO-RHINOSTOMY (ENDOSCOPIC/LASER ASSISTED), INCLUDING
DRG 4.3C2542 Xmajor
INSERTION AND LATER REMOVAL OF TUBE 600 120 730
DRG 4.3C2550 LACRIMAL INTUBATION (AS SOLE PROCEDURE) Intermediate 250 50 300
DRG 4.3C2610 EXCISION/BIOPSY OF LACRIMAL SAC Intermediate 250 50 300
DRG 4.3C2640 INCISION OF LACRIMAL SAC Minor 100 20 155
PROBING OF NASOLACRIMAL SYSTEM WITH/WITHOUT SYRINGING AND/OR
DRG 4.3C2650 Minor
IRRIGATION 100 20 155
DRG 4.3C2910 PUNCTO-CANALICULOPLASTY Minor 100 20 155
DRG 4.3C2920 INSERTION OF CANALICULAR OR PUNCTAL PLUGS Minor 100 20 155
DRG 4.4 MUSCLES
DRG 4.4C3112 SURGICAL CORRECTION OF SQUINT - HORIZONTAL 1 MUSCLE Major 500 100 450
SURGICAL CORRECTION OF SQUINT - HORIZONTAL 2 MUSCLES (IN ONE EYE,
DRG 4.4C3113 Major
OR ONE MUSCLE IN EACH OF TWO EYES) 500 100 450
DRG 4.4C3114 SURGICAL CORRECTION OF SQUINT - INFERIOR OBLIQUE SURGERY Major 500 100 450
DRG 4.4C3115 SURGICAL CORRECTION OF SQUINT - OTHER VERTICAL MUSCLES Major 500 100 450
DRG 4.4C3180 REVISION OF SQUINT SURGERY Xmajor 600 120 730
DRG 4.4C3530 SURGICAL CORRECTION OF SQUINT WITH ADJUSTABLE SUTURES Xmajor 600 120 730
System Category Day
INJECTION OF BOTULINUM TOXIN INTO EXTRAOCULAR OR PERIOCULAR
DRG 4.4C3780 Intermediate
MUSCLES 250 50 300
DRG 4.5 CONJUCTIVA
DRG 4.5C3910 EXCISION/BIOPSY OF CONJUNCTIVAL LESION Minor 100 20 155
DRG 4.5C3920 CAUTERISATION INCLUDING CRYOTHERAPY TO CONJUNCTIVAL LESION Minor 100 20 155
BLEB NEEDLING +/- ANTIMETABOLITES (INCLUDING TOPICAL OR LOCAL
DRG 4.5C6180
ANAESTHETIC) 100 0
DRG 4.5C3950 RADIOTHERAPY TO CONJUNCTIVAL LESION Minor 100 20 155
DRG 4.5C4010 MUCOSAL GRAFT TO CONJUNCTIVA Intermediate 250 50 300
DRG 4.5C4050 SUTURE OF CONJUNCTIVA Minor 100 20 155
DRG 4.5C4100 DRAINAGE OF CONJUNCTIVAL CYST Minor 100 20 155
DRG 4.5C4340 SUBCONJUNCTIVAL INJECTION Minor 100 20 155
EXPLORATION OF CONJUNCTIVA (INCLUDING REMOVAL OF FOREIGN BODY)
DRG 4.5C4350 Minor
100 20 155
DRG 4.6 CORNEA
DRG 4.6C3960 EXCISION OF PTERYGIUM Intermediate 250 50 300
DRG 4.6C4520 EXCISION OF LESION OF CORNEA Intermediate 250 50 300
DRG 4.6C4620 LAMELLAR GRAFT (KERATOPLASTY) TO CORNEA Xmajor 600 120 730
DRG 4.6C4630 PERFORATING GRAFT (KERATOPLASTY) TO CORNEA Xmajor 600 120 730
DRG 4.6C4640 DESCEMETS STRIPPING ENDOTHELIAL KERATOPLASTY (DSEK) Xmajor 600 120 730
DRG 4.6C4650 REVISION OF CORNEAL GRAFT/WOUND Major 500 100 450
IMPLANTATION OF SYNTHETIC CORNEAL RINGS FOR KERATOCONUS
(INCLUDING INTACS) 250 50 300
DRG 4.6C4710 REPAIR OF CORNEAL WOUND Intermediate 250 50 300
DRG 4.6C4730 REMOVAL OF CORNEAL SUTURE Minor 100 20 155
DRG 4.6C4810 REMOVAL OF SUPERFICIAL CORNEAL FOREIGN BODY Minor 100 20 155
DRG 4.6C4980 TENSION SUTURES Intermediate 250 50 300
DRG 4.6C5180 CORNEAL SCRAPING FOR CULTURE Minor 100 20 155
DRG 4.7 SCLERA
DRG 4.7C5300 EXCISION OF LESION OF SCLERA Intermediate 250 50 300
DRG 4.7C5720 REPAIR OF SCLERAL LACERATION Intermediate 250 50 300
DRG 4.7C5730 SCLERAL GRAFT Major 500 100 450
DRG 4.7C6181 LASER SUTURE LYSIS (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 100 0
DRG 4.8 IRIS AND ANTERIOR CHAMBER
DRG 4.8C5910 IRIDOCYCLECTOMY Xmajor 600 120 730
DRG 4.8C5920 SURGICAL IRIDECTOMY Major 500 100 450
SURGICAL TRABECULECTOMY OR OTHER PENETRATING GLAUCOMA
DRG 4.8C6010 Major
PROCEDURES (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
CANALOPLASTY (OF SCHLEMM'S CANAL WITH MICROCATHETER) COMBINED
DRG 4.8C6012 WITH PHAKOEMULSIFICATION OF LENS WITH IMPLANT "PHAKO- Major
CANALOPLASTY" (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
LASER TRABECULOPLASTY (INCLUDING TOPICAL OR LOCAL ANAESTHETIC)
(AND BILATERAL) 250 50 300
GONIOTOMY (SURGICAL TREATMENT OF GLAUCOMA) (INCLUDING TOPICAL
DRG 4.8C6130 Major
OR LOCAL ANAESTHETIC) 500 100 450
REVISION OF PREVIOUS GLAUCOMA SURGERY (INCLUDING TOPICAL LOCAL
DRG 4.8C6150 Major
ANAESTHETIC) 500 100 450
System Category Day
COMPLEX GLAUCOMA SURGERY (INCLUDING ANTI-METABOLITES/INSERTION
DRG 4.8C6160 Major
OF SETON DEVICES) (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
GONIOSYNECHIALYSIS OR GONIOPUNCTURE (WITH LASER OR
OPERATIVELY) (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 250 50 300
DRG 4.8C6230 LASER IRIDOTOMY Intermediate 250 50 300
DRG 4.8C6410 REPAIR OF PROLAPSED IRIS Major 500 100 450
DRG 4.8C6420 EXCISION OF LESION OF IRIS Major 500 100 450
DRG 4.8C6450 REMOVAL OF FOREIGN BODY FROM IRIS Major 500 100 450
DRG 4.8C6610 CILIARY BODY ABLATION Intermediate 250 50 300
DRG 4.8C6710 CYCLODIALYSIS (SEPARATION OF CILIARY BODY) Major 500 100 450
DRG 4.8C6910 REFORMATION OF ANTERIOR CHAMBER Major 500 100 450
DRG 4.8C6920 PARACENTESIS Intermediate 250 50 300
INJECTION INTO ANTERIOR CHAMBER (INCLUDING TOPICAL OR LOCAL
DRG 4.8C6930 Minor
DRG 4.8C6940 IRRIGATION/ASPIRATION OF ANTERIOR CHAMBER Minor 100 20 155
DRG 4.8C6980 REMOVAL OF FOREIGN BODY FROM ANTERIOR CHAMBER Intermediate 250 50 300
DRG 4.8C6990 INSERTION OF VALVE INTO ANTERIOR CHAMBER OF EYE Major 500 100 450
DRG 4.9 LENS
EXTRACAPSULAR CATARACT EXTRACTION WITHOUT IMPLANT - BILATERAL
DRG 4.9C7100 Xmajor
600 120 730
EXTRACAPSULAR CATARACT EXTRACTION WITHOUT IMPLANT - UNILATERAL
DRG 4.9C7110 Major
500 100 450
PHAKOEMULSIFICATION OF CATARACT, WITH LENS IMPLANT - UNILATERAL
DRG 4.9C7122 Major
(INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
PHAKOEMULSIFICATION OF CATARACT, WITHOUT LENS IMPLANT -
DRG 4.9C7123 Major
UNILATERAL (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
PHAKOEMULSIFICATION OF CATARACTS, WITHOUT LENS IMPLANT -
DRG 4.9C7124 Major
BILATERAL (INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
PHAKOEMULSIFICATION OF CATARACTS, WITH LENS IMPLANT - BILATERAL
DRG 4.9C7125 Major
(INCLUDING TOPICAL OR LOCAL ANAESTHETIC) 500 100 450
YAG LASER PHOTODISRUPTION OF POSTERIOR CAPSULE OF LENS
(INCLUDING LASER CAPSULOTOMY) - BILATERAL 250 50 300
DRG 4.9C7180 EXTRACAPSULAR CATARACT EXTRACTION WITH IMPLANT - UNILATERAL Major 500 100 450
DRG 4.9C7190 EXTRACAPSULAR CATARACT EXTRACTION WITH IMPLANT - BILATERAL Xmajor 600 120 730
YAG LASER PHOTODISRUPTION OF POSTERIOR CAPSULE OF LENS
DRG 4.9C7340 Minor
(INCLUDING LASER CAPSULOTOMY) - UNILATERAL 100 20 155
DRG 4.9C7510 SECONDARY INSERTION OF LENS IMPLANT Major 500 100 450
DRG 4.9C7520 LENS IMPLANT/EXCHANGE Major 500 100 450
DRG 4.9C7530 REMOVAL OF LENS IMPLANT Intermediate 250 50 300
DRG 4.10 VITREOUS
DRG 4.10C7910 ANTERIOR VITRECTOMY Xmajor 600 120 730
PARS PLANA VITRECTOMY WITH INTERNAL TAMPONADE, SCLERAL
DRG 4.10C7920 Xmajor
BUCKLING AND RETINOPEXY 600 120 730
DRG 4.10C7922 PARS PLANA VITRECTOMY/VITREOUS BIOPSY Major 500 100 450
PARS PLANA VITRECTOMY WITH INTERNAL TAMPONADE, SCLERAL
DRG 4.10C7982 BUCKLING AND RETINOPEXY, INCLUDING DISSECTION OR EXCISION OF Complex
EPIRETINAL MEMBRANE/MACULAR SURGERY 1000 150 950
System Category Day
DRG 4.10C7940 INTRAVITREAL INJECTION OF PHARMACEUTICAL AGENT Minor 100 20 155
DRG 4.11 RETINA
CONVENTIONAL RETINAL SURGERY (MAY INCLUDE SCLERAL BUCKLING,
DRG 4.11C5432 Xmajor
INJECTION OF GAS, DRAINAGE AND RETINOPEXY) 600 120 730
DRG 4.11C5480 REMOVAL OF SILICONE OIL Intermediate 250 50 300
DRG 4.11C8200 LASER PHOTOCOAGULATION/CRYOTHERAPY OF LESION OF RETINA Intermediate 250 50 300
DRG 4.11C8240 PHOTODYNAMIC THERAPY TO THE RETINA (PDT) Intermediate 250 50 300
RETINAL EXAMINATION UNDER ANAESTHETIC INCLUDING RETINOPEXY IF
DRG 4.11C8440 Minor
NECESSARY 100 20 155
DRG 4.12 GENERAL
FLUORESCEIN ANGIOGRAPHY OF EYE (INCLUDING OCULAR PHOTOGRAPHY)
DRG 4.12C8650 Minor
100 20 155
FUNDUS OR ANTERIOR SEGMENT OCULAR PHOTOGRAPHY (AS SOLE
DRG 4.12C8652 Minor
INSERTION OF RADIOACTIVE PLAQUE INTO EYE (INCLUDING LATER
DRG 4.12C8654 Major
REMOVAL) 500 100 450
DRG 5 EAR, NOSE AND THROAT
DRG 5.1 EXTERNAL EAR
DRG 5.1D0110 TOTAL EXCISION OF PINNA Major 500 100 450
DRG 5.1D0132 EXCISION ACCESSORY AURICLE/PREAURICULAR APPENDAGE Minor 100 20 155
DRG 5.1D0140 EXCISION OF PREAURICULAR SINUS Intermediate 250 50 300
DRG 5.1D0210 EXCISION OF LESION OF PINNA Intermediate 250 50 300
DRG 5.1D0280 REMOVAL OF MULTIPLE BONEY EXOSTOSES EAC Intermediate 250 50 300
RECONSTRUCTION OF EXTERNAL EAR FOR ANOTIA/MICROTIA USING
DRG 5.1D0310 Complex
CARTILAGE 1000 150 950
DRG 5.1D0330 PINNAPLASTY (INCLUDING BILATERAL) (CHILD 14 AND BELOW ONLY) Major 500 100 450
DRG 5.1D0340 SOFT TISSUE MEATOPLASTY OF EAC Intermediate 250 50 300
DRG 5.1D0342 BONEY MEATOPLASTY Major 500 100 450
DRG 5.1D0410 DRAINAGE OF HAEMATOMA/ABSCESS OF PINNA Minor 100 20 155
DRG 5.1D0610 BIOPSY OF LESION OF PINNA (AS SOLE PROCEDURE) Minor 100 20 155
DRG 5.1D0630 REPAIR OF PINNA Minor 100 20 155
DRG 5.1D0702 AURAL TOILET - INCLUDING MICROSUCTION 50 0 0
REMOVAL OF FOREIGN BODY FROM EXTERNAL AUDITORY CANAL (AND
DRG 5.1D0730 Minor
BILATERAL) 100 20 155
DRG 5.1D0810 EXCISION OF LESION OF EXTERNAL AUDITORY CANAL Minor 100 20 155
DRG 5.1D0812 REMOVAL OF SOLITARY OSTEOMA OF EAC Intermediate 250 50 300
DRG 5.1D0820 RECONSTRUCTION OF EXTERNAL AUDITORY CANAL Xmajor 600 120 730
CPT 69399-01 AURAL TOILET A 7 0 0
CPT 69399-02 AURAL TOILET B 10 0 0
CPT 69399-03 EAR PACKING 5 0 0
CPT 69399-04 INCISION AND DRAINAGE - ENT OPD 15 0 0
DRG 5.2 MIDDLE EAR AND MASTOID
DRG 5.2D1010 RADICAL MASTOIDECTOMY (INCLUDING MEATOPLASTY) Major 500 100 450
DRG 5.2D1020 MODIFIED RADICAL MASTOIDECTOMY (INCLUDING MEATOPLASTY) Xmajor 600 120 730
DRG 5.2D1040 SIMPLE MASTOIDECTOMY Major 500 100 450
DRG 5.2D1060 REVISION OF MASTOIDECTOMY (INCLUDING MEATOPLASTY) Major 500 100 450
DRG 5.2D1240 EXPLORATION OF FACIAL NERVE, MASTOID SEGMENT, FACIAL NERVE Xmajor 600 120 730
DRG 5.2D1420 MYRINGOPLASTY Major 500 100 450
System Category Day
COMBINED APPROACH TYMPANOPLASTY - INTACT CANAL WALL
DRG 5.2D1440 Major
TYMPANOPLASTY 500 100 450
MYRINGOTOMY AND INSERTION OF TUBE THROUGH TYMPANIC MEMBRANE
DRG 5.2D1510 Intermediate
(AND BILATERAL) 250 50 300
DRG 5.2D1520 SUCTION CLEARANCE OF MIDDLE EAR (AS SOLE PROCEDURE) Minor 100 20 155
DRG 5.2D1530 MYRINGOTOMY (AND BILATERAL) Minor 100 20 155
DRG 5.2D1540 EXPLORATION OF ENTIRE MIDDLE EAR COURSE OF VII Complex 1000 150 950
DRG 5.2D1610 OSSICULOPLASTY Xmajor 600 120 730
DRG 5.2D1710 STAPEDECTOMY Major 500 100 450
DRG 5.2D1720 REVISION STAPEDECTOMY Xmajor 600 120 730
TRANSTYMPANIC STEROID INJECTION (INCLUDING TOPICAL OR LOCAL
DRG 5.2D2070 Minor
DRG 5.2D1900 MIDDLE EAR TUMOUR EXCISION Major 500 100 450
DRG 5.2D1910 MIDDLE EAR POLYPECTOMY Minor 100 20 155
DRG 5.2D2030 REMOVAL OF GROMMETS Minor 100 20 155
DRG 5.2D2040 DIAGNOSTIC TYMPANOTOMY (AS SOLE PROCEDURE) Major 500 100 450
DRG 5.2D2050 TYMPANIC NEURECTOMY Xmajor 600 120 730
DRG 5.2T8950 REPAIR OF PERI-LYMPH FISTULA Major 500 100 450
DRG 5.2V0382 TOTAL PETROSECTOMY (FOR TUMOUR) Complex 1000 150 950
DRG 5.2V0383 LATERAL PETROSECTOMY (FOR TUMOUR) Complex 1000 150 950
DRG 5.2W1870 DRAINAGE OF PETROUS APEX FOR SEPSIS Complex 1000 150 950
EXAMINATION OF EAR UNDER GENERAL ANAESTHETIC (AS SOLE
DRG 5.2D2822 Minor
DRG 5.3 INNER EAR
EXCISON OF ACOUSTIC NEUROMA (VESTIBULAR SCHWANNOMA) - TUMOURS
LESS THAN 2.5CM (PERFORMED BY SINGLE SURGEON) 1000 150 950
DRG 5.3A2953 TUMOURS MORE THAN 2.5CM OR COMPRESSING BRAIN STEM (PERFORMED Complex
BY SINGLE SURGEON) 1000 150 950
DRG 5.3A2954 TUMOURS MANAGED BY COMBINED OTO-NEUROSURGICAL TEAM Complex
IRRESPECTIVE OF TUMOUR SIZE 1000 150 950
DRG 5.3E2880 EPLEY MANOEUVRE (CODE FOR SPECIALIST USE ONLY) 25 0
DRG 5.3A8480 TRANSTYMPANIC ELECTROCOCHLEOGRAPHY Intermediate 250 50 300
DRG 5.3AA489 TRANSTYMPANIC CHEMICAL LABRYNTHECTOMY Minor 100 20 155
DRG 5.3D2420 INSERTION OF COCHLEAR IMPLANT Complex 1000 150 950
DRG 5.3D2610 OPERATION(S) ON ENDOLYMPHATIC SAC Major 500 100 450
DRG 5.3D2620 MEMBRANOUS LABYRINTHECTOMY Xmajor 600 120 730
DRG 5.3D2630 OSSEOUS LABYRINTHECTOMY Xmajor 600 120 730
DRG 5.4 NOSE AND NASAL CAVITY
DRG 5.4E0110 TOTAL EXCISION OF NOSE Major 500 100 450
SEPTORHINOPLASTY +/- GRAFT/IMPLANT FOLLOWING TRAUMA OR EXCISION
DRG 5.4E0230 Major
OF TUMOUR (INCLUDING ATTENTION TO TURBINATES) 500 100 450
RHINOPLASTY FOLLOWING TRAUMA OR EXCISION OF TUMOUR (INCLUDING
DRG 5.4E0260 Major
ATTENTION TO TURBINATES) 500 100 450
DRG 5.4E0310 SUBMUCOUS RESECTION OF NASAL SEPTUM Intermediate 250 50 300
DRG 5.4E0330 BIOPSY OF OF SEPTUM OF NOSE Minor 100 20 155
DRG 5.4E0340 CLOSURE OF PERFORATION OF SEPTUM OF NOSE Intermediate 250 50 300
System Category Day
DRG 5.4E0360 SEPTOPLASTY OF NOSE (INCLUDING ATTENTION TO TURBINATES) Intermediate 250 50 300
DRG 5.4E0380 NASAL SEPTUM CAUTERISATION (AND BILATERAL) Minor 100 20 155
REDUCTION TURBINATES OF NOSE (LASER, DIATHERMY, OUT FRACTURE
DRG 5.4E0412 Minor
ETC) 100 20 155
DRG 5.4E0420 REDUCTION TURBINATES OF NOSE (TRIM, RADICAL EXCISION) Intermediate 250 50 300
DRG 5.4E0440 DIVISION OF ADHESIONS OF TURBINATE OF NOSE (AND BILATERAL) Minor 100 20 155
LIGATION OF ARTERY OF INTERNAL NOSE (INCLUDING ENDOSCOPIC, AS
DRG 5.4E0520 Intermediate
SOLE PROCEDURE) 250 50 300
DRG 5.4E0610 PACKING OF CAVITY OF NOSE (AS SOLE PROCEDURE) Minor 100 20 155
POLYPECTOMY OF INTERNAL NOSE (AND BILATERAL, INCLUDING
DRG 5.4E0810 Minor
ENDOSCOPIC) 100 20 155
DRG 5.4E0820 EXCISION OF LESION OF INTERNAL NOSE Minor 100 20 155
CORRECTION OF CONGENITAL ATRESIA OF CHOANA (INCLUDING
DRG 5.4E0830 Major
ENDOSCOPIC) 500 100 450
DRG 5.4E0850 REMOVAL OF FOREIGN BODY FROM CAVITY OF NOSE Minor 100 20 155
DRG 5.4E0910 EXCISION OF LESION OF EXTERNAL NOSE Minor 100 20 155
DRG 5.5 NASAL SINUSES
DRG 5.5E1220 CALDWELL-LUC PROCEDURE Intermediate 250 50 300
DRG 5.5E1240 VIDIAN NEURECTOMY (INCLUDING ENDOSCOPIC) Major 500 100 450
IMAGE GUIDED ENDOSCOPIC FRONTAL, SPHENOID AND/OR ETHMOID SINUS
DRG 5.5E1260 Major
SURGERY (FESS) 500 100 450
DRG 5.5E1310 ANTRAL PUNCTURE AND WASH-OUT (AND BILATERAL) Minor 100 20 155
INTRANASAL ANTROSTOMY INCLUDING ENDOSCOPIC AND ANTRAL
WASHOUT (INCLUDING BILATERAL) 250 50 300
DRG 5.5E1350 CLOSURE OF ORO-ANTRAL FISTULA WITH LOCAL FLAP Intermediate 250 50 300
DRG 5.5E1360 ENDOSCOPIC BALLOON DILATION FRONTAL SINUPLASTY Major 500 100 450
DRG 5.5E1370 ENDOSCOPIC BALLOON DILATION MAXILLARY SINUPLASTY Major 500 100 450
DRG 5.5E1380 ENDOSCOPIC BALLOON DILATION SPHENOID SINUPLASTY Major 500 100 450
DRG 5.5E1410 EXTERNAL FRONTOETHMOIDECTOMY Major 500 100 450
FESS UNCINECTOMY, ETHMOIDECTOMY, ANTROSTOMY OR ANTRAL
DRG 5.5E1432 Major
PUNCTURE INC POLYPECTOMY AND ATTENTION TO TURBINATES ETC 500 100 450
DRG 5.5E1450 BONE FLAP TO FRONTAL SINUS (AND BILATERAL) Major 500 100 450
DRG 5.5E1460 TREPHINING OF FRONTAL SINUS Minor 100 20 155
MEDIAN DRAINAGE OF FRONTAL SINUS (MODIFIED LOTHROP PROCEDURE)
DRG 5.5E1470 Complex
1000 150 950
ENDOSCOPIC EXPLORATION FRONTAL SINUS BEYOND FRONTOETHMOID
DRG 5.5E1480 Xmajor
RECESS 600 120 730
DRG 5.5E1500 OPERATION(S) ON SPHENOID SINUS (INCLUDING ENDOSCOPIC) Intermediate 250 50 300
DRG 5.5E1742 LATERAL RHINOTOMY INTO SINUSES Major 500 100 450
DRG 5.5E1750 TRANSNASAL REPAIR OF LEAKING CSF (INCLUDING ENDOSCOPIC) Xmajor 600 120 730
DIAGNOSTIC ENDOSCOPY OF SINUS AND BILATERAL (AS SOLE PROCEDURE)
DRG 5.5E1780 Minor
100 20 155
DRG 5.5V0700 CRANIO-FACIAL RESECTION Complex 1000 150 950
MANIPULATION UNDER ANAESTHESIA OF FRACTURED NOSE (AS SOLE
DRG 5.5W2620 Minor
CPT 30999-01 NASAL PACKING 5 0 0
DRG 5.6 THROAT
DRG 5.6E1910 TOTAL PHARYNGECTOMY Complex 1000 150 950
System Category Day
DRG 5.6E1920 PARTIAL PHARYNGECTOMY Xmajor 600 120 730
DRG 5.6E2010 ADENOIDECTOMY Minor 100 20 155
DRG 5.6E2100 REPAIR OF PHARYNX Major 500 100 450
DRG 5.6E2320 OPERATION(S) ON PHARYNGEAL POUCH (EXTERIOR APPROACH) Major 500 100 450
DRG 5.6E2400 THERAPEUTIC ENDOSCOPIC OPERATION ON PHARYNX Minor 100 20 155
DRG 5.6E2480 PHARYNGEAL POUCH - ENDOSCOPIC PROCEDURES Major 500 100 450
DIAGNOSTIC ENDOSCOPIC EXAMINATION OF PHARYNX/LARYNX (INCLUDING
DRG 5.6E2500 Minor
BIOPSY) (AS SOLE PROCEDURE) 100 20 155
ENDOSCOPIC LARYNGO-PHARYNGOSCOPY AS SOLE OUTPATIENT
DRG 5.6E3680
PROCEDURE +/- STROBOSCOPY 100 0
TONSILLECTOMY - CHILD (AND BILATERAL) UP TO AND INCLUDING AGE 12
DRG 5.6F3400 Intermediate
250 50 300
DRG 5.6F3440 TONSILLECTOMY - ADULT, AGE 13 + (AND BILATERAL) Intermediate 250 50 300
DRG 5.6F3480 ADENOTONSILLECTOMY (AND BILATERAL) Intermediate 250 50 300
DRG 5.6F3620 DRAINAGE OF PERITONSILLAR ABSCESS ('QUINSY') Minor 100 20 155
ARREST OF HAEMORRHAGE FOLLOWING
TONSILLECTOMY/ADENOIDECTOMY 250 50 300
DRG 5.7 LARYNX AND TRACHEA
RECONSTRUCTION USING STOMACH PULL UP FOLLOWING
PHARYNGOLARYNGECTOMY 1000 150 950
DRG 5.7E3681 STROBOSCOPY OF LARYNX Minor 100 20 155
RECONSTRUCTION FREE JEJUNAL GRAFT FOLLOWING
PHARYNGOLARYNGECTOMY 1000 150 950
DRG 5.7E2300 PHARYNGEAL MYOTOMY Intermediate 250 50 300
DRG 5.7E2910 TOTAL LARYNGECTOMY Complex 1000 150 950
DRG 5.7E2920 HORIZONTAL SUPRA-GLOTTIC LARYNGECTOMY Major 500 100 450
DRG 5.7E2930 VERTICAL HEMI-LARYNGECTOMY Major 500 100 450
DRG 5.7E2940 PARTIAL LARYNGECTOMY Major 500 100 450
DRG 5.7E2950 LARYNGOFISSURE AND CORDECTOMY OF VOCAL CORD Major 500 100 450
DRG 5.7E2952 LARYNGOFISSURE Major 500 100 450
DRG 5.7E2970 SUB-TOTAL LARYNGECTOMY Xmajor 600 120 730
DRG 5.7E3010 GLOTTOPLASTY Major 500 100 450
DRG 5.7E3100 RECONSTRUCTION OF LARYNX WITH GRAFT Complex 1000 150 950
DRG 5.7E3400 CORDECTOMY (ENDOSCOPIC) Intermediate 250 50 300
DRG 5.7E3410 LASER SURGERY TO VOCAL CORD (INCLUDING MICROLARYNGOSCOPY) Intermediate 250 50 300
MICROLARYNGOSCOPY/LARYNGOSCOPY +/- ENDOSCOPIC EXCISION OF
LESION OF LARYNX 250 50 300
DRG 5.7E3810 INJECTION INTO LARYNX Intermediate 250 50 300
DRG 5.7E3900 PARTIAL EXCISION OF TRACHEA WITH RECONSTRUCTION Complex 1000 150 950
DRG 5.7E4030 TRACHEOPLASTY Major 500 100 450
DRG 5.7E4032 TRACHEOPLASTY FOR CONGENITAL CONDITIONS Complex 1000 150 950
DRG 5.7E4100 INSERTION OF VOICE PROSTHESIS (TOF) Major 500 100 450
DRG 5.7E4210 TRACHEOSTOMY Intermediate 250 50 300
DRG 5.7E4230 MINI-TRACHEOSTOMY (PERCUTANEOUS) Minor 100 20 155
DRG 5.8 FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA)
FIBREOPTIC EXAMINATION OF TRACHEA INCLUDING BIOPSY/REMOVAL OF
DRG 5.8E4510 Minor
FOREIGN BODY 100 20 155
System Category Day
THERAPEUTIC BRONCHOSCOPY (INCLUDING LASER, CRYOTHERAPY,
DRG 5.8E4800 Minor
LAVAGE, SNARE, DILATATION OF STRICTURE, INSERTION OF STENT) 100 20 155
DRG 5.8E4840 DILATATION OF TRACHEAL STRICTURE INCLUDING INSERTION OF STENT Intermediate 250 50 300
DRG 5.8E4850 THERAPEUTIC BRONCHOSCOPY FOR REMOVAL OF FOREIGN BODY Minor 100 20 155
DRG 5.8E4990 PANENDOSCOPY +/- INCISIONAL BIOPSY Intermediate 250 50 300
THERAPEUTIC PANENDOSCOPY +/- EXCISION BIOPSY, EXCISION OR
DESTRUCTION OF LESIONS 250 50 300
DRG 5.8E5180 DIAGNOSTIC BRONCHOSCOPY +/- BIOPSY Minor 100 20 155
DRG 6 FACE, MOUTH, SALIVARY AND THYROID
DRG 6.1 FACE AND JAWS
DRG 6.1V0820 OPEN REDUCTION AND FIXATION OF FRACTURED JAW Intermediate 250 50 300
DRG 6.1V0830 CLOSED REDUCTION AND FIXATION OF FRACTURED JAW Intermediate 250 50 300
DRG 6.1V0910 OPEN REDUCTION AND FIXATION OF NASAL ETHMOIDAL FRACTURE Complex 1000 150 950
CLOSED REDUCTION OF FRACTURE OF ZYGOMATIC COMPLEX OF BONES
DRG 6.1V0930 Intermediate
250 50 300
DRG 6.1V0980 OPEN REDUCTION OF FRACTURE OF ZYGOMATIC COMPLEX OF BONES Major 500 100 450
DRG 6.1V1082 PARTIAL MAXILLECTOMY FOR MALIGNANCY Xmajor 600 120 730
DRG 6.1V1083 HEMI-MAXILLECTOMY FOR MALIGNANCY Xmajor 600 120 730
REMOVAL OF INTERNAL FIXATION AND/OR INTER-MAXILLARY FIXATION
DRG 6.1V1150 Minor
FROM JAW 100 20 155
DRG 6.1V1330 BIOPSY OF LESION OF FACIAL BONE Minor 100 20 155
DRG 6.1V1400 EXCISION OF MANDIBLE Major 500 100 450
DRG 6.1V1422 EXTENSIVE SEGMENTAL EXCISION OF MANDIBLE Xmajor 600 120 730
DRG 6.1V1423 EXTENSIVE EXCISION OF MANDIBLE WITH DISARTICULATION Xmajor 600 120 730
DRG 6.1V1440 EXCISION OF LESION OF JAW Intermediate 250 50 300
DRG 6.1V1730 EXTRA-ORAL FIXATION OF MANDIBLE Intermediate 250 50 300
DRG 6.1V1910 RECONSTRUCTION OF JAW (NON-VASCULARISED RECONSTRUCTION) Xmajor 600 120 730
DRG 6.1V1930 ALVEOLAR BONE GRAFT - UNILATERAL Intermediate 250 50 300
DRG 6.1V1931 ALVEOLAR BONE GRAFT - BILATERAL Xmajor 600 120 730
DRG 6.1V2020 PROSTHETIC REPLACEMENT OF TEMPOROMANDIBULAR JOINT Xmajor 600 120 730
DRG 6.1V2030 ARTHROPLASTY OF TEMPOROMANDIBULAR BONE JOINT Major 500 100 450
DRG 6.1V2110 TEMPOROMANDIBULAR MENISCECTOMY Major 500 100 450
DRG 6.1V2120 REDUCTION OF DISLOCATION OF TEMPOROMANDIBULAR JOINT Intermediate 250 50 300
DRG 6.2 LIPS
EXCISION OF VERMILION BORDER OF LIP AND ADVANCE OF MUCOSA OF LIP
250 50 300
DRG 6.2F0200 EXCISION OF LESION OF LIP Intermediate 250 50 300
DRG 6.2F0312 PRIMARY CLOSURE OF CLEFT LIP - UNILATERAL Major 500 100 450
DRG 6.2F0313 PRIMARY CLOSURE OF CLEFT LIP - BILATERAL Major 500 100 450
PRIMARY CLOSURE OF CLEFT LIP - UNILATERAL INCLUDING ANTERIOR
DRG 6.2F0314 Major
PALATE 500 100 450
PRIMARY CLOSURE OF CLEFT LIP - BILATERAL INCLUDING ANTERIOR
DRG 6.2F0315 Major
PALATE 500 100 450
DRG 6.2F0320 REVISION OF PRIMARY CLOSURE OF CLEFT LIP Major 500 100 450
DRG 6.2F0420 RECONSTRUCTION OF LIP USING SKIN FLAP Major 500 100 450
DRG 6.2F0530 SUTURE OF LIP Minor 100 20 155
DRG 6.3 TONGUE
DRG 6.3F2210 TOTAL GLOSSECTOMY Xmajor 600 120 730
System Category Day
DRG 6.3F2220 PARTIAL GLOSSECTOMY FOR MALIGNANCY Major 500 100 450
DRG 6.3F2310 EXCISION/DESTRUCTION OF LESION OF TONGUE Intermediate 250 50 300
DRG 6.3F2620 FRENOTOMY/FRENECTOMY OF TONGUE Minor 100 20 155
DRG 6.3F2640 FREEING OF ADHESIONS OF TONGUE Minor 100 20 155
DRG 6.3F2650 SUTURE OF TONGUE Intermediate 250 50 300
DRG 6.3F2660 TONGUE FLAP - FIRST STAGE AND SECOND STAGE Major 500 100 450
DRG 6.4 PALATE
DRG 6.4F2810 EXCISION/DESTRUCTION OF LESION OF PALATE Intermediate 250 50 300
DRG 6.4F2910 PRIMARY REPAIR OF CLEFT PALATE Xmajor 600 120 730
DRG 6.4F3070 SUTURE OF PALATE Minor 100 20 155
DRG 6.4F3240 OPERATIONS ON UVULA Intermediate 250 50 300
DRG 6.5 MOUTH CAVITY
DRG 6.5F1140 VESTIBULOPLASTY Intermediate 250 50 300
DRG 6.5F3810 EXCISION/DESTRUCTION OF LESION OF MOUTH Minor 100 20 155
DRG 6.5F4040 SUTURE OF MOUTH AS SOLE PROCEDURE Minor 100 20 155
DRG 6.5F4050 GRAFT OF SKIN OR MUCOSA TO MOUTH Intermediate 250 50 300
DRG 6.5F4210 BIOPSY OF LESION OF MOUTH Minor 100 20 155
DRG 6.5F4230 REMOVAL OF EXCESS MUCOSA FROM MOUTH Intermediate 250 50 300
DRG 6.6 SALIVARY GLANDS
DRG 6.6F4400 EXCISION OF PAROTID GLAND (OTHER THAN F4410/F4430) Major 500 100 450
TOTAL EXCISION OF PAROTID GLAND AND PRESERVATION OF FACIAL
DRG 6.6F4410 Xmajor
NERVE 600 120 730
PARTIAL EXCISION OF PAROTID GLAND AND PRESERVATION OF FACIAL
DRG 6.6F4430 Xmajor
NERVE 600 120 730
DRG 6.6F4440 EXCISION OF SUBMANDIBULAR GLAND Intermediate 250 50 300
DRG 6.6F4450 EXCISION OF SUBLINGUAL GLAND Intermediate 250 50 300
INCISIONAL DRAINAGE OF ABSCESS OR HAEMATOMA OF SALIVARY GLANDS
DRG 6.6F4600 Minor
(IE INCLUDING SUBMANDIBULAR, PAROTID AND SUBLINGUAL GLANDS) 100 20 155
DRG 6.6F4640 FINE NEEDLE ASPIRATION OF PAROTID GLAND Minor 100 20 155
DRG 6.6F4810 OPEN BIOPSY OF LESION OF SALIVARY GLAND Minor 100 20 155
DRG 6.6F4830 THERAPEUTIC SIALENDOSCOPY Intermediate 250 50 300
DRG 6.6F5010 TRANSPOSITION OF PAROTID DUCT (INCLUDING BILATERAL) Intermediate 250 50 300
DRG 6.6F5020 TRANSPOSITION OF SUBMANDIBULAR DUCT (INCLUDING BILATERAL) Intermediate 250 50 300
DRG 6.6F5110 OPEN EXTRACTION OF CALCULUS FROM PAROTID DUCT Intermediate 250 50 300
DRG 6.6F5120 OPEN EXTRACTION OF CALCULUS FROM SUBMANDIBULAR DUCT Intermediate 250 50 300
DRG 6.6F5510 DILATATION OF PAROTID DUCT Minor 100 20 155
DRG 6.6F5610 MANIPULATIVE REMOVAL OF CALCULUS FROM PAROTID DUCT Intermediate 250 50 300
DRG 6.7 TEETH
DRG 6.7F0830 REPLANTATION OF NATURAL TOOTH/TEETH FOLLOWING TRAUMA minor 100 20 155
DRG 6.7F0910 SURGICAL REMOVAL OF IMPACTED/BURIED TOOTH/TEETH Minor 100 20 155
DRG 6.7F0950 SURGICAL REMOVAL OF COMPLICATED BURIED ROOTS minor 100 20 155
DRG 6.7F1810 ENUCLEATION OF CYST OF JAW Intermediate 250 50 300
DRG 6.8 NECK
DRG 6.8T8510 RADICAL DISSECTION OF CERVICAL LYMPH NODES Complex 1000 150 950
DRG 6.8T8610 BIOPSY/SAMPLING OF CERVICAL LYMPH NODES Minor 100 20 155
DRG 6.8T8722 SELECTIVE DISSECTION OF CERVICAL LYMPH NODES, LEVELS 1 TO 4 Xmajor 600 120 730
System Category Day
SELECTIVE DISSECTION OF CERVICAL LYMPH NODES, LEVELS 1 TO 5 (+/- 6)
DRG 6.8T8723 Complex
1000 150 950
DRG 6.8T9400 OPERATIONS ON BRANCHIAL CYST Intermediate 250 50 300
DRG 6.8T9420 OPERATIONS ON BRANCHIAL FISTULA Major 500 100 450
CPT 21899-01 ASPIRATION-OPD 10 0 0
CPT 21899-02 FB THROAT (A)-OPD 15 0 0
CPT 21899-03 FB THROAT (B)- OPD 25 0 0
DRG 6.9 THYROID AND PARATHYROID GLANDS
DRG 6.9B0812 TOTAL THYROIDECTOMY/NEAR TOTAL THYROIDECTOMY Major 500 100 450
TOTAL THYROIDECTOMY INCLUDING BLOCK DISSECTION OF LYMPH NODES
DRG 6.9B0813 Xmajor
600 120 730
DRG 6.9B0820 BILATERAL SUBTOTAL THYROIDECTOMY Major 500 100 450
DRG 6.9B0830 TOTAL THYROID LOBECTOMY AND ISTHMECTOMY Major 500 100 450
DRG 6.9B0850 ISTHMECTOMY OF THYROID GLAND Major 500 100 450
DRG 6.9B0860 PARTIAL THYROIDECTOMY (NOT ELSEWHERE CLASSIFIED) Major 500 100 450
OPERATIONS ON ABERRANT THYROID TISSUE (INCLUDING
DRG 6.9B0900 Xmajor
EXCISION/REMOVAL OF RETROSTERNAL GOITRE) 600 120 730
DRG 6.9B1012 EXCISION OF THYROGLOSSAL CYST/TRACT Intermediate 250 50 300
DRG 6.9B1220 FINE NEEDLE ASPIRATION OF THYROID GLAND Minor 100 20 155
DRG 6.9B1230 CORE BIOPSY OF THYROID GLAND Minor 100 20 155
DRG 6.9B1250 THYROID: RE-OPERATION Complex 1000 150 950
DRG 6.9B1450 PARATHYROIDECTOMY Xmajor 600 120 730
DRG 6.9B1680 PARATHYROID: RE-OPERATION Xmajor 600 120 730
DRG 6.9B1690 MEDIASTINAL PARATHYROIDECTOMY WITH STERNOTOMY Complex 1000 150 950
DRG 6.9E3180 THYROPLASTY (ISSHIKI TYPE 1) Major 500 100 450
DRG 7 BREAST
DRG 7.1 EXCISION/BIOPSY CODES
DRG 7.1B2800 EXCISION OF BREAST LUMP/FIBROADENOMA Intermediate 250 50 300
WIDE LOCAL EXCISION OF BREAST +/- LOCAL MOBILISATION OF GLANDULAR
DRG 7.1B2820 Intermediate
BREAST TISSUE TO FILL SURGICAL CAVITY 250 50 300
RE-EXCISION OF LESION OF BREAST IF RESECTION MARGINS ARE NOT
CLEAR (AS SOLE PROCEDURE) 250 50 300
DRG 7.1B2880 EXCISION BIOPSY OF BREAST LESION AFTER LOCALISATION Intermediate 250 50 300
DRG 7.1B3212 PERCUTANEOUS SUCTION CORE BIOPSY Minor 100 20 155
DRG 7.1B3220 CORE BIOPSY OF LESION OF BREAST Minor 100 20 155
SENTINEL NODE MAPPING AND SAMPLING WITH BLUE DYE OR RADIOACTIVE
DRG 7.1T9000 Intermediate
PROBE FOR BREAST CANCER 250 50 300
SENTINEL NODE MAPPING AND SAMPLING WITH BLUE DYE AND
RADIOACTIVE PROBE FOR BREAST CANCER 250 50 300
RE-EXCISION OF LESION OF BREAST IF RESECTION MARGINS ARE NOT
CLEAR WITH LOCAL MOBILISATION 250 50 300
INTRAOPERATIVE SENTINEL NODE MAPPING, USING ONE STEP NUCLEIC
ACID AMPLIFICATION (OSNA), FOR BREAST CANCER 250 50 300
DRG 7.2 MASTECTOMY (EXCLUDING IMPLANT/RECONSTRUCTION)
DRG 7.2B2710 RADICAL MASTECTOMY INCLUDING BLOCK DISSECTION Major 500 100 450
DRG 7.2B2742 MODIFIED RADICAL MASTECTOMY INCLUDING LYMPH NODE SAMPLING Major 500 100 450
DRG 7.2B2743 MODIFIED RADICAL MASTECTOMY EXCLUDING LYMPH NODE SAMPLING Major 500 100 450
System Category Day
SKIN/NIPPLE SPARING MASTECTOMY (INCLUDING AXILLARY NODE BIOPSY)
DRG 7.2B2760 Major
500 100 450
DRG 7.2B2744 MODIFIED RADICAL MASTECTOMY INCLUDING LYMPH NODE CLEARANCE Major 500 100 450
DRG 7.2B2752 SUBCUTANEOUS MASTECTOMY Major 500 100 450
SIMPLE MASTECTOMY (INCLUDING AXILLARY NODE BIOPSY) – UNILATERAL
DRG 7.2B2780 Major
500 100 450
DRG 7.3 RECONSTRUCTION
DRG 7.3B2700 SUBCUTANEOUS MASTECTOMY WITH IMMEDIATE IMPLANT Major 500 100 450
MASTECTOMY AND IMMEDIATE RECONSTRUCTION OF BREAST USING
DRG 7.3B2912 Xmajor
LATISSIMUS DORSI 600 120 730
RECONSTRUCTION OF BREAST USING LATISSIMUS DORSI INCLUDING
DRG 7.3B2913 Xmajor
IMPLANTATION OF PROSTHESIS (INCLUDING DELAYED RECONSTRUCTION) 600 120 730
RECONSTRUCTION OF BREAST USING EXTENDED LATISSIMUS DORSI FLAP
DRG 7.3B2915 Xmajor
(INCLUDING DELAYED RECONSTRUCTION) 600 120 730
DRG 7.3B2916 Xmajor
EXTENDED LATISSIMUS DORSI FLAP 600 120 730
RECONSTRUCTION OF BREAST USING PEDICLED TRAM (INCLUDING
DRG 7.3B2984 Xmajor
DELAYED RECONSTRUCTION) 600 120 730
RECONSTRUCTION OF BREAST USING FREE TRAM (INCLUDING DELAYED
DRG 7.3B2985 Complex
RECONSTRUCTION 1000 150 900
RECONSTRUCTION OF BREAST USING DEEP INFERIOR EPIGASTRIC
PERFORATOR FLAP (DIEP) (INCLUDING DELAYED RECONSTRUCTION) 1000 150 900
RECONSTRUCTION OF BREAST USING DEEP INFERIOR EPIGASTRIC
DRG 7.3B2996 PERFORATOR FLAP (DIEP) (INCLUDING DELAYED RECONSTRUCTION) - Complex
BILATERAL 1000 150 900
RECONSTRUCTION OF BREAST USING TRANSVERSE UPPER GRACILIS (TUG)
DRG 7.3B2987 FLAP (INCLUDING DELAYED RECONSTRUCTION AND NIPPLE Complex
RECONSTRUCTION) 1000 150 900
RECONSTRUCTION OF BREAST USING ALT (ANTERIOLATERAL THIGH) FLAP
INCLUDING DELAYED RECONSTRUCTION 1000 150 900
LUMPECTOMY AND IMMEDIATE PARTIAL RECONSTRUCTION OF BREAST
DRG 7.3B2921 USING PEDICLED PERFORATOR FLAP (EG. LATERAL INTERCOSTAL ARTERY Xmajor
PERFORATOR (LICAP) OR THORACO-DORSAL ARTERY PERFORATOR (TDAP)) 600 120 730
PARTIAL RECONSTRUCTION OF BREAST USING PEDICLED PERFORATOR
FLAP (EG. LATERAL INTERCOSTAL ARTERY PERFORATOR (LICAP) OR
DRG 7.3B2922 Xmajor
THORACO-DORSAL ARTERY PERFORATOR (TDAP) INCLUDING DELAYED
LAPAROSCOPIC MOBILISATION OF THE GREATER OMENTUM FOR
DRG 7.3B2991 Major
RECONSTRUCTION OF BREAST (INCLUDING DELAYED RECONSTRUCTION) 500 100 450
DRG 7.3B3012 Xmajor
EXPANDABLE PROSTHESIS 600 120 730
MASTECTOMY AND IMMEDIATE RECONSTRUCTION OF BREAST USING FIXED
DRG 7.3B3013 Xmajor
PROSTHESIS 600 120 730
RECONSTRUCTION OF BREAST USING EXPANDABLE PROSTHESIS
DRG 7.3B3014 Major
(INCLUDING DELAYED RECONSTRUCTION) 500 100 450
System Category Day
RECONSTRUCTION OF BREAST USING FIXED PROSTHESIS (INCLUDING
DRG 7.3B3015 Major
DELAYED RECONSTRUCTION) 500 100 450
MASTECTOMY AND IMMEDIATE RECONSTRUCTION OF BREAST USING FAT
DRG 7.3B3016 Xmajor
TRANSFER 600 120 730
RECONSTRUCTION OF BREAST USING FAT TRANSFER (INCLUDING DELAYED
DRG 7.3B3017 Major
DRG 7.3B3018 REVISION RECONSTRUCTION OF BREAST USING FAT TRANSFER Intermediate 250 50 300
DRG 7.3B3180 IMPLANTATION OF PROSTHESIS INTO BREAST AS SOLE PROCEDURE Intermediate 250 50 300
NIPPLE AREOLA COMPLEX RECONSTRUCTION +/- LIPOSUCTION AND FAT
DRG 7.3B3580 Major
RECONSTRUCTION OF BREAST USING SGAP (SUPERIOR GLUTEAL ARTERY
PERFORATOR) FLAP INCLUDING DELAYED RECONSTRUCTION. 1000 150 950
DRG 7.4 OTHER
DRAINAGE OF BREAST ABSCESS INCLUDING HAEMATOMA AND SEROMA
DRG 7.4B3310 Minor
100 20 155
DRG 7.4B3440 MICRODOCHOTOMY Intermediate 250 50 300
DRG 7.4B3592 MICROPIGMENTATION (TATTOOING) OF NIPPLE AREOLA COMPLEX Minor 100 20 155
MICRODOCHECTOMY OR MAMMODOCHECTOMY (HADFIELD’S PROCEDURE)
250 50 300
DRG 7.4B3594 PLASTIC PROCEDURES ON NIPPLE Intermediate 250 50 300
DRG 7.4B3595 EXCISION OF MAMMARY FISTULA Intermediate 250 50 300
DRG 8 THORAX AND INTRA-THORACIC ORGANS
DRG 8.1 OESOPHAGUS
OESOPHAGECTOMY/OESOPHAGOGASTRECTOMY WITH ANASTOMOSIS IN
DRG 8.1G0100 Complex
CHEST 1000 150 950
FIBREOPTIC ENDOSCOPIC PHOTODYNAMIC THERAPY (PDT) OF LESION OF
DRG 8.1G1470 Intermediate
OESOPHAGUS 250 50 300
DRG 8.1G0220 TOTAL OESOPHAGECTOMY AND INTERPOSITION OF INTESTINE Complex 1000 150 950
DRG 8.1G0260 ENDOSCOPICALLY ASSISTED OESOPHAGECTOMY Complex 1000 150 950
DRG 8.1G0300 SUB-TOTAL OESOPHAGECTOMY WITH ANASTOMOSIS IN NECK Complex 1000 150 950
DRG 8.1G0400 OPEN EXCISION OF LESION OF OESOPHAGUS Xmajor 600 120 730
DRG 8.1G0500 BYPASS OF OESOPHAGUS Xmajor 600 120 730
DRG 8.1G0640 CLOSURE OF BYPASS OF OESOPHAGUS Major 500 100 450
REPAIR OF CONGENITAL OESOPHAGEAL ATRESIA (WITH OR WITHOUT
FISTULA) 1000 150 950
DRG 8.1G0740 REPAIR OF RUPTURED OESOPHAGUS Complex 1000 150 950
DRG 8.1G0920 OESOPHAGOCARDIOMYOTOMY (HELLER'S OPERATION) Major 500 100 450
DRG 8.1G1400 VATS EXCISION LESION OF OESOPHAGUS Xmajor 600 120 730
DRG 8.1G2312 TRANSTHORACIC REPAIR OF PARAOESOPHAGEAL HIATUS HERNIA Xmajor 600 120 730
DRG 8.1G2320 TRANSTHORACIC REPAIR OF DIAPHRAGMATIC HERNIA (ACQUIRED) Xmajor 600 120 730
DRG 8.1G2330 TRANSABDOMINAL REPAIR OF HIATUS HERNIA Major 500 100 450
DRG 8.1G2340 TRANSABDOMINAL REPAIR OF DIAGPHRAGMATIC HERNIA Xmajor 600 120 730
DRG 8.1G2400 TRANSTHORACIC FUNDOPLICATION AND GASTROPLASTY Xmajor 600 120 730
DRG 8.1G2402 TRANSTHORACIC FUNDOPLICATION Xmajor 600 120 730
DRG 8.1G2430 TRANSABDOMINAL ANTI-REFLUX OPERATIONS Xmajor 600 120 730
DRG 8.1G2590 REVISION OF ANTI-REFLUX PROCEDURES Xmajor 600 120 730
DRG 8.1A2781 LAPAROSCOPIC VAGOTOMY/SEROMYOTOMY Major 500 100 450
DRG 8.2 CHEST WALL
System Category Day
DRG 8.2E4722 THORACOTOMY AND CLOSURE OF BRONCHO-PLEURAL FISTULA Xmajor 600 120 730
DRG 8.2T0110 THORACOPLASTY PNEUMONECTOMY Complex 1000 150 950
EXCISION OF CHEST WALL TUMOUR - WITH CHEST WALL RECONSTRUCTION
DRG 8.2T0132 Xmajor
600 120 730
EXCISION OF CHEST WALL TUMOUR - WITHOUT CHEST WALL
DRG 8.2T0133 Xmajor
CORRECTION OF PECTUS DEFORMITY OF CHEST WALL (OR OTHER
DRG 8.2T0210 complex
CONGENITAL DEFECT THEREOF) 1000 150 950
SECONDARY CORRECTION OF SCOLIOS-RELATED CHEST WALL DEFORMITY
(POSTERIOR COSTOPLASTY) (AS SOLE PROCEDURE) 1000 150 950
DRG 8.2T0320 EXPLORATORY THORACOTOMY Major 500 100 450
DRG 8.2T0810 RESECTION OF RIB AND OPEN DRAINAGE OF PLEURAL CAVITY Major 500 100 450
DRG 8.2T1500 REPAIR OF RUPTURE OF DIAPHRAGM complex 1000 150 950
DRG 8.2T1620 PLICATION OF PARALYSED DIAPHRAGM Xmajor 600 120 730
DRG 8.2T1640 REPAIR OF CONGENITAL DIAPHRAGMATIC HERNIA Xmajor 600 120 730
DRG 8.2T2781 REPAIR OF EPIGASTRIC HERNIA Intermediate 250 50 300
DRG 8.3 TRACHEA
DRG 8.3E3900 PARTIAL EXCISION OF TRACHEA WITH RECONSTRUCTION Complex 1000 150 950
DRG 8.3E4030 TRACHEOPLASTY Xmajor 600 120 730
DRG 8.3E4032 TRACHEOPLASTY FOR CONGENITAL CONDITIONS Complex 1000 150 950
DRG 8.3E4100 INSERTION OF VOICE PROSTHESIS (TOF) Major 500 100 450
DRG 8.3E4210 TRACHEOSTOMY Intermediate 250 50 300
DRG 8.3E4230 MINI-TRACHEOSTOMY (PERCUTANEOUS) Minor 100 20 155
DRG 8.4 FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA)
FIBREOPTIC EXAMINATION OF TRACHEA INCLUDING BIOPSY/REMOVAL OF
DRG 8.4E4510 Minor
FOREIGN BODY 100 20 155
THERAPEUTIC BRONCHOSCOPY (INCLUDING LASER, CRYOTHERAPY,
LAVAGE, SNARE, DILATATION OF STRICTURE, INSERTION OF STENT) 250 50 300
DRG 8.4E4840 DILATATION OF TRACHEAL STRICTURE INCLUDING INSERTION OF STENT Intermediate 250 50 300
DRG 8.4E4850 THERAPEUTIC BRONCHOSCOPY FOR REMOVAL OF FOREIGN BODY Intermediate 250 50 300
DRG 8.4E5180 DIAGNOSTIC BRONCHOSCOPY +/- BIOPSY Minor 100 20 155
DRG 8.5 BRONCHI/LUNGS/PLEURA
DRG 8.5E4400 CARINAL RESECTION +/- PNEUMONECTOMY Complex 1000 150 950
SLEEVE RESECTION OF BRONCHUS OR PULMONARY ARTERY WITH
PULMONARY RESECTION 1000 150 950
DRG 8.5E5410 PNEUMONECTOMY Complex 1000 150 950
DRG 8.5E5430 PULMONARY LOBECTOMY INCLUDING SEGMENTAL RESECTION Xmajor 600 120 730
DRG 8.5E5480 LUNG RESECTION WITH RESECTION OF CHEST WALL Xmajor 600 120 730
DRG 8.5E5520 OPEN EXCISION OF LESION OF LUNG Xmajor 600 120 730
DRG 8.5E5532 THORACOTOMY AND LUNG BIOPSY AS SOLE PROCEDURE Major 500 100 450
PERCUTANEOUS RADIOFREQUENCY ABLATION OF MALIGNANT NEOPLASM
OF LUNG 1000 150 950
DRG 8.5E5700 THORACTOMY LUNG VOLUME REDUCTION - BILATERAL Complex 1000 150 950
DRG 8.5E5702 THORACOTOMY LUNG VOLUME REDUCTION - UNILATERAL Xmajor 600 120 730
DRG 8.5E5703 THORACOTOMY BULLECTOMY - BILATERAL Complex 1000 150 950
THORACOTOMY BULLECTOMY - UNILATERAL +/- PLEURODESIS IN PRESENCE
DRG 8.5E5704 Xmajor
OF EMPHYSEMA 600 120 730
System Category Day
THORACOTOMY PLEURECTOMY/PLEURODESIS +/- LIGATION OF BULLAE FOR
DRG 8.5E5705 Xmajor
PNEUMOTHORAX 600 120 730
DRG 8.5E5910 NEEDLE BIOPSY OF LUNG Minor 100 20 155
DRG 8.5T0710 DECORTICATION OF PLEURA OF LUNG Xmajor 600 120 730
DRG 8.5T0910 OPEN PLEURAL BIOPSY AS SOLE PROCEDURE Major 500 100 450
DRG 8.5T1220 DRAINAGE OF PLEURAL CAVITY Minor 100 20 155
DRG 8.5T1240 INSERTION OF TUBE DRAIN INTO PLEURAL CAVITY Minor 100 20 155
INTRODUCTION OF SUBSTANCE INTO PLEURAL CAVITY WITH CHEST DRAIN
DRG 8.5T1300 Minor
100 20 155
DRG 8.5T1410 NEEDLE BIOPSY OF PLEURA Minor 100 20 155
DRG 8.5E5100 ENDOBRONCHIAL ULTRASOUND (AS SOLE PROCEDURE) Minor 100 20 155
DRG 8.5T1480 INSERTION OF PLEURO-PERITONEAL SHUNT Intermediate 250 50 300
DRG 8.6 MEDIASTINUM
DRG 8.6B1690 MEDIASTINAL PARATHYROIDECTOMY WITH STERNOTOMY Complex 1000 150 950
DRG 8.6B1800 THYMECTOMY FOR MYASTHENIA GRAVIS Xmajor 600 120 730
DRG 8.6E6100 OPEN RESECTION OF INVASIVE MEDIASTINAL TUMOUR Complex 1000 150 950
OPEN EXCISION OF MEDIASTINAL TUMOUR INCLUDING CONGENITAL
DRG 8.6E6110 Xmajor
CYSTS/POSTERIOR CHEST WALL LESIONS 600 120 730
DRG 8.6E6300 DIAGNOSTIC MEDIASTINOSCOPY Intermediate 250 50 300
ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE
DRG 8.6E6310 Major
ASPIRATION (EBUS-TBNA) FOR MEDIASTINAL MASSES 500 100 450
DRG 8.7 VIDEO ASSISTED THORACIC SURGERY (VATS)
DRG 8.7A7560 VATS SYMPATHECTOMY - UNILATERAL Major 500 100 450
DRG 8.7A7561 VATS SYMPATHECTOMY - BILATERAL Xmajor 600 120 730
DRG 8.7E5432 VATS LOBECTOMY Major 500 100 450
DRG 8.7E5442 VATS WEDGE RESECTION OF LUNG Major 500 100 450
DRG 8.7E5590 VATS BULLECTOMY - UNILATERAL Major 500 100 450
DRG 8.7E5591 VATS BULLECTOMY - BILATERAL Complex 1000 150 950
DRG 8.7E5592 VATS LUNG VOLUME REDUCTION - UNILATERAL Complex 1000 150 950
DRG 8.7E5593 VATS LUNG VOLUME REDUCTION - BILATERAL Complex 1000 150 950
DRG 8.7E5594 VATS DEBRIDEMENT OF EMPYEMA Major 500 100 450
DRG 8.7E5932 VATS LUNG BIOPSY Intermediate 250 50 300
DRG 8.7E6200 VATS EXCISION LESION OF MEDIASTINUM INCLUDING THYMECTOMY Xmajor 600 120 730
DRG 8.7G0922 VATS OESOPHAGEAL / OESOPHAGOGASTRIC MYOTOMY Major 500 100 450
DRG 8.7G1400 VATS EXCISION LESION OF OESOPHAGUS Xmajor 600 120 730
LAPAROSCOPIC REPAIR OF HIATUS HERNIA WITH ANTI-REFLUX PROCEDURE
DRG 8.7G2331 Major
(EG FUNDOPLICATION) 500 100 450
DRG 8.7T1030 VATS PLEURODESIS/PLEURECTOMY Major 500 100 450
DRG 8.7T1032 THORACOSCOPY AND DRAINAGE AND CHEMICAL PLEURODESIS Intermediate 250 50 300
DRG 8.7T1100 DIAGNOSTIC THORACOSCOPY (+/- BIOPSY) Intermediate 250 50 300
DRG 8.8 Heart – cardiac surgery N/A
DRG 8.8K0400 CORRECTION OF TETRALOGY OF FALLOT N/A 1900 1100
DRG 8.8K0500 ATRIAL INVERSION FOR TRANSPOSITION OF GREAT VESSELS N/A 1900 1100
DRG 8.8K0530 DOUBLE SWITCH PROCEDURE (ATRIAL AND ARTERIAL) N/A 1900 1100
MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB)
DRG 8.8K4610 N/A
INCLUDING HARVESTING OF GRAFT 2300 1100
CORRECTION OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
DRG 8.8K0700 N/A
1900 1100
System Category Day
DRG 8.8K0900 REPAIR OF COMPLETE ATRIOVENTRICULAR SEPTAL DEFECT N/A 1900 1100
DRG 8.8K0930 CLOSURE OF PARTIAL ATRIOVENTRICULAR SEPTAL DEFECT N/A 1900 1100
CLOSURE OF DEFECT OF INTERATRIAL SEPTUM (SECUNDUM ATRIAL SEPTAL
DRG 8.8K1000 N/A
DEFECT OR PATENT FORAMEN OVALE) 1900 990
DRG 8.8K1100 CLOSURE OF DEFECT OF INTERVENTRICULAR SEPTUM N/A 1900 990
ENDOVASCULAR CLOSURE OF PERIMEMBRANOUS VENTRICULAR SEPTAL
DRG 8.8K1180 N/A
DEFECT 800 990
DRG 8.8K1200 NORWOOD STAGE 1 PROCEDURE N/A 1900 1100
THERAPEUTIC TRANSLUMINAL OPERATIONS ON ATRIAL SEPTUM OF HEART
DRG 8.8K1600 N/A
800 825
TRANSLUMINAL CLOSURE OF ATRIAL SEPTAL DEFECT / PATENT FORAMEN
DRG 8.8K1680 Complex
OVALE 1000 150 950
DRG 8.8K1800 PLACEMENT OF VALVE TO CARDIAC CONDUIT Complex 1000 150 950
DRG 8.8K1850 REVISION PLACEMENT OF VALVE TO CARDIAC CONDUIT Complex 1000 150 950
DRG 8.8K2310 EXCISION OF CARDIAC TUMOUR Complex 1000 150 950
REPLACEMENT OF MITRAL VALVE WITH SUB-VALVE PRESERVATION
(INCLUDING BIOPSIES) 1000 150 950
DRG 8.8K2542 REVISION REPLACEMENT OF MITRAL VALVE Complex 1000 150 950
DRG 8.8K2580 REPAIR OF MITRAL VALVE Complex 1000 150 950
DRG 8.8K2600 REPLACEMENT OR REPAIR OF AORTIC VALVE Complex 1000 150 950
DRG 8.8K2602 MINIMALLY INVASIVE REPLACEMENT OF AORTIC VALVE Complex 1000 150 950
DRG 8.8K2610 ROSS PROCEDURE Complex 1000 150 950
REPLACEMENT OF AORTIC VALVE WITH HOMOGRAFT OR STENTLESS
PORCINE 1000 150 950
DRG 8.8K2613 REVISION REPLACEMENT OF AORTIC VALVE Complex 1000 150 950
DRG 8.8K2700 REPLACEMENT OF TRICUSPID VALVE (INCLUDING VALVULOPLASTY) Complex 1000 150 950
DRG 8.8K2780 REPAIR OF TRICUSPID VALVE, EG FOR EBSTEIN'S DISEASE Complex 1000 150 950
REPLACEMENT OF PULMONARY VALVE (INCLUDING
VALVULOPLASTY/VALVOTOMY) 1000 150 950
DRG 8.8K2810 PERCUTANEOUS REPLACEMENT/IMPLANTATION OF PULMONARY VALVE Complex 1000 150 950
DRG 8.8K3100 OPEN VALVOTOMY Complex 1000 150 950
DRG 8.8K3210 CLOSED MITRAL VALVOTOMY Complex 1000 150 950
DRG 8.8K3500 THERAPEUTIC TRANSLUMINAL OPERATION(S) ON VALVE OF HEART Xmajor 600 120 730
DRG 8.8K3580 TRANS CATHETER AORTIC VALVE IMPLANTATION (TAVI) Complex 1000 150 950
BYPASS FOR CORONARY ARTERY(IES) INCLUDING HARVESTING OF GRAFTS
AND ENDARTERECTOMY 1000 150 950
ENDOVASCULAR ANEURYSM REPAIR (EVAR) OF SUPRARENAL AORTA, WITH
DRG 8.8L2720 Complex
INSERTION OF FENESTRATED GRAFT (UP TO TWO ORIFICES) 1000 150 950
ENDOVASCULAR ANEURYSM REPAIR (EVAR) OF SUPRARENAL AORTA, WITH
INSERTION OF FENESTRATED GRAFT (THREE TO FOUR ORIFICES) 1000 150 950
DRG 8.8L2710 ENDOVASCULAR ANEURYSM REPAIR (EVAR) OF INFRARENAL AORTA Complex 1000 150 950
REVISION BYPASS FOR CORONARY ARTERY(IES) (INCLUDING HARVESTING
OF GRAFTS) 1000 150 950
DRG 8.8K4600 OFF-PUMP CORONARY ARTERY BYPASS (OPCAB) Complex 1000 150 950
DRG 8.8K4880 CORRECTION OF ANOMALOUS CORONARY ARTERIES Complex 1000 150 950
INTRAVASCULAR ULTRASOUND OF CORONARY ARTERIES (AS SOLE
DRG 8.8K5120 Major
DRG 8.8K5283 COMPLEX COX LESION SET MAZE OPERATION Complex 1000 150 950
System Category Day
DRG 8.8K5330 REPAIR OF POST INFARCTION VENTRICULAR SEPTAL DEFECT Complex 1000 150 950
DRG 8.8K5380 REPAIR OF VENTRICULAR ANEURYSM Complex 1000 150 950
SHORT-TERM CIRCULATORY SUPPORT WITH LEFT VENTRICULAR ASSIST
DEVICE 1000 150 950
DRG 8.8K6700 PERICARDIECTOMY Complex 1000 150 950
DECOMPRESSION OF CARDIAC TAMPONADE OR RE-EXPLORATION FOR
DRG 8.8K6810 Xmajor
BLEEDING 600 120 730
DRG 8.8L0110 CORRECTION OF TRUNCUS ARTERIOSUS Complex 1000 150 950
FORMATION OF ATRIOPULMONARY CONNECTION (OR ANY MODIFICATION OF
FONTAN TYPE PROCEDURE) 1000 150 950
DRG 8.8L2360 REPAIR OF INTERRUPTED AORTIC ARCH Complex 1000 150 950
AORTIC ROOT REPLACEMENT WITH VALVE CONDUIT OR HOMOGRAFT
AND/OR REMODELLING 1000 150 950
PERCUTANEOUS OR OPEN PLACEMENT OF INTRA-AORTIC BALLOON
DRG 8.8L2560 Xmajor
(INCLUDING SUBSEQUENT REMOVAL) 600 120 730
DRG 8.9 HEART – CARDIOLOGY N/A
NON-SURGICAL REDUCTION OF MYOCARDIAL SEPTUM (E.G. ALCOHOL
SEPTAL ABLATION) 1000 150 950
CORONARY ANGIOPLASTY FOLLOWING ANGIOGRAPHY WITH FRACTIONAL
FLOW STUDY ON THE SAME DAY, +/- INSERTION OF STENT 1000 150 950
ABLATION OF AV NODAL RE-ENTRY TACHYCARDIA (INCLUDING MAPPING)
1000 150 950
ABLATION OF ARRHYTHMIA IN COMPLEX CONGENITAL HEART DISEASE
(INCLUDING MAPPING) 1000 150 950
DRG 8.9K5790 ABLATION OF LEFT ATRIAL TACHYCARDIA (INCLUDING MAPPING) Complex 1000 150 950
DRG 8.9K2280 PERCUTANEOUS OCCLUSION OF LEFT ATRIAL APPENDAGE Xmajor 600 120 730
INSERTION OF DUAL CHAMBER IMPLANTABLE CARDIOVERTER
DEFIBRILLATOR (ICD) 1000 150 950
LEAD REPLACEMENT FOR PACEMAKER OR IMPLANTABLE CARDIOVERTER
DRG 8.9K6060 Major
REPLACEMENT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD),
DRG 8.9K6050 Xmajor
WITHOUT LEAD CHANGE 600 120 730
ADULT CARDIAC CATHETERISATION - RADIAL ACCESS (INCLUDING
CORONARY ARTERIOGRAPHY/CATHETERISATION OF RIGHT/LEFT SIDE OF
DRG 8.9K6582 Xmajor
HEART/CONTRAST RADIOLOGY) - WITH PRESSURE WIRE (INCLUDING
FRACTIONAL FLOW RESERVE MEASUREMENT) 600 120 730
ADULT CARDIAC CATHETERISATION - FEMORAL ACCESS (INCLUDING
DRG 8.9K6584 Xmajor
HEART/CONTRAST RADIOLOGY) - WITH PRESSURE WIRE (INCLUDING
ADULT CARDIAC CATHETERISATION - RADIAL ACCESS (INCLUDING
DRG 8.9K6513 CORONARY ARTERIOGRAPHY/ CATHETERISATION OF RIGHT/LEFT SIDE OF Xmajor
HEART/CONTRAST RADIOLOGY) 600 120 730
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF CORONARY
ARTERY(IES) (INCLUDING LASER) 1000 150 950
ARTERY(IES) WITH INTRAVASCULAR ULTRASOUND (INCLUDING LASER) 1000 150 950
System Category Day
ARTERY(IES) WITH STENT INSERTION 1000 150 950
ARTERY(IES) WITH STENT INSERTION AND INTRAVASCULAR ULTRASOUND 1000 150 950
MAP GUIDED SURGERY FOR VENTRICULAR ARRHYTHMIAS (INCLUDING
DRG 8.9K5280 Xmajor
MAPPING) 600 120 730
DRG 8.9K5710 ABLATION OF ATRIO-VENTRICULAR JUNCTION (INCLUDING MAPPING) Xmajor 600 120 730
DRG 8.9K5730 ABLATION OF ATRIAL ARRHYTHMIA (INCLUDING MAPPING) Complex 1000 150 950
DRG 8.9K5740 ABLATION OF VENTRICULAR ARRHYTHMIA (INCLUDING MAPPING) Complex 1000 150 950
DRG 8.9K5750 INTERNAL CARDIOVERSION Xmajor 600 120 730
ABLATION OF ATRIAL FIBRILLATION BY ISOLATION OF THE PULMONARY
VEINS (INCLUDING MAPPING) 1000 150 950
ABLATION OF ACCESSORY PATHWAY OR SELECTED MODIFICATION OF AV
NODE (INCLUDING MAPPING) 1000 150 950
DIAGNOSTIC INTRACARDIAC ELECTROPHYSIOLOGICAL STUDY INCLUDING
DRG 8.9K5810 CHARACTERISATION OF INTRACARDIAC CONDUCTION AND ANY TESTING OF Major
ANTI-ARRHYTHMIC DRUG EFFICACY BY PROGRAMMED STIMULATION 500 100 450
ADULT CARDIAC CATHETERISATION - FEMORAL ACCESS (INCLUDING
INSERTION OF AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR WITH
SUBCUTANEOUS LEADS (SUBCUTANEOUS ICD) 1000 150 950
ADULT CARDIAC CATHETERISATION - BRACHIAL ACCESS (INCLUDING
DRG 8.9K6586 Xmajor
HEART / CONTRAST RADIOLOGY) - WITH PRESSURE WIRE (INCLUDING
INSERTION OF COMBINED BIVENTRICULAR PACEMAKER AND
CARDIOVERTER DEFIBRILLATOR (CRT-D) 1000 150 950
ADULT CARDIAC CATHETERISATION - BRACHIAL ACCESS (INCLUDING
DRG 8.9K4920 ARTERY(IES) FOR CHRONIC TOTAL OCCLUSIONS (CTO), +/- INSERTION OF Complex
STENT 1000 150 950
DRG 8.9K5110 ANGIOSCOPY Intermediate 250 50 300
CARDIAC PACEMAKER SYSTEM INTRODUCED THROUGH VEIN (SINGLE
DRG 8.9K6000 Major
CHAMBER) 500 100 450
CARDIAC PACEMAKER SYSTEM INTRODUCED THROUGH VEIN (DUAL
DRG 8.9K6010 Major
CHAMBER) 500 100 450
DRG 8.9K6015 IMPLANTATION OF BIVENTRICULAR PACEMAKER Complex 1000 150 950
RESITING OF PACEMAKER OR IMPLANTABLE CARDIOVERTER
DRG 8.9K6020 Intermediate
REPLACEMENT OF GENERATOR FOR INTRAVENOUS CARDIAC PACEMAKER
DRG 8.9K6030 Major
SYSTEM (WITHOUT LEAD CHANGE) 500 100 450
DRG 8.9K6040 REMOVAL OF PACING SYSTEM WITH BYPASS Complex 1000 150 950
DRG 8.9K6080 REMOVAL OF PACING SYSTEM WITHOUT BYPASS (INCLUDING LEADS) Minor 100 20 155
System Category Day
DRG 8.9K6082 REMOVAL OF PACING SYSTEM (GENERATOR ONLY) Intermediate 250 50 300
INSERTION OF SINGLE CHAMBER IMPLANTABLE CARDIOVERTER
CORONARY ANGIOGRAPHY PROCEEDING TO ANGIOPLASTY ON THE SAME
DAY, +/- INSERTION OF STENT 1000 150 950
DRG 8.9K6590 CORONARY ANGIOGRAPHY INCLUDING INTRAVASCULAR ULTRASOUND Major 500 100 450
DRG 8.9K6520 PAEDIATRIC CARDIAC CATHETERISATION Major 500 100 450
DRG 8.9K5830 ENDOMYOCARDIAL BIOPSY Intermediate 250 50 300
CORONARY ANGIOPLASTY FOLLOWING ANGIOGRAPHY WITH
INTRAVASCULAR ULTRASOUND ON THE SAME DAY, +/- INSERTION OF STENT 1000 150 950
DRG 8.9K6820 PERICARDIOCENTESIS Intermediate 250 50 300
DRG 8.10 GREAT VESSELS
DRG 8.10L0200 CLOSED LIGATION OF PATENT DUCTUS ARTERIOSUS Complex 1000 150 950
DRG 8.10L0230 VATS CLOSURE OF PATENT DUCTUS ARTERIOSUS Complex 1000 150 950
PERCUTANEOUS TRANSLUMINAL PROSTHETIC OCCLUSION OF PATENT
DUCTUS ARTERIOSUS 1000 150 950
CREATION OF COMMUNICATION BETWEEN PULMONARY ARTERY AND
AORTA 1000 150 950
CREATION OF SHUNT FROM SUBCLAVIAN ARTERY TO PULMONARY ARTERY
1000 150 950
DRG 8.10L0900 FORMATION OF CAVO-PULMONARY SHUNT (GLENN) Complex 1000 150 950
DRG 8.10L1080 OPEN OPERATIONS/REPAIR OF PULMONARY ARTERY Complex 1000 150 950
DRG 8.10L1240 PULMONARY EMBOLECTOMY Complex 1000 150 950
DRG 8.10L1300 TRANSLUMINAL OPERATIONS ON PULMONARY ARTERY Xmajor 600 120 730
DRG 8.10L1810 REPAIR OF LEAKING ANEURYSM OF ASCENDING AORTA Complex 1000 150 950
DRG 8.10L1880 REPAIR OF LEAKING ANEURYSM OF ARCH OF AORTA Complex 1000 150 950
DRG 8.10L1890 REPAIR OF LEAKING ANEURYSM OF THORACIC AORTA Complex 1000 150 950
IMMEDIATE REPAIR OF AORTIC DISSECTION (IE WITHIN TWO WEEKS OF
HAPPENING) 1000 150 950
DRG 8.10L1910 ELECTIVE REPAIR OF ANEURYSM OF ASCENDING AORTA Complex 1000 150 950
DRG 8.10L1980 ELECTIVE REPAIR OF ANEURYSM OF ARCH OF AORTA Complex 1000 150 950
DRG 8.10L1990 ELECTIVE REPAIR OF ANEURYSM OF THORACIC AORTA Complex 1000 150 950
DELAYED REPAIR OF AORTIC DISSECTION (IE MORE THAN TWO WEEKS
AFTER HAPPENING) 1000 150 950
DRG 8.10L2190 REPLACEMENT OF GRAFT OF THORACO-ABDOMINAL ANEURYSM Complex 1000 150 950
DRG 8.10L2200 REVISION OF PROSTHESIS OF ABDOMINAL AORTA Complex 1000 150 950
DRG 8.10L2290 EXCISION OF INFECTED AORTIC GRAFT WITH BYPASS Complex 1000 150 950
DRG 8.10L2302 COARCTATION REPAIR Complex 1000 150 950
DRG 8.10L2303 COARCTATION REPAIR INVOLVING PROSTHETIC GRAFT Complex 1000 150 950
REVISION OPERATION ON ASCENDING AORTA AND PROXIMAL DESCENDING
AORTA 1000 150 950
DRG 8.10L2600 PERCUTANEOUS TRANSLUMINAL BALLOON OPERATIONS ON AORTA Major 500 100 450
DRG 8.10L7042 ATRIAL SWITCH PROCEDURE FOR TRANSPOSITION OF GREAT VESSELS Complex 1000 150 950
CANNULATION OR DECANNULATION FOR ECMO (EXTRACORPOREAL
DRG 8.10W7042 Major
MEMBRANE OXYGENATION) 500 100 450
DRG 8.11 OTHER
System Category Day
TRANSOESOPHAGEAL ECHOCARDIOGRAPHY (INCLUDING REPORTING) (AS
DRG 8.11A2720 PROXIMAL GASTRIC VAGOTOMY Major 500 100 450
DRG 8.11A2730 HIGHLY SELECTIVE VAGOTOMY Major 500 100 450
DRG 8.11A2780 VAGOTOMY AND PYLOROPLASTY Major 500 100 450
DRG 8.11AA588 CORONARY ANGIOPLASTY STANDBY TEAM Minor 100 20 155
DRG 8.11X5020 EXTERNAL CARDIOVERSION Minor 100 20 155
DRG 9 VASCULAR SYSTEM
DRG 9.1 HEAD AND NECK
DRG 9.1L2930 BYPASS CAROTID ARTERY FROM THE ARCH Complex 1000 150 950
DRG 9.1L2950 CAROTID ENDARTERECTOMY Complex 1000 150 950
DRG 9.1L3710 BYPASS OF SUBCLAVIAN ARTERY FROM THE ARCH Complex 1000 150 950
DRG 9.1L3711 BYPASS OF SUBCLAVIAN ARTERY - EXTRA-THORACIC Complex 1000 150 950
DRG 9.1L3730 ENDARTERECTOMY AND PATCH REPAIR OF SUBCLAVIAN ARTERY Complex 1000 150 950
DRG 9.2 THORACIC VESSELS
DRG 9.2L1810 REPAIR OF LEAKING ANEURYSM OF ASCENDING AORTA Complex 1000 150 950
DRG 9.2L1880 REPAIR OF LEAKING ANEURYSM OF ARCH OF AORTA Complex 1000 150 950
DRG 9.2L1890 REPAIR OF LEAKING ANEURYSM OF THORACIC AORTA Complex 1000 150 950
IMMEDIATE REPAIR OF AORTIC DISSECTION (IE WITHIN TWO WEEKS OF
HAPPENING) 1000 150 950
DRG 9.2L1910 ELECTIVE REPAIR OF ANEURYSM OF ASCENDING AORTA Complex 1000 150 950
DRG 9.2L1980 ELECTIVE REPAIR OF ANEURYSM OF ARCH OF AORTA Complex 1000 150 950
DRG 9.2L1990 ELECTIVE REPAIR OF ANEURYSM OF THORACIC AORTA Complex 1000 150 950
DELAYED REPAIR OF AORTIC DISSECTION (IE MORE THAN TWO WEEKS
AFTER HAPPENING) 1000 150 950
DRG 9.2L2190 REPLACEMENT OF GRAFT OF THORACO-ABDOMINAL ANEURYSM Complex 1000 150 950
DRG 9.2L2290 EXCISION OF INFECTED AORTIC GRAFT WITH BYPASS Complex 1000 150 950
DRG 9.3 RENAL VESSELS
DRG 9.3L4140 ENDARTERECTOMY OF RENAL ARTERY Complex 1000 150 950
DRG 9.3L4190 RECONSTRUCTION OF RENAL ARTERY(IES) Complex 1000 150 950
DRG 9.3L4292 RECONSTRUCTION OF TRANSPLANT RENAL ARTERY Xmajor 600 120 730
DRG 9.3L4300 TRANSLUMINAL OPERATIONS ON RENAL ARTERY Major 500 100 450
DRG 9.4 ABDOMINAL VESSELS
DRG 9.4L1620 AXILLO-UNIFEMORAL BYPASS Complex 1000 150 950
DRG 9.4L1680 AXILLO-BIFEMORAL BYPASS Complex 1000 150 950
DRG 9.4L1940 OPEN INFRARENAL ABDOMINAL AORTIC ANEURYSM TUBE GRAFT Complex 1000 150 950
OPEN INFRARENAL ABDOMINAL AORTIC ANEURYSM BIFURCATION GRAFT
1000 150 950
DRG 9.4L2200 REVISION OF PROSTHESIS OF ABDOMINAL AORTA Complex 1000 150 950
ENDARTERECTOMY AND PATCH REPAIR OF VISCERAL BRANCH OF
ABDOMINAL AORTA 1000 150 950
OTHER OPEN OPERATIONS ON OTHER VISCERAL BRANCH OF ABDOMINAL
AORTA 1000 150 950
DRG 9.5 ILEO-FEMORAL VESSELS
DRG 9.5L5100 AORTO-ILIAC, AORTO-FEMORAL, ILIO-FEMORAL BYPASS Complex 1000 150 950
DRG 9.5L5180 AORTO-BIFEMORAL BYPASS Complex 1000 150 950
System Category Day
DRG 9.5L5210 ENDARTERECTOMY AND PATCH REPAIR OF ILIAC ARTERY Complex 1000 150 950
DRG 9.5L5300 OPEN OPERATIONS ON ILIAC ARTERY Complex 1000 150 950
DRG 9.5L5400 TRANSLUMINAL OPERATIONS ON ILIAC ARTERY Intermediate 250 50 300
DRG 9.5L5910 FEMORO-FEMORAL BYPASS Complex 1000 150 950
DRG 9.5L5922 FEMORO-POPLITEAL BYPASS USING PROSTHESIS Complex 1000 150 950
DRG 9.5L5923 FEMORO-POPLITEAL BYPASS USING VEIN Complex 1000 150 950
DRG 9.5L5924 FEMORO-POPLITEAL BYPASS USING VEIN CUFF/PATCH Complex 1000 150 950
FEMORO-DISTAL CALF BYPASS USING PROSTHESIS +/- VEIN CUFF/PATCH
1000 150 950
DRG 9.5L5960 FEMORO-DISTAL CALF BYPASS USING VEIN Complex 1000 150 950
DRG 9.5L6000 ENDARTERECTOMY OF FEMORAL ARTERY Complex 1000 150 950
DRG 9.5L6230 RECONSTRUCTION/BYPASS FOR POPLITEAL ANEURYSM Complex 1000 150 950
DRG 9.5L6300 TRANSLUMINAL PROCEDURES ON FEMORAL ARTERY Major 500 100 450
DRG 9.5L6530 REVISION FEMORAL BYPASS GRAFT Xmajor 600 120 730
DRG 9.6 NON-SPECIFIC
DRG 9.6L6710 BIOPSY OF ARTERY (INCLUDING TEMPORAL) (AS SOLE PROCEDURE) Minor 100 20 155
DRG 9.6L6800 REPAIR OF LIMB ARTERY Xmajor 600 120 730
DRG 9.6L6840 REPAIR OF LIMB ARTERY USING VEIN GRAFT Xmajor 600 120 730
DRG 9.6L7010 OPEN EMBOLECTOMY OF ARTERY Xmajor 600 120 730
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF ARTERY, +/- INSERTION
DRG 9.6L7110 Intermediate
OF STENT 250 50 300
DRG 9.6L7410 CREATION OF ARTERIOVENOUS SHUNT (SYNTHETIC GRAFT) Major 500 100 450
CREATION OF ARTERIOVENOUS FISTULA (INCLUDING SUBSEQUENT
CLOSURE) 250 50 300
DRG 9.6L7422 CREATION OF ARTERIOVENOUS FISTULA FOR DIALYSIS Intermediate 250 50 300
DRG 9.6L7423 LIGATION OF ARTERIOVENOUS FISTULA FOR DIALYSIS Intermediate 250 50 300
DRG 9.6L7520 REPAIR OF ACQUIRED ARTERIOVENOUS FISTULA Major 500 100 450
DRG 9.6L7580 REPAIR ARTERIOVENOUS FISTULA Major 500 100 450
DRG 9.6L8110 CREATION OF PERITONEOVENOUS SHUNT (LEVINE/DENVER) Intermediate 250 50 300
DRG 9.6L9000 OPEN REMOVAL OF THROMBUS FROM VEIN Intermediate 250 50 300
INSERTION OF TUNNELLED CENTRAL VENOUS CATHETER (HICKMAN LINE)
250 50 300
DRG 9.6L9112 SURGICAL INSERTION OF CENTRAL VENOUS DIALYSIS LINE Intermediate 250 50 300
DRG 9.6L9113 PERCUTANEOUS INSERTION OF CENTRAL VENOUS DIALYSIS LINE Intermediate 250 50 300
DRG 9.6L9114 REMOVAL OF CENTRAL VENOUS DIALYSIS LINE Minor 100 20 155
DRG 9.6L9115 IMPLANTATION OF PORT DEVICE (POWERPORT) Intermediate 250 50 300
INSERTION OF IMPLANTABLE CENTRAL VENOUS PORT (PORTACATH) E.G
PORT-A-CATH UNDER IMAGE GUIDANCE 250 50 300
EXCISION OF ARTERIOVENOUS MALFORMATION FROM PERIPHERAL VESSEL
250 50 300
DRG 9.6L9181 REMOVAL OF PORTACATH/VASOPORT UNIT Minor 100 20 155
DRG 9.6L9350 BASILIC VEIN TRANSPOSITION Major 500 100 450
DRG 9.6L9730 ISOLATED LIMB PERFUSION Xmajor 600 120 730
DRG 9.6X4110 OPEN INSERTION OF TENCKHOFF CATHETER Intermediate 250 50 300
DRG 9.6X4112 PERCUTANEOUS INSERTION OF TENCKHOFF CATHETER Minor 100 20 155
DRG 9.6X4120 REMOVAL OF TENCKHOFF CATHETER Minor 100 20 155
DRG 9.7 VARICOSE VEINS
System Category Day
LIGATION/STRIPPING OF LONG OR SHORT SAPHENOUS VEIN (INCLUDING
LOCAL EXCISION/MULTIPLE PHLEBECTOMY) 250 50 300
ENDOVENOUS LASER TREATMENT (EVLT) OF SINGLE VENOUS TRUNK +/-
PHLEBECTOMIES - UNILATERAL 250 50 300
ENDOVENOUS LASER TREATMENT (EVLT) OF SINGLE VENOUS TRUNK +/-
DRG 9.7L8513 Major
PHLEBECTOMIES - BILATERAL 500 100 450
ENDOVENOUS LASER TREATMENT (EVLT) OF MORE THAN ONE VENOUS
DRG 9.7L8514 Major
TRUNK +/- PHLEBECTOMIES - UNILATERAL 500 100 450
ENDOVENOUS LASER TREATMENT (EVLT) OF MORE THAN ONE VENOUS
DRG 9.7L8515 Major
TRUNK +/-PHLEBECTOMIES - BILATERAL 500 100 450
LIGATION/STRIPPING OF LONG OR SHORT SAPHENOUS VEIN (INCLUDING
DRG 9.7L8520 Major
LOCAL EXCISION/MULTIPLE PHLEBECTOMY) - BILATERAL 500 100 450
OPERATIONS FOR RECURRENT VARICOSE VEINS WITH RE-EXPLORATION OF
DRG 9.7L8530 Major
GROIN AND/OR POPLITEAL FOSSA - UNILATERAL 500 100 450
OPERATIONS FOR RECURRENT VARICOSE VEINS WITHOUT RE-
DRG 9.7L8532 Major
EXPLORATION OF GROIN OR POPLITEAL FOSSA - UNILATERAL 500 100 450
RADIOFREQUENCY ABLATION OF MORE THAN ONE VENOUS TRUNK +/-
RADIOFREQUENCY ABLATION OF MORE THAN ONE VENOUS TRUNK +/-
DRG 9.7L8541 Major
OPERATIONS FOR RECURRENT VARICOSE VEINS WITH RE-EXPLORATION OF
DRG 9.7L8580 Xmajor
GROIN AND/OR POPLITEAL FOSSA - BILATERAL 600 120 730
OPERATIONS FOR RECURRENT VARICOSE VEINS WITHOUT RE-
DRG 9.7L8582 Xmajor
EXPLORATION OF GROIN OR POPLITEAL FOSSA - BILATERAL 600 120 730
ULTRASOUND-GUIDED FOAM SCLEROTHERAPY FOR VARICOSE VEIN(S)
UNILATERAL 350 0 150
ULTRASOUND-GUIDED FOAM SCLEROTHERAPY FOR VARICOSE VEIN(S) –
BILATERAL 350 0 150
RADIOFREQUENCY ABLATION OF SINGLE VENOUS TRUNK +/-
RADIOFREQUENCY ABLATION OF SINGLE VENOUS TRUNK +/-
DRG 9.7L8543 Major
DRG 9.7L8680 BILATERAL VARICOSE VEIN INJECTION SCLEROTHERAPY Intermediate 350 0 150
LIGATION/STRIPPING OF LONG AND SHORT SAPHENOUS VEINS (INCLUDING
DRG 9.7L8700 Major
LOCAL EXCISION/MULTIPLE PHLEBECTOMY) 500 100 450
LOCAL EXCISION (MULTIPLE PHLEBECTOMY) OF VARICOSE VEIN(S) OF LEG -
UNILATERAL 250 50 300
LOCAL EXCISION (MULTIPLE PHLEBECTOMY) OF VARICOSE VEIN(S) OF LEG -
LIGATION/STRIPPING OF LONG AND SHORT SAPHENOUS VEINS (INCLUDING
LOCAL EXCISION/MULTIPLE PHLEBECTOMY) BILATERAL 1000 300 800
DRG 9.7L9510 VENOGRAPHY (AND BILATERAL) Minor 100 20 155
DRG 9.8 LYMPHATIC SYSTEM
DRG 9.8T8510 RADICAL DISSECTION OF CERVICAL LYMPH NODES Major 500 100 450
DRG 9.8T8520 BLOCK DISSECTION OF AXILLARY LYMPH NODES (AXILLARY CLEARANCE Major 500 100 450
LEVELS 1-3)
DRG 9.8T8540 BLOCK DISSECTION OF PARA-AORTIC LYMPH NODES Xmajor 600 120 730
DRG 9.8T8550 BLOCK DISSECTION OF INGUINAL LYMPH NODES Major 500 100 450
DRG 9.8T8580 BLOCK DISSECTION OF PELVIC LYMPH NODES (AS SOLE PROCEDURE) Major 500 100 450
System Category Day
DRG 9.8T8592 LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION Major 500 100 450
DRG 9.8T8594 LAPAROSCOPIC PARA-AORTIC LYMPH NODE DISSECTION Major 500 100 450
DRG 9.8T8610 BIOPSY/SAMPLING OF CERVICAL LYMPH NODES Minor 100 20 155
DRG 9.8T8620 SAMPLING OF AXILLARY LYMPH NODES Intermediate 250 50 300
INTRAOPERATIVE SENTINEL NODE MAPPING, USING ONE STEP NUCLEIC
ACID AMPLIFICATION (OSNA), FOR BREAST CANCER 250 50 300
DRG 9.8T8640 SAMPLING OF INTERNAL MAMMARY LYMPH NODES Intermediate 250 50 300
EXCISION BIOPSY OF LYMPH NODE FOR DIAGNOSIS (CERVICAL, INGUINAL,
AXILLARY) 250 50 300
DRG 9.8T8722 SELECTIVE DISSECTION OF CERVICAL LYMPH NODES, LEVELS 1 TO 4 Major 500 100 450
SELECTIVE DISSECTION OF CERVICAL LYMPH NODES, LEVELS 1 TO 5 (+/- 6)
DRG 9.8T8723 Xmajor
600 120 730
SENTINEL NODE MAPPING AND SAMPLING WITH BLUE DYE OR RADIOACTIVE
PROBE FOR BREAST CANCER 250 50 300
SENTINEL NODE MAPPING AND SAMPLING WITH BLUE DYE AND
RADIOACTIVE PROBE FOR BREAST CANCER 250 50 300
DRG 9.8T8780 SENTINEL NODE BIOPSY (EXCEPT WHERE OTHERWISE LISTED) Intermediate 250 50 300
DRG 9.8T9610 EXCISION OF CYSTIC HYGROMA Major 500 100 450
DRG 10 ENDOSCOPIC GASTROINTESTINAL PROCEDURES
DRG 10.1 ENDOSCOPIC GASTROINTESTINAL PROCEDURES
RIGID OESOPHAGOSCOPY INCLUDING ANY BIOPSY, LASER OR DIATHERMY
DESTRUCTION OF LESIONS 250 50 300
DRG 10.1G2110 OESOPHAGEAL PHYSIOLOGY STUDIES (INCLUDING PH MEASUREMENT) Minor 100 20 155
THERAPEUTIC OESOPHAGO-GASTRO-DUODENOSCOPY (OGD) WITH
INSERTION OF PROSTHESIS 250 50 300
DILATATION 250 50 300
DRG 10.1H6260 PROCTOSCOPY (+/- BIOPSY) Minor 100 20 155
DRG 10.1H2350 ENDOSCOPIC MUCOSAL RESECTION (EMR) OF COLORECTAL TUMOUR Intermediate 250 50 300
DRG 10.1G2120 HIGH RESOLUTION OESOPHAGEAL MANOMETRY Minor 100 20 155
ELECTIVE BANDING OF OESOPHAGEAL VARICES 250 50 300
THERAPY FOR ACUTELY BLEEDING ULCER OR VARICES 250 50 300
DRG 10.1G4440 INSERTION OF PERCUTANEOUS ENDOSCOPIC Intermediate
GASTROSTOMY/PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMY 250 50 300
DRG 10.1G4480 THERAPEUTIC ENTEROSCOPY Intermediate 250 50 300
DRG 10.1G4520 DIAGNOSTIC ENTEROSCOPY Intermediate 250 50 300
DRG 10.1G4530 CATHETERLESS OESOPHAGEAL PH MONITORING (EG BRAVO) Minor 100 20 155
DIAGNOSTIC EOSOPHAGO-GASTRO-DUODENOSCOPY (OGD) INCLUDES
DRG 10.1G6500 Minor
FORCEPS BIOPSY, BIOPSY UREASE TEST AND DYE SPRAY 100 20 155
DRG 10.1G7900 ILEOSCOPY VIA STOMA WITH THERAPY Minor 100 20 155
DRG 10.1G8080 CAPSULE ENDOSCOPY INCLUDING INTERPRETATION AND EVALUATION Intermediate 350 0 150
DIAGNOSTIC OESOPHAGO-GASTRO-DUODENOSCOPY (OGD) AND IMMEDIATE
DRG 10.1G8082 COLONOSCOPY INCLUDES FORCEPS BIOPSIES, BIOPSY TEST AND DYE Intermediate
SPRAY (AS SOLE PROCEDURE) 250 50 300
DRG 10.1H2001 DOUBLE BALLOON ENTEROSCOPY Intermediate 250 50 300
System Category Day
DIAGNOSTIC COLONOSCOPY, INCLUDES FORCEPS BIOPSY OF COLON AND
DRG 10.1H2002 Minor
ILEUM 100 20 155
THERAPEUTIC COLONOSCOPY WITH SNARE LOOP BIOPSY OR EXCISION OF
DRG 10.1H2003 Intermediate
LESION 250 50 300
DRG 10.1H2180 FIBREOPTIC COLONOSCOPY AND RECANALISATION OF TUMOUR Intermediate 250 50 300
ENDOSCOPIC ULTRASOUND FOR TUMOUR STAGING, INCLUDING
DIAGNOSTIC ENDOSCOPY 250 50 300
DIAGNOSTIC FLEXIBLE SIGMOIDOSCOPY, INCLUDING FORCEPS BIOPSY AND
DRG 10.1H2502 Minor
PROCTOSCOPY 100 20 155
THERAPEUTIC SIGMOIDOSCOPY WITH SNARE LOOP BIOPSY OR EXCISION
DRG 10.1H2503 Minor
OF LESION 100 20 155
THERAPEUTIC HIGH RESOLUTION ANOSCOPY (HRA) IN SYMPTOMATIC
DRG 10.1H4190 Minor
PATIENTS (+/- BIOPSY OR ABLATION OF LESION OF ANUS) 100 20 155
THERAPEUTIC ERCP WITH INSERTION OF BILIARY OR PANCREATIC
DRG 10.1J3900 Major
STENT(S), SPHINCTEROTOMY OR STONE EXTRACTION 500 100 450
DRG 10.1J4300 DIAGNOSTIC ERCP (INCLUDES FORCEPS BIOPSY) Intermediate 250 50 300
ENDOSCOPIC UPPER GASTROINTESTINAL ULTRASOUND, EG FOR
DRG 10.1J6730 Intermediate
PANCREATICOBILIARY DIAGNOSIS/TRANSMUCOSAL BIOPSY 250 50 300
DRG 11 ABDOMEN (EXCLUDING URINARY AND REPRODUCTIVE ORGANS)
DRG 11.1 OESOPHAGUS
DRG 11.1A2781 LAPAROSCOPIC VAGOTOMY/SEROMYOTOMY Major 500 100 450
OESOPHAGECTOMY/OESOPHAGOGASTRECTOMY WITH ANASTOMOSIS IN
CHEST 1000 150 950
DRG 11.1G0220 TOTAL OESOPHAGECTOMY AND INTERPOSITION OF INTESTINE Complex 1000 150 950
DRG 11.1G0300 SUB-TOTAL OESOPHAGECTOMY WITH ANASTOMOSIS IN NECK Complex 1000 150 950
DRG 11.1G0400 OPEN EXCISION OF LESION OF OESOPHAGUS Major 500 100 450
DRG 11.1G0500 BYPASS OF OESOPHAGUS Xmajor 600 120 730
DRG 11.1G0640 CLOSURE OF BYPASS OF OESOPHAGUS 500 350
REPAIR OF CONGENITAL OESOPHAGEAL ATRESIA (WITH OR WITHOUT
FISTULA) 1000 150 950
DRG 11.1G0920 OESOPHAGOCARDIOMYOTOMY (HELLER'S OPERATION) Major 500 100 450
DRG 11.1G0980 THORASCOPIC OESOPHAGOGASTRIC MYOTOMY Major 500 100 450
DRG 11.1G2312 TRANSTHORACIC REPAIR OF PARAOESOPHAGEAL HIATUS HERNIA Xmajor 600 120 730
DRG 11.1G2320 TRANSTHORACIC REPAIR OF DIAPHRAGMATIC HERNIA (ACQUIRED) Xmajor 600 120 730
DRG 11.1G2330 TRANSABDOMINAL REPAIR OF HIATUS HERNIA Major 500 100 450
LAPAROSCOPIC REPAIR OF HIATUS HERNIA WITH ANTI-REFLUX PROCEDURE
DRG 11.1G2331 Major
(EG FUNDOPLICATION) 500 100 450
DRG 11.1G2340 TRANSABDOMINAL REPAIR OF DIAPHRAGMATIC HERNIA Major 500 100 450
DRG 11.1G2400 TRANSTHORACIC FUNDOPLICATION AND GASTROPLASTY Xmajor 600 120 730
DRG 11.1G2402 TRANSTHORACIC FUNDOPLICATION Xmajor 600 120 730
DRG 11.1G2430 TRANSABDOMINAL ANTI-REFLUX OPERATIONS Major 500 100 450
DRG 11.1G2590 REVISION OF ANTI-REFLUX PROCEDURES Xmajor 600 120 730
DRG 11.1G4610 TRANSORAL INCISIONLESS FUNDOPLICATION (TIF) Major 500 100 450
ENDOSCOPIC MUCOSAL RESECTION OF HIGH-GRADE DYSPLASIA IN
DRG 11.1G1460 Major
BARRETT'S OESOPHAGUS 500 100 450
DRG 11.2 STOMACH
DRG 11.2A2720 PROXIMAL GASTRIC VAGOTOMY Major 500 100 450
DRG 11.2A2730 HIGHLY SELECTIVE VAGOTOMY Major 500 100 450
System Category Day
DRG 11.2A2780 VAGOTOMY AND PYLOROPLASTY Major 500 100 450
DRG 11.2G2710 TOTAL GASTRECTOMY AND EXCISION OF SURROUNDING TISSUE Complex 1000 150 950
DRG 11.2G2800 PARTIAL GASTRECTOMY Xmajor 600 120 730
DRG 11.2G2810 PARTIAL GASTRECTOMY AND EXCISION OF SURROUNDING TISSUE Complex 1000 150 950
DRG 11.2G3100 LAPAROSCOPIC BILIARY GASTRIC BYPASS Complex 1000 150 950
DRG 11.2G3210 GASTRO–JEJUNOSTOMY Major 500 100 450
DRG 11.2G3220 REVISION OF GASTRO–JEJUNOSTOMY Xmajor 600 120 730
DRG 11.2G3400 GASTROSTOMY Major 500 100 450
DRG 11.2G3440 CLOSURE OF GASTROSTOMY Major 500 100 450
DRG 11.2G3520 CLOSURE OF PERFORATED ULCER OF STOMACH Major 500 100 450
DRG 11.2G3580 LAPAROSCOPIC CLOSURE OF PEPTIC ULCER Major 500 100 450
DRG 11.2G3610 GASTROPEXY FOR REFLUX Major 500 100 450
DRG 11.2G3800 OPEN OPERATIONS ON STOMACH NOT ELSEWHERE CLASSIFIED Major 500 100 450
DRG 11.2G4010 PYLOROMYOTOMY Major 500 100 450
DRG 11.2G4030 PYLOROPLASTY Major 500 100 450
ENDOSCOPIC MUCOSAL RESECTION (UPPER GASTROINTESTINAL TRACT)
(EMR) 250 50 300
DRG 11.2G4690 ENDOSCOPIC SUBMUCOSAL DISSECTION OF GASTRIC LESIONS Intermediate 250 50 300
ENDOSCOPIC REMOVAL OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
(PEG) TUBE 250 50 300
DRG 11.3 DUODENUM
DRG 11.3G5000 OPEN EXCISION OF LESION OF DUODENUM Xmajor 600 120 730
OPEN EXCISION OF CONGENITAL LESION OF DUODENUM INCLUDING
MALROTATION 1000 150 950
DRG 11.3G5050 ENDOSCOPIC SUBMUCOSAL DISSECTION OF DUODENAL LESIONS Major 500 100 450
DRG 11.3G5100 BYPASS OF DUODENUM Major 500 100 450
DRG 11.3G5320 CLOSURE OF PERFORATED ULCER OF DUODENUM Major 500 100 450
DRG 11.4 SMALL INTESTINE
DRG 11.4G4020 SURGERY FOR CORRECTION OF CONGENITAL INTESTINAL ATRESIAS Xmajor 600 120 730
DRG 11.4G5810 EXCISION OF JEJUNUM Major 500 100 450
DRG 11.4G6000 OPEN FORMATION OF JEJUNOSTOMY Major 500 100 450
DRG 11.4G6080 LAPAROSCOPICALLY ASSISTED RESECTION OF SMALL INTESTINE Major 500 100 450
DRG 11.4G6082 OPEN RESECTIONOF SMALL INTESTINE TUMOUR Major 500 100 450
DRG 11.4G6100 BYPASS OF JEJUNUM Major 500 100 450
INTUBATION OF JEJUNUM FOR DECOMPRESSION OF INTESTINE (WITHOUT
DRG 11.4G6710 Major
LAPAROTOMY) 500 100 450
DRG 11.4G7100 BYPASS OF ILEUM Major 500 100 450
DRG 11.4G7250 ILEOANAL ANASTOMOSIS AND CREATION OF POUCH Complex 1000 150 950
DRG 11.4G7402 OPEN FORMATION OF ILEOSTOMY Major 500 100 450
DRG 11.4G7403 LAPAROSCOPIC ILEOSTOMY Major 500 100 450
DRG 11.4G7512 REVISION OF ILEOSTOMY - LOCAL Major 500 100 450
DRG 11.4G7513 REVISION OF ILEOSTOMY - LAPAROTOMY Major 500 100 450
DRG 11.4G7530 CLOSURE OF ILEOSTOMY (AS SOLE PROCEDURE) Intermediate 250 50 300
DRG 11.5 LARGE INTESTINE
DRG 11.5H0210 APPENDICECTOMY Intermediate 250 50 300
DRG 11.5H0280 LAPAROSCOPIC APPENDICECTOMY Intermediate 250 50 300
DRAINAGE OF ABSCESS OF APPENDIX OR DRAINAGE OF INTRA-ABDOMINAL
DRG 11.5H0310 Major
ABSCESS 500 100 450
System Category Day
DRG 11.5H0510 TOTAL EXCISION OF COLON AND ILEORECTAL ANASTOMOSIS Complex 1000 150 950
DRG 11.5H0610 EXTENDED EXCISION OF RIGHT HEMICOLON Major 500 100 450
DRG 11.5H0700 RIGHT HEMICOLECTOMY Major 500 100 450
DRG 11.5H0750 LAPAROSCOPICALLY ASSISTED RIGHT HEMICOLECTOMY Major 500 100 450
DRG 11.5H0800 EXCISION OF TRANSVERSE COLON Major 500 100 450
DRG 11.5H0900 EXCISION OF LEFT HEMICOLON Major 500 100 450
DRG 11.5H1000 EXCISION OF SIGMOID COLON Major 500 100 450
DRG 11.5H1200 EXCISION OF LESION OF COLON (TRANSABDOMINAL) Major 500 100 450
DRG 11.5H1300 BYPASS OF COLON Major 500 100 450
DRG 11.5H1542 CLOSURE OF COLOSTOMY Intermediate 250 50 300
LAPAROSCOPIC COLOSTOMY AND STOMA FORMATION (INCLUDING
DRG 11.5H1581 Major
REVISION) 500 100 450
DRG 11.5H1590 OPEN FORMATION OF COLOSTOMY Major 500 100 450
INTRA ABDOMINAL MANIPULATION OF COLON FOR INTUSSUSCEPTION (AS
DRG 11.5H1700 Major
DRG 11.5H1880 LAPAROSCOPICALLY ASSISTED LEFT COLON RESECTION Major 500 100 450
DRG 11.6 RECTUM/ANUS
DRG 11.6G7250 ILEOANAL ANASTOMOSIS AND CREATION OF POUCH Complex 1000 150 950
DRG 11.6H0410 PANPROCTOCOLECTOMY AND ILEOSTOMY Complex 1000 150 950
DRG 11.6H0480 ABDOMINAL REVISION OF RESTORATIVE PROCTOCOLECTOMY Complex 1000 150 950
ABDOMINAL OPERATION FOR HIRSCHPRUNG'S DISEASE (EG DUHAMEL,
DRG 11.6H1550 Major
SÖAVE AND SURCUSON OPERATIONS) 500 100 450
ABDOMINOPERINEAL PULL THROUGH RESECTION WITH COLO-ANAL
DRG 11.6H3310 Xmajor
ANASTOMOSIS +/- COLONIC POUCH AND ASSOCIATED STOMA 600 120 730
DRG 11.6H3320 ABDOMINOPERINEAL RESECTION OF RECTUM AND ANUS Xmajor 600 120 730
DRG 11.6H3322 LAPAROSCOPIC ABDOMINOPERINEAL RESECTION Xmajor 600 120 730
ANTERIOR RESECTION - HIGH (I.E. COLORECTAL ANASTOMOSIS ABOVE THE
DRG 11.6H3332 Major
PERITONEAL REFLECTION) 500 100 450
ANTERIOR RESECTION - LOW (IE COLORECTAL ANASTOMOSIS AT OR BELOW
THE PERITONEAL REFLECTION 600 120 730
DRG 11.6H3362 HARTMANN'S PROCEDURE Xmajor 600 120 730
DRG 11.6H3363 COLECTOMY AND COLOSTOMY AND PRESERVATION OF RECTUM Xmajor 600 120 730
LAPAROSCOPIC ANTERIOR RESECTION - HIGH (I.E. COLORECTAL
DRG 11.6H3364 Major
ANASTOMOSIS ABOVE THE PERITONEAL REFLECTION) 500 100 450
LAPARASCOPIC ANTERIOR RESECTION - LOW (IE COLORECTAL
ANASTOMOSIS AT OR BELOW THE PERITONEAL REFLECTION) 600 120 730
DRG 11.6H3380 PARTIAL EXCISION OF RECTUM AND SIGMOID COLON FOR PROLAPSE Xmajor 600 120 730
DRG 11.6H3390 REVERSAL OF HARTMANN'S PROCEDURE Major 500 100 450
DRG 11.6H3400 OPEN EXCISION OF LESION OF RECTUM AND COLON Major 500 100 450
DRG 11.6H3500 FIXATION OF RECTUM FOR PROLAPSE Major 500 100 450
DRG 11.6H3580 LAPAROSCOPIC RECTOPEXY Major 500 100 450
STAPLED TRANSANAL RECTAL RESECTION (STARR) FOR OBSTRUCTED
DRG 11.6H3590 Major
DEFAECATION SYNDROME 500 100 450
DRG 11.6H4000 TRANSANAL RESECTION OF RECTAL CANCER Major 500 100 450
DRG 11.6H4080 INJECTION OF BULKING AGENTS FOR FAECAL INCONTINENCE Intermediate 250 50 300
DRG 11.6H4122 TRANSANAL ENDOSCOPIC MIRCOSURGERY Xmajor 600 120 730
PERIANAL EXCISION OF LESION OF RECTUM (INCLUDING SIGMOIDOSCOPY)
250 50 300
System Category Day
DRG 11.6H4180 FULL OR PARTIAL THICKNESS RECTAL BIOPSY Minor 100 20 155
DRG 11.6H4200 PERINEAL REPAIR OF PROLAPSE OF RECTUM Major 500 100 450
EXAMINATION OF RECTUM UNDER ANAESTHETIC (AS SOLE PROCEDURE)
DRG 11.6H4430 Minor
100 20 155
DRG 11.6H4480 DILATION OF STRICTURE OF RECTUM Minor 100 20 155
DRG 11.6H4680 REPAIR OF FAECAL FISTULA Major 500 100 450
DRG 11.6H4800 EXCISION OF LESION OF ANUS Minor 100 20 155
DRG 11.6H4900 DESTRUCTION OF LESION OF ANUS Minor 100 20 155
DRG 11.6H5020 REPAIR OF ANAL SPHINCTER (INCLUDING SIGMOIDOSCOPY) Major 500 100 450
PRIMARY REPAIR OF HIGH/INTERMEDIATE CONGENITAL ANO-RECTAL
DRG 11.6H5042 Complex
ANOMALY 1000 150 950
DRG 11.6H5043 PRIMARY REPAIR OF LOW CONGENITAL ANORECTAL ANOMALY Xmajor 600 120 730
DRG 11.6H5080 REPAIR OF ANAL TRAUMA Intermediate 250 50 300
DRG 11.6H5100 HAEMORRHOIDECTOMY (INCLUDING SIGMOIDOSCOPY) Intermediate 250 50 300
DRG 11.6H5101 LASER HAEMORRHOIDECTOMY (INCLUDING SIGMOIDOSCOPY) Intermediate 250 50 300
DRG 11.6H5250 CIRCULAR STAPLING HAEMORRHOIDECTOMY Intermediate 250 50 300
DRG 11.6H5400 ANORECTAL STRETCH Minor 100 20 155
LAYING OPEN OF LOW ANAL FISTULA (FISTULOTOMY) +/- INSERTION OF
STITCH (INCLUDING SIGMOIDOSCOPY) 250 50 300
LAYING OPEN OF HIGH ANAL FISTULA (FISTULOTOMY) +/- INSERTION OF
STITCH (INCLUDING SIGMOIDOSCOPY) 250 50 300
DRG 11.6H5620 LATERAL SPHINCTEROTOMY OF ANUS Minor 100 20 155
PLANNING FOR INSERTION AND REMOVAL OF RADIOACTIVE AGENT
DRG 11.6BT251 Intermediate
(BRACHYTHERAPY) INTO RECTAL TUMOUR 350 0 150
INSERTION AND REMOVAL OF RADIOACTIVE AGENT (BRACHYTHERAPY) INTO
DRG 11.6BT252 Major
RECTAL TUMOUR 500 100 450
DRG 11.6H5640 EXCISION OF ANAL FISSURE Minor 100 20 155
DRAINAGE THROUGH PERINEAL REGION (INCLUDING ISCHIORECTAL
DRG 11.6H5800 Minor
ABSCESS) (INCLUDING SIGMOIDOSCOPY) 100 20 155
DRG 11.6H5940 EXCISION OF PILONIDAL SINUS AND SUTURE/SKIN GRAFT Intermediate 250 50 300
DRG 11.6H6020 LAYING OPEN OF PILONIDAL SINUS Intermediate 250 50 300
DRG 11.6H3381 TOTAL MESORECTAL EXCISION (TME) Complex 1000 150 950
HAEMORRHOIDAL ARTERY LIGATION OPERATION (INCLUDING IMAGE-
GUIDED) +/- RECTO ANAL PROLAPSE REPAIR 250 50 300
DRG 11.7 OTHER ORGANS (MAINLY DIGESTIVE)
DRG 11.7B2222 ADRENALECTOMY - BILATERAL (OPEN) Xmajor 600 120 730
DRG 11.7B2223 ADRENALECTOMY - BILATERAL (LAPAROSCOPIC) Xmajor 600 120 730
DRG 11.7B2232 ADRENALECTOMY - UNILATERAL (OPEN) Major 500 100 450
DRG 11.7B2233 ADRENALECTOMY - UNILATERAL (LAPAROSCOPIC) Major 500 100 450
DRG 11.7J0200 PARTIAL HEPATECTOMY Xmajor 600 120 730
DRG 11.7J1041 HEPATIC VENOUS WEDGE PRESSURE (HVWP) Intermediate 250 50 300
DRG 11.7J0210 HEMIHEPATECTOMY Complex 1000 150 950
DRG 11.7J0310 RESECTION OF LIVER TUMOUR(S) Complex 1000 150 950
REPAIR OF LIVER (INCLUDING THERAPEUTIC LAPAROSCOPIC OPERATIONS
DRG 11.7J0400 Major
ON LIVER) 500 100 450
DRG 11.7J0510 OPEN DRAINAGE OF LIVER Major 500 100 450
RADIOFREQUENCY THERMOCOAGULATION OF LIVER WITH SCALPEL LIVER
DRG 11.7J0780 Complex
RESECTION 1000 150 950
System Category Day
DRG 11.7J0740 OPEN HEPATECTOMY AND ABLATION Complex 1000 150 950
DRG 11.7J0900 DIAGNOSTIC LAPAROSCOPY (INCLUDING ANY BIOPSY) Major 500 100 450
DRG 11.7J1300 PERCUTANEOUS BIOPSY OF LESION OF LIVER Minor 100 20 155
DRG 11.7J1400 OPEN PUNCTURE OF LIVER Major 500 100 450
DRG 11.7J1800 OPEN CHOLECYSTECTOMY Major 500 100 450
DRG 11.7J1820 CHOLECYSTECTOMY WITH EXPLORATION OF COMMON BILE DUCT Xmajor 600 120 730
DRG 11.7J1830 LAPAROSCOPIC CHOLECYSTECTOMY Major 500 100 450
LAPAROSCOPIC CHOLECYSTECTOMY WITH PERIOPERATIVE
DRG 11.7J1880 Xmajor
CHOLANGIOGRAM 600 120 730
DRG 11.7J1900 ANASTOMOSIS OF GALL BLADDER (TO ANOTHER VISCUS) Major 500 100 450
PARTIAL EXCISION OF BILE DUCT AND ANASTOMOSIS OF BILE DUCT TO
DRG 11.7J2720 Xmajor
DUODENUM/JEJUNUM 600 120 730
DRG 11.7J2800 EXCISION OF LESION OF BILE DUCT Xmajor 600 120 730
DRG 11.7J2900 ANASTOMOSIS OF HEPATIC DUCT Complex 1000 150 950
DRG 11.7J3000 ANASTOMOSIS OF COMMON BILE DUCT Xmajor 600 120 730
DRG 11.7J3100 OPEN INTRODUCTION OF PROSTHESIS INTO BILE DUCT Major 500 100 450
DRG 11.7J3200 REPAIR OF BILE DUCT Xmajor 600 120 730
INCISION OF BILE DUCT (INCLUDING EXPLORATION FOR CALCULUS
DRG 11.7J3300 Major
REMOVAL) 500 100 450
SPHINCTEROTOMY OF BILE DUCT AND PANCREATIC DUCT USING
DRG 11.7J3500 Major
DUODENAL APPROACH 500 100 450
DRG 11.7J5000 PERCUTANEOUS EXAMINATION OF BILE DUCT Intermediate 250 50 300
DRG 11.7J5750 LAPAROSCOPIC DISTAL PANCREATECTOMY Xmajor 600 120 730
DRG 11.7J5500 TOTAL PANCREATECTOMY AND EXCISION OF SURROUNDING TISSUE Complex 1000 150 950
DRG 11.7J5520 TOTAL PANCREATECTOMY Complex 1000 150 950
PANCREATODUODENECTOMY AND EXCISION OF SURROUNDING TISSUE
(WHIPPLE'S PROCEDURE) 1000 150 950
DRG 11.7J5700 DISTAL PANCREATECTOMY Xmajor 600 120 730
DRG 11.7J5800 EXCISION OF LESION OF PANCREAS Xmajor 600 120 730
DRG 11.7J5900 ANASTOMOSIS OF PANCREATIC DUCT (TO ANOTHER VISCUS) Xmajor 600 120 730
DRG 11.7J6100 OPEN DRAINAGE OF LESION OF PANCREAS Major 500 100 450
DRG 11.7J6180 DRAINAGE OF PANCREATIC ABSCESS Major 500 100 450
DRG 11.7J6200 INCISION OF PANCREAS Major 500 100 450
DRG 11.7J6300 OPEN EXAMINATION OF PANCREAS Major 500 100 450
DRG 11.7J6600 THERAPEUTIC PERCUTANEOUS OPERATIONS ON PANCREAS Major 500 100 450
DRG 11.7J6900 OPEN SPLENECTOMY Major 500 100 450
DRG 11.7J6980 LAPAROSCOPIC SPLENECTOMY Major 500 100 450
DRG 11.7L8110 CREATION OF PERITONEOVENOUS SHUNT (LEVINE/DENVER) Intermediate 250 50 300
DRG 11.8 MAJOR VESSELS
OPEN CANNULATION OF INTRA ABDOMINAL ARTERY FOR INFUSION
DRG 11.8L7040 Major
CHEMOTHERAPY 500 100 450
DRG 11.8L7710 CREATION OF PORTOCAVAL SHUNT Complex 1000 150 950
DRG 11.8L7920 PLICATION OF VENA CAVA Xmajor 600 120 730
REPAIR OF WOUND OF MAJOR ARTERY OR VEIN OF ABDOMEN (INCLUDING
DRG 11.8L7980 Major
AORTA AND VENA CAVA) 500 100 450
DRG 11.9 ABDOMINAL WALL
DRG 11.9T1640 REPAIR OF CONGENITAL DIAPHRAGMATIC HERNIA Xmajor 600 120 730
System Category Day
SIMPLE EXCISION OF INGUINAL HERNIAL SAC (HERNIOTOMY) - UNILATERAL
250 50 300
SIMPLE EXCISION OF INGUINAL HERNIAL SAC (HERNIOTOMY) – BILATERAL
DRG 11.9T1910 Major
500 100 450
DRG 11.9T2000 PRIMARY REPAIR OF INGUINAL HERNIA Intermediate 250 50 300
DRG 11.9T2002 LAPAROSCOPIC REPAIR OF INGUINAL HERNIA - UNILATERAL Major 500 100 450
DRG 11.9T2010 PRIMARY REPAIR OF INGUINAL HERNIA – BILATERAL Major 500 100 450
DRG 11.9T2012 LAPAROSCOPIC REPAIR OF INGUINAL HERNIA - BILATERAL Major 500 100 450
DRG 11.9T2080 PRIMARY REPAIR OF STRANGULATED INGUINAL HERNIA Major 500 100 450
DRG 11.9T2100 REPAIR OF RECURRENT INGUINAL HERNIA Major 500 100 450
LAPAROSCOPIC REPAIR OF RECURRENT INGUINAL HERNIA - UNILATERAL
DRG 11.9T2102 Major
500 100 450
DRG 11.9T2110 REPAIR OF RECURRENT INGUINAL HERNIA - BILATERAL Xmajor 600 120 730
DRG 11.9T2112 LAPAROSCOPIC REPAIR OF RECURRENT INGUINAL HERNIA - BILATERAL Xmajor 600 120 730
DRG 11.9T2200 PRIMARY REPAIR OF FEMORAL HERNIA Intermediate 250 50 300
DRG 11.9T2280 PRIMARY REPAIR OF STRANGULATED FEMORAL HERNIA Major 500 100 450
DRG 11.9T2300 REPAIR OF RECURRENT FEMORAL HERNIA Major 500 100 450
DRG 11.9T2400 REPAIR OF UMBILICAL HERNIA (IRRESPECTIVE OF AGE) Intermediate 250 50 300
DRG 11.9T2500 PRIMARY REPAIR OF INCISIONAL HERNIA NOT REQUIRING MESH Intermediate 250 50 300
DRG 11.9T2502 LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA Major 500 100 450
REPAIR OF RECURRENT INCISIONAL OR VENTRAL HERNIA NOT REQUIRING
DRG 11.9T2600 Major
MESH 500 100 450
DRG 11.9T2710 PRIMARY REPAIR OF VENTRAL HERNIA NOT REQUIRING MESH Intermediate 250 50 300
PRIMARY REPAIR OF INCISIONAL OR VENTRAL HERNIA REQUIRING MESH
250 50 300
DRG 11.9T2730 REPAIR OF DORSAL HERNIA INCLUDING LUMBAR HERNIA Major 500 100 450
REPAIR OF PERINEAL HERNIA INCLUDING SCROTAL THAT ARE NOT
DRG 11.9T2740 Major
INGUINAL 500 100 450
DRG 11.9T2750 REPAIR OF SCIATIC HERNIAS Major 500 100 450
RESUTURE OF PREVIOUS INCISION IN ABDOMINAL WALL (“BURST
DRG 11.9T2830 Major
ABDOMEN”) 500 100 450
REPAIR OF RECURRENT INCISIONAL OR VENTRAL HERNIA REQUIRING MESH
DRG 11.9T2620 Major
500 100 450
REPAIR OF RECURRENT INCISIONAL OR VENTRAL HERNIA REQUIRING
DRG 11.9T2640 Major
REMOVAL OF PREVIOUSLY INSERTED MESH 500 100 450
COMPONENT SEPARATION TECHNIQUE (CST) REPAIR OF RECURRENT
DRG 11.9T2780 Xmajor
INCISIONAL ABDOMINAL HERNIA +/- MESH 600 120 730
EXPLORATION AND REPAIR OF GROIN DISRUPTION INCLUDING REPAIR OF
MUSCLE FASCIA AND TENDONS (GILMORE'S GROIN REPAIR) 250 50 300
DRG 11.9T7973 REMOVAL OF ABDOMINAL WALL LIPOMA UNDER LOCAL ANAESTHESIA 150 50
DRG 11.1 PERITONEUM
DRG 11.1T3010 LAPAROTOMY FOR POSTOPERATIVE HAEMORRHAGE Major 500 100 450
CYTOREDUCTIVE SURGERY (SUGARBAKER TECHNIQUE) WITH
INTRAPERITONEAL CHEMOTHERAPY [FEES ON APPLICATION] 1000 150 950
DRG 11.1T3080 LAPAROTOMY AND REPAIR OF MULTIPLE VISCERAL TRAUMA Complex 1000 150 950
DRG 11.1T3410 OPEN DRAINAGE OF SUBPHRENIC ABSCESS Major 500 100 450
DRG 11.1T3600 WEDGE EXCISION OR REMOVAL OF OMENTUM (AS SOLE PROCEDURE) Major 500 100 450
DRG 11.1T3910 EXCISION OF RETROPERITONEAL TUMOUR, +/-URETEROLYSIS Xmajor 600 120 730
System Category Day
DRG 11.1T3930 RETROPERITONEAL ABSCESS Major 500 100 450
DRG 11.1T3980 EXCISION OF PRESACRAL TUMOUR Intermediate 250 50 300
DRG 11.1T4300 LAPAROSCOPIC ADHESIOLYSIS (INCLUDING BIOPSY) Major 500 100 450
DRG 11.1T4610 PARACENTESIS ABDOMINIS FOR ASCITES Minor 100 20 155
DRG 11.1T4680 SUPRAPUBIC DRAINAGE OF PELVIC ABSCESS Intermediate 250 50 300
DRG 12 URINARY SYSTEM AND MALE REPRODUCTIVE ORGANS
DRG 12.1 KIDNEY/RENAL PELVIC
PANCREATIC WITH KIDNEY TRANSPLANT (SIMULTANEOUS PANCREAS SPK)
1000 150 950
DRG 12.1M0102 TRANSPLANTATION OF KIDNEY - 1ST AND 2ND TRANSPLANT Xmajor 600 120 730
DRG 12.1M0103 TRANSPLANTATION OF KIDNEY - 3RD TRANSPLANT Xmajor 600 120 730
DRG 12.1M0282 LAPAROSCOPIC NEPHROURETERECTOMY Xmajor 600 120 730
DRG 12.1M1350 ANTEGRADE PYELOGRAM (INCLUDING BILATERAL) Intermediate 250 50 300
DRG 12.1N1101 CORRECTION OF HYDROCELE(S) - BILATERAL Intermediate 250 50 300
TRANSPLANTATION OF KIDNEY INTO PATIENT WITH ABNORMAL,
DRG 12.1M0104 Xmajor
AUGMENTED OR ABSENT BLADDER 600 120 730
DRG 12.1M0210 NEPHRECTOMY AND EXCISION OF PERIRENAL TISSUE Xmajor 600 120 730
DRG 12.1M0220 NEPHROURETERECTOMY - UNILATERAL Major 500 100 450
DRG 12.1M0221 NEPHROURETERECTOMY - BILATERAL Xmajor 600 120 730
DRG 12.1M0222 NEPHROURETERECTOMY FOR LIVE DONOR TRANSPLANTATION Xmajor 600 120 730
DRG 12.1M0250 NEPHRECTOMY - UNILATERAL Major 500 100 450
DRG 12.1M0251 NEPHRECTOMY - BILATERAL Major 500 100 450
DRG 12.1M0260 TRANSPLANT NEPHRECTOMY Major 500 100 450
DRG 12.1M0280 LAPAROSCOPIC NEPHRECTOMY Major 500 100 450
DRG 12.1M0303 ROBOT ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY n/a
DRG 12.1M0300 OPEN PARTIAL NEPHRECTOMY Major 500 100 450
DRG 12.1M0302 LAPAROSCOPIC PARTIAL NEPHRECTOMY Major 500 100 450
DRG 12.1M0380 LAPAROSCOPIC UPPER OR LOWER POLE HEMINEPHRECTOMY Xmajor 600 120 730
DRG 12.1M0412 DE-ROOFING AND ASPIRATION OF RENAL PARA PELVIC CYST Major 500 100 450
DRG 12.1M0510 OPEN PYELOPLASTY Major 500 100 450
DRG 12.1M0550 REPAIR OF KIDNEY WOUND Xmajor 600 120 730
DRG 12.1M0610 OPEN REMOVAL OF CALCULI FROM KIDNEY Major 500 100 450
DRG 12.1M0680 DRAINAGE OF PYONEPHROSIS Intermediate 250 50 300
DRG 12.1M0800 OTHER OPEN OPERATIONS ON KIDNEY Major 500 100 450
DRG 12.1M0812 OPEN BIOPSY OF RENAL TRANSPLANT Intermediate 250 50 300
DRG 12.1M0813 PERCUTANEOUS BIOPSY OF RENAL TRANSPLANT Minor 100 20 155
DRG 12.1M0814 OPEN BIOPSY OF NATIVE KIDNEY Major 500 100 450
DRG 12.1M0840 EXPLORATION OF RENAL TRANSPLANT FOR BLEEDING Intermediate 250 50 300
DRG 12.1M0880 OPEN DRAINAGE OF PERINEPHRIC ABSCESS Major 500 100 450
ENDOSCOPIC FRAGMENTATION OF CALCULI OF KIDNEY (INCLUDING
DRG 12.1M0910 Major
CYSTOSCOPY AND INSERTION/REMOVAL OF STENT) 500 100 450
PERCUTANEOUS NEPHROLITHOTOMY (INCLUDING CYSTOSCOPY AND
DRG 12.1M0940 Complex
RETROGRADE CATHETERISATION) 1000 150 950
THERAPEUTIC ENDOSCOPIC OPERATIONS ON KIDNEY (INCLUDING
DRG 12.1M1000 Major
CYSTOSCOPY AND RETROGRADE CATHETERISATION) 500 100 450
DRG 12.1M1080 LAPAROSCOPIC PYELOPLASTY Major 500 100 450
DRG 12.1M1090 ROBOT ASSISTED LAPAROSCOPIC PYELOPLASTY n/a 1500 500
System Category Day
DIAGNOSTIC ENDOSCOPIC EXAMINATION OF KIDNEY (INCLUDING BIOPSY)
DRG 12.1M1110 Intermediate
250 50 300
DRG 12.1M1310 PERCUTANEOUS FINE NEEDLE BIOPSY OF LESION OF KIDNEY Minor 100 20 155
DRG 12.1M1360 PERCUTANEOUS INSERTION OF NEPHROSTOMY TUBE Intermediate 250 50 300
DRG 12.1M1380 PERCUTANEOUS TRU-CUT NEEDLE BIOPSY OF LESION OF KIDNEY Intermediate 250 50 300
EXTRACORPOREAL FRAGMENTATION OF CALCULUS OF KIDNEY
(LITHOTRIPSY) - SINGLE TREATMENT 250 50 300
PUSH MANIPULATION OF STONE PRIOR TO LITHOTRIPSY (AS SOLE
DRG 12.2 URETER
DRG 12.2M1820 EXCISION OF SEGMENT OF URETER Major 500 100 450
DRG 12.2M1910 CONSTRUCTION OF ILEAL CONDUIT INCLUDING URETERIC IMPLANTATION Xmajor 600 120 730
DRG 12.2M2012 REPLANTATION OF URETER INTO BOWEL (INCLUDING BILATERAL) Xmajor 600 120 730
DRG 12.2M2030 BILATERAL REPLANTATION OF URETER INTO BLADDER Xmajor 600 120 730
UNILATERAL REPLANTATION OF URETER INTO BLADDER (INCLUDING
DRG 12.2M2080 Major
CYSTOSCOPY) 500 100 450
DRG 12.2M2100 OTHER CONNECTION OF URETER Major 500 100 450
DRG 12.2M2130 ILEAL OR COLONIC REPLACEMENT OF URETER Complex 1000 150 950
DRG 12.2M2160 RECONSTRUCTION OF TRANSPLANT URETER Xmajor 600 120 730
DRG 12.2M2200 URETEROSTOMY - CLOSURE Major 500 100 450
DRG 12.2M2202 URETEROSTOMY - FORMATION Major 500 100 450
DRG 12.2M2210 OPEN CORRECTION VESICOURETERIC REFLUX-UNILATERAL Major 500 100 450
DRG 12.2M2280 OPEN CORRECTION VESICOURETERIC REFLUX-BILATERAL Xmajor 600 120 730
DRG 12.2M2310 OPEN URETEROLITHOTOMY (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
EXCISION OF URETEROCELE (WITH OR WITHOUT URETERIC
DRG 12.2M2510 Major
REIMPLANTATION) - UNILATERAL 500 100 450
EXCISION OF URETEROCELE (WITH OR WITHOUT URETERIC
REIMPLANTATION) - BILATERAL 600 120 730
DRG 12.2M2530 URETEROLYSIS – UNILATERAL Major 500 100 450
DRG 12.2M2580 URETEROLYSIS – BILATERAL Xmajor 600 120 730
THERAPEUTIC NEPHROSCOPIC OPERATIONS ON URETER (INCLUDING
DRG 12.2M2600 Major
ENDOSCOPIC REMOVAL AND INSERTION OF PROSTHESIS INTO URETER
DRG 12.2M2680 Major
(INCLUDING CYSTOSCOPY) 500 100 450
URETEROSCOPIC EXTRACTION OF CALCULUS OF URETER (INCLUDING
ENDOSCOPIC INSERTION/REMOVAL OF PROSTHESIS INTO URETER
DRG 12.2M2920 Major
(INCLUDING BILATERAL AND CYSTOSCOPY, +/- PYELOGRAPHY) 500 100 450
HOLMIUM LASER LITHOTRIPSY FOR CALCULI OF URETER (INCLUDING
DRG 12.2M3111 Major
DRG 12.2M2930 REMOVAL OF PROSTHESIS FROM URETER (INCLUDING CYSTOSCOPY) Minor 100 20 155
DRG 12.2M2932 CYSTOSCOPY AND REMOVAL OF TRANSPLANT STENT Minor 100 20 155
ENDOSCOPIC EXAMINATION OF URETER (+/- CYSTOSCOPY AND
INSERTION/REMOVAL OF STENT) 250 50 300
ENDOSCOPIC RETROGRADE PYELOGRAPHY (INCLUDING BILATERAL AND
EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY OF CALCULUS OF URETER
250 50 300
System Category Day
DRG 12.2M3202 OPERATIONS ON URETERIC ORIFICE (INCLUDING ENDOSCOPIC) Intermediate 250 50 300
DRG 12.3 BLADDER
PERCUTANEOUS POSTERIOR TIBIAL NERVE STIMULATION (PTNS) FOR
DRG 12.3A7081 Minor
OVERACTIVE BLADDER (OAB) SYNDROME OR FAECAL INCONTINENCE 100 20 155
ENDOSCOPIC INVESTIGATION OF BLADDER USING HEXAMINOLEVULINATE
DRG 12.3M4290 Major
BLUE LIGHT FLORESCENCE +/- RESECTION OF LESIONS 500 100 450
ENDOSCOPIC VESICO-URETERIC ANTI-REFLUX PROCEDURE (AND
BILATERAL) (INCLUDING CYSTOSCOPY) 250 50 300
DRG 12.3M4713 BLADDER INSTILLATION AS SOLE PROCEDURE Minor 100 20 155
THERAPEUTIC INJECTION INTO BLADDER WALL (INCLUDING CYSTOSCOPY)
DRG 12.3M4714 Minor
100 20 155
OPEN TOTAL CYSTECTOMY (WITH CONSTRUCTION OF INTESTINAL CONDUIT
OR BLADDER) 1000 150 950
DRG 12.3M3420 LAPAROSCOPIC CYSTECTOMY (INCLUDING CYSTOSCOPY) Complex 1000 150 950
DRG 12.3M3500 PARTIAL CYSTECTOMY (INCLUDING CYSTOSCOPY) Major 500 100 450
DRG 12.3M3510 DIVERTICULECTOMY OF BLADDER Major 500 100 450
DRG 12.3M3600 ENLARGEMENT OF BLADDER (INCLUDING CYSTOSCOPY) Complex 1000 150 950
DRG 12.3M3602 ENTEROCYSTOPLASTY (INCLUDING CYSTOSCOPY) Complex 1000 150 950
DRG 12.3M3640 REPAIR OF BLADDER EXSTROPHY Complex 1000 150 950
DRG 12.3M3700 REPAIR OF BLADDER (INCLUDING CYSTOSCOPY) Major 500 100 450
DRG 12.3M3720 REPAIR OF VESICOCOLIC FISTULA Xmajor 600 120 730
DRG 12.3M3780 REPAIR OF CUTANEOUS VESICAL FISTULA Intermediate 250 50 300
CYSTOSTOMY AND INSERTION OF SUPRAPUBIC TUBE INTO BLADDER
DRG 12.3M3880 STAB CYSTOSTOMY Minor 100 20 155
OPEN REMOVAL OF CALCULUS FROM BLADDER (INCLUDING CYSTOSCOPY)
250 50 300
DRG 12.3M4110 OPEN EXCISION OF LESION FROM BLADDER (INCLUDING CYSTOSCOPY) Major 500 100 450
ENDOSCOPIC RESECTION OF LESION OF BLADDER (INCLUDING
DRG 12.3M4210 Major
ENDOSCOPIC DESTRUCTION OF LESION OF BLADDER (INCLUDING
DRG 12.3M4310 ENDOSCOPIC TRANSECTION OF BLADDER (INCLUDING CYSTOSCOPY) Major 500 100 450
ENDOSCOPIC HYDROSTATIC DISTENTION OF BLADDER (INCLUDING
DRG 12.3M4320 Minor
DRG 12.3M4400 URETHRAL SPHINCTEROTOMY (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
ENDOSCOPIC EXAMINATION OF BLADDER (RIGID CYSTOSCOPY) INCLUDING
DRG 12.3M4514 Minor
ANY BIOPSY 100 20 155
DRG 12.3M4410 LITHOLAPAXY (INCLUDING CYSTOSCOPY) Major 500 100 450
ENDOSCOPIC EXTRACTION OF CALCULUS OF BLADDER (INCLUDING
ENDOSCOPIC REMOVAL OF FOREIGN BODY FROM BLADDER (INCLUDING
DRG 12.3M4480 RESECTION OF BLADDER NECK (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
DIAGNOSTIC ENDOSCOPIC EXAMINATION OF BLADDER (FLEXIBLE
DRG 12.3M4510 Minor
CYSTOSCOPY) INCLUDING ANY BIOPSY 100 20 155
System Category Day
BLADDER INSTILLATION OF PHARMACOLOGIC AGENT (INCLUDING
DRG 12.3M4712 Minor
DRG 12.3M4910 CLOSURE OF CYSTOSTOMY Intermediate 250 50 300
COMBINED ABDOMINAL AND VAGINAL OPERATIONS TO SUPPORT OUTLET
DRG 12.3M5100 OF FEMALE BLADDER (INCLUDING SLING PROCEDURES) (INCLUDING Major
REVISION COMBINED ABDOMINAL AND VAGINAL OPERATIONS TO SUPPORT
DRG 12.3M5180 OUTLET OF FEMALE BLADDER (INCLUDING SLING PROCEDURES AND Xmajor
RETROPUBIC SUSPENSION OF NECK OF BLADDER (INCLUDING
DRG 12.3M5220 Major
COLPOSUSPENSION) (INCLUDING CYSTOCOPY) 500 100 450
DRG 12.3M5222 LAPAROSCOPIC COLPOSUSPENSION Major 500 100 450
DRG 12.3M5250 NEEDLE SUSPENSION OF BLADDER NECK (INCLUDING CYSTOSCOPY) Major 500 100 450
REVISION RETROPUBIC SUSPENSION OF NECK OF BLADDER (INCLUDING
DRG 12.3M5280 Major
COLPOSUSPENSION AND CYSTOSCOPY) 500 100 450
VAGINAL OPERATIONS TO SUPPORT OUTLET OF FEMALE BLADDER
DRG 12.3M5300 Major
IMPLANTATION OF ARTIFICIAL URINARY SPHINCTER AT BLADDER NECK
DRG 12.3M5520 Major
AND/OR REMOVAL (INCLUDING CYSTOSCOPY) 500 100 450
THERAPEUTIC INJECTION INTO BLADDER NECK FOR TREATMENT OF
DRG 12.3M5630 STRESS INCONTINENCE (PERIURETHRAL BULKING AGENTS), INCLUDING Intermediate
CYSTOSCOPY 250 50 300
DRG 12.3M5820 DILATATION OF OUTLET OF FEMALE BLADDER (WITH CYSTOSCOPY) Minor 100 20 155
OPERATION TO SUPPORT OUTLET OF MALE BLADDER (INCLUDING SLING
DRG 12.3M6480 Major
PROCEDURES) (INCLUDING CYSTOSCOPY) 500 100 450
ENDOSCOPIC INCISION OF OUTLET OF MALE BLADDER (WITH CYSTOSCOPY)
250 50 300
INSERTION OF SUBURETHRAL TAPE SLING (E.G. TOT OR TVT) +/-
DRG 12.3M7590 ADMINISTRATION OF LOCAL ANAESTHETIC BY OPERATING SURGEON Major
DRG 12.3P2510 REPAIR OF VESICOVAGINAL FISTULA Major 500 100 450
DRG 12.4 URETHRA
DRG 12.4M5580 EXCISION OF URETHRAL CARUNCLE Minor 100 20 155
THERAPEUTIC ENDOSCOPIC OPERATIONS ON OUTLET OF FEMALE BLADDER
DRG 12.4M7200 URETHRECTOMY Major 500 100 450
DRG 12.4M7280 URETHRAL VALVE RESECTION Major 500 100 450
DRG 12.4M7312 REPAIR OF PENILE/PERINEAL HYPOSPADIAS Major 500 100 450
DRG 12.4M7313 REPAIR OF PENILE SHAFT HYPOSPADIAS Major 500 100 450
DRG 12.4M7314 REPAIR OF DISTAL HYPOSPADIA Intermediate 250 50 300
SECONDARY ADJUSTMENT OF PENILE SKIN FOLLOWING HYPOSPADIAS
DRG 12.4M7315 Major
REPAIR 500 100 450
DRG 12.4M7316 COMPLEX SECONDARY REPAIR OF HYPOSPADIAS Xmajor 600 120 730
DRG 12.4M7320 REPAIR OF EPISPADIAS Xmajor 600 120 730
DRG 12.4M7330 CLOSURE OF FISTULA OF URETHRA (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
DRG 12.4M7332 CLOSURE OF FISTULA OF URETHRA AFTER HYPOSPADIAS Major 500 100 450
DRG 12.4M7340 REPAIR OF URETHRORECTAL FISTULA Major 500 100 450
System Category Day
SIMPLE URETHROPLASTY, EG PRIMARY REPAIR, SEGMENT, ANTERIOR
DRG 12.4M7360 Major
URETHRA (INCLUDING CYSTOSCOPY) 500 100 450
DRG 12.4M7380 REPAIR OF RUPTURE OF URETHRA (INCLUDING CYSTOSCOPY) Major 500 100 450
DRG 12.4M7500 EXCISION OF DIVERTICULUM OF URETHRA (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
DRG 12.4M7620 REMOVAL OF FOREIGN BODY FROM URETHRA Minor 100 20 155
DIAGNOSTIC ENDOSCOPIC EXAMINATION OF URETHRA (AS SOLE
DRG 12.4M7700 Minor
PROCEDURE) (INCLUDING CYSTOSCOPY) 100 20 155
DRG 12.4M7920 DILATATION OF URETHRA (INCLUDING CYSTOSCOPY) Minor 100 20 155
DRG 12.4M7940 INTERNAL URETHROTOMY (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
DRG 12.5 PROSTATE
PLANNING FOR INSERTION AND REMOVAL OF A RADIOACTIVE AGENT
DRG 12.5BT211 Major
(BRACHYTHERAPY) INTO PROSTATE TUMOUR 500 100 450
INSERTION OF LOW DOSE RADIOACTIVE AGENT (BRACHYTHERAPY) INTO
DRG 12.5BT212 Complex
PROSTATE TUMOUR 1000 150 950
INSERTION AND REMOVAL OF HIGH DOSE RADIOACTIVE AGENT
DRG 12.5BT222 Complex
(BRACHYTHERAPY) INTO PROSTATE TUMOUR 1000 150 950
LIMITED/SINGLE CORE TRANSRECTAL NEEDLE BIOPSY OF PROSTATE +/-
DRG 12.5M7030 Minor
ULTRASOUND GUIDANCE 100 20 155
DRG 12.5M6100 OPEN EXCISION OF PROSTATATIC ADENOMA Major 500 100 450
RADICAL PROSTATECTOMY, RECONSTRUCTION OF BLADDER NECK
DRG 12.5M6180 INCLUDING BILATERAL PELVIC LYMPHADENECTOMY (INCLUDING Complex
LAPAROSCOPIC RADICAL PROSTATECTOMY, RECONSTRUCTION OF
DRG 12.5M6182 BLADDER NECK INCLUDING BILATERAL PELVIC LYMPHADENECTOMY Complex
ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY (INCLUDING
DRG 12.5M6192 n/a
CYSTOSCOPY) 1600 550
ENDOSCOPIC RESECTION OF PROSTATE (TUR) (INCLUDING CYSTOSCOPY)
250 50 300
HOLMIUM LASER RESECTION OF PROSTATE (HOLRP) (INCLUDING
DRG 12.5M6532 Major
DRG 12.5M6533 HOLMIUM LASER ENUCLEATION OF PROSTATIC ADENOMA (HOLEP) Major 500 100 450
DRG 12.5M6580 ENDOSCOPIC BIOPSY OF PROSTATE (INCLUDING CYSTOSCOPY) Intermediate 250 50 300
TRANSPERINEAL TEMPLATE-GUIDED BIOPSIES OF THE PROSTATE UNDER
IMAGE GUIDANCE 250 50 300
DRG 12.5M6712 PROSTATIC CRYOTHERAPY Complex 1000 150 950
DRG 12.5M6720 TRANSURETHRAL MICROWAVE THERAPY Intermediate 250 50 300
DRG 12.5M6730 DRAINAGE OF PROSTATIC ABSCESS Intermediate 250 50 300
DRG 12.5M6750 TRANSURETHRAL NEEDLE ABLATION (TUNA) Major 500 100 450
PHOTOSELECTIVE VAPORISATION OF PROSTATE (GREENLIGHT/NIAGARA
LASER PVP) (INCLUDING CYSTOSCOPY) 600 120 730
PHOTOSELECTIVE VAPORISATION OF PROSTATE (KTP LASER PVP)
HIGH INTENSITY FOCUSED ULTRASOUND OF PROSTATE (INCLUDING
DRG 12.5M6780 PROSTATIC HYPERTHERMIA (UP TO SIX COURSES) Major 500 100 450
TRANSRECTAL SEXTANT NEEDLE BIOPSY OF PROSTATE WITH ULTRASOUND
DRG 12.5M7020 Minor
GUIDANCE 100 20 155
System Category Day
INSERTION OF URETHRAL STENT FOR RELIEF OF PROSTATIC OBSTRUCTION
DRG 12.5M7080 Major
DRG 12.6 GENITALIA
DRG 12.6G8120 MEATOPLASTY Intermediate 250 50 300
DRG 12.6G8130 EXTERNAL MEATOTOMY OF URETHRAL ORIFICE Minor 100 20 155
DRG 12.6G500 BILATERAL EXCISION OF TESTES Major 500 100 450
DRG 12.6G630 LAPAROSCOPIC ORCHIDECTOMY Intermediate 250 50 300
ORCHIDECTOMY AND EXCISION OF SPERMATIC CORD (+/- INSERTION OF
PROSTHESIS) 250 50 300
DRG 12.6G700 EXCISION OF LESION OF TESTIS Intermediate 250 50 300
DRG 12.6G820 ORCHIDOPEXY BILATERAL Intermediate 250 50 300
DRG 12.6G920 ORCHIDOPEXY Intermediate 250 50 300
DRG 12.6G1000 PROSTHESIS OF TESTIS (INSERTION OR REMOVAL) Intermediate 250 50 300
DRG 12.6G1100 CORRECTION OF HYDROCELE(S) – UNILATERAL Intermediate 250 50 300
DRG 12.6G1320 FIXATION OF TESTIS Intermediate 250 50 300
DRG 12.6G1340 BIOPSY OF TESTIS Minor 100 20 155
DRG 12.6G1350 EXPLORATION OF TESTIS (INCLUDING BIOPSY) Intermediate 250 50 300
DRG 12.6N1352 LAPAROSCOPY FOR IMPALPABLE TESTIS Intermediate 250 50 300
DRG 12.6N1380 BILATERAL FIXATION OF TESTIS Intermediate 250 50 300
DRG 12.6N1510 BILATERAL EPIDIDYMECTOMY Intermediate 250 50 300
DRG 12.6N1520 UNILATERAL EPIDIDYMECTOMY Minor 100 20 155
DRG 12.6N1580 EXCISION OF EPIDIDYMAL CYST Intermediate 250 50 300
DRG 12.6N1900 OPERATION(S) ON VARICOCELE Intermediate 250 50 300
DRG 12.6N1910 LAPAROSCOPIC VARICOCELECTOMY Intermediate 250 50 300
DRG 12.6N2200 OPERATION(S) ON SEMINAL VESICLE Intermediate 250 50 300
DRG 12.6N2610 TOTAL AMPUTATION OF PENIS Major 500 100 450
DRG 12.6N2620 PARTIAL AMPUTATION OF PENIS Major 500 100 450
DRG 12.6N2710 EXCISION OF LESION OF PENIS Intermediate 250 50 300
DRG 12.6N2780 OPERATION FOR PEYRONIE'S DISEASE (EG NESBITT'S) Intermediate 250 50 300
DRG 12.6N2781 LUE'S PROCEDURE FOR PEYRONIE'S DISEASE Intermediate 250 50 300
DRG 12.6N3032 REVISION OF CIRCUMCISION Intermediate 250 50 300
DRG 12.6N2820 RECONSTRUCTION OF PENIS Major 500 100 450
DRG 12.6N2840 REPAIR OF AVULSION OF PENIS Major 500 100 450
DRG 12.6N2842 FRENULOPLASTY OF PENIS Minor 100 20 155
DRG 12.6N2880 REPAIR OF INJURY TO PENIS Intermediate 250 50 300
DRG 12.6N3010 PREPUTIOPLASTY Intermediate 250 50 300
DRG 12.6N3020 DIVISION OF PREPUTIAL ADHESIONS Minor 100 20 155
DRG 12.6N3021 CIRCUMCISION ADULT Intermediate 250 50 300
DRG 12.6N3030 CIRCUMCISION INFANT / CHILD Minor 100 20 155
DRG 12.6G3031 VASECTOMY Intermediate 250 50 300
DRG 12.6N3210 BIOPSY OF LESION OF PENIS Minor 100 20 155
DRG 13 PREGNANCY AND CONFINEMENT
DRG 13.1 PREGNANCY AND CONFINEMENT
DRG 13.1R1210 CERCLAGE OF CERVIX OF GRAVID UTERUS (One Day Stay Included) Minor 100 20 155
REMOVAL OF CERCLAGE OF CERVIX OF GRAVID UTERUS -Day Case Under GA
DRG 13.1R1220 Minor
90 75 10
DRG 13.1R1221 REMOVAL OF CERCLAGE OF CERVIX OF GRAVID UTERUS -Day Case Package 90 0 10
CPT 59426 ANTENATAL COMPREHENSIVE FOLLOW-UP Package 280 0 0
System Category Day
DRG 13.1R1820 ANTENATAL, CESAREAN AND POSTNATAL Package 1200 0
NORMAL DELIVERY WITHOUT EPIDURAL-COMPLICATION NOT INCLUDED-(2
CPT 59409 Package
DAYS STAY SINGLE ROOM) 600 0 0
CESAREAN SECTION, 1ST CESAREAN (INCLUDES 4 DAYS STAY SINGLE
CPT 59514 Package
ROOM) COMPLICATION NOT INCLUDED 950 0 0
CESAREAN SECTION, 2ND CESAREAN (4 DAYS STAY) COMPLICATION NOT
CPT Package
59620 INCLUDED 950 0 0
CESAREAN SECTION, 3RD CESAREAN (4 DAYS STAY) COMPLICATION NOT
CPT Package
59620-01 INCLUDED 750 0 250
ANTENATAL, NORMAL DELIVERAY AND POSTNATAL FIRST VISIT (FOR
CPT 59400 Package
UNCOMPLICATED PREGNANCY) 850 0 0
DRG 13.1R2120 FORCEPS CEPHALIC DELIVERY (INCLUDES 2 DAYS STAY) Intermediate 250 50 300
DRG 13.1R2130 VAGINAL DELIVERY (INCLUDES 2 DAYS STAY) Intermediate 250 50 300
DRG 13.1R2135 VAGINAL DELIVERY, WALK-IN PATIENT Intermediate 250 50 300
CAESAREAN DELIVERY, WALK-IN PATIENT (4 DAYS STAY) COMPLICATION
DRG 13.1R2140 Major
NOT INCLUDED 500 100 450
DRG 13.1R2510 CAESAREAN HYSTERECTOMY (4 DAYS STAY) Xmajor 600 120 730
CPT 59414 Manual Removal of placenta; GA Minor 50 50
DILATION OF CERVIX UTERI AND CURETTAGE OF RETAINED PRODUCTS OF
DRG 14.3Q1010 CONCEPTION FOLLOWING SPONTANEOUS ABORTION (ONE DAY STAY Minor
INCLUDED) 150 75 75
DILATATION OF CERVIX UTERI AND CURETTAGE OF UTERUS INCLUDING
DRG 14.3Q1030 Minor
POLYPECTOMY AND DIATHERMY OF CERVIX (ONE DAY STAY INCLUDED) 150 75 75
DRG 14.3Q1031 Minor
POLYPECTOMY AND DIATHERMY OF CERVIX (ONE DAY STAY INCLUDED) 150 75 75
Ligation or transection of fallopian tube(s), abdominal or vaginal approach,
CPT postpartum, unilateral or bilateral, during same hospitalization (separate procedure) Minor
58605 (ONE DAY STAY INCLUDED) 200 75 25
Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery
CPT Minor
58611 or intra-abdominal surgery (not a separate procedure) 100 0 0
EPIDURAL INJECTION; IMPLANTATION OR REPLACEMENT OF DEVICE FOR
CPT INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, Injection
62362 INCLUDING PREPARATION OF PUMP, 100 0 0
CPT 59025 FOETAL NON STRESS TEST (CTG) Service 5 0 0
CPT 76817 CLINIC ULTRASOUND Service 10 0 0
CPT 58300 Insertion of intrauterine device (IUD) 40 0 0
DRG 14 FEMALE REPRODUCTIVE ORGANS
DRG 14.1 UTERUS/ADNEXA
RADICAL HYSTERECTOMY AND LYMPHADENECTOMY (WERTHEIM'S) +/-
DRG 14.1Q0710 Complex
URETEROLYSIS 1000 150 950
RADICAL TRACHELECTOMY INCLUDING LAPAROSCOPIC AND REMOVAL OF
DRG 14.1Q0712 Complex
LYMPH NODES +/- URETEROLYSIS 1000 150 950
TOTAL ABDOMINAL HYSTERECTOMY (+/- OOPHORECTOMY) +/-
DRG 14.1Q0740 Major
VAGINAL HYSTERECTOMY INCLUDING SALPINGO-OOPHORECTOMY
DRG 14.1Q0890 Xmajor
(INCLUDING LAPAROSCOPICALLY ASSISTED) +/- URETEROLYSIS 600 120 730
VAGINAL HYSTERECTOMY WITH LAPAROSCOPIC ASSISTANCE +/-
DRG 14.1Q0830 Major
System Category Day
SUBTOTAL ABDOMINAL HYSTERECTOMY (+/- OOPHORECTOMY) +/-
DRG 14.1Q0750 Major
LAPAROSCOPIC SUBTOTAL HYSTERECTOMY (+/- OOPHORECTOMY) +/-
DRG 14.1Q0751 Major
DRG 14.1Q2081 MYOLYSIS OF UTERINE FIBROIDS Major 500 100 450
DRG 14.1Q0800 VAGINAL HYSTERECTOMY WITHOUT LAPAROSCOPIC ASSISTED Major 500 100 450
LAPAROSCOPIC TOTAL HYSTERECTOMY (+/- OOPHORECTOMY) +/-
DRG 14.1Q0790 Major
HYSTERECTOMY WITH EXCISION / BIOPSY AND/OR REMOVAL OF OMENTUM
DRG 14.1Q0880 Xmajor
AND UTERINE ADNEXA FOR OVARIAN MALIGNANCY +/- URETEROLYSIS 600 120 730
DRG 14.1Q0920 MYOMECTOMY (INCLUDING LAPAROSCOPICALLY) +/- URETEROLYSIS Major 500 100 450
DRG 14.1Q0950 PLASTIC RECONSTRUCTION OF UTERUS Major 500 100 450
THERAPEUTIC ENDOSCOPIC OPERATIONS ON UTERUS (INCLUDING
DRG 14.1Q1700 ENDOMETRIAL ABLATION EXCLUDING MICROWAVE OR RADIOFREQUENCY Major
ABLATION) 500 100 450
DRG 14.1Q1701 LAPAROSCOPIC EXCISION OF ENDOMETRIOSIS, +/-URETEROLYSIS Major 500 100 450
DRG 14.1Q1702 MICROWAVE ENDOMETRIAL ABLATION INCLUDING HYSTEROSCOPY Major 500 100 450
IMPEDANCE CONTROLLED BIPOLAR RADIOFREQUENCY ABLATION FOR
DRG 14.1Q1703 Major
MENORRHAGIA INCLUDING HYSTEROSCOPY 500 100 450
HYSTEROSCOPY (INCLUDING BIOPSY, DILATATION, CURETTAGE AND
DRG 14.1Q1800 Intermediate
RESECTION OF POLYP(S) +/- MIRENA COIL INSERTION) 250 50 300
HYSTEROSCOPY WITH RESECTION OF FIBROIDS +/- INSERTION ON MIRENA
DRG 14.1Q1802 Major
COIL 500 100 450
OOPHORECTOMY AND SALPINGECTOMY, +/- BIOPSY EG. OMENTUM,
DRG 14.1Q2230 Major
PERITONEUM, LYMPH NODE (AS SOLE PROCEDURE) (INCLUDING BILATERAL) 500 100 450
REMOVAL OF PRODUCTS OF CONCEPTION FROM FALLOPIAN TUBE
DRG 14.1Q3110 Major
(ECTOPIC PREGNANCY) INCLUDING LAPAROSCOPICALLY 500 100 450
LAPAROSCOPY AND THERAPEUTIC PROCEDURES (INCLUDING LASER,
DRG 14.1Q3800 DIATHERMY AND DESTRUCTION E.G. ENDOMETRIOSIS, ADHESIOLYSIS, Major
TUBAL AND OVARIAN SURGERY, +/-URETEROLYSIS) 500 100 450
LAPAROSCOPY (INCLUDING E.G. PUNCTURE OF OVARIAN CYSTS, +/- BIOPSY,
MINOR ENDOMETRIOSIS, +/- URETEROLYSIS) 250 50 300
OVARIAN CYSTECTOMY +/- OMENTAL BIOPSY (AS SOLE PROCEDURE AND
DRG 14.1Q4400 Major
INCLUDING BILATERAL) 500 100 450
DRG 14.1T8580 BLOCK DISSECTION OF PELVIC LYMPH NODES (AS SOLE PROCEDURE) Major 500 100 450
DRG 14.1X1410 TOTAL EXENTERATION OF PELVIS Complex 1000 150 950
DRG 14.1X1420 ANTERIOR EXENTERATION OF PELVIS Complex 1000 150 950
DRG 14.1X1430 POSTERIOR EXENTERATION OF PELVIS Complex 1000 150 950
DRG 14.2 SUSPENSION
COMBINED ABDOMINAL AND VAGINAL OPERATIONS TO SUPPORT OUTLET
DRG 14.2M5100 Major
OF FEMALE BLADDER (INCLUDING SLING PROCEDURES) 500 100 450
REVISION COMBINED ABDOMINAL AND VAGINAL OPERATIONS TO SUPPORT
DRG 14.2M5180 OUTLET OF FEMALE BLADDER (INCLUDING SLING PROCEDURES AND Xmajor
RETROPUBIC SUSPENSION OF NECK OF BLADDER (INCLUDING
DRG 14.2M5220 Major
COLPOSUSPENSION) 500 100 450
System Category Day
DRG 14.2M5250 NEEDLE SUSPENSION OF BLADDER NECK Intermediate 250 50 300
REVISION RETROPUBIC SUSPENSION OF NECK OF BLADDER (INCLUDING
DRG 14.2M5280 Major
COLPOSUSPENSION AND CYSTOSCOPY) 500 100 450
VAGINAL OPERATIONS TO SUPPORT OUTLET OF FEMALE BLADDER
DRG 14.2M5300 Major
THERAPEUTIC INJECTION INTO BLADDER NECK FOR TREATMENT OF
DRG 14.2M5630 STRESS INCONTINENCE (PERIURETHRAL BULKING AGENTS), INCLUDING Intermediate
CYSTOSCOPY 250 50 300
INSERTION OF SUBURETHRAL TAPE SLING (E.G. TOT OR TVT) +/-
DRG 14.2M7590 ADMINISTRATION OF LOCAL ANAESTHETIC BY OPERATING SURGEON Major
DRG 14.2Q2080 VENTROSUSPENSION OF UTERUS (INCLUDING LAPAROSCOPIC) Intermediate 250 50 300
DRG 14.3 CERVIX UTERI
PLANNING FOR INSERTION AND REMOVAL OF A RADIOACTIVE AGENT
(BRACHYTHERAPY) INTO CERVIX OR OTHER FEMALE INTRA-PELVIC TISSUE 250 50 300
INSERTION AND REMOVAL OF A RADIOACTIVE AGENT (BRACHYTHERAPY)
DRG 14.3BT342 Major
INTO CERVIX OR OTHER FEMALE INTRA-PELVIC TISSUE 500 100 450
DRG 14.3Q0100 AMPUTATION OF CERVIX UTERI Intermediate 250 50 300
LASER DESTRUCTION OF LESION OF CERVIX UTERI (+/- COLPOSCOPY OR
DRG 14.3Q0220 Minor
POLYPECTOMY) 100 20 155
CAUTERISATION OF LESION OF CERVIX UTERI (+/- LOOP DIATHERMY,
DRG 14.3Q0230 Minor
COLPOSCOPY OR POLYPECTOMY) 100 20 155
CONE BIOPSY OF CERVIX UTERI AND/OR (+/- LASER, COLPOSCOPY OR
POLYPECTOMY) 250 50 300
DRG 14.3Q0340 PUNCH BIOPSY OF CERVIX UTERI Minor 100 20 155
DILATION OF CERVIX UTERI AND CURETTAGE OF RETAINED PRODUCTS OF
CONCEPTION FOLLOWING SPONTANEOUS ABORTION. 250 50 300
DRG 14.3Q10301 Minor
POLYPECTOMY AND DIATHERMY OF CERVIX 100 20 155
DRG 14.4 VAGINA/PERINEUM
DRG 14.4M3710 CYSTOURETHROPLASTY (INCLUDING CYSTOSCOPY) Major 500 100 450
DRG 14.4M5582 DIATHERMY OF URETHRAL CARUNCLE Minor 100 20 155
DRG 14.4P1300 OPERATIONS ON FEMALE PERINEUM Minor 100 20 155
DRG 14.4P1400 INCISION OF INTROITUS OF VAGINA Minor 100 20 155
DRG 14.4P1920 EXCISION OF SEPTUM OF VAGINA Intermediate 250 50 300
DRG 14.4P2000 EXCISION OF LESION OF VAGINA (E.G. WARTS AND CYSTS) Intermediate 250 50 300
DRG 14.4P2100 RECONSTRUCTION OF VAGINA Xmajor 600 120 730
ANTERIOR +/- POSTERIOR COLPORRHAPHY AND AMPUTATION OF CERVIX
DRG 14.4P2210 Major
UTERI (INCLUDING PRIMARY REPAIR OF ENTEROCELE) 500 100 450
DRG 14.4P2230 POSTERIOR COLPORRHAPHY Intermediate 250 50 300
ANTERIOR +/- POSTERIOR COLPORRHAPHY (INCLUDING PRIMARY REPAIR
DRG 14.4P2310 Major
OF ENTEROCELE) (INCLUDING CYSTOSCOPY) 500 100 450
REPAIR OF ENTEROCELE (+/- POSTERIOR REPAIR COLPORRHAPHY) (AS
DRG 14.4P2340 Major
DRG 14.4P2930 BIOPSY OF LESION OF VAGINA Minor 100 20 155
System Category Day
ANTERIOR (+/- POSTERIOR) COLPORRHAPHY WITH VAGINAL
DRG 14.4P2380 HYSTERECTOMY (INCLUDING PRIMARY REPAIR OF ENTEROCELE AND Xmajor
DRG 14.4P2420 SACROCOLPOPEXY (INCLUDING LAPAROSCOPIC) Major 500 100 450
DRG 14.4P2450 SACROSPINOUS FIXATION Major 500 100 450
DRG 14.4P2510 REPAIR OF VESICOVAGINAL FISTULA (INCLUDING CYSTOSCOPY) Major 500 100 450
DRG 14.4P2520 REPAIR OF URETHROVAGINAL FISTULA (INCLUDING CYSTOSCOPY) Major 500 100 450
DRG 14.4P2530 REPAIR OF RECTOVAGINAL FISTULA Xmajor 600 120 730
PLANNING FOR INSERTION AND REMOVAL OF RADIOACTIVE AGENT
(BRACHYTHERAPY) INTO VAGINAL TUMOUR 350 0 150
INSERTION AND REMOVAL OF RADIOACTIVE AGENT (BRACHYTHERPY) INTO
DRG 14.4BT282 Major
VAGINAL TUMOUR 500 100 450
TOTAL REMOVAL OF VAGINAL MESH/TAPE WITH RECONSTRUCTION OF
DRG 14.4P2120 VAGINA AND/OR URETHA, INCLUDING CYSOSCOPY AND/OR PROCTOSCOPY Complex
[FEES ON APPLICATION] 1000 150 950
PARTIAL REMOVAL OF VAGINAL MESH/TAPE WITH RECONSTRUCTION OF
DRG 14.4P2110 VAGINA AND OR/URETHA, INCLUDING CYSTOSCOPY AND/OR PROCTOSCOPY Complex
[FEES ON APPLICATION] 1000 150 950
DRG 14.4P2932 EXAMINATION OF VAGINA UNDER ANAESTHETIC AS SOLE PROCEDURE Minor 100 20 155
DRG 14.5 VULVA/LABIA
DRG 14.5P0310 EXCISION OF BARTHOLIN GLAND Intermediate 250 50 300
DRG 14.5P0320 MARSUPIALISATION OF BARTHOLIN CYST Intermediate 250 50 300
DRG 14.5P0510 SIMPLE VULVECTOMY Major 500 100 450
RADICAL VULVECTOMY (INCLUDING BLOCK DISSECTION OF INGUINAL
DRG 14.5P0580 Complex
GLAND) 1000 150 950
DRG 14.5P0600 EXCISION OF LESION OF VULVA Minor 100 20 155
DRG 14.5P0910 BIOPSY OF LESION OF VULVA Minor 100 20 155
DRG 15 SKIN AND SUBCUTANEOUS TISSUE
DRG 15.1 LESIONS OF SKIN
DRG 15.1H5680 EXCISION OF PRESSURE SORE EXCLUDING REPAIR Intermediate 250 50 300
DRG 15.1S0410 WIDE EXCISION OF SWEAT GLANDS - BILATERAL AXILLAE Intermediate 250 50 300
MICROSCOPICALLY CONTROLLED EXCISION OF LESION OF SKIN OR
DRG 15.1S0520 SUBCUTANEOUS TISSUE (MOHS MICROGRAPHIC SURGERY) WITH Xmajor
IMMEDIATE RECONSTRUCTION 600 120 730
DRG 15.1S0602 PRIMARY EXCISION OF MALIGNANT LESION - HEAD AND NECK Intermediate 250 50 300
DRG 15.1S0603 PRIMARY EXCISION OF MALIGNANT LESION - TRUNK AND LIMBS Intermediate 250 50 300
DRG 15.1S0604 SECONDARY EXCISION OF MALIGNANT LESION - HEAD AND NECK Intermediate 250 50 300
DRG 15.1S0605 SECONDARY EXCISION OF MALIGNANT LESION - TRUNK AND LIMBS Intermediate 250 50 300
MICROSCOPICALLY CONTROLLED EXCISION OF LESION OF SKIN OR
DRG 15.1S0521 SUBCUTANEOUS TISSUE (MOHS MICROGRAPHIC SURGERY) WITHOUT Major
PHOTODYNAMIC THERAPY TO MALIGNANT LESION OF SKIN - UP TO THREE
DRG 15.1S0606 Intermediate
350 0 150
PHOTODYNAMIC THERAPY TO MALIGNANT LESION OF SKIN - FOUR OR MORE
DRG 15.1S0607 Major
500 100 450
DRG 15.1S0608 SENTINEL LYMPH NODE BIOPSY FOR MELANOMA Intermediate 250 50 300
EXCISION OF LESION OF SKIN OR SUBCUTANEOUS TISSUE - UP TO THREE,
DRG 15.1S0632 Minor
HEAD & NECK (EXCLUDING LIPOMA) 100 20 155
System Category Day
EXCISION OF LESION OF SKIN OR SUBCUTANEOUS TISSUE - UP TO THREE,
DRG 15.1S0633 Minor
TRUNK & LIMBS (EXCLUDING LIPOMA) 100 20 155
EXCISION OF LESION OF SKIN OR SUBCUTANEOUS TISSUE - FOUR OR
MORE, HEAD & NECK (EXCLUDING LIPOMA) 250 50 300
EXCISION OF LESION OF SKIN OR SUBCUTANEOUS TISSUE - FOUR OR
MORE, TRUNK & LIMBS (EXCLUDING LIPOMA) 250 50 300
REMOVAL OF BENIGN LESION ON TRUNK OR LIMBS LESS THAN 10 CM IN
DRG 15.1S0651 DIAMETER OR ON SCALP LESS THAN 5CM IN DIAMETER (EXCLUDING Minor
LIPOMA) 100 20 155
REMOVAL OF BENIGN LESION ON TRUNK OR LIMBS GREATER THAN 10 CM IN
DRG 15.1S0652 DIAMETER OR ON SCALP GREATER THAN 5 CM IN DIAMETER (EXCLUDING Intermediate
LIPOMA) 250 50 300
REMOVAL OF BENIGN LESION IN MUSCLE OR DEEPER TISSUE (EXCLUDING
LIPOMA) 250 50 300
REMOVAL OF BENIGN LESION ON HEAD AND NECK (EXCLUDING SCALP)
DRG 15.1S0654 WHICH IS CLOSED BY PRIMARY CLOSURE OR ADVANCEMENT FLAP Intermediate
(EXCLUDING LIPOMA) 250 50 300
REMOVAL OF BENIGN LESION ON HEAD AND NECK REQUIRING FLAP
CLOSURE (EXCLUDING ADVANCEMENT FLAP) (EXCLUDING LIPOMA) 250 50 300
DRG 15.1S0656 REMOVAL OF LIPOMA Intermediate 250 50 300
CURETTAGE/CRYOTHERAPY OF LESIONS OF SKIN INCLUDING
CAUTERISATION - FOUR OR MORE 250 50 300
DRG 15.1S0922 LASER DESTRUCTION OF LESION(S) OF SKIN - UP TO 25CM² IN AREA Minor 150 0 50
DRG 15.1S0923 LASER DESTRUCTION OF LESION(S) OF SKIN - OVER 25CM² IN AREA Minor 150 0 50
DRG 15.1S0940 PHOTODYNAMIC THERAPY TO NON MALIGNANT LESIONS OF SKIN Intermediate 250 50 300
DRG 15.1S1420 SHAVE BIOPSY OF LESION OF SKIN Minor 100 20 155
DRG 15.1S4480 REMOVAL OF FOREIGN BODY IN DEEPER TISSUE Intermediate 250 50 300
DRG 15.1S4720 DRAINAGE OF LESION OF SKIN, INCLUDING ABSCESS Minor 100 20 155
DRG 15.1S4740 DRAINAGE OF LARGE SUBCUTANEOUS ABSCESS/HAEMATOMA Minor 100 20 155
DRG 15.1S6400 EXCISION OF NAIL BED (ZADIK'S) (INCLUDING ANAESTHETIC) Intermediate 250 50 300
DRG 15.1S7010 WEDGE EXCISION OR AVULSION OF NAIL INCLUDING CHEMICAL ABLATION Minor 100 20 155
OF NAIL BED
DRG 15.2 REPAIR
DEBRIDEMENT AND PRIMARY SUTURE OF WOUND WITH INVOLVEMENT OF
DEEPER TISSUE - HEAD AND NECK 250 50 300
DEBRIDEMENT AND PRIMARY SUTURE OF WOUND WITH INVOLVEMENT OF
DEEPER TISSUE - TRUNK AND LIMBS 250 50 300
DEBRIDEMENT AND PRIMARY SUTURE OF WOUND WITHOUT INVOLVEMENT
DRG 15.2S4212 OF DEEPER TISSUE (SKIN AND SUBCUTANEOUS FAT ONLY) - HEAD AND Intermediate
NECK 250 50 300
DEBRIDEMENT AND PRIMARY SUTURE OF WOUND WITHOUT INVOLVEMENT
DRG 15.2S4213 OF DEEPER TISSUE (SKIN AND SUBCUTANEOUS FAT ONLY) - TRUNK AND Intermediate
LIMBS 250 50 300
DRG 15.2S4230 SECONDARY SUTURE OF SKIN Minor 100 20 155
DRG 15.2S4812 INSERTION OF SKIN EXPANDER INTO TISSUE Intermediate 250 50 300
DRG 15.2S4910 ADJUSTMENT TO SKIN EXPANDER IN SUBCUTANEOUS TISSUE Minor 100 20 155
FAT TRANSFER, INCLUDING EXTRACTION AND VOLUME ADJUSTMENT, OF
SCAR DEFECT FOLLOWING TRAUMA (EXCLUDING BREAST) 250 50 300
DRG 15.2S4930 REMOVAL OF SKIN EXPANDER OR VALVE Intermediate 250 50 300
System Category Day
DEBRIDEMENT OF WOUND (AND SURGICAL TOILET) - UP TO 25CM² IN AREA
DRG 15.2S5710 Minor
100 20 155
DEBRIDEMENT OF WOUND (AND SURGICAL TOILET) - OVER 25CM² IN AREA
DRG 15.2S5712 Minor
100 20 155
RADICAL CLEARANCE OF SARCOMA OF TRUNK OR LIMBS, +/- AMPUTATION
DRG 15.2W0950 Complex
OR INSERTION OF PROSTHESIS 1000 150 950
DRG 15.2W0960 EXCISION OF BENIGN TUMOUR OF BONE WITH BONE GRAFTING Xmajor 600 120 730
RADICAL CLEARANCE OF SARCOMA OF HEAD AND NECK NECESSITATING
FLAP RECONSTRUCTION 1000 150 950
DRG 15.3 BURNS, SCARS AND CONTRACTURES
BURN EXCISION (WOUND/SCAR) HEAD, NECK, HANDS, FEET & GENITALIA, UP
DRG 15.3S5520 Xmajor
TO 9CM² 600 120 730
BURN EXCISION (WOUND/SCAR) HEAD, NECK, HANDS, FEET & GENITALIA,
9CM² - 25CM² 600 120 730
BURN EXCISION (WOUND/SCAR) HEAD, NECK, HANDS, FEET & GENITALIA,
DRG 15.3S5523 Major
GREATER THAN 25CM² 500 100 450
BURN EXCISION (WOUND/SCAR) TRUNK & LIMBS (NOT MORE THAN 2% OF
BODY AREA) 250 50 300
BURN EXCISION (WOUND/SCAR) TRUNK & LIMBS (BETWEEN 2% AND 10% OF
DRG 15.3S5525 Major
BODY AREA) 500 100 450
BURN EXCISION (WOUND/SCAR) TRUNK & LIMBS (BETWEEN 10% AND 25% OF
DRG 15.3S5526 Major
BODY AREA) 500 100 450
DRESSING OF BURN OF SKIN OR SUBCUTANEOUS TISSUE - LESS THAN 2%
DRG 15.3S5532 Minor
100 20 155
DRG 15.3S5533 DRESSING OF BURN OF SKIN OR SUBCUTANEOUS TISSUE - 2% - 10% Minor 100 20 155
DRG 15.3S5534 DRESSING OF BURN OF SKIN OR SUBCUTANEOUS TISSUE - 10% - 25% Minor 100 20 155
DRESSING OF BURN OF SKIN OR SUBCUTANEOUS TISSUE - GREATER THAN
DRG 15.3S5535 Minor
25% 100 20 155
RELEASE OF BURN SCAR CONTRACTURE, HEAD, NECK, HANDS, FEET AND
GENITALIA 600 120 730
DRG 15.3S5562 RELEASE OF BURN SCAR CONTRACTURE, TRUNK AND LIMBS Major 500 100 450
DRG 15.4 FLAPS AND FREE SKIN GRAFTS
DRG 15.401 FLAPS
DRG 15.401S2500 LOCAL FLAP – LESS THAN 9CM2 Major 500 100 450
LOCAL FLAP – 9CM2 OR MORE (EXCLUDING GRAFT/FLAP TO SECONDARY
DRG 15.401S2502 Major
DEFECT) 500 100 450
LOCAL FLAP – 9CM2 OR MORE (INCLUDING GRAFT/FLAP TO SECONDARY
DEFECT) 600 120 730
DRG 15.401S1700 DISTANT FLAP – DELAY/DIVISION/INSET Major 500 100 450
DRG 15.401S2002 SMALL ISLAND FLAP (LESS THAN 9CM2) Major 500 100 450
LARGE ISLAND SKIN FLAP (9CM2 OR MORE) (EG RADICAL FOREARM)
DRG 15.401S2000
INCLUDING CLOSURE OF SECONDARY DEFECT Xmajor 600 120 730
LARGE MYOCUTANEOUS (MUSCULAR/CUTANEOUS) FLAP (9CM2 OR MORE)
INCLUDING CLOSURE OF SECONDARY DEFECT 600 120 730
DRG 15.401B2984 DELAYED RECONSTRUCTION OF BREAST USING PEDICLED TRAM Complex 1000 150 950
LARGE MUSCLE FLAP (9CM2 OR MORE) INCLUDING SKIN GRAFT AND
CLOSURE OF SECONDARY DEFECT 600 120 730
DRG 15.401S2220 NEUROVASCULAR ISLAND FLAP Xmajor 600 120 730
System Category Day
MICROVASCULAR FREE TISSUE TRANSFER (WHEN ADDED TO OTHER
CODES) INCLUDING CLOSURE OF SECONDARY DEFECT 1000 150 950
FREE FUNCTIONING MUSCLE TRANSFER (AS SOLE PROCEDURE) INCLUDING
CLOSURE OF SECONDARY DEFECT 1000 150 950
DISTANT PEDICLE FLAP – ELEVATION INCLUDING TRANSFER (INCLUDING
DRG 15.401S1900 Complex
CLOSURE/GRAFTING TO SECONDARY DEFECT) 1000 150 950
MICROVASCULAR FREE TISSUE TRANSFER (AS SOLE PROCEDURE
INCLUDING CLOSURE OF SECONDARY DEFECT) 1000 150 950
VEIN/ARTERY GRAFT OF PART OF MICROVASCULAR FREE TISSUE
DRG 15.401W3180 FREE COMPOSITE (IE INCLUDING BONE) VASCULARISED GRAFTS Complex 1000 150 950
DRG 15.401S3100 RE-EXPLORATION OF FREE FLAP Xmajor 600 120 730
DRG 15.402 FREE SKIN GRAFTS
DRG 15.402S3500 SPLIT AUTOGRAFT OF SKIN, TRUNK AND LIMBS – UP TO 25CM2 IN AREA Intermediate 250 50 300
SPLIT AUTOGRAFT OF SKIN, TRUNK AND LIMBS – OVER 25CM2 AND UP TO
5% OF BODY SURFACE AREA 500 100 450
SPLIT AUTOGRAFT OF SKIN, TRUNK AND LIMBS – EACH ADDITIONAL 5% OF
BODY SURFACE AREA 500 100 450
DRG 15.402S3622 FULL THICKNESS GRAFT, TRUNK AND LIMBS – UP TO 9CM2 IN AREA Intermediate 250 50 300
FULL THICKNESS GRAFT, TRUNK AND LIMBS – EACH ADDITIONAL 25CM2 IN
DRG 15.402S3623 Minor
AREA 100 20 155
FULL THICKNESS GRAFT, HEAD, NECK, HANDS AND GENITALIA – UP TO 9CM2
IN AREA 500 100 450
FULL THICKNESS GRAFT, HEAD, NECK, HANDS AND GENITALIA EACH
ADDITIONAL 16CM2 IN AREA 100 20 155
DRG 16 BONES, JOINTS AND CONNECTIVE TISSUE/TENDON MUSCLE
DRG 16.1 CONNECTIVE TISSUE/TENDON MUSCLE
STATIC SINGLE MEASUREMENT OF MUSCLE COMPARTMENT PRESSURES
DRG 16.1A8460 Minor
DYNAMIC LABORATORY INVESTIGATION INVOLVING MEASUREMENT OF
MUSCLE COMPARTMENT PRESSURES WITH MANOMETER 250 50 300
DRG 16.1T5230 EXCISION OF PLANTAR FIBROMA Intermediate 250 50 300
DRG 16.1T5250 ENDOSCOPIC PLANTAR FASCIA RELEASE Intermediate 250 50 300
DRG 16.1T5900 EXCISION OF GANGLION Intermediate 250 50 300
DRG 16.1T6000 REPEAT EXCISION OF GANGLION Intermediate 250 50 300
DRG 16.1T6220 EXCISION OF BURSA Intermediate 250 50 300
DRG 16.1T6580 TENDON GRAFT, AS SOLE PROCEDURE (NOT OTHERWISE SPECIFIED) Intermediate 250 50 300
DELAYED OR SECONDARY REPAIR OF TENDON (INCLUDING GRAFT,
DRG 16.1T6800 Major
TRANSFER AND/OR PROSTHESIS) (NOT OTHERWISE SPECIFIED) 500 100 450
DRG 16.1T6910 TENOLYSIS, OF EXTENSOR, NOT OTHERWISE SPECIFIED Intermediate 250 50 300
DRG 16.1T6980 TENOLYSIS, OF FLEXOR TENDON (NOT OTHERWISE SPECIFIED) Major 500 100 450
DRG 16.1T7010 PERCUTANEOUS TENOTOMY Minor 100 20 155
DRG 16.1T7050 LENGTHENING OF TENDON(S), OR OPEN TENOTOMY Intermediate 250 50 300
DRG 16.1T7110 TENOSYNOVECTOMY Intermediate 250 50 300
RELEASE OF CONSTRICTION OF SHEATH OF TENDON (EG TRIGGER FINGER)
250 50 300
MINOR RELEASE OF MUSCLE FOR PAIN OR CONTRACTURE (INVOLVING
SMALL JOINT) 250 50 300
System Category Day
MAJOR RELEASE OF MUSCLE FOR PAIN OR CONTRACTURE (EG
QUADRICEPS) (INVOLVING LARGE JOINT) 250 50 300
DRG 16.1T8100 OPEN BIOPSY OF MUSCLE OR SOFT TISSUE LESION Minor 100 20 155
DRG 16.1W6960 NEEDLE BIOPSY OF SYNOVIUM Minor 100 20 155
DRG 16.1W8100 OPEN EXCISION OF CALCIFIC DEPOSIT (EG SHOULDER, HIP) Minor 100 20 155
DRG 16.2 BONE (NON-SPECIFIC)
DRG 16.2W0640 TOTAL EXCISION OF SESAMOID BONE Intermediate 250 50 300
DRG 16.2W0700 EXCISION OF ECTOPIC BONE Minor 100 20 155
DRG 16.2W0850 PARTIAL EXCISION OF BONE (INCLUDING EXOSTOSES) Intermediate 250 50 300
RADICAL CLEARANCE OF SARCOMA OF TRUNK OR LIMBS, +/- AMPUTATION
OR INSERTION OF PROSTHESIS 1000 150 950
DRG 16.2W0960 EXCISION OF BENIGN TUMOUR OF BONE WITH BONE GRAFTING Xmajor 600 120 730
RADICAL CLEARANCE OF SARCOMA OF HEAD AND NECK NECESSITATING
FLAP RECONSTRUCTION 1000 150 950
OSTEOTOMY OF LONG BONE, WITH/WITHOUT FIXATION, INCLUDING GRAFT
DRG 16.2W1080 Major
500 100 450
DRAINAGE/DEBRIDEMENT OF BONE(S), INCLUDING SEQUESTECTOMY FOR
DRG 16.2W1800 Intermediate
OSTEOMYELITIS 250 50 300
FIXATION OF EPIPHYSIS, INCLUDING EPIPHYSIODESIS, CORRECTION OF
ANGULAR DEFORMITY 250 50 300
DRG 16.2W2702 EPIPHYSIOLYSIS (EG LANGENSKIOLD PROCEDURE) Intermediate 250 50 300
DRG 16.2W3620 OPEN BONE BIOPSY AS SOLE PROCEDURE Intermediate 250 50 300
DRG 16.2W3622 NEEDLE BIOPSY OF BONE AS SOLE PROCEDURE Minor 100 20 155
DIAGNOSTIC ASPIRATION AND TREPHINE BIOPSY OF BONE MARROW,
DRG 16.2W3650 Minor
INCLUDING ANALYSIS 100 20 155
DRG 16.2W3651 DIAGNOSTIC ASPIRATION OF BONE MARROW Minor 100 20 155
DRG 16.2W3652 TREPHINE BIOPSY OF BONE MARROW Minor 100 20 155
RADICAL CLEARANCE OF BENIGN BONE TUMOUR WITH RECONSTRUCTION
+/- INSERTION OF PROSTHESIS 1000 150 950
DRG 16.3 FRACTURES
DRG 16.30 LONG BONES
DRG 16.30W1920 PRIMARY OPEN REDUCTION OF LONG BONE WITH FIXATION Major 500 100 450
PRIMARY OPEN REDUCTION OF INTRA-ARTICULAR FRACTURE OF LONG
DRG 16.30W2100 BONE WITH INTERNAL FIXATION, EG PROXIMAL HUMERUS OR PROXIMAL Major
TIBIA (WITH OR WITHOUT ARTHROSCOPIC ASSISTANCE) 500 100 450
SECONDARY OPEN REDUCTION OF FRACTURED LONG BONE AND INTRA-
DRG 16.30W2310 MEDULLARY FIXATION OR INTERNAL FIXATION FOR NON-UNION/MAL UNION – Xmajor
INCLUDING INTRA-ARTICULAR (INCLUDING BONE GRAFT) 600 120 730
DRG 16.30W2380 LOCKED INTRAMEDULLARY NAILING OF FRACTURED LONG BONE Xmajor 600 120 730
CLOSED REDUCTION OF FRACTURE OF LONG BONE WITH EXTERNAL
DRG 16.30W2500 Major
FIXATION (EXCLUDING FIXATION BY CAST OR PERCUTANEOUS K-WIRES) 500 100 450
CLOSED REDUCTION OF FRACTURE OF LONG BONE, INCLUDING CAST OR
PERCUTANEOUS K-WIRES 250 50 300
DRG 16.31 SMALL BONES
PRIMARY OPEN REDUCTION OF SMALL BONE WITH FIXATION INCLUDING
INTRA-ARTICULAR 250 50 300
System Category Day
SECONDARY OPEN REDUCTION OF FRACTURE OF SMALL BONE, INCLUDING
DRG 16.3W2300 INTRA-ARTICULAR FRACTURE FOR DELAYED/NON-UNION (INCLUDING BONE Major
GRAFT) 500 100 450
CLOSED REDUCTION OF FRACTURE OF SMALL BONE WITH EXTERNAL
FIXATOR 250 50 300
CLOSED REDUCTION OF FRACTURE OF SMALL BONE, INCLUDING CAST OR
PERCUTANEOUS K-WIRES 250 50 300
DRG 16.31 PELVIS/ACETABULUM AND FEMUR
PRIMARY REDUCTION OF FRACTURE OF NECK OF FEMUR AND INTERNAL
DRG 16.31W1910 Xmajor
FIXATION 600 120 730
DRG 16.31W1320 OSTEOTOMY OF PROXIMAL FEMUR Xmajor 600 120 730
ARTHROSCOPIC FEMORO-ACETABULAR SURGERY FOR HIP IMPINGEMENT
SYNDROME 600 120 730
DRG 16.31W1390 OPEN FEMORO-ACETABULAR SURGERY FOR HIP IMPINGEMENT Xmajor 600 120 730
OPEN REDUCTION/INTERNAL FIXATION OF POSTERIOR RIM OF ACETABULUM
1000 150 950
OPEN REDUCTION/INTERNAL FIXATION OF EITHER POSTERIOR
WALL/COLUMN OR ACETABULUM OR ANTERIOR COLUMN OF ACETABULUM 1000 150 950
OPEN REDUCTION/INTERNAL FIXATION OF BOTH COLUMNS OF ACETABULUM
1000 150 950
OPEN REDUCTION/INTERNAL FIXATION PLUS BONE GRAFT SYMPHYSIS
PUBIS 1000 150 950
DRG 16.31W1646 OPEN REDUCTION/INTERNAL FIXATION OF SACRO-ILIAC JOINT Complex 1000 150 950
OPEN REDUCTION/INTERNAL FIXATION OF FRACTURES OF THE GREATER
DRG 16.31W1647 TROCHANTER, INCLUDING FIXATION OF NON-UNION OF GREATER Xmajor
TROCHANTER AFTER TROCHANTERIC OSTEOTOMY 600 120 730
DRG 16.32 JOINTS
PRIMARY CLOSED REDUCTION OF FRACTURE OR DISLOCATION OF JOINT,
WITH OR WITHOUT FIXATION INCLUDING CAST APPLICATION 250 50 300
DRG 16.32W6522 PRIMARY OPEN REDUCTION OF DISLOCATION OF SMALL JOINT Intermediate 250 50 300
DRG 16.32W6523 PRIMARY OPEN REDUCTION OF DISLOCATION OF LARGE JOINT Major 500 100 450
DRG 16.32W6702 SECONDARY OPEN REDUCTION OF DISLOCATION OF SMALL JOINT Intermediate 250 50 300
DRG 16.32W6703 SECONDARY OPEN REDUCTION OF DISLOCATION OF LARGE JOINT Major 500 100 450
DRG 16.34 FIXATION DEVICES
REMOVAL OF INTERNAL FIXATION FROM BONE/JOINT, EXCLUDING K-WIRES
250 50 300
DRG 16.34W3020 ADJUSTMENTS TO ILIZAROV FRAME/RINGS Major 500 100 450
APPLICATION OF ILIZAROV FRAME FOR SECONDARY NON-UNION/MAL-UNION
INCLUDING OSTEOTOMY 1000 150 950
ADJUSTMENTS TO PIN SITES SECONDARY FOR NON-UNION/MAL-UNION
DRG 16.34W3050 Minor
MINOR 100 20 155
DRG 16.34W3032 REMOVAL OF FIXATOR/FRAME/PINS/WIRES AND CHANGE OF PLASTER Intermediate 250 50 300
DRG 16.34W3530 REMOVAL OF PERCUTANEOUS WIRE MINOR Minor 100 20 155
DRG 16.35 OTHER (EG POP)
DRG 16.35X4822 CHANGE OF CAST UNDER GENERAL ANAESTHETIC MINOR Minor 100 20 155
DRG 16.35X4810 CHANGE OF CAST WITHOUT GENERAL ANAESTHETIC 75 0
DRG 16.35T5540 FASCIOTOMY OF LIMB Major 500 100 450
System Category Day
SURGICAL TOILET AND DEBRIDEMENT OF DEEP WOUND, INCLUDING
TRAUMATIC OR POST-OPERATIVE AETIOLOGY 100 20 155
DRG 16.35W3100 BONE GRAFT (EXCEPT WHERE PART OF ANOTHER PROCEDURE) Major 500 100 450
DRG 16.4 NERVES
DRG 16.4A6030 TRANSECTION OF PERIPHERAL NERVE FOR NEUROMA Intermediate 250 50 300
DRG 16.4A6080 NEURECTOMY (MAJOR NERVE) Intermediate 250 50 300
DRG 16.4A6110 EXCISION OF LESION OF PERIPHERAL NERVE (EG NEURILEMOMA) Intermediate 250 50 300
DRG 16.4A6180 EXCISION OF LESION OF MAJOR NERVE Intermediate 250 50 300
DRG 16.4A6300 GRAFT TO PERIPHERAL NERVE Xmajor 600 120 730
DRG 16.4A6302 GRAFT TO MAJOR NERVE Xmajor 600 120 730
DRG 16.4A6400 REPAIR OF PERIPHERAL NERVE Intermediate 250 50 300
DRG 16.4A6402 REPAIR OF MAJOR NERVE Major 500 100 450
DRG 16.4A6510 CARPAL TUNNEL RELEASE (OPEN) Intermediate 250 50 300
DRG 16.4A6580 CARPAL TUNNEL RELEASE (OPEN) - BILATERAL Intermediate 250 50 300
DRG 16.4A6600 RELEASE OF ENTRAPMENT OF DEEPLY PLACED PERIPHERAL NERVE Intermediate 250 50 300
DRG 16.4A6700 RELEASE OF ENTRAPMENT OF PERIPHERAL NERVE Intermediate 250 50 300
DRG 16.4A6710 CUBITAL TUNNEL RELEASE (OPEN) (WITHOUT TRANSPOSITION) Intermediate 250 50 300
CUBITAL TUNNEL RELEASE (OPEN) BILATERAL (WITHOUT TRANSPOSITION)
250 50 300
NEUROLYSIS AND TRANSPOSITION OF PERIPHERAL NERVE (EXCLUDES
CARPAL TUNNEL RELEASE) 250 50 300
DRG 16.4A6900 REVISION OF RELEASE OF PERIPHERAL NERVE Major 500 100 450
DRG 16.4A7010 IMPLANTATION OF NEUROSTIMULATOR TO PERIPHERAL NERVE Major 500 100 450
TRIAL OF NEUROSTIMULATOR TO PERIPHERAL NERVE (AS SOLE
PROCEDURE) NOT AT TIME OF PERMANENT IMPLANT 250 50 300
DRG 16.4A6530 CARPAL TUNNEL RELEASE (ENDOSCOPIC) Intermediate 250 50 300
DRG 16.4A6570 CARPAL TUNNEL RELEASE (ENDOSCOPIC) - BILATERAL Intermediate 250 50 300
DRG 16.4A6740 CUBITAL TUNNEL RELEASE (ENDOSCOPIC) (WITHOUT TRANSPOSITION) Intermediate 250 50 300
CUBITAL TUNNEL RELEASE (ENDOSCOPIC) BILATERAL (WITHOUT
TRANSPOSITION) 250 50 300
DRG 16.4A7310 BIOPSY OF PERIPHERAL NERVE Intermediate 250 50 300
DRG 16.5 JOINTS, INCLUDING REPLACEMENT/RECONSTRUCTION (NOT LISTED
ELSEWHERE)
DRG 16.5W5540 DEBRIDEMENT OF INFECTED TOTAL JOINT REPLACEMENT Major 500 100 450
DRG 16.5W5722 EXCISION RECONSTRUCTION OF SMALL JOINT Major 500 100 450
DRG 16.5W5723 EXCISION RECONSTRUCTION OF LARGE JOINT Major 500 100 450
DRG 16.5W6912 TOTAL SYNOVECTOMY OF SMALL JOINT Major 500 100 450
DRG 16.5W9050 SHOULDER HYDRODISTENSION +/- IMAGE GUIDANCE Minor 150 0 50
THREE OR MORE INJECTIONS, +/- ASPIRATION, INTO JOINT(S), CYST, BURSA
DRG 16.5W9031 Minor
OR SOFT TISSUE, WITH IMAGE GUIDANCE 100 20 155
DRG 16.5W6913 TOTAL SYNOVECTOMY OF LARGE JOINT Major 500 100 450
RECONSTRUCTION OF ONE OR TWO LIGAMENTS NOT ELSEWHERE
DRG 16.5W7400 Major
SPECIFIED 500 100 450
DRG 16.5W7500 PROSTHETIC OPEN REPAIR OF LIGAMENT Major 500 100 450
RELEASE OF CONTRACTURE OF INTERPHALANGEAL JOINT OF FINGER
(EXCLUDING TRIGGER FINGER OR DUPUYTREN'S DISEASE) 250 50 300
ARTHROTOMY OF LARGE JOINT, INCLUDING REMOVAL OF LOOSE BODY
FROM JOINT 250 50 300
System Category Day
ARTHROTOMY OF SMALL JOINT, INCLUDING REMOVAL OF LOOSE BODY
DRG 16.5W8180 Minor
FROM JOINT 100 20 155
THERAPEUTIC ARTHROSCOPIC OPERATION ON ARTICULAR CARTILAGE
(OTHER THAN W8200 AND W8230) (AS SOLE PROCEDURE) 250 50 300
THERAPEUTIC ARTHROSCOPIC OPERATION ON ARTICULAR CARTILAGE
DRG 16.5W8380 Major
(OTHER THAN W8200) - BILATERAL (AS SOLE PROCEDURE) 500 100 450
THERAPEUTIC ARTHROSCOPIC OPERATION ON CAVITY OF JOINT (NOT
DRG 16.5W8600 Major
OTHERWISE SPECIFIED) (AS SOLE PROCEDURE) 500 100 450
THERAPEUTIC ARTHROSCOPIC OPERATION ON CAVITY OF JOINT -
BILATERAL (NOT OTHERWISE SPECIFIED) (AS SOLE PROCEDURE) 1000 150 950
DIAGNOSTIC ARTHROSCOPIC EXAMINATION OF JOINT, WITH OR WITHOUT
BIOPSY (NOT OTHERWISE SPECIFIED) (AS SOLE PROCEDURE) 250 50 300
DIAGNOSTIC ARTHROSCOPIC EXAMINATION OF JOINT, WITH OR WITHOUT
BIOPSY - BILATERAL (NOT OTHERWISE SPECIFIED) (AS SOLE PROCEDURE) 250 50 300
DRG 16.5W8782 FLEXIBLE ARTHROSCOPY, +/- BIOPSY (AS SOLE PROCEDURE) Intermediate 250 50 300
DRG 16.5W9017 YTTRIUM JOINT INJECTION (WITH RADIOACTIVE PRECAUTIONS) Minor 150 0 50
DRG 16.5W9020 DYNAMIC ARTHROGRAM OF JOINT Intermediate 250 50 300
INJECTION(S) +/- ASPIRATION, INTO JOINT, CYST, BURSA OR SOFT TISSUE
DRG 16.5W9030 Minor
WITH IMAGE GUIDANCE 100 20 155
DRG 16.5W9032 INJECTION OF VISCOSUPPLEMENT INTO JOINT WITH IMAGE GUIDANCE Minor 100 20 155
INJECTION OF VISCOSUPPLEMENT INTO JOINT WITH IMAGE GUIDANCE -
DRG 16.5W9033 Minor
INJECTION(S) +/- ASPIRATION, INTO TWO OR MORE JOINTS, CYSTS, BURSAE
DRG 16.5W9035 Minor
OR SOFT TISSUE, WITH IMAGE GUIDANCE 100 20 155
DRG 16.5W9042 INJECTION OF VISCOSUPPLEMENT INTO JOINT Minor 100 20 155
DRG 16.5W9043 INJECTIONS OF VISCOSUPPLEMENT INTO JOINTS - BILATERAL Minor 100 20 155
INJECTION(S) +/- ASPIRATION, INTO TWO OR MORE JOINTS, CYSTS, BURSAE
DRG 16.5W9045 Minor
OR SOFT TISSUE 100 20 155
DRG 16.6 HAND
DRG 16.60 INCISION/EXCISION
INJECTION INTO CORD FOR DUPUYTREN’S CONTRACTURE (INCLUDING POST
DRG 16.60T7440 Minor
INJECTION FINGER EXTENSION) 100 20 155
DRG 16.60T5202 DUPUYTREN’S FASCIECTOMY PALM ONLY Intermediate 250 50 300
DUPUYTREN’S FASCIECTOMY SINGLE DIGIT WITH PROXIMAL
INTERPHALANGEAL JOINT 250 50 300
DUPUYTREN’S FASCIECTOMY MULTIPLE DIGITS WITH PROXIMAL
DRG 16.60T5210 Major
INTERPHALANGEAL JOINTS 500 100 450
DUPUYTREN’S DERMOFASCIECTOMY AND GRAFT, OR FOR RECURRENT
DISEASE – SINGLE DIGIT 500 100 450
DUPUYTREN’S DERMOFASCIECTOMY AND GRAFT, OR FOR RECURRENT
DISEASE – MULTIPLE DIGITS 500 100 450
DRG 16.60T5410 DUPUYTREN’S SUBCUTANEOUS FASCIOTOMY MINOR Minor 100 20 155
DRG 16.60W0282 TOTAL EXCISION OF TRAPEZIUM Xmajor 600 120 730
DRG 16.60W0283 TOTAL EXCISION OF TRAPEZIUM WITH SPACER Xmajor 600 120 730
DRG 16.60W0284 TOTAL EXCISION OF TRAPEZIUM AND LIGAMENT RECONSTRUCTION Xmajor 600 120 730
DRG 16.60W0285 TRAPEZIO-METACARPAL JOINT SURFACE REPLACEMENT Major 500 100 450
DRG 16.61 REPAIR/RECONSTRUCTION
System Category Day
OSTEOTOMY OF SMALL BONE OF HAND INCLUDING FIXATION AND BONE
GRAFTING 250 50 300
DRG 16.61T6710 PRIMARY REPAIR OF EXTENSOR OF HAND Intermediate 250 50 300
SECONDARY REPAIR OR RECONSTRUCTION OF EXTENSOR OF
HAND/FOREARM 500 100 450
DRG 16.61T6914 TENOLYSIS OF EXTENSOR TENDON OF HAND Intermediate 250 50 300
DRG 16.61T6750 PRIMARY REPAIR OF FLEXOR OF HAND (EXCLUDING ZONE II) Intermediate 250 50 300
DRG 16.61T6752 PRIMARY REPAIR OF FLEXOR OF HAND IN ZONE II Major 500 100 450
SECONDARY OR SECOND REPAIR OF 1ST STAGE RECONSTRUCTION OF
FLEXOR OF HAND 500 100 450
DRG 16.61T6832 SECOND STAGE RECONSTRUCTION OF FLEXOR OF HAND Major 500 100 450
DRG 16.61T6982 TENOLYSIS OF FLEXOR TENDON OF HAND Intermediate 250 50 300
DRG 16.61T6402 TENDON TRANSFER OF HAND – SINGLE Major 500 100 450
TENDON TRANSFER OF HAND – MULTIPLE (EG FOR RADIAL NERVE INJURY)
500 100 450
DRG 16.61W0120 POLLICISATION OF FINGER FOR THUMB RECONSTRUCTION Complex 1000 300 800
INTERPOSITIONAL SILASTIC ARTHROPLASTY OF MCP/PIP JOINTS – SINGLE
500 100 450
INTERPOSITIONAL SILASTIC ARTHROPLASTY OF MCP/PIP JOINTS - MULTIPLE
500 100 450
PROSTHETIC SURFACE ARTHROPLASTY OF
DRG 16.61W0514 INTERPHALANAGEAL/METACARPO-PHALANGEAL JOINT – SINGLE JOINT Major
(BOTH CEMENTED AND UNCEMENTED) 500 100 450
DRG 16.61W5310 TOTAL PROSTHETIC REPLACEMENT OF WRIST JOINT Xmajor 600 120 730
DIAGNOSTIC ARTHROSCOPIC EXAMINATION OF WRIST JOINT, WITH OR
WITHOUT BIOPSY (AS SOLE PROCEDURE) 250 50 300
DRG 16.61W8602 THERAPEUTIC ARTHROSCOPY OF WRIST JOINT (SOLE PROCEDURE) Major 500 100 450
DRG 16.61W7482 SCAPHOID LUNATE LIGAMENT RECONSTRUCTION Major 500 100 450
DRG 16.61W7483 TRIQUETROLUNATE LIGAMENT RECONSTRUCTION Major 500 100 450
DRG 16.61W7484 MULTIPLE LIGAMENT RECONSTRUCTION Xmajor 600 120 730
SMALL JOINT (EG INTERPHALANGEAL/METACARPO-PHALANGEAL JOINT)
LIGAMENT RECONSTRUCTION 500 100 450
DRG 16.61W7486 CARPO-METACARPAL JOINT LIGAMENT RECONSTRUCTION Major 500 100 450
DRG 16.61W6230 VASCULAR IMPLANTATION TO CARPAL BONE Xmajor 600 120 730
TOE TO HAND TRANSFER (AS SOLE PROCEDURE) INCLUDING CLOSURE OF
SECONDARY DEFECT 1000 150 950
DRG 16.62 FIXATION/ARTHRODESIS
OPEN REDUCTION AND INTERNAL FIXATION OF CANCELLOUS BONE GRAFT
SCAPHOID NON-UNION 500 100 450
OPEN REDUCTION AND INTERNAL FIXATION WEDGE RECONSTRUCTION
BONE GRAFT SCAPHOID NON-UNION 500 100 450
EARLY OPEN REDUCTION AND INTERNAL FIXATION OF SCAPHOID FRACTURE
IE WITHIN 6 WEEKS OF FRACTURE 500 100 450
DRG 16.62W6202 PARTIAL FUSION OF WRIST Intermediate 250 50 300
TOTAL FUSION OF ALL JOINTS OF WRIST WITH OR WITHOUT GRAFT AND
WITH OR WITHOUT INTERNAL FIXATION 500 100 450
FUSION OF DIGIT JOINT(S) OF HAND WITH OR WITHOUT GRAFT AND WITH OR
WITHOUT INTERNAL FIXATION 250 50 300
System Category Day
DRG 16.63 OTHER (EG AMPUTATION)
DRG 16.63X0710 FOREQUARTER AMPUTATION Complex 1000 150 950
DRG 16.63X0720 DISARTICULATION OF SHOULDER Xmajor 600 120 730
DRG 16.63X0750 AMPUTATION OF ARM Major 500 100 450
DRG 16.63X0820 PARTIAL AMPUTATION OF DIGIT Intermediate 250 50 300
DRG 16.63X0822 AMPUTATION OF WHOLE RAY Major 500 100 450
DRG 16.63X0880 AMPUTATION THROUGH MID-CARPAL/TRANSMETACARPAL Intermediate 250 50 300
DRG 16.63X0910 HINDQUARTER AMPUTATION Complex 1000 150 950
DRG 16.7 SHOULDER
DRG 16.70W0610 TOTAL EXCISION OF CERVICAL RIB Major 500 100 450
DRG 16.70W0890 EXCISION DISTAL CLAVICLE, AS SOLE PROCEDURE Major 500 100 450
DRG 16.71W4900 SHOULDER HEMIARTHROPLASTY, AS SOLE PROCEDURE Xmajor 600 120 730
DRG 16.71W4930 REVISIONAL SHOULDER HEMIARTHROPLASTY Xmajor 600 120 730
DRG 16.71W5050 REVERSE POLARITY ARTHROPLASTY OF SHOULDER Xmajor 600 120 730
DRG 16.71W5060 RESURFACING ARTHROPLASTY OF SHOULDER Xmajor 600 120 730
SHOULDER HEMIARTHROPLASTY WITH RECONSTRUCTION FOR FRACTURE
600 120 730
DRG 16.71W5000 PRIMARY TOTAL SHOULDER REPLACEMENT Xmajor 600 120 730
DRG 16.71W5030 REVISION TOTAL SHOULDER REPLACEMENT Complex 1000 150 950
CONVERSION OF HEMIARTHROPLASTY TO TOTAL SHOULDER REPLACEMENT
1000 150 950
PRIMARY REPAIR OF RUPTURE OF ACROMIOCLAVICULAR OR
STERNOCLAVICULAR JOINT INCLUDING INTERNAL FIXATION 600 120 730
SECONDARY REPAIR OF ACROMIOCLAVICULAR OR STERNOCLAVICULAR
JOINT +/– INTERNAL FIXATION 600 120 730
STABILISATION OF UNIDIRECTIONAL INSTABILITY OF SHOULDER JOINT,
INCLUDING ANTERIOR, POSTERIOR AND ARTHROSCOPIC 500 100 450
DRG 16.71W7713 STABILISATION OF MULTI-DIRECTIONAL INSTABILITY OF SHOULDER JOINT Major 500 100 450
COROCOID BONE BLOCK TRANSFER FOR RECURRENT INSTABILITY OF
SHOULDER (BRISTOW-LATARJET PROCEDURE) 500 100 450
DRG 16.71W7760 LABRAL REPAIR (SHOULDER STABILISATION) Major 500 100 450
DRG 16.71W7780 REVISION STABILISATION OF SHOULDER JOINT Xmajor 600 120 730
DRG 16.71W7810 OPEN ARTHROLYSIS OF SHOULDER CONTRACTURE Major 500 100 450
DRG 16.71W7872 ARTHROSCOPIC ARTHROLYSIS OF SHOULDER CONTRACTURE Major 500 100 450
EXTRACORPOREAL SHOCKWAVE THERAPY OF CALCIFIC TENDONITIS OF
THE SHOULDER 250 50 300
DRG 16.71W8110 ARTHROSCOPIC EXCISION OF CALCIFIC DEPOSITS FROM SHOULDER Major 500 100 450
OPEN SUB-ACROMIAL DECOMPRESSION AND EXTENSIVE, GREATER THAN
2CM TEAR ROTATOR CUFF REPAIR WITH EXCISION OF DISTAL CLAVICLE 500 100 450
ARTHROSCOPIC ROTATOR CUFF REPAIR GREATER THAN 2CM (AS SOLE
EXTENSIVE, GREATER THAN 2CM TEAR REPAIR OF LARGE MUSCLE
INCLUDING ARTHROSCOPIC (EXCLUDING ROTATOR CUFF) 500 100 450
System Category Day
ARTHROSCOPIC SUB-ACROMIAL DECOMPRESSION AND LIMITED, LESS THAN
DRG 16.71T7982 2CM TEAR ROTATOR CUFF REPAIR (INCLUDING ARTHROSCOPIC Major
PROCEDURES IN GLENOHUMERAL JOINT) 500 100 450
OPEN SUB-ACROMIAL DECOMPRESSION AND LIMITED, LESS THAN 2CM TEAR
ROTATOR CUFF REPAIR 250 50 300
DRG 16.71T7990 REVISION ROTATOR CUFF REPAIR Major 500 100 450
DRG 16.71W8192 OPEN SUB-ACROMIAL DECOMPRESSION, AS SOLE PROCEDURE Major 500 100 450
ARTHROSCOPIC SUB-ACROMIAL DECOMPRESSION AS SOLE PROCEDURE
500 100 450
ARTHROSCOPIC SUB-ACROMIAL DECOMPRESSION AND EXCISION OF
DRG 16.71W8194 DISTAL CLAVICLE (INCLUDING ARTHROSCOPIC PROCEDURES IN Major
GLENOHUMERAL JOINT) 500 100 450
DRG 16.71W8603 THERAPEUTIC ARTHROSCOPY OF SHOULDER (AS SOLE PROCEDURE) Major 500 100 450
DIAGNOSTIC ARTHROSCOPIC EXAMINATION OF SHOULDER JOINT, WITH OR
WITHOUT BIOPSY (AS SOLE PROCEDURE) 250 50 300
DRG 16.71T6450 TENODESIS OF BICEPS TENDON (AS SOLE PROCEDURE) Intermediate 250 50 300
PRIMARY ARTHRODESIS OF JOINT WITH OR WITHOUT GRAFT AND WITH OR
WITHOUT INTERNAL FIXATION – SHOULDER 500 100 450
DRG 16.72W6030 REVISION OR CONVERSION TO ARTHRODESIS OF SHOULDER Xmajor 600 120 730
DRG 16.72W2810 PLATING AND BONE GRAFTING FOR NON-UNION OF CLAVICLE Major 500 100 450
DRG 16.72W4940 SCAPULO-THORACIC FUSION Xmajor 600 120 730
MANIPULATION OF JOINT (INCLUDING INTRA-ARTICULAR INJECTION) FOR
“FROZEN SHOULDER” (AS SOLE PROCEDURE) – BILATERAL 250 50 300
MANIPULATION OF JOINT (INCLUDING INTRA-ARTICULAR INJECTION) FOR
“FROZEN SHOULDER” (AS SOLE PROCEDURE) 100 20 155
DRG 16.8 ELBOW
DRG 16.80W5550 EXCISION OF RADIAL HEAD (AS SOLE PROCEDURE) Major 500 100 450
DRG 16.81W5510 TOTAL PROSTHETIC REPLACEMENT OF ELBOW Xmajor 600 120 730
DRG 16.81W5520 REVISIONAL PROSTHETIC REPLACEMENT OF ELBOW Complex 1000 150 950
SURGICAL RELEASE OF HUMERAL EPICONDYLITIS (LATERAL OR MEDIAL) (EG
“TENNIS ELBOW”) 250 50 300
DRG 16.81W5560 OK (OUTERBRIDGE AND KASHIWAGI) PROCEDURE Major 500 100 450
DRG 16.81W5512 PROSTHETIC REPLACEMENT OF RADIAL HEAD Xmajor 600 120 730
DRG 16.81T6782 REPAIR OF DISTAL BICEPS TENDON Major 500 100 450
DRG 16.81W7850 OPEN ARTHROLYSIS OF ELBOW Major 500 100 450
DRG 16.81W7860 ARTHROSCOPIC ARTHROLYSIS OF ELBOW (AS SOLE PROCEDURE) Major 500 100 450
DRG 16.81W5502 INTERPOSITION ARTHROPLASTY OF ELBOW Xmajor 600 120 730
DRG 16.81W5040 REPLACEMENT OF ELBOW AND SHOULDER (SINGLE OPERATION) Complex 1000 150 950
DRG 16.81W8880 ARTHROSCOPY OF ELBOW (AS SOLE PROCEDURE) Major 500 100 450
DRG 16.9 HIP, LEG AND PELVIS
DRG 16.90W0702 EXCISION OF ECTOPIC BONE AROUND A TOTAL HIP REPLACEMENT Intermediate 250 50 300
DRG 16.90W7761 REPAIR OF HIP LABRAL TEAR Major 500 100 450
DRG 16.91 REPAIR, RECONSTRUCTION AND REPLACEMENT
DRG 16.91W1911 CORE DECOMPRESSION OF HIP Major 500 100 450
System Category Day
DRG 16.91W3712 PRIMARY TOTAL HIP REPLACEMENT WITH OR WITHOUT CEMENT Xmajor 600 120 730
COMPLEX PRIMARY TOTAL HIP REPLACEMENT INCLUDING BONE GRAFTING
OR FEMORAL OSTEOTOMY 600 120 730
TOTAL HIP REPLACEMENT, WITH OR WITHOUT CEMENT, AFTER EXCISION
ARTHROPLASTY OR ARTHRODESIS, INCLUDING CONVERSION OF
HEMIARTHROPLASTY OR REVISION OF OTHER PREVIOUS HIP SURGERY
WHICH INVOLVED INTERNAL FIXATION 600 120 730
DRG 16.91W3715 METAL ON METAL HIP RESURFACING ARTHROPLASTY Xmajor 600 120 730
DRG 16.91W3716 MINIMALLY INVASIVE HIP REPLACEMENT (2 INCISIONS) Xmajor 600 120 730
DRG 16.91W3717 MINIMALLY INVASIVE HIP REPLACEMENT (ONE INCISION) Xmajor 600 120 730
DRG 16.91W3719 METAL ON METAL HIP RESURFACING ARTHROPLASTY – BILATERAL Xmajor 600 120 730
REVISION OF UNCEMENTED OR CEMENTED TOTAL HIP REPLACEMENT
WITHOUT ADJUNCTIVE PROCEDURES 1000 150 950
REVISION OF TOTAL HIP REPLACEMENT INCLUDING INSERTION OF
DRG 16.91W3733 RECONSTRUCTION RINGS, PLATES, SCREWS, ETC., AND/OR IMPACTION Complex
BONE GRAFTING TO ACETABULUM AND/OR FEMUR 1000 150 950
SECOND, THIRD OR FURTHER REVISION TOTAL HIP REPLACEMENT OR
DRG 16.91W3734 PROXIMAL FEMORAL REPLACEMENT (EXCLUDING ACETABULAR LINER AND Complex
HEAD CHANGES) 1000 150 950
REMOVAL OF TOTAL HIP REPLACEMENT AND CREATING A
PSEUDARTHROSIS 600 120 730
REMOVAL OF TOTAL HIP REPLACEMENT AND COMPLETE CLEARANCE OF
CEMENT 600 120 730
DRG 16.91W3944 ACETABULAR LINER AND HEAD CHANGES Complex 1000 150 950
TOTAL PROSTHETIC REPLACEMENT OF THE HIP, WITH OR WITHOUT
CEMENT, BILATERAL 1000 150 950
DRG 16.91W4600 PROSTHETIC REPLACEMENT OF HEAD OF FEMUR Major 500 100 450
DRG 16.91W1700 SHELF AUGMENTATION OF ACETABULUM, EG WAINWRIGHT OR TRILLAT Xmajor 600 120 730
DRG 16.91T7930 REPAIR OF ABDUCTOR MECHANISM OF HIP Major 500 100 450
DRG 16.91W1648 OSTEOTOMY/TRANSFER OF GREATER TROCHANTER IN ISOLATION Xmajor 600 120 730
DRG 16.91W6600 CLOSED REDUCTION OF DISLOCATED HIP PROSTHESIS Intermediate 250 50 300
DRG 16.91W6540 OPEN REDUCTION OF DISLOCATED HIP PROSTHESIS Major 500 100 450
DIAGNOSTIC ARTHROSCOPIC EXAMINATION OF HIP JOINT INCLUDING WASH-
OUT, WITH OR WITHOUT BIOPSY (AS SOLE PROCEDURE) 250 50 300
THERAPEUTIC ARTHROSCOPIC EXAMINATION OF HIP JOINT WITH OR
WITHOUT BIOPSY 600 120 730
PRIMARY ARTHRODESIS OF HIP JOINT WITH OR WITHOUT GRAFT AND WITH
OR WITHOUT INTERNAL FIXATION – HIP 500 100 450
SIMPLE PELVIC OSTEOTOMY AND FIXATION EG SALTER OR CHIARI
OSTEOTOMIES 500 100 450
COMPLEX PELVIC OSTEOTOMIES AND FIXATION, EG TRIPLE OSTEOTOMY,
PERI-ACETABULAR OSTEOTOMY 1000 150 950
PINNING OF HEAD OF FEMUR – OPEN OR PERCUTANEOUS (EG SLIPPED
FEMORAL EPIPHYSIS, UNDISPLACED NECK FRACTURE) 500 100 450
DRG 16.92W1913 PINNING FOR BILATERAL SLIPPED UPPER FEMORAL EPIPHYSIS Xmajor 600 120 730
OPEN REDUCTION AND INTERNAL FIXATION FOR PERIPROSTHETIC
FRACTURE AROUND HIP 600 120 730
System Category Day
OPEN REDUCTION, INTERNAL FIXATION AND REVISION OF FEMORAL
COMPONENT FOR PERI-PROSTHETIC FRACTURE 1000 150 950
OPEN REDUCTION, INTERNAL FIXATION AND COMPLETE REVISION FOR
PERI-PROSTHETIC FRACTURE 1000 150 950
DRG 16.93 OTHER
AMPUTATION OF LEG/FOOT (INCLUDING SYMES LISFRANC AND CHOPART)
DRG 16.93X0930 Major
500 100 450
DRG 16.93X2280 MANIPULATION OF HIP AND CASTING (AS SOLE PROCEDURE) Minor 100 20 155
SOFT TISSUE OPERATIONS IN THE REGION OF THE GREATER TROCHANTER
(TROCHANTERIC BURSITIS, SNAPPING HIP) 500 100 450
PERCUTANEOUS BIOPSY/ ARTHROGRAPHY/ ASPIRATION IN ASSESSMENT
OF TOTAL HIP REPLACEMENT 100 20 155
CLOSED REDUCTION AND FROG POP FOR CONGENITAL DISLOCATION OF
DRG 16.93X2200 HIP (INCLUDING DYNAMIC ARTHROGRAM, TRACTION AND SOFT TISSUE Major
RELEASE) 500 100 450
OPEN REDUCTION AND FROG POP FOR CONGENITAL DISLOCATION OF HIP
DRG 16.93X2260 Complex
(INCLUDING TRACTION AND INNOMINATE/FEMORAL OSTEOTOMY) 1000 150 950
COMPLEX OPEN REDUCTION FOR CONGENITAL DISLOCATION OF HIP (I.E.
DRG 16.93X2262 PELVIC AND FEMORAL OR PEMBERTON OSTEOTOMY OR REVISION OF OPEN Complex
REDUCTION) 1000 150 950
DRG 16.10 KNEE
DRG 16.100W1660 TIBIAL OSTEOTOMY Major 500 100 450
DRG 16.101W3090 CORE DECOMPRESSION OF KNEE Major 500 100 450
HARVESTING FOR AUTOLOGOUS CHONDROCYTE TRANSPLANTATION INTO
KNEE INCLUDING ARTHROSCOPY 500 100 450
DRG 16.101W0633 PROSTHETIC REPLACEMENT OF PATELLOFEMORAL JOINT - BILATERAL Xmajor 600 120 730
DRG 16.101W7440 ALLOGRAFT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Xmajor 600 120 730
TOTAL PROSTHETIC REPLACEMENT OF KNEE JOINT, WITH OR WITHOUT
CEMENT, +/– PATELLA 600 120 730
DRG 16.101W4212 MINIMALLY INVASIVE KNEE REPLACEMENT Complex 1000 150 950
DRG 16.101W5200 UNICOMPARTMENTAL KNEE REPLACEMENT Xmajor 600 120 730
DRG 16.101W5201 UNICOMPARTMENTAL KNEE REPLACEMENT - BILATERAL Complex 1000 150 950
DRG 16.101W4280 TOTAL PROSTHETIC REPLACEMENT OF KNEE JOINT – BILATERAL Complex 1000 150 950
DRG 16.101W4230 REVISION OF TOTAL REPLACEMENT OF KNEE JOINT Complex 1000 150 950
COMPLEX PRIMARY TOTAL KNEE REPLACEMENT (IE INCLUDING BONE
GRAFT, AUGMENTATION OR OSTEOTOMY) 600 120 730
2 STAGE REVISION OF TOTAL KNEE REPLACEMENT FOR INFECTION – FIRST
STAGE 600 120 730
2 STAGE REVISION OF TOTAL KNEE REPLACEMENT FOR INFECTION –
SECOND STAGE 600 120 730
OPEN SURGICAL STABILISATION OF PATELLA, INCLUDING SOFT
TISSUE/TENDON TRANSFER OR RELEASE, +/- APPLICATION OF CAST (ADULT) 600 120 730
OPEN SURGICAL STABILISATION OF PATELLA, INCLUDING SOFT
TISSUE/TENDON TRANSFER OR RELEASE, +/- APPLICATION OF CAST (CHILD) 600 120 730
System Category Day
2 STAGE REVISION ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION -
FIRST STAGE 500 100 450
2 STAGE REVISION ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION -
SECOND STAGE 500 100 450
PROSTHETIC PATELLO-FEMORAL REPLACEMENT (AS SOLE PROCEDURE)
500 100 450
DRG 16.101W7583 REPAIR OF PATELLAR/QUADRICEP TENDON Major 500 100 450
ARTHROSCOPY OF KNEE (INCLUDING EXAMINATION UNDER ANAESTHETIC,
WASHOUT AND BIOPSY) (AS SOLE PROCEDURE) 250 50 300
DRG 16.101W8200 ARTHROSCOPIC MENISCECTOMY (INCLUDING DEBRIDEMENT) Major 500 100 450
ARTHROSCOPIC MENISCECTOMY (INCLUDING DEBRIDEMENT) – BILATERAL
600 120 730
MULTIPLE ARTHROSCOPIC OPERATION ON KNEE (INCLUDING
MENISCECTOMY, CHONDROPLASTY, DRILLING OR MICROFRACTURE) 600 120 730
MULTIPLE ARTHROSCOPIC OPERATION ON KNEE (INCLUDING
DRG 16.101W8580 MENISCECTOMY, CHONDROPLASTY, DRILLING OR MICROFRACTURE) – Xmajor
DRG 16.101W8230 ARTHROSCOPIC MENISCAL REPAIR Major 500 100 450
DRG 16.101W7492 OPEN/ARTHROSCOPIC LATERAL RELEASE Intermediate 250 50 300
DRG 16.101W0630 PATELLECTOMY Major 500 100 450
DRG 16.101W8400 REPAIR OF KNEE LIGAMENTS (OPEN OR ARTHROSCOPIC) Xmajor 600 120 730
AUTOGRAFT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
(INCLUDING ARTHROSCOPIC AND MENISCECTOMY) 600 120 730
DRG 16.101W8240 MENISCAL ALLOGRAFT TRANSPLANTATION Xmajor 600 120 730
DRG 16.101W7490 RECONSTRUCTION OF POSTERIOR LATERAL CORNER OF KNEE Major 500 100 450
MULTIPLE LIGAMENT RECONSTRUCTION OF KNEE INCLUDING POSTERIOR
CRUCIATE LIGAMENT 600 120 730
DRG 16.101W7470 REVISION OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Xmajor 600 120 730
POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION INCLUDING
ARTHROSCOPIC 600 120 730
PRIMARY ARTHRODESIS OF KNEE JOINT WITH OR WITHOUT GRAFT AND
WITH OR WITHOUT INTERNAL FIXATION 500 100 450
DRG 16.11 FOOT
DRG 16.110 ANKLE
DRG 16.110W5790 REPAIR TO PLANTAR PLATE Major 500 100 450
DRG 16.110T6720 TENDO ACHILLES LENGTHENING PERCUTANEOUS Intermediate 250 50 300
DRG 16.110T6722 TENDO ACHILLES LENGTHENING PRIMARY OPEN Major 500 100 450
DRG 16.110T6723 TENDO ACHILLES LENGTHENING REPEAT PROCEDURE Major 500 100 450
DRG 16.110T6780 PRIMARY REPAIR OF ACHILLES TENDON Intermediate 250 50 300
DRG 16.110T6810 SECONDARY REPAIR OF ACHILLES TENDON Major 500 100 450
DELAYED OR SECONDARY REPAIR OF ACHILLES TENDON WITH TENDON OR
FASCIAL GRAFT 600 120 730
DIAGNOSTIC ARTHROSCOPIC EXAMINATION OF ANKLE INCLUDING
ANTERIOR SYNOVECTOMY TO GAIN VISION (AS SOLE PROCEDURE) 250 50 300
THERAPEUTIC ARTHROSCOPY OF ANKLE WITH EITHER SOFT TISSUE
DRG 16.110W8630 PROCEDURES OR BONY PROCEDURES +/– JOINT SURFACE PROCEDURE (AS Major
System Category Day
COMPLEX THERAPEUTIC ARTHROSCOPY OF ANKLE, WITH MULTIPLE BONY,
JOINT SURFACE AND SOFT TISSUE PROCEDURES 500 100 450
OPEN OR ARTHROSCOPIC RELEASE OF ANKLE JOINT CONTRACTURE
(EXCLUDING ACHILLES TENDON LENGTHENING) 500 100 450
DRG 16.110W4410 TOTAL PROSTHETIC REPLACEMENT OF ANKLE JOINT Xmajor 600 120 730
COMPLEX TOTAL REPLACEMENT OF ANKLE (IE INCLUDING CUSTOM
PROSTHESIS, WEDGES, INTERNAL FIXATION OF FRACTURES) 1000 150 950
DRG 16.110W4430 REVISION OF TOTAL PROSTHETIC REPLACEMENT OF ANKLE JOINT Complex 1000 150 950
PERONEAL SLING/GROOVE RECONSTRUCTION AND REPLACEMENT OF
DISLOCATED PERONEAL TENDONS 500 100 450
DRG 16.110W7530 REPAIR OF LATERAL COLLATERAL LIGAMENT COMPLEX Major 500 100 450
DRG 16.110W7430 RECONSTRUCTION OF LATERAL COLLATERAL LIGAMENT COMPLEX Major 500 100 450
DRG 16.110W6015 ANKLE ARTHRODESIS – OPEN Major 500 100 450
DRG 16.110W6016 ANKLE ARTHRODESIS WITH AUTOGENOUS GRAFT Major 500 100 450
DRG 16.110W6017 ANKLE ARTHRODESIS WITH INTERNAL FIXATION (ARTHROSCOPIC) Major 500 100 450
ANKLE ARTHRODESIS – REVISION, INCLUDING CONVERSTION FROM TOTAL
ANKLE REPLACEMENT 600 120 730
DRG 16.110W6019 ANKLE SYNDESMOSIS RECONSTRUCTION Complex 1000 150 950
DRG 16.111 HIND FOOT AND MID FOOT
DIAGNOSTIC SUBTALAR ARTHROSCOPY INCLUDING SYNOVECTOMY TO
GAIN VISION (AS SOLE PROCEDURE) 250 50 300
THERAPEUTIC SUB-TALAR ARTHROSCOPY ADDITIONAL TO SYNOVECTOMY
TO GAIN VISION 500 100 450
ISOLATED SUB TALAR FUSION OR MID FOOT FUSION WITH AUTOGENOUS
GRAFT (ADULT) 500 100 450
ISOLATED SUB TALAR FUSION OR MID FOOT FUSION WITHOUT
AUTOGENOUS GRAFT (ADULT) 500 100 450
DRG 16.111W0420 TRIPLE FUSION OF JOINTS OF HINDFOOT WITHOUT AUTOGENOUS GRAFT Major 500 100 450
DRG 16.111W0422 TRIPLE FUSION OF JOINTS OF HINDFOOT WITH AUTOGENOUS GRAFT Major 500 100 450
COMPLEX PROCEDURE TO MID FOOT OR HIND FOOT WITHOUT
AUTOGENOUS BONE GRAFT (OSTEOTOMY/FUSION +/– TENDON TRANSFERS) 600 120 730
COMPLEX PROCEDURE TO MID FOOT OR HIND FOOT WITH AUTOGENOUS
BONE GRAFT (OSTEOTOMY/FUSION +/– TENDON TRANSFERS/FIXATION) 600 120 730
COMPLEX PROCEDURE TO MID FOOT AND HIND FOOT WITHOUT
DRG 16.111W0463 AUTOGENOUS GRAFT (OSTEOTOMY/FUSION +/– TENDON Complex
TRANSFERS/FIXATION) 1000 150 950
COMPLEX PROCEDURE TO MID FOOT AND HIND FOOT WITH AUTOGENOUS
DRG 16.111W0464 GRAFT (INCLUDING OSTEOTOMY, FUSION +/– TENDON TRANSFERS, Complex
FIXATION) 1000 150 950
DRG 16.112 FOREFOOT
MULTIPLE PROCEDURES ON FOREFOOT, DISTAL TO AND INCLUDING THE
DRG 16.112W0300 TARSOMETATARSAL JOINTS, WHICH INVOLVES AT LEAST TWO DISTINCT Xmajor
PROCEDURES NOT INTRINSIC TO EACH OTHER 600 120 730
MULTIPLE PROCEDURES ON FOREFOOT, DISTAL TO AND INCLUDING THE
DRG 16.112W0310 TARSOMETATARSAL JOINTS, WHICH INVOLVES AT LEAST TWO DISTINCT Complex
PROCEDURES NOT INTRINSIC TO EACH OTHER - BILATERAL 1000 150 950
System Category Day
CORRECTION OF RETRACTED/DISLOCATED METATARSO-PHALANGEAL
DRG 16.112W1590 JOINT INCLUDING TENDON TRANSFER, DIVISION/REALIGNMENT OF BONE Major
AND INTERNAL FIXATION 500 100 450
OSTEOTOMY OF SMALL BONE OF FOOT (EXCLUDING HALLUX VALGUS AND
INCLUDING INTERNAL FIXATION) 250 50 300
DRG 16.113 HALLUX
METATARSO-PHALANGEAL CHEILECTOMY - UNILATERAL, AS SOLE
PROCEDURE 500 100 450
METATARSO-PHALANGEAL CHEILECTOMY - BILATERAL, AS SOLE
PROCEDURE 600 120 730
METATARSAL OSTEOTOMY (EG SCARF) FOR HALLUX VALGUS, WITH OR
WITHOUT INTERNAL FIXATION AND SOFT TISSUE CORRECTION 500 100 450
METATARSAL OSTEOTOMY (EG SCARF) FOR HALLUX VALGUS, WITH OR
WITHOUT INTERNAL FIXATION AND SOFT TISSUE CORRECTION - BILATERAL 600 120 730
EXCISION ARTHROPLASTY OF FIRST METATARSO-PHALANGEAL JOINT WITH
PROSTHETIC IMPLANTATION OR INTERPOSITION ARTHROPLASTY 500 100 450
EXCISION ARTHROPLASTY OF FIRST METATARSO-PHALANGEAL JOINT WITH
DRG 16.113W5701 PROSTHETIC IMPLANTATION OR INTERPOSITION ARTHROPLASTY – Xmajor
EXCISION ARTHROPLASTY OF FIRST METATARSO-PHALANGEAL JOINT, (E.G.
KELLER, BONNEY-KESSEL PROCEDURES) INCLUDING CHEILECTOMY 250 50 300
EXCISION ARTHROPLASTY OF FIRST METATARSO-PHALANGEAL JOINT, (E.G.
DRG 16.113W5780 KELLER, BONNEY-KESSEL PROCEDURES) INCLUDING CHEILECTOMY - Major
OSTEOTOMY/IES (EG SCARF AND AKIN) FOR HALLUX VALGUS CORRECTION
WITH OR WITHOUT INTERNAL FIXATION AND SOFT TISSUE CORRECTION 500 100 450
OSTEOTOMY/IES (EG SCARF AND AKIN) FOR HALLUX VALGUS CORRECTION
DRG 16.113W0322 WITH OR WITHOUT INTERNAL FIXATION AND SOFT TISSUE CORRECTION - Xmajor
DRG 16.113W0330 FUSION OF FIRST METATARSO-PHALANGEAL JOINT Intermediate 250 50 300
DRG 16.113W0380 FUSION OF FIRST METATARSO-PHALANGEAL JOINT – BILATERAL Major 500 100 450
DRG 16.114 TOES
DRG 16.114T6460 TENDON TRANSFER OF TOE – UNILATERAL Intermediate 250 50 300
DRG 16.114T6461 TENDON TRANSFER OF TOE – BILATERAL Major 500 100 450
FUSION OF INTERPHALANGEAL JOINT(S) OF TOE (INCLUDING INTERNAL
FIXATION) 250 50 300
FUSION OF INTERPHALANGEAL JOINT(S) OF TOE (INCLUDING INTERNAL
FIXATION) – BILATERAL 500 100 450
EXCISION OF JOINT OF TOE WITH RELEASE OF CONTRACTURE AND SOFT
TISSUE CORRECTION 500 100 450
EXCISION OR PARTIAL EXCISION OF IP JOINT OF LESSER TOE WITH TENDON
TRANSFER 250 50 300
DRG 16.115 GENERAL FOOT
DRG 16.115T6762 REPAIR OF TENDON OF FOOT – FLEXOR MINOR Minor 100 20 155
System Category Day
EXCISION OF MEDIAL EMINENCE 1ST OR 5TH MT HEAD WITH SOFT TISSUE
REPAIR (BUNIONECTOMY) 250 50 300
DRG 16.115T6763 REPAIR OF TENDON OF FOOT – EXTENSOR MINOR Minor 100 20 155
DRG 16.115X1110 AMPUTATION OF TOE Intermediate 250 50 300
DRG 16.115X0822 AMPUTATION OF WHOLE RAY Major 500 100 450
AMPUTATION OF LEG/FOOT (INCLUDING SYMES LISFRANC AND CHOPART)
DRG 16.115X0930 Major
500 100 450
DRG 16.12 EXTERNAL FIXATION/TRACTION
DRG 16.12W2910 APPLICATION OF SKELETAL TRACTION TO BONE Minor 100 20 155
DRG 16.12W2930 REMOVAL OF SKELETAL TRACTION FROM BONE Minor 100 20 155
DRG 16.12W3010 APPLICATION OF EXTERNAL FIXATION TO BONE Major 500 100 450
DRG 16.12W3030 REMOVAL OF EXTERNAL FIXATION FROM BONE Minor 100 20 155
DRG 17 Interventional radiology
DRG 17.1 BIOPSY
ULTRASOUND GUIDED INTERSTITIAL LASER ABLATION OF BREAST LESION
250 50 300
DRG 17.1XR100 FLUOROSCOPICALLY GUIDED BIOPSY(IES) Intermediate 250 50 300
DRG 17.1XR110 ULTRASOUND GUIDED BIOPSY(IES) Intermediate 250 50 300
DRG 17.1XR120 CT/MRI GUIDED BIOPSY(IES) Intermediate 250 50 300
IMAGE GUIDED VACUUM ASSISTED EXCISION BIOPSY OF BREAST LESIONS
DRG 17.1XR121 Intermediate
250 50 300
DRG 17.1XR130 TRANSJUGULAR/TRANSFEMORAL PLUGGED LIVER BIOPSY(IES) Intermediate 250 50 300
DRG 17.1XR160 PERCUTANEOUS IMAGE GUIDED FINE NEEDLE ASPIRATION (FNA) Minor 150 0 50
DRG 17.1XR140 UNILATERAL STEREOTACTIC CORE BIOPSY BREAST Intermediate 250 50 300
DRG 17.1XR142 BILATERAL STEREOTACTIC CORE BIOPSY OF BREASTS Intermediate 250 50 300
DRG 17.2 DRAINAGE
DRG 17.2XR170 FLUOROSCOPICALLY GUIDED DRAINAGE OF FLUID COLLECTION Intermediate 250 50 300
DRG 17.2XR180 ULTRASOUND GUIDED DRAINAGE OF FLUID COLLECTION Intermediate 250 50 300
DRG 17.2XR190 CT/MRI GUIDED DRAINAGE OF FLUID COLLECTION Major 500 100 450
DRG 17.3 ANGIOPLASTY
DRG 17.3XR252 VENOPLASTY Major 500 100 450
ANGIOPLASTY OF OTHER ARTERIES (E.G. SUB-CLAVIAN, TIBIAL, FEMORO-
DRG 17.3XR254 Major
POPLITEAL), +/- INSERTION OF STENT 500 100 450
DRG 17.3XR260 ANGIOPLASTY WITH INSERTION OF METALLIC STENT Major 500 100 450
DRG 17.3XR270 ANGIOPLASTY WITH INSERTION OF METALLIC STENT-GRAFT Major 500 100 450
DRG 17.3XR280 INSERTION OF AORTIC METALLIC STENT-GRAFT Complex 1000 150 950
CEREBRAL ANGIOPLASTY WITH OR WITHOUT INSERTION OF METALLIC
DRG 17.3XR290 Complex
STENT 1000 150 950
DRG 17.3XR430 RENAL ANGIOPLASTY, +/- INSERTION OF STENT Major 500 100 450
DRG 17.3XR516 ANGIOPLASTY OF ILIAC ARTERY, +/- INSERTION OF STENT Major 500 100 450
DRG 17.4 EMBOLISATION
ENDOVASCULAR MANAGEMENT OF BRAIN ARTERIOVENOUS MALFORMATION
(INCLUDING 2 SEPARATE INTERVENTIONS) 1000 150 950
ADDITIONAL MANAGEMENT OF BRAIN ARTERIOVENOUS MALFORMATION
DRG 17.4XR303 Minor
(PER ADDITIONAL INTERVENTION) 100 20 155
DRG 17.4XR306 ENDOVASCULAR TREATMENT OF CEREBRAL ANEURYSM Xmajor 600 120 730
DRG 17.4XR352 EMBOLISATION OF ARTERY/VEIN Major 500 100 450
System Category Day
EMBOLISATION OF VASCULAR MASS (INCLUDING UTERINE EMBOLISATION)
1000 150 950
DRG 17.4XR370 EMBOLISATION OF BRONCHIAL ARTERY Complex 1000 150 950
DRG 17.4XR380 EMBOLISATION OF ANEURYSM Complex 1000 150 950
EMBOLISATION OF ARTERIOVENOUS MALFORMATION (AVM) E.G. OF FOOT,
DRG 17.4XR391
MINOR ORGAN Major 500 100 450
DRG 17.4XR442 EMBOLISATION OF VARICOCELE OF GONADAL VEIN Major 500 100 450
DRG 17.5 THROMBOLYSIS
THROMBOLYSIS OR ASPIRATION OF THROMBUS UNDER IMAGING CONTROL
DRG 17.5XR410
Intermediate 250 50 300
DRG 17.6 DILATATION
DRG 17.6XR450 DILATATION OF STRICTURE UNDER IMAGING CONTROL Intermediate 250 50 300
PERCUTANEOUS DILATATION OF BILIARY STRICTURE UNDER IMAGING
DRG 17.6XR565
CONTROL Xmajor 600 120 730
DRG 17.7 HEAD AND NECK
ENDOLUMINAL STONE EXTRACTION FROM SALIVARY DUCT UNDER IMAGING
DRG 17.7XR315
CONTROL Intermediate 350 0 150
DILATATION/STENTING OF NASOLACRIMAL DUCT UNDER IMAGING CONTROL
DRG 17.7XR320
Major 500 100 450
DRG 17.8 SPINE
DRG 17.8XR500 CHEMONUCLEOLYSIS Intermediate 250 50 300
DRG 17.8XR530 FLUOROSCOPICALLY GUIDED PERCUTANEOUS VERTEBROPLASTY Major 500 100 450
DRG 17.8XR540 CT GUIDED PERCUTANEOUS VERTEBROPLASTY Complex 1000 150 950
DRG 17.9 THORAX
DRG 17.9XR595 INSERTION OF TRACHEAL/BRONCHIAL METALLIC STENT Major 500 100 450
INSERTION OF OESOPHAGEAL METALLIC STENT UNDER IMAGING CONTROL
DRG 17.9XR600
Major 500 100 450
DRG 17.10 GASTROINTESTINAL
DRG 17.10XR585 PERCUTANEOUS GASTROSTOMY Major 500 100 450
DRG 17.10XR590 PERCUTANEOUS GASTROJEJUNOSTOMY Major 500 100 450
DRG 17.11 LIVER
DRG 17.11XR570 PERCUTANEOUS INSERTION OF PLASTIC BILIARY ENDOPROSTHESIS Major 500 100 450
DRG 17.11XR575 PERCUTANEOUS INSERTION OF METALLIC BILIARY ENDOPROSTHESIS Xmajor 500 100 450
DRG 17.11XR576 BILIARY DRAINAGE WITH OCCLUDED STENT IN PLACE Major 500 100 450
DRG 17.11XR580 PERCUTANEOUS CHOLECYSTOSTOMY Major 500 100 450
DRG 17.11XR610 TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT Xmajor 600 120 730
DRG 17.12 URINARY
DRG 17.12XR630 PERCUTANEOUS NEPHROSTOMY Intermediate 250 50 300
PERCUTANEOUS CREATION OF TRACK TO KIDNEY FOR NEPHROLITHOTOMY
DRG 17.12XR640
+/- INSERTION OF STENT Xmajor 600 120 730
DRG 17.12XR650 PERCUTANEOUS PYELOLYSIS Xmajor 600 120 730
DRG 17.12XR660 INSERTION OF STENT INTO URETERS - UNILATERAL Major 500 100 450
DRG 17.12XR661 INSERTION OF STENT INTO URETERS - BILATERAL Major 500 100 450
DRG 17.12XR670 RADIOFREQUENCY KIDNEY ABLATION Complex 1000 150 950
DRG 17.13 OTHER
INSERTION OF CENTRAL VENOUS CATHETER - NON-TUNNELLED (X-RAY
DRG 17.13XR910
GUIDED) Intermediate 250 50 300
System Category Day
INSERTION OF CENTRAL VENOUS CATHETER-TUNNELLED (X-RAY GUIDED)
DRG 17.13XR915
Intermediate 250 50 300
PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS (PICCS) UNDER X-
DRG 17.13XR917
RAY GUIDANCE Intermediate 350 0 150
DRG 17.13XR920 CYST ABLATION UNDER IMAGING CONTROL Intermediate 350 0 150
DRG 17.13XR935 INSERTION/REMOVAL OF VENA CAVA FILTER Intermediate 350 0 150
INSERTION OF GUIDEWIRE INTO BREAST LESION UNDER IMAGING CONTROL
DRG 17.13XR936
Minor 100 20 155
DRG 17.13XR940 RETRIEVAL OF FOREIGN BODY UNDER X-RAY GUIDANCE Major 500 100 450
DRG 17.13XR950 OCCLUSION OF FISTULA UNDER IMAGING CONTROL Major 500 100 450
DRG 17.13XR960 PERCUTANEOUS THERMAL COAGULATION OF MASS Complex 1000 150 950
PERCUTANEOUS CHEMICAL ABLATION OF TUMOUR - ULTRASOUND GUIDED
DRG 17.13XR962
Xmajor 600 120 730
DRG 17.13XR963 PERCUTANEOUS CHEMICAL ABLATION OF TUMOUR - CT GUIDED Xmajor 600 120 730
DRG 17.13XR964 LIVER ABLATION (RADIOFREQUENCY) Complex 1000 150 950
DRG 17.13XR967 CT GUIDED THERMOCOAGULATION OF OSTEOID OSTEOMA Major 500 100 450
DRG 17.13XR968 COLONIC STENT INSERTION Major 500 100 450
DRG 18 CHEMOTHERAPY
DRG 18.1 CHEMOTHERAPY
CLINICAL SUPERVISION AND PLANNING FOR THE DELIVERY OF
DRG 18.1X0001
CHEMOTHERAPY REGIMENS FOR 0 - 7 DAYS 125 0
CLINICAL SUPERVISION AND PLANNING FOR DELIVERY OF CHEMOTHERAPY
DRG 18.1X0002
CYCLE 1-14 DAYS 250 0
DRG 18.1X0003
CYCLE 1 - 21 DAYS 375 0
DRG 18.1X0004
REGIMENS FOR 1 - 28 DAYS 500 0
DRG 18.1A5480 INTRATHECAL CHEMOTHERAPY Minor 150 0 50
CLINICAL SUPERVISION OF THE DELIVERY OF A SINGLE FRACTION OF
DRG 18.1X6581
RADIOTHERAPY Minor 100 20 155
DRG 19 HAEMATOLOGY (HOSPITAL USE ONLY)
DRG 19.1 BONE MARROW
THE CCSD CODES BELOW ARE SOLELY FOR USE BY HOSPITAL. THE FEES
FOR THESE SERVICES SHOULD BE CONFIRMED BY THE INSURANCE
DRG
COMPANY AND APPROVAL MUST BE OBTAINED IN ADVANCE OF
TREATMENT.
DRG 19.1U0010 HARVESTING FOR AUTOLOGOUS BONE MARROW TRANSPLANT 0 0 0
DRG 19.1U0020 HARVESTING FOR ALLOGENEIC BONE MARROW TRANSPLANT 0 0 0
DRG 19.1U0030 HARVESTING FOR MATCHED UNRELATED BONE MARROW TRANSPLANT 0 0 0
DRG 19.1U0040 AUTOLOGOUS BONE MARROW TRANSPLANT 0 0 0
DRG 19.1U0050 ALLOGENEIC BONE MARROW TRANSPLANT 0 0 0
DRG 19.1U0060 MATCHED UNRELATED BONE MARROW TRANSPLANT 0 0 0
DRG 19.2 STEM CELL
THE CCSD CODES BELOW ARE SOLELY FOR USE BY HOSPITAL. THE FEES
FOR THESE SERVICES SHOULD BE CONFIRMED BY THE INSURANCE
DRG
COMPANY AND APPROVAL MUST BE OBTAINED IN ADVANCE OF
TREATMENT.
System Category Day
HARVESTING FOR AUTOLOGOUS PERIPHERAL BLOOD STEM CELL
DRG 19.2U0080
TRANSPLANT 0 0 0 0
HARVESTING FOR ALLOGENEIC PERIPHERAL BLOOD STEM CELL
DRG 19.2U0090
TRANSPLANT 0 0 0 0
DRG 19.2U0100 AUTOLOGOUS PERIPHERAL BLOOD STEM CELL TRANSPLANT 0 0 0 0
DRG 19.2U0110 ALLOGENEIC PERIPHERAL BLOOD STEM CELL TRANSPLANT 0 0 0 0
DRG 19.2U0120 MATCHED UNRELATED PERIPHERAL BLOOD STEM CELL TRANSPLANT 0 0 0 0
20 DENTAL OPD
20.1 DENTAL DIAGNOSTIC
CDT D0120 Office/ OUT PATIENT VISIT CONSULTANT , NEW PATIENT 20 0 0 0
CDT D0140 OFFICE/ OUT PATIENT VISIT GENERAL DENTIST , NEW PATIENT 10 0 0 0
CDT D0150 Office/ OUT PATIENT VISIT SPECIALIST , NEW PATIENT 15 0 0 0
CDT D0191 INPATIENT CONSULTATION 20 0 0 0
CDT D0220 INTRAORAL -PERIAPICAL FIRST FILM 5 0 0 0
CDT D0230 INTRAORAL -PERIAPICAL ADDITIONAL FILM 3 0 0 0
CDT D0240 INTRAORAL-OCCLUSAL FILM 7 0 0 0
CDT D0250 EXTRA-ORAL POSTERIOR RADIOGRAPHIC IMAGE 15 0 0 0
CDT D0270 BITEWING- SINGLE FILM 5 0 0 0
CDT D0272 BITEWING-TWO FILMS 8 0 0 0
CDT D0273 BITEWING-THREE FILMS 12 0 0 0
CDT D0274 BITEWING -FOUR FILMS 15 0 0 0
CDT D0310 SIALOGRAPHY 30 0 0 0
CDT D0320 TEMPOROMANDIBULAR JOINT ARTHROGRAM 25 0 0 0
CDT D0321 OTHER TEMPROMANDIBULAR JOINT FILMS 25 0 0 0
CDT D0330 PANORAMIC FILM 15 0 0 0
CDT D0340 CEPHALOMETRIC FILM -LATERAL 20 0 0 0
CDT D0341 CEPHALOMETRIC- PA VIEW 20 0 0 0
CDT D0350 ORAL/ FACIAL PHOTOGRAPHIC IMAGES 10 0 0 0
CDT D0360 PANORAMIC 3DTS 30 0 0 0
CDT D0418 ANALYSIS OF SALIVA SAMPLE 0 0 0
CDT D0421 GENETIC TEST FOR SUSCEPTIBILITY TO ORAL DISEASES 0 0 0
CDT D0460 PULP VITALITY TESTS 5 0 0 0
CDT D0470 DIAGNOSTIC CASTS 15 0 0 0
CDT D0471 DIAGNOSTIC RECORDS 50 0 0 0
20.2 PREVENTIVE
CDT D1110 PROPHYLAXIS - ADULT 20 0 0 0
CDT D1120 PRPHYLAXIS -CHILD 15 0 0 0
CDT D1201 TOPICAL APPLICATION OF FLUORIDE (INCLUDING PROPHYLAXIS ) CHILD 25 0 0 0
CDT D1206 TOPICAL FLUORIDE APPLICATION VARNISH 10 0 0 0
CDT D1351 SEALANT PER TOOTH 5 0 0 0
CDT D1510 SPACE MAINTAINER- FIXED- UNILATERAL 60 0 0 0
CDT D1515 SPACE MAINTAINER- FIXED- BILATERAL 100 0 0 0
CDT D1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL 50 0 0 0
CDT D1525 SPACE MAINTAINER- REMOVABLE- BILATERAL 60 0 0 0
CDT D1550 RE-CEMENT OR REBOND SPACE MAINTAINER 15 0 0 0
CDT D1555 REMOVAL OF FIXED SPACE MAINTAINER 10 0 0 0
20.3 RESTORATIVE
CDT D2140 AMALGAM ONE SURFACE PRIMARY OR PERMANENT 15 0 0 0
System Category Day
CDT D2150 AMALGAM TWO SURFACES PRIMARY OR PERMANENT 20 0 0 0
CDT D2160 AMALGAM THREE SURFACES PRIMARY OR PERMANENT 25 0 0 0
CDT D2161 AMALGAM -FOUR OR MORE SURFACES PRIMAR OR PERMANENT 30 0 0 0
CDT D2330 RESIN BASED COMPOSITE - ONE SURFACE ANTERIOR 15 0 0 0
CDT D2331 RESIN BASED COMPOSITE - TWO SURFACES ANTERIOR 20 0 0 0
CDT D2332 RESIN BASED COMPOSITE - THREE SURFACES ANTERIOR 25 0 0 0
CDT D2335 RESIN BASED COMPOSITE - FOUR OR MORESURFACES ANTERIOR 30 0 0 0
CDT D2390 RESIN BASED COMPOSITE - CROWN ANTERIOR 50 0 0 0
CDT D2391 RESIN BASED COMPOSITE - ONE SURFACE POSTERIOR 20 0 0 0
CDT D2392 RESIN BASED COMPOSITE -TWO SURFACES POSTERIOR 25 0 0 0
CDT D2393 RESIN BASED COMPOSITE - THREE SURFACES POSTERIOR 30 0 0 0
CDT D2394 RESIN BAASED COMPOSITE - FOUR OR MORE SRFACES - PSTERIOR 30 0 0 0
CDT D2510 INLAY - METALIC ONE SURFACE 50 0 0 0
CDT D2520 INLAY - METALIC TWO SURFACES 60 0 0 0
CDT D2530 INLAY - METALIC THREE OR MORE SURFACES 70 0 0 0
CDT D2543 ONLAY- METALIC THREE SURFACES 60 0 0 0
CDT D2544 ONLAY -METALIC FOUR OR MORE SURFACES 70 0 0 0
CDT D2610 INLAY- PORCELAIN-CERAMIC- ONE SURFACE 120 0 0 0
CDT D2620 INLAY- PORCELAIN-CERAMIC- TWO SURFACES 130 0 0 0
CDT D2630 INLAY- PORCELAIN-CERAMIC- THREE OR MORE SURFACES 150 0 0 0
CDT D2642 ONLAY- PORCELAIN-CERAMIC- TWO SURFACES 120 0 0 0
CDT D2643 ONLAY- PORCELAIN-CERAMIC- THREE SURFACES 130 0 0 0
CDT D2644 ONLAY- PORCELAIN-CERAMIC- FOUR OR MORE SURFACES 150 0 0 0
CDT D2650 INLAY- COMPOSITE RESIN ONE SURFACE(LAB PROCESSED) EMAX 120 0 0 0
CDT D2651 INLAY- COMPOSITE RESIN TWO SURFACES(LAB PROCESSED) EMAX 130 0 0 0
INLAY- COMPOSITE RESIN THREE OR MORE SURFACES(LAB PROCESSED)
CDT D2652
EMAX 150 0 0 0
CDT D2662 ONLAY- COMPOSITE RESIN TWO SURFACES (LAB PROCEESSED) E MAX 120 0 0 0
ONLAY- COMPOSITE RESIN THREE SURFACES (LAB PROCEESSED) EMAX
CDT D2663
130 0 0 0
ONLAY- COMPOSITE RESIN FOUR OR MORE SURFACES (LAB PROCEESSED)
CDT D2664
EMAX 150 0 0 0
CDT D2710 CROWN RESIN BASED COMPOSITE INDIRECT 80 0 0 0
CDT D2720 PORCELAIN CROWN- CIRCON 150 0 0 0
CDT D2740 CORWN -PORCELAIN CERAMIC- EMAX 120 0 0 0
CDT D2750 CROWN PORCELAIN- FUSED TO HIGH NOBLE METAL 100 0 0 0
CDT D2751 CROWN PORCELAIN- FUSED TO BASE METAL 90 0 0 0
CDT D2752 CROWN+ BRIDGE PORCELAIN ONE UNIT 150 0 0 0
CDT D2753 CROWN AND BRIDGE METALL FUSED PORCELAIN PER UNIT 100 0 0 0
CDT D2754 CROWN FULL CAST PREDOMINANTLY BASE METAL 60 0 0 0
CDT D2755 CROWN FULL CAST NOBLE METAL 80 0 0 0
CDT D2757 RECEMENT -INLAY 10 0 0 0
CDT D2758 RECEMENT - CROWN/ BRIDGE 10 0 0 0
RECEMENT- OR REBOND INLAY/ONLAY/VENEER OR PARTIAL COVERAGE
CDT D2910
RESTO 10 0 0 0
CDT D2930 PREFABRICATED STSINLESS STEEL CROWN PRIMARY TOOTH 50 0 0 0
CDT D2932 PRE FABRICATED RESIN CROWN 60 0 0 0
CDT D2940 SEDATIVE FILLING 15 0 0 0
System Category Day
CDT D2950 CORE BUILDUP INCLUDING ANY PINS WHEN REQUIRED 60 0 0 0
CDT D2952 POST AND CORE INADDITION TO CROWN INDIRECTLY FABRICATED 60 0 0 0
CDT D2955 POST REMOVAL 15 0 0 0
CDT D2960 LABIAL VENEER LAMINATE CHAIRSIDE- COMPOSITE 50 0 0 0
CDT D2961 LABIAL VENEER RESIN LAMINATE- LABORATORY- EMAX 130 0 0 0
CDT D2970 TEMPORARY CROWN -FRACTURED TOOTH 20 0 0 0
CDT D2980 CROWN REPAIR 25 0 0 0
CDT D2981 GI RESTORATION 15 0 0 0
20.4 ENDODONTICS
CDT D3110 PULP CAP DIRECT EXCLUDING FINAL RESTORATION 15 0 0 0
CDT D3120 PULPCAP-INDIRECT EXCLUDING FINAL RESTORATION 20 0 0 0
CDT D3220 THERAPEUTIC PULPOTOMY EXCLUDING FINAL RESTORATION 25 0 0 0
CDT D3221 PULPAL DEBRIDEMENT- PRIMARY/PERMENANT TOOTH 25 0 0 0
CDT D3230 PULPAL THERAPY -ANTERIOR / PRIMARY 20 0 0 0
CDT D3240 PULPAL THERAPY- POSTERIOR/PRIMARY 25 0 0 0
ENDODONTIC THERAPY ANTERIOR TOOTH EXCLUDING FINAL RESTORATION
CDT D3310
70 0 0 0
CDT D3320 ENDODONTIC THERAPY BICUSPID EXCLUDING FINAL RESTORATION 80 0 0 0
CDT D3330 ENDODNTIC THERAPY MOLAR EXCLUDING FINAL RESTORATION 100 0 0 0
CDT D3346 RETREATMENT OF PREVIOUS RCT ANTERIOR 80 0 0 0
CDT D3347 RETREATMENT OF PREVIOUS RCT BICUSPID 100 0 0 0
CDT D3348 RETREATMENT OF PREVIOUS RCT MOLAR 120 0 0 0
CDT D3352 APEXIFICATION/RECALCIFICATION- INTIAL VISIT 30 0 0 0
CDT D3353 APEXIFICATION/RECALCIFICATION- FINAL VISIT 30 0 0 0
CDT D3410 APICOECTOMY- ANTERIOR 100 0 0 0
CDT D3421 APICOECTOMY- PERIRADICULAR SURGERY(FIRST ROOT) 120 0 0 0
CDT D3425 APICOECTOMY- PERIRADICULAR SURGERY MOLAR 150 0 0 0
CDT D3430 RETROGRADE FILLING PER TOOTH 30 0 0 0
CDT D3450 ROOT AMPUTATION 60 0 0 0
CDT D3470 INTENTIONAL REIMPLANTATION INCLUDING NECESSARY SPLINTING 100 0 0 0
CDT D3910 SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM 20 0 0 0
CDT D3920 HEMISECTION INCLUDING ANY ROOT REMOVED, NOT INCLUDING RCT 60 0 0 0
CDT D3960 BLEACHING OF DISCOLORED TOOTH 40 0 0 0
CDT D3961 ROOT CANAL TREATEMNT - ACESS OPENING AND DRESSING 15 0 0 0
CDT D3962 ROOT CANAL TREATMENT SINGLE ROOT-FIRST VISIT 30 0 0 0
CDT D3963 ROOT CANAL TREATMENT SINGLE ROOT-SECOND VISIT 30 0 0 0
CDT D3964 ROOT CANAL TREATMENT DOUBLE ROOT-FIRST VISIT 40 0 0 0
CDT D3965 ROOT CANAL TREATMENT DOUBLE ROOT-SECOND VISIT 40 0 0 0
CDT D3966 ROOT CANAL TREATMENT MULTI ROOT-FIRST VISIT 50 0 0 0
CDT D3967 ROOT CANAL TREATMENT MULTI ROOT-SECOND VISIT 50 0 0 0
CDT D3968 ROOT CANAL TREATMENT -OBTTURATION- SINGLE ROOT 30 0 0 0
CDT D3969 ROOT CANAL TREATMENT -OBTTURATION- DOUBLE ROOT 30 0 0 0
CDT D3970 ROOT CANAL TREATMENT -OBTTURATION- MULTI ROOT 30 0 0 0
CDT D3971 ROOT CANAL OVERFILLING - ANTERIOR 20 0 0 0
CDT D3972 ROOT CANAL OVERFILLING - BICUSPID 25 0 0 0
CDT D3973 ROOT CANAL OVERFILLING- MOLAR 25 0 0 0
CDT D3974 ROOT CANAL TREATMENT -SINGLE ROOT- ONE VISIT 100 0 0 0
CDT D3975 ROOT CANAL TREATMENT -DOUBLE ROOT- ONE VISIT 120 0 0 0
System Category Day
CDT D3976 ROOT CANAL TREATMENT -MULTIPLE ROOTS - ONE VISIT 150 0 0 0
20.5 PERIODONTICS
CDT D4210 GINGIVECTOMY OR GINGIVOPLASTY- PER QUADRANT 60 0 0 0
CDT D4220 GINGIVAL CURETTAGE SURGICAL PER QUADRANT 50 0 0 0
GINGIVAL FLAP PROCEDURE INCLUDING ROOT PLANNING PER QUADRANT
CDT D4240
60 0 0 0
CDT D4245 APICALLY POSITIONED FLAP 50 0 0 0
CDT D4249 CLINICAL CROWN LENGTHENING- HARD TISSUE 60 0 0 0
CDT D4250 MUCOGINGIVAL SURGERY PER QUADRANT 60 0 0 0
CDT D4260 OSSEOUS SURGERY INCLUDING FLAP ENTRY -PER QUADRANT 80 0 0 0
CDT D4263 BONE REPLACEMENT GRAFT- FIRST SITE IN QUADRANT 120 0 0 0
CDT D4264 BONE REPLACEMENT GRAFT- EACH ADDITIONAL SIDE IN QUADRANT 30 0 0 0
CDT D4266 GUIDED TISSUE REGENERATION -PER SIDE PER TOOTH 150 0 0 0
GUIDED TISSUE REGENERATION NON RESORABLE BARRIER PER SIDE PER
CDT D4267
TOOTH 180 0 0 0
CDT D4270 PEDICLE SOFT TISSUE GRAFT PROCEDURE 180 0 0 0
CDT D4271 FREE SOFT TISSUE GRAFT PROCEDURE 120 0 0 0
CDT D4320 SPLINTING OF TEETH- FIBER SPLINT 60 0 0 0
CDT D4320-01 SPLINTING OF TEETH -WIRE 50 0 0 0
PERIODONTAL SCALING AND ROOT PLANNING 4 OR MORE TOOTH PER
CDT D4341
QUADRANT 30 0 0 0
PERIODONTAL SCALING AND ROOT PLANNING 1-3 TOOTH PER QUADRANT
CDT D4342
20 0 0 0
CDT D4355 FULL MOUTH DEBRIDEMENT 30 0 0 0
CDT D4910 PERIODONTL MAINTANENCE 20 0 0 0
CDT D4920 PROPHYJET AIR POLISHING 20 0 0 0
CDT D4930 INCISION AND DRAIN PERIODONTAL ABSCESS 20 0 0 0
CDT 4999 UNSPECIFIED PERIODONTAL PROCEDURE
CDT 20.6 PROSTHODONTICS - REMOVABLE
CDT D5110 COMPLETE DENTURE -MAXILLARY 120 0 0 0
CDT D5120 COMPLETE DENTURE -MANDIBULAR 120 0 0 0
CDT D5130 IMMEDIATE DENTURE - MAXILLARY 100 0 0 0
CDT D5140 IMMEDIATE DENTURE -MANDBULAR 100 0 0 0
CDT D5211 MAXILLARY -PARTIAL DENTURE RESIN BASED 1-3 TEETH 40 0 0 0
CDT D5212 MANDIBULAR PARTIAL DENTURE RESIN BASED 1-3 TEETH 40 0 0 0
CDT D5213 MAXILLARY -PARTIAL DENTURE CAST METAL FRAME WORK -1-3 TEETH 130 0 0 0
CDT D5214 MANDIBULAR-PARTIAL DENTURE CAST METAL FRAME WORK 1-3 TEETH 130 0 0 0
CLEANING OR INSPECTION L REMOVABLE COMPLETE DENTURE MAXILLARY
CDT D5221
20 0 0 0
CLEANING OR INSPECTION L REMOVABLE COMPLETE DENTURE
CDT D5222
MANDIBULAR 20 0 0 0
CLEANING OR INSPECTION L REMOVABLE PARTIAL DENTURE MAXILLARY
CDT D5223
20 0 0 0
CLEANING OR INSPECTION L REMOVABLE PARTIAL DENTURE MANDIBULAR
CDT D5224
20 0 0 0
CDT D5225 VITAPLEX REMOVABLE PARTIAL DENTURE 1-3 TEETH 75 0 0 0
CDT D5226 VITAPLEX COMPLETE DENTURE PER SRCH 150 0 0 0
CDT D5227 ADDITION OF EACH TOOTH IN PARTIAL DENTURE 10 0 0 0
System Category Day
CDT D5410 ADJUST COMPLETE DENTURE MAXILLARY 15 0 0 0
CDT D5411 ADJUST COMPLETE DENTURE MANDIBULAR 15 0 0 0
CDT D5421 ADJUST PARTIAL DENTURE MAXILLARY 15 0 0 0
CDT D5422 ADJUST PARTIAL DENTURE MANDIBULAR 15 0 0 0
CDT D5510 REPAIR BROKEN COMPLETE DENTURE BASE 30 0 0 0
CDT D5520 REPLACE MISSING OR BROKEN TEETH -COMPLETE DENTURE 20 0 0 0
CDT D5610 REPAIR RESIN DENTURE BASE 60 0 0 0
CDT D5620 REPAIR CAST FRAME WORK 20 0 0 0
CDT D5630 REPAIR / REPLACE BROKEN CLASP PER TOOTH 20 0 0 0
CDT D5640 REPLACE BROKEN TEETH/ PER TOOTH 10 0 0 0
CDT D5650 ADD TOOTH TO EXISTING PARTIAL DENTURE 15 0 0 0
CDT D5710 REBASE COMPLETE MAXILLARY DENTURE 50 0 0 0
CDT D5711 REBASE COMPLETE MANDIBULARY DENTURE 50 0 0 0
CDT D5720 REBASE PARTIAL MAXILLARY DENTURE 40 0 0 0
CDT D5721 REBASE MANDIBULAR PARTIAL DENTURE 40 0 0 0
CDT D5750 RELINE COMPLETE MAXILLARY DENTURE- LAB 40 0 0 0
CDT D5751 RELINE COMPLETE MANDIBULAR DENTURE - LAB 40 0 0 0
CDT D5760 RELINE PARTIAL DENTURE MAXILLARY - LAB 30 0 0 0
CDT D5761 RELINE PARTIAL DENTURE MANDIBULAR LAB 30 0 0 0
CDT D5850 TISSUE CONDITIONING MAXILLARY 30 0 0 0
CDT D5851 TISSUE CONDITIONING MANDIBULAR 30 0 0 0
CDT D5862 PRECISION ATTACHMENT BY REPORT
CDT D5863 OVERDENTURE COMPLETE MAXILLARY 120 0 0 0
CDT D5865 OVERDENTURE COMPLETE MANDIBULAR 120 0 0 0
CDT D5899 UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE-BY REPORT
20.7 IMPLANT SERVICES
CDT D6012 DENTAL IMPLANT - ANTERIOR TOOTH 450 0 0 0
CDT D6040 DENTAL IMPLANT - BICUSPID 500 0 0 0
CDT D6050 DENTAL IMPLANT- MOLAR 600 0 0 0
CDT D6053 IMPLANT SUPPOERTED FULL DENTURE 300 0 0 0
CDT D6054 IMPLANT/ABUTMENT SUPPORTED REMOVABLE PARTIAL DENTURE 150 0 0 0
CDT D6060 DENTAL IMPALNT CROWN PFM 150 0 0 0
CDT D6065 IMPLANT SUPPORTED PORCELAIN /CERAMIC CROWN 200 0 0 0
CDT D6199 UNSPECIFIED IMPLANT PROCEDURE BY REPORT
20.8 PROSTHODONTICS- FIXED
CDT D6245 CERC 3D PORCELAIN BRIDGE FOR THE ABUTMENT 160 0 0 0
CDT D6245-1 CERC 3D PORCELAIN BRIDGE FOR THE PONTIC 160 0 0 0
CDT D6930 RECEMENT OR REBOND FIXED PARTIAL DENTURE 20 0 0 0
CDT D6999 UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE BY REPORT
20.9 ORAL &MAXILLOFACIAL SURGERY
CDT D7111 EXTRACTION CORONAL REMNANTS OF DECIDUOUS TOOTH 15 0 0 0
CDT D7140 EXTRACTION ERUPTED TOOTH 30 0 0 0
CDT D7210 SURGICAL REMOVAL OF ERUPTED TOOTH- BONE REMOVAL -SUTURING 50 0 0 0
CDT D7220 REMOVAL OF IMPACTED TOOTH -SOFT TISSUE 75 0 0 0
CDT D7230 REMOVAL OF IMPACTED TOOTH PARTIALLY BONY 80 0 0 0
CDT D7240 REMOVAL OF IMPACTED TOOTH COMPLETLY BONY 150 0 0 0
REMOVAL OF IMPACTED TOOTH COMPLETELY BONY WITH UNSUAL
CDT D7241
COMPLICATION 200 0 0 0
System Category Day
CDT D7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOT 60 0 0 0
CDT D7260 ORAL ANTRAL FISTULA CLOSURE 100 0 0 0
TOOTH REIMPLANTAION/ OR STABILIZATION OF ACCIDENTLY EVULSED
CDT D7270
TOOTH 80 0 0 0
CDT D7280 SURGICAL ACCESS OF UNERUPTED TOOTH 100 0 0 0
CDT D7283 PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH 30 0 0 0
CDT D7286 INCISIONAL BIOPSY OF ORAL TISSUE 50 0 0 0
CDT D7288 BRUSH BIOPSY- TRANSEPITHELIAL SAMPLE COLLECTION 30 0 0 0
CDT D7290 SURGICAL REPOSITIONING OF TEETH 90 0 0 0
CDT D7291 TRANSEPTAL FIBEROTOMY 50 0 0 0
CDT D7310 ALVEOLOPLASTY- 4 OR MORE TEETH 80 0 0 0
CDT D7311 ALVELOPLASTY 1-3 TEETH 50 0 0 0
CDT D7340 VESTBULOPLASTY - RIDGE EXTENSION 100 0 0 0
CDT D7410 EXCISION OF BENIGN LESION UP TO 1.25 CM 75 0 0 0
CDT D7471 REMOVAL OF LATERAL EXOSTOSIS 100 0 0 0
CDT D7472 REMOVAL OF TORUS PALATINUS 150 0 0 0
CDT D7473 REMOVAL OF TORUS MANDIBULARIS 150 0 0 0
CDT D7485 SURGICAL REDUCTION OF OSSEOUS TUBEROSITY 120 0 0 0
CDT D7510 INCISION AND DRAINAGE OF ABSCESS INTRA ORAL SOFT TISSUE 20 0 0 0
CDT D7520 INCISION AND DRAINAGE OF ABSCESS EXTRA ORAL SOFT TISSUE 50 0 0 0
CDT D7960 FRENECTOMY 50 0 0 0
CDT D7610 MAXILLA OPEN REDUCTION 500 0 0 0
CDT D7620 MAXILLA CLOSED REDUCTION 200 0 0 0
CDT D7630 MANDIBLE OPEN REDUCTION 500 0 0 0
CDT D7640 MANDIBLE CLOSED REDUCTION 200 0 0 0
CDT D7660 MALAR OR ZYGOMATIC ARCH FRACTURE REDUCTION 300 0 0 0
CDT D7670 ALVELOUS CLOSED REDUCTION 300 0 0 0
CDT D7671 ALVEOLUS OPEN REDUCTION 200 0 0 0
CDT D7970 EXCISION OF HYPERPLASTIC TISSUE PER ARCH 60 0 0 0
CDT D7971 EXCISION OF PERICORONAL GINGIVA 40 0 0 0
CDT D7972 SURGICAL REDUCTION OF FIBROUS TUBEROSITY 60 0 0 0
CDT D7680 FACIAL BONE COMPLICATED OPEN REDUCTION 500 0 0 0
CDT D7710 LEFORT 1 FRACTURE OPEN REDUCTION 300 0 0 0
CDT D7730 MANDIBULAR FRACTURE OPEN REDUCTION 400 0 0 0
CDT D7820 CLOSED REDUCTION OF DISLOCATION 100 0 0 0
CDT D7880 OCCLUSAL ORTHOTIC APPLIANCE 60 0 0 0
CDT D7899 UNSPECIFIED TMD THERAPY
CDT D7910 COMPLICATED SUTURE 60 0 0 0
CDT D7911 EXTRACTION SIMPLE 10 0 0 0
CDT D7912 EXTRACTION NORMAL 15 0 0 0
CDT D7913 EXTRACTION MINOR 20 0 0 0
CDT D7914 EXTRACTION THIRD MOLAR SIMPLE 30 0 0 0
CDT D7915 CYST ENUCLEATION MINOR 60 0 0 0
CDT D7916 CYST ENUCLEATION MAJOR 100 0 0 0
20.10 ORTHODONTICS
CDT D8010 LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION 150 0 0 0
CDT D8020 LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION 250 0 0 0
CDT D8030 LIMITED ORTHODONTIC TREATMENT OF THE ADOLESENT DENTITION 450 0 0 0
System Category Day
CDT D8040 LIMITED ORTHODONTIC TREATMENT OF THE ADULTL DENTITION 550 0 0 0
CDT D8050 INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION 150 0 0 0
INTERCEPTIVE ORTHODONTIC TREATMENT OF THETRANSITION DENTITION
CDT D8060
250 0 0 0
CDT D8070 COMPREHENSIVE TREATMENT OF THE TRANSITIONAL DENTITION 480 0 0 0
CDT D8210 REMOVABLE APPLIANCE THERAPY 100 0 0 0
CDT D8220 FIXED APPLIANCE SS STRAIGHT WIRE FOLLOW UP -SINGLE ARCH 20 0 0 0
CDT D8221 FIXED APPLIANCE SS STRAIGHT WIRE FILLOW UP 30 0 0 0
CDT D8222 FIXED APPLIANCE SS STRAIGHT WIRE FILLOW UP- 1 40 0 0 0
CDT D8223 FIXED APPLIACE CERAMIC FOLLOW UP FULL ARCH 40 0 0 0
CDT D8225 FIXED APPLIANCE SELF LIGATING SS FOLLOW UP 50 0 0 0
CDT D8226 FIXED APPLIANCE SELF LIGATING CERAMIC FOLLOW UP 60 0 0 0
CDT D8227 FIXED APPLIANCE FULL TREATMENT SS 900 0 0 0
CDT D8228 FIXED APPLIANCE FULL TREATMENT CERAMIC 1200 0 0 0
CDT D8229 FIXED APPLIANCE SELF LIGATING FULL TREATMENT 1500 0 0 0
CDT D8230 FIXED APPLIANCE SELFLIGATING CERAMIC FULL TREATMENT 1700 0 0 0
CDT D8660 PRE ORTHODONTIC VISIT 20 0 0 0
CDT D8670 PERIODIC ORTHODONTIC TREATMENT VISIT-AS PART OF CONTRACT 30 0 0 0
CDT D8671 FIXED APPLIANCE SS UPPER BRACKETING -1 150 0 0 0
CDT D8674 FIXED APPLIANCE SS LOWER BRACKETING -1 100 0 0 0
CDT D8675 FIXED APPLIANCE SS LOWER BRACKETING -2 60 0 0 0
CDT D8676 FIXED APPLIANCE CERAMIC UPPER BRACKETING -1 250 0 0 0
CDT D8677 FIXED APPLIANCE CERAMIC UPPER BRACKETING -2 200 0 0 0
CDT D8678 FIXED APPLIANCE CERAMIC LOWER BRACKETING -1 150 0 0 0
CDT D8679 FIXED APPLIANCE CERAMIC LOWER BRACKETING -2 100 0 0 0
CDT D8680 HAWLEY'S RETAINER 50 0 0 0
CDT D8681 FIXED APPLIANCE SS SELF LIGATING UPPER BRACKETING -1 250 0 0 0
CDT D8682 FIXED APPLIANCE SS SELF LIGATING UPPER BRACKETING -2 200 0 0 0
CDT D8683 FIXED APPLIANCE SS SELF LIGATING LOWER BRACKETING 150 0 0 0
CDT D8684 FIXED APPLIANCE CERAMIC SELF LIGATING UPPER BRACKETING -1 350 0 0 0
CDT D8685 FIXED APPLIANCE CERAMIC SELF LIGATING UPPER BRACKETING -2 250 0 0 0
CDT D8686 FIXED APPLIANCE CERAMIC SELF LIGATING LOWER BRACKETING -1 150 0 0 0
CDT D8687 FIXED APPLIANCE CERAMIC SELF LIGATING LOWER BRACKETING -2 100 0 0 0
CDT D8690 PERIODIC ORTHODONTIC TREATMENT - ALTERNATIVE TO CNTRACT 35 0 0 0
CDT D8691 REPAIR OF ORTHODONTIC APPLIANCE 15 0 0 0
CDT D8692 REPLACEMENT OF LOST OR BROKEN RETAINER 40 0 0 0
CDT D8693 REBONDING/ RECEMENTING OF FIXED RETAINERS 20 0 0 0
CDT D8710 LINGUAL ORTHODONTIC TREATMENT PER ARCH 1500 0 0 0
CDT D8711 LINGUAL ORTHODONTIC TREATMENT INITIAL PAYMENT 500 0 0 0
CDT D8712 LINGUAL ORTHODONTIC TREATMENT MONTHLY PAYMENT 70 0 0 0
CDT D8713 INVISALIGN/CLEARPATH FULL TREATMENT 2200 0 0 0
CDT D8714 INVISALIGN/CLEARPATH TREATMENT- SINGLE ARCH 1100 0 0 0
CDT D8715 LOWER LINGUAL ARCH 60 0 0 0
CDT D8716 TRANSPALATAL ARCH 50 0 0 0
CDT D8717 MYOFUNCTIONAL APPLIANCE FR 2/FR3 225 0 0 0
CDT D8718 TWINBLOCK APPLIANCE 250 0 0 0
System Category Day
CDT D8719 FORSYS APPLIANCE 300 0 0 0
CDT D8720 LIP BUMPER 60 0 0 0
CDT D8721 HABIT BREAKER APPLIANCE 100 0 0 0
CDT D8722 CHIP CAP WITH HEADGEAR 120 0 0 0
CDT D8723 HEADGEAR WITH FACE BOW 60 0 0 0
CDT D8724 REVERSE PULL HEADGEAR 250 0 0 0
CDT D8725 RAPID PALATAL EXPANDER 100 0 0 0
CDT D8726 OCCLUSAL NIGHT GUARD 60 0 0 0
CDT D8727 MOUTH GUARD SPORTS 120 0 0 0
CDT D8728 UPPER / LOWER ESSIX RETAINER 60 0 0 0
CDT D8729 ESSIX RETAINER -SINGLE 40 0 0 0
CDT D8730 BONDED LINGUAL RETAINER UPPER/ LOWER 60 0 0 0
CDT D8731 BONDED PALATAL RETAINER SMALL 40 0 0 0
CDT D8732 REMOVABLE APPLIANCE -FOLLOW UP 10 0 0 0
CDT D8733 DEBONDING FIXED APPLIANCE -1 100 0 0 0
CDT D8734 DEBONDING FIXED APPLIANCE -2 60 0 0 0
CDT D8735 DEBONDING FIXED APPLIANCE WITHOUT RETAINER 40 0 0 0
CDT D8736 TAD SINGLE PICEE 60 0 0 0
CDT D8737 ORTHODONTIC SCALING AND POLISHING 15 0 0 0
CDT D8738 REPACEMENT OF LOST OR BOKEN BRACKET 10 0 0 0
CDT D8739 RECEMENTING MOLAR BAND 15 0 0 0
CDT D8740 DISTALIZATION APPLIANCE 60 0 0 0
CDT D8741 MYOBRACE APPLIANCE 100 0 0 0
CDT D8742 EXPANSION APPLIANCE REMOVABLE 75 0 0 0
CDT D8743 OCCLUSAL ADJUSTMENT LIMITED 15 0 0 0
CDT D8744 MYOSA SLEEP APNOEA APPLIANCE 150 0 0 0
CDT D8999 UNSPECIFIED ORTHODONTIC PROCEDURE 25 0 0 0
CDT D5875 CEPALOMETRIC RADIOGRAPHIC IMAGE -ACQUISITION, MEAAUREMENT 25 0 0 0
,,ANALYSIS
20.11 ADJUNCTIVE GENERAL SERVICES
CDT D9110 PALLAITIVE TREATMENT OF DENTAL PAIN MINOR PROCEDURE 20 0 0 0
CDT D9248 IMMEDIATE DENTURE MAXILLARY -PARTIAL 40 0 0 0
CDT D9420 HOSPITAL CALL 25 0 0 0
CDT D9440 OFFICE AFTER REGULARLY SHEDULED HOURS 25 0 0 0
CDT D9920 BEHAVIOURAL MANAGEMENT 10 0 0 0
TREATMENT OF COMPLICTION POST SURGICAL UNUSUAL CIRCUMSTANCES
CDT D9930
20 0 0 0
CDT D9932 IMMEDIATE DENTUREMANDIBULAR PARTIAL- 4 TEETH 40 0 0 0
MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT
CDT D9935
SURGERY 25 0 0 0
20.12 LASER DENTISTRY
CDT D9972 LASER BLEACHING 180 0 0 0
CDT D9973 LASER BLEACHING WITH HOME MAITENANCE 200 0 0 0
CDT D9974 DENTAL WHITENING- HOME KIT WITH TRAYS 60 0 0 0
CDT D9975 TMJ PAIN THERAPY- PER SESSION 15 0 0 0
CDT D9976 DEPIGMENTATION -GINGIVA- PER ARCH 100 0 0 0
CDT D9977 APHTHOUS ULCER TREATMENT 10 0 0 0
CDT D9978 CROWN LENGTHENING PER TOOTH 15 0 0 0
CDT D9979 PERIODONTAL LASER POCKET ELIMINATION PER QUADRANT 20 0 0 0
System Category Day
CDT D9980 GINGIVOPLASTY PER ARCH 60 0 0 0
CDT D9981 EXCISION FIBROMA 40 0 0 0
CDT D9982 FRNECTOMY 60 0 0 0
CDT D9983 IMPLANT RECOVERY PER TOOTH 30 0 0 0
CDT D9984 EXPOSURE OF IMPACTED TOOTH - SOFT TISSUE 25 0 0 0
CDT D9985 PULPOTOMY PER TOOTH 20 0 0 0
CDT D9986 OPERCULECTOMY THIRD MOLAR 20 0 0 0
CDT D9987 UNSPECIFIED LASER PROCEDURE
21 Radiology
21.1 DIAGNOSTIC RADIOLOGY
CPT 70030 X-RAY ORBIT 12 0 0
CPT 70110 X-RAY MANDIBLE 13 0 0
CPT 70130 X-RAY MASTOID 17 0 0
CPT 70150 X-RAY FACIAL BONES 15 0 0
CPT 70160 X-RAY NASAL BONES 12 0 0
CPT 70190 X-RAY OPTIC FORAMEN 15 0 0
CPT 70210 X-RAY PARANASAL SINUSES 17 0 0
CPT 70240 X-RAY SKULL LATERAL FOR SELLA 12 0 0
CPT 70250 X-RAY SKULL 12 0 0
CPT 70260 X-RAY SKULL FOR SALIVARY GLANDS 12 0 0
CPT 70310 X-RAY TEETH INTRA ORAL 12 0 0
CPT 70328 X-RAY TMJ 17 0 0
CPT 70350 X-RAY WHOLE SPINE 30 0 0
CPT 70355 X-RAY OPG 20 0 0
CPT 70360 X-RAY NECK SOFT TISSUE 12 0 0
CPT 71010 X-RAY CHEST 12 0 0
CPT 71101 X-RAY CHEST FOR RIBS 15 0 0
CPT 71120 X-RAY STERNUM 15 0 0
CPT 71130 X-RAY STERNOCLAVICULAR JOINT 15 0 0
CPT 72050 X-RAY CERVICAL SPINE 15 0 0
CPT 72070 X-RAY DORSAL SPINE 15 0 0
CPT 72100 X-RAY LSS 15 0 0
CPT 72170 X-RAY PELVIS 15 0 0
CPT 72200 X-RAY SIJ 17 0 0
CPT 72220 X-RAY SACOCOCCYGEAL SPINE 15 0 0
CPT 73000 X-RAY CLAVICLE 12 0 0
CPT 73010 X-RAY CAPULA 15 0 0
CPT 73020 X-RAY SHOULDER 12 0 0
CPT 73050 X-RAY AC JOINT 15 0 0
CPT 73060 X-RAY HUMERUS 12 0 0
CPT 73070 X-RAY ELBOW 12 0 0
CPT 73090 X-RAY FOREARM 15 0 0
CPT 73100 X-RAY WRIST 15 0 0
CPT 73101 X-RAY WRIST FOR SCAPHOID 20 0 0
CPT 73120 X-RAY HAND 15 0 0
CPT 73140 X-RAY FINGER 12 0 0
CPT 73510 X-RAY HIP 15 0 0
CPT 73530 X-RAY HIP PORTABLE ON C ARM 40 0 0
System Category Day
CPT 73550 X-RAY FEMUR 15 0 0
CPT 73560 X-RAY KNEE X-RAY 15 0 0
CPT 73565 X-RAY KNEE ; both knees, standing, anteroposterior 25 0 0
CPT 73590 X-RAY TIBIA AND FIBULA 15 0 0
CPT 73600 X-RAY ANKLE 15 0 0
CPT 73620 X-RAY FOOT 15 0 0
CPT 73650 OS CALIS 15 0 0
CPT 74000 ABDOMEN/ KUB 12 0 0
CPT 76010 X-RAY ABDOMEN CHILD 12 0 0
CPT 77080 BMD 38 0 0
21.2 DIAGNOSTIC ULTRASOUND
CPT 10022 FNAC 30 30 40
CPT 55700 PROSTATE NEEDLE BIOPSY, TRANSRECTAL 100 0 40
CPT 74710 CT PELVIMETRY 100 0 0
CPT 76510 OPHTHALMIC ULTRASOUND 30 0 0
CPT 76536 ULTRASOUND SOFT TISSUES 30 0 0
CPT 76604 ULTRASOUND CHEST 25 0 0
CPT 76700 ULTRASOUND ABDOMEN 25 0 0
CPT 76770 ULTRASOUND KIDNEYS 25 0 0
CPT 76776 ULTRASOUND KIDNEYS TRANSPLANTED 35 0 0
CPT 76801 ULTRASOUND PREGNANCY UP TO 7 WEEKS 25 0 0
CPT 76802 ULTRASOUND PREGNANCY 7 TO 12 WEEKS 25 0 0
CPT 76803 ULTRASOUND PREGNANCY 24 WEEKS PLULTRASOUND 25 0 0
CPT 76804 ULTRASOUND PREGNANCY ANOMALY SCAN 18 TO 22 WEEKS 35 0 0
CPT 76805 ULTRASOUND PREGNANCY 12 TO 24 WEEKS 25 0 0
CPT 76805-01 ULTRASOUND PREGNANCY AFTER 1ST TRI 1/1ST GESTATION 25 0 0
ULTRASOUND PREGNANCY PLULTRASOUND DOPPLER UMBILICAL ARTERY
CPT 76808
35 0 0
CPT 76809 ULTRASOUND PREGNANCY, DOPPLER UMB ART, BIOPHYS PROFILE 35 0 0
CPT 76810 ULTRASOUND PREGNANCY 4 D 50 0 0
CPT 76813 ULTRASOUND PREGNANCY NUCHAL TRANSLUCENCY 11 TO 14 WEEKS 25 0 0
CPT 76818 ULTRASOUND BIOPHYSICAL PROFILE 25 0 0
CPT 76820 DOP VELOCIMETRY FTL UMBILICAL ART 35 0 0
CPT 76820-01 ULTRASOUND PREGNANCY DOPPLER UMBILICAL ARTERY ONLY 35 0 0
CPT 76821 DOP VELOCIMETRY FTL MIDDLE CERE ART 35 0 0
CPT 76830 ULTRASOUND TRANSVAGINAL 25 0 0
CPT 76832 ULTRASOUND FOLLICULAR STUDY TRANSVAGINAL 35 0 0
CPT 76833 ULTRASOUND FOLLICULAR STUDY ABDOMINAL 35 0 0
CPT 76856 ULTRASOUND PELVIS 25 0 0
CPT 76870 SCROTAL ULTRASOUND 30 0 0
CPT 76872 TRANSRECTAL ULTRASOUND 30 0 0
CPT 76880 ULTRASOUND EXTREMITY 30 0 0
CPT 76885 ULTRASOUND HIPS 30 0 0
CPT 76942 ULTRASOUND GUIDED BIOPSY 30 0 0
CPT 76998 ULTRASOUND GUIDANCE OPERATIVE 30 0 0
CPT 93880 CAROTID DOPPLER 35 0 0
CPT 93925 ULTRASOUND LOWER EXTREMITY ARTERIES DOPPLER BILATERAL 50 0 0
CPT 93926 ULTRASOUND LOWER EXTREMITY ARTERIES DOPPLER UNILATERAL 30 0 0
System Category Day
CPT 93931 ULTRASOUND UPPER EXTREMITY ARTERIES DOPPLER UNILATERAL 30 0 0
CPT 93970 ULTRASOUND VENOULTRASOUND DOPPLER LOWER LIMB BILATERAL 50 0 0
CPT 93971 ULTRASOUND VENOULTRASOUND DOPPLER LOWER LIMB UNILATERAL 30 0 0
CPT 93972 ULTRASOUND VENOULTRASOUND DOPPLER UPPER LIMB UNILATERAL 30 0 0
CPT 93980 PENILE DOPPLER 50 0 0
CPT 93984 ULTRASOUND DOPPLER TESTICULAR 30 0 0
CPT 93987 ULTRASOUND RENAL DOPPLER 30 0 0
21.3 FLUOROSCOPY
CPT 74220 BA SWALLOW 35 0 0
CPT 74245 BA FOLLOW THROUGH 50 0 0
CPT 74249 BA MEAL 40 0 0
CPT 74250 BA MEAL FOLLOW THROUGH 50 0 0
CPT 74270 BA ENEMA 50 0 0
CPT 74400 IVU 50 0 0
CPT 74430 MCUG 50 0 0
CPT 74450 URETHROGRAPHY 50 0 0
CPT 74740 HSG-XRAY HYSTEROSALPINGOGRAPHY 50 0 0
CPT 75635 CT ANGIO ABDOMEN AND FEMORAL 300 0 0
21.4 BREAST, MAMMOGRAPHY
CPT 77055 MAMMOGRAM 30 0 0
21.5 BONE/JOINT STUDIES
CPT 77072 BONE AGE XRAY 15 0 0
CPT 77074 SKELETAL SURVEY 100 0 0
21.6 CT COMPUTERIZED TOMOGRAPHY
CPT 70450 CT HEAD/BRAIN 100 0 0
CPT 70460 CT HEAD/BRAIN WITH IV CONTRAST 130 0 0
CPT 70480 CT SCAN ORBITS- WITHOUT CONTRAST 100 0 0
CPT 70481 CT SCAN ORBITS - WITH CONTRAST 130 0 0
CPT 70486 CT FACIAL BONES 100 0 0
CPT 70486-01 CT SINUS 100 0 0
CPT 70490 CT NECK 100 0 0
CPT 70491 CT NECK WITH IV CONTRAST 130 0 0
CPT 70498 CT ANGIO CAROTIDS 200 0 0
CPT 71250 CT CHEST 100 0 0
CPT 71260 CT CHEST WITH IV CONTRAST 130 0 0
CPT 71275 CT ANGIO CHEST 200 0 0
CPT 72125 CT CERVICAL SPINE 100 0 0
CPT 72126 CT CERVICAL SPINE WITH IV CONTRAST 130 0 0
CPT 72130 CT DORSAL SPINE 100 0 0
CPT 72131 CT LUMBER SPINE 100 0 0
CPT 72132 CT LUMBER SPINE WITH IV CONTRAST 130 0 0
CPT 72191 CT ANGIO PELVIS 200 0 0
CPT 72192 CT PELVIS 100 0 0
CPT 72193 CT PELVIS WITH IV CONTRAST 130 0 0
CPT 72240 CT, MYELOGRAPHY, CERVICAL SPINE WITH CONTRAST 300 0 0
CPT 73200 CT UPPER EXTREMITY 100 0 0
CPT 73201 CT UPPER EXTREMITY WITH IV CONTRAST 130 0 0
CPT 73206 CT ANGIO UPPER EXTREMITY 200 0 0
System Category Day
CPT 73700 CT LOWER EXTREMITY 100 0 0
CPT 73701 CT LOWER EXTREMITY WITH IV CONTRAST 130 0 0
CPT 74150 CT ABDOMEN 100 0 0
CPT 74160 CT ABDOMEN WITH IV CONTRAST 130 0 0
CPT 74262 CT COLONOGRAPHY 100 0 0
CPT 75265 CT, MYELOGRAPHY, LUMBOSACRAL, WITH CONTRAST 300 0 0
CPT 75571 CALCIUM SCORING 100 0 0
CPT 75572 CT CORONARY 300 0 0
CPT 76381 CT GUIDED BIOPSY 200 0 0
CPT 77073 SCANOGRAM 50 0 0
21.7 MRI MAGNETIC RESONANCE IMAGING
CPT 70336 MRI TMJ 150 0 0
CPT 70540 MRI ORBITS 150 0 0
CPT 70542 MRI ORBITS WITH IV CONTRAST 180 0 0
CPT 70544 MRA HEAD 50 0 0
CPT 70545 MRA HEAD WITH IV CONTRAST 180 0 0
CPT 70547 MRA NECK 50 0 0
CPT 70548 MRA CAROTIDS 50 0 0
CPT 70551 MRI BRAIN 150 0 0
CPT 70553 MRI BRAIN WITH IV CONTRAST 180 0 0
CPT 71550 MRI CHEST 150 0 0
CPT 71551 MRI CHEST WITH IV CONTRAST 180 0 0
CPT 72141 MRI LUMBAR SPINE 150 0 0
CPT 72142 MRI LUMBAR SPINE WITH IV CONTRAST 180 0 0
CPT 72146 MRI DORSAL SPINE 150 0 0
CPT 72147 MRI DORSAL SPINE WITH IV CONTRAST 180 0 0
CPT 72195 MRI PELVIS 150 0 0
CPT 72196 MRI PELVIS WITH IV CONTRAST 180 0 0
CPT 72198 MRA PELVIS 50 0 0
CPT 73218 MRA UPPER EXTREMITY 50 0 0
CPT 73219 MRI UPPER EXTREMITY 150 0 0
CPT 73220 MRI UPPER EXTREMITY WITH IV CONTRAST 180 0 0
CPT 73221 MRI SHOULDER, 150 0 0
CPT 73223 MRI ELBOW 150 0 0
CPT 73225 MRI WRIST 150 0 0
CPT 73718 MRI THIGH 150 0 0
CPT 73719 MRI THIGH WITH IV CONTRAST 180 0 0
CPT 73721 MRI HIP/KNEE OR ANKLE 150 0 0
CPT 73722 MRI JOINT WITH IV CONTRAST 150 0 0
CPT 74181 MRI ABDOMEN 150 0 0
CPT 74182 MRI ABDOMEN WITH IV CONTRAST 150 0 0
CPT 74185 MRCP 180 0 0
CPT 77058 MRI BREAST 150 0 0
21.8 OTHER RADIOLOGY SERVICES
CPT 76140 WRITING A REPORT OUTSIDE FILMS CT/MRI 20 0 0
CPT 76140-CD001 PATIENT IMAGING EXTRA CD FEES 0 0 1
CPT 76140-R0001 X-RAY REPORT 5 0 0
CPT 76140-L0001 X-RAY LIMITED 7 0 0
System Category Day
22 Pathology & Laboratory
22.1 Biochemistry
CPT 82009 Acetone (Ketones) 15
CPT 84066 Acid Phosphatase, Prostatic 20
CPT 84060 Acid Phosphatase, Total 15
CPT 82030-01 Adenosine Deaminase (ADA) (Serum,Body fluids) 15
CPT 84460 Alanine Aminotransferase (ALT), (SGPT) 5
CPT 82040 Albumin (Serum) 5
CPT 82040-01 Albumin/Globulin Ratio 6
CPT 82055 Alcohol (Ethanol), Blood 12
CPT 82085 Aldolase 14
CPT 84075 Alkaline Phosphatase (ALP) 5
CPT 80150 Amikacin 25
CPT 82140 Ammonia 20
CPT 82145 Amphetamines, Urine (Confirmation) 48
CPT 82150 Amylase (Alpha) Isoenzymes 20
CPT 82150-02 Amylase, Serum 8
CPT 82164 Angiotensin Converting Enzyme (ACE), Serum 17
CPT 82103 Alpha-1-antitrypsin; total 19
CPT 82172-01 Apo B/Apo A1 Ratio 18
CPT 82172 Apolipoprotein A1 (ApoA1) 12
CPT 82172-02 Apolipoprotein B (ApoB) 12
CPT 82805 Arterial Blood Gas Analysis (ABG) 30
CPT 84450 Aspartate Aminotransferase (AST), (SGOT) 5
CPT 82232-03 Beta-2 Transferrin 28
CPT 82374 Bicarbonate (HCO3) 5
CPT 82239 Bile Acids (Serum); Total 18
CPT 82248 Bilirubin Direct 5
CPT 82248-01 Bilirubin Indirect 5
CPT 82247-01 Bilirubin Panel 6
CPT 82247 Bilirubin Total 5
CPT 84520 Blood Urea Nitrogen 4
CPT 82565-01 BUN/Creatinine (serum) Ratio 6
CPT 82330 Calcium (Ionized) 10
CPT 82310 Calcium (Total) 5
CPT 80156 Carbamazepine (Tegretol) 17
CPT 82553-01 Cardiac Markers (CK,LDH,CK-MB,Troponin, AST) 45
CPT 82390 Ceruloplasmin 17
CPT 82435 Chloride (Cl); Blood 5
CPT 83718 Cholesterol, HDL 5
CPT 83721 Cholesterol, LDL 5
CPT 82465 Cholesterol, Total 5
CPT 82525 Copper (Serum) 8
CPT 80299-01 Cotinine, Serum (Quantitative) 28
CPT 82550 Creatine Kinase (CK) 7
CPT 82553 Creatine Kinase-MB (CK-MB) 10
CPT 82575 Creatinine Clearance 18
CPT 82565 Creatinine, Serum 4
System Category Day
CPT 82947-02 Diabetic Profile 25
CPT 82947-03 Diabetic Profile (BNI) 40
CPT 80162 Digoxin 30
CPT 80185 Diphenylhydantoin (Phenytoin, Dilantin, Eptoin) 22
CPT 80299-02 Drugs of abuse (Urine) -10 drug panel 48
CPT 80299-03 Drugs of abuse (Urine) -5 drug panel 35
CPT 80299-04 Drugs of Abuse (Urine)- Opiates, Cannabinoid (Marijuana), Amphetamine 18
CPT 80051 Electrolytes 8
CPT 80076-01 Fatty Liver Profile 35
CPT 82728 Ferritin 18
CPT 82747 Folate, Red Cell 18
CPT 82746 Folate (Folic Acid, Vitamin B9), Serum 18
CPT 84302 Fractional Excretion of Sodium (FENa) 24
CPT 82985 Fructosamine 25
CPT 82775 Galactose-1-P Uridyltransferase (GALT), Quantitative 55
CPT 82977 Gamma-Glutamyltransferase (GGT) 7
CPT 80170 Gentamicin 23
CPT 82951 Glucose Challenge Test (GCT) 6
CPT 82952-01 Glucose Tolerance Test (GTT, OGTT), half-hourly 14
CPT 82952-02 Glucose Tolerance Test (GTT, OGTT), hourly 14
CPT 82951-01 Glucose Tolerance Test of Pregnancy (GTTP) 14
CPT 82947 Glucose, Fasting 2
CPT 82944 Glucose, Random 2
CPT 82947-01 Glucose, Post Prandial (PPBS) 2
CPT 83036 Glycosylated Hemoglobin (HbA1c) 12
CPT 83090 Homocysteine (Serum) 18
CPT 83540 Iron (Fe) 10
CPT 83550 Iron Binding Capacity, Total (TIBC) 15
CPT 83605 Lactate 8
CPT 83615 Lactate Dehydrogenase (LDH) 7
CPT 80175 Lamotrigine (Lamictal) 25
CPT 80061-01 LDL/HDL Cholesterol Ratio 7
CPT 83655 Lead (Blood) 17
CPT 80177 Levetiracetam (Keppra) 28
CPT 83883-02 Light Chains Kappa/Lambda, Free, Serum 30
CPT 83690 Lipase 20
CPT 80061 Lipid Profile 12
CPT 83695 Lipoprotein(a) (Lp(a)) 17
CPT 80178 Lithium 7
CPT 80076 Liver Function Tests (LFT) 18
CPT 83735 Magnesium 7
CPT 83921 Methylmalonic Acid 45
CPT 83887 Nicotine, Serum (Quantitative) 35
CPT 82541 Omega3/Omega6 Fatty Acids 70
CPT 83925 Opiates (incl. Morphine), Urine (Confirmation)
CPT 82003 Paracetamol (Acetaminophen) 25
CPT 80184 Phenobarbital (Phenobarbitone), Serum 15
CPT 84100 Phosphorus, Inorganic (Phosphate) 6
System Category Day
CPT 84132 Potassium (K) 6
CPT 80366 Pregabalin (Lyrica) 40
CPT 84165 Protein Electrophoresis, Serum (SPEP) 24
CPT 84166 Protein Electrophoresis, Urine 18
CPT 86334 Protein Immunofixation Electrophoresis, Serum 30
CPT 84155 Protein, Total 5
CPT 80069-01 Renal Function Profile 32
CPT 80069 Renal Function Tests (RFT) 17
CPT 82757 Semen Fructose 15
CPT 83018 Silver (Serum,Urine) 58
CPT 84295 Sodium (Na) 6
CPT 80377 Sulfonylurea Screen (Urine) 80
CPT 80197 Tacrolimus 25
CPT 80198 Theophylline 22
CPT 80061-02 Total/HDL Cholesterol Ratio 7
CPT 84478 Triglycerides 5
CPT 84484 Troponin I 15
CPT 84484-01 Troponin T 22
CPT 84540 Urea 5
CPT 84550 Uric Acid 7
CPT 83497-01 Urine 5-HIAA 18
CPT 82043-01 Urine Albumin/Creatinine Ratio 12
CPT 82139 Urine Amino Acids (Incl. Cystine) 40
CPT 82150-01 Urine Amylase 8
CPT 82340 Urine Calcium 9
CPT 82340-01 Urine Calcium (24 Hour) 18
CPT 82525-01 Urine Copper (24 Hour) 22
CPT 80299-05 Urine Cotinine (Quantitative) 30
CPT 80299-06 Urine Creatinine (24 Hour) 10
CPT 82570-02 Urine Creatinine (Spot) 5
CPT 83921-01 Urine Hippuric Acid 40
CPT 83735-01 Urine Magnesium (24 Hour) 12
CPT 83874-01 Urine Myoglobin (Spot) 10
CPT 82043-03 Urine Microalbumin (24 Hour) 18
CPT 82044-01 Urine Microalbumin (Spot) 10
CPT 83921-02 Urine Methylhippuric Acid 38
CPT 83921-03 Urine Methylmalonic Acid (Quantitative) 22
CPT 83887-01 Urine Nicotine (Quantitative) 35
CPT 83921-04 Urine Organic Acids 125
CPT 83945-01 Urine Oxalates 17
CPT 84681-01 Urine Peptides 100
CPT 84600-01 Urine Phenol 30
CPT 84105 Urine Phosphorous (24 Hour) 10
CPT 84119 Urine Porphyrins 40
CPT 84133 Urine Potassium 8
CPT 84156 Urine Protein (Quantitative, 24 Hour) 20
CPT 82570-03 Urine Protein (Quantitative, Spot) 7
CPT 82570-04 Urine Protein/Creatinine Ratio 14
System Category Day
CPT 83789 Urine Purines 32
CPT 84300 Urine Sodium 7
CPT 84560 Urine Uric Acid (24 Hour) 6
CPT 80164 Valproic Acid 15
CPT 80202 Vancomycin 25
CPT 84590 Vitamin A (Retinol) 20
CPT 84425 Vitamin B1 (Thiamine) 30
CPT 82607 Vitamin B12 (Cobalamin) 16
CPT 84252 Vitamin B2 (Riboflavin) 30
CPT 84207 Vitamin B6 (Pyridoxine) 28
CPT 82180 Vitamin C (Ascorbic Acid) 32
CPT 82652 Vitamin D; 1,25-dihydroxy 55
CPT 82306 Vitamin D; 25-hydroxy(OH) 10
CPT 84446 Vitamin E (Tocopherol) 25
CPT 84597 Vitamin K1 (Phylloquinone) 42
CPT 84630 Zinc, Serum 18
22.2 Clinical Pathology
CPT 83883-01 Bence Jones Protein 4
CPT 83883-03 C diphtheriae, Albert's Stain 6
CPT 89051 Body Fluid Analysis 15
CPT 89130 Gastric Aspirate Smear 5
CPT 83013 H pylori Detection- Urea Breath Test (UBT) 18
CPT 82271 Occult Blood (Body fluids) 8
CPT 83930 Osmolality, Serum 16
CPT 83935 Osmolality, Urine (Random) 16
CPT 89300 Semen analysis; Post-Coital Test 5
CPT 82355 Renal Stone Analysis 20
CPT 83516-03 Secretory IgA- Salivary 30
CPT 89320 Semen Analysis 10
CPT 89331-01 Sperm DNA Fragmentation 100
CPT 83993 Stool Calprotectin 32
CPT 83520-01 Stool Calprotectin+Lactoferrin 32
CPT 82274 Stool Occult Blood 6
CPT 8704-01 Stool Routine Analysis 4
CPT 84376 Stool Reducing Substances 9
CPT 84376-01 Stool Total Fat 20
CPT 82043-02 Urine Albumin (Strip) 2
CPT 82239-01 Urine Bile Pigments 3
CPT 82239-02 Urine Bile Salts 3
CPT 81001 Urine Complete Analysis 5
CPT 80299-07 Urine Cotinine (Qualitative) 22
CPT 81003 Urine Dipstick Analysis 2
CPT 81000 Urine Ketone Bodies (Strip) 2
CPT 81015 Urine Microscopy 2
CPT 81002 Urine pH (Strip) 2
CPT 81005 Urine Routine Analysis 3
CPT 81099-01 Urine Sugar (Strip) 2
22.3 Hematology
System Category Day
CPT 85048-01 Absolute Eosinophill Count (AEC) 5
CPT 85730 Activated Partial Thromboplastin Time (APTT) 12
CPT 85307 Activated Protein C Resistance (APCR) 30
CPT 85300 Antithrombin III 15
CPT 85002 Bleeding Time (BT) 4
CPT 86900 Blood Group & Rh Type 4
CPT 86900-01 Blood Routine Analysis 4
CPT 85345 Clotting Time 4
CPT 86157 Cold Agglutinins; Titer 22
CPT 85027 Complete Blood Count (CBC) 8
CPT 86886 Coombs Indirect, Rh Antibody Titre 20
CPT 86880 Coombs Test, Direct (DCT) 12
CPT 86885 Coombs Test, Indirect (ICT) 12
CPT 82800 Cord Blood pH 12
CPT 85378 D-Dimer Test 18
CPT 85652 Erythrocyte Sedimentation Rate (ESR) 4
CPT 82668 Erythropoietin 32
CPT 85210 Factor II (Prothrombin) Activity 25
CPT 81240 Factor II Mutation 75
CPT 85250 Factor IX (Christmas Factor) Activity 20
CPT 85220 Factor V (Proaccelerin, Labile factor) Activity 40
CPT 81241 Factor V Leiden Mutation 62
CPT 85230 Factor VII (Prothrombin Conversion Accelerator) Activity 22
CPT 85240 Factor VIII (Anti Hemophilic Globulin) Activity 20
CPT 85384 Fibrinogen 14
CPT 85370 Fibrinogen Degradation Products (FDP's) 18
CPT 82955 Glucose-6-Phosphate Dehydrogenase (G6PD), Quantitative 12
CPT 82960 Glucose-6-Phosphate Dehydrogenase (G6PD), Screen 8
CPT 83010 Haptoglobin 15
CPT 83021 Hb F Estimation 15
CPT 83021-01 Hb S (Sickle Hb), Quantitative 12
CPT 83020 Hb Variant Analysis (HPLC/Electrophoresis) 16
CPT 85014 Hematocrit (HCT) 4
CPT 85018 Hemoglobin 3
CPT 87207 Malarial parasite, smear for 5
CPT 83050 Methemoglobin; Quantitaitive 17
CPT 87207-01 Microfilaria Smear 7
CPT 85060 Peripheral Smear 7
CPT 85810 Plasma Viscosity 35
CPT 85049 Platelet Count 4
CPT 88185 PNH, Flow Cytometry (CD55,CD59) 82
CPT 85610 Prothrombin Time (PT), INR 14
CPT 85611 Prothrombin Time Mixing Study 35
CPT 85303 Protein C Activity 30
CPT 85305 Protein S Activity 30
CPT 85008 RBC Morphology 6
CPT 85045 Reticulocyte Count 7
CPT 85660 Sickle Cell Test 8
System Category Day
CPT 84466 Transferrin Saturation 18
CPT 85247 Von Willebrand Diagnostic 60
CPT 85025 WBC Count, Differential 3
CPT 85048 WBC Count, Total 3
22.4 Endocrinology
CPT 83497 5-Hydroxy Indole Acetic Acid (5-HIAA) 18
CPT 82024 Adrenocorticotrophic Hormone (ACTH) 28
CPT 82088 Aldosterone (Serum) 50
CPT 82088-01 Aldosterone (Urine) 55
CPT 82157 Androstenedione (A4) 20
CPT 84588 Antidiuretic Hormone (ADH) 50
CPT 83520-02 Antimullerian Hormone (AMH) 38
CPT 84702 Beta-Human Chorionic Gonadotrophin (Beta HCG), Serum; Quantitative 16
CPT 84999-01 CAH (Congenital Adrenal Hyperplasia) Panel 50
CPT 82308 Calcitonin (Thyrocalcitonin) 55
CPT 82383 Catecholamines, Plasma 35
CPT 82382 Catecholamines, Urine 35
CPT 82528 Corticosterone, 17-Hydroxy 38
CPT 82530 Cortisol (Free), Urine 18
CPT 82533 Cortisol (Total), Blood 15
CPT 82533-01 Cortisol, Saliva 14
CPT 82626 Dehydroepiandrosterone (DHEA) 18
CPT 82627 Dehydroepiandrosterone-Sulfate (DHEA-S) 25
CPT 82634 Deoxycortisol,11 (11-Deoxycortisol) 32
CPT 80420-01 Dexamethasone Suppression Test (overnight)-ACTH 32
CPT 80420 Dexamethasone Suppression Test (overnight)-Cortisol 20
CPT 82651 Dihydrotestosterone (DHT) 55
CPT 82670 Estradiol 12
CPT 80440-01 Female Hormone Profile 55
CPT 83001 Follicle Stimulating Hormone (FSH) 10
CPT 82941 Gastrin 45
CPT 80430 Growth Hormone (HGH) Stimulation/Inhibition Study 60
CPT 83003 Growth Hormone, Human (HGH, Somatotropin) 30
CPT 84144-01 Hydroxyprogesterone,17 (17-OH Progesterone) 42
CPT 84305 Insulin-Like Growth Factor 1 (IGF-1, Somatomedin C) 60
CPT 83525 Insulin, Total 12
CPT 83002 Luteinizing Hormone (LH) 10
CPT 83835 Metanephrines, Free, Plasma 80
CPT 83835-01 Metanephrines, Urine 35
CPT 83970 Parathyroid Hormone (PTH) - Intact 18
CPT 84703 Pregnancy Test (Blood); Qualitative 7
CPT 81025 Pregnancy Test (Urine) 6
CPT 84144 Progesterone 10
CPT 84206 Proinsulin 30
CPT 84146 Prolactin 10
CPT 84244 Renin 25
CPT 84402 Testosterone, Free 45
CPT 84403 Testosterone, Total 10
System Category Day
CPT 83970-01 Thyroid Function Tests (TFT) 25
CPT 84443 Thyroid Stimulating Hormone (TSH) 10
CPT 84439 Thyroxine, Free T4 10
CPT 84479 Thyroxine, Total (T4) 10
CPT 84481 Triiodothyronine, Free (FT3) 10
CPT 84482 Triiodothyronine, Reverse (RT3) 65
CPT 84480 Triiodothyronine, Total (T3) 10
CPT 84585 Vanillylmandelic Acid (VMA), Urine 35
22.5 Serology
CPT 86849-01 Acetylcholine Receptor Antibodies 35
CPT 86003-01 Allergen Panel 1 75
CPT 86001 Allergen, Single 12
CPT 86225 Anti ds DNA 25
CPT 86337 Anti Insulin Antibodies 20
CPT 86148 Anti Phospholipid Antibodies 55
CPT 86800 Anti Thyroglobulin Antibody 25
CPT 86376-01 Anti Thyroperoxidase Antibody 25
CPT 86200 Anti-CCP Antibodies 24
CPT 86255 Antimitochondrial Antibody (AMA) 18
CPT 86256 Antimitochondrial Antibody (AMA), Quantitative 25
CPT 86256-01 Antineutrophil Cytoplasmic Antibody-c (c-ANCA) 25
CPT 86256-02 Antineutrophil Cytoplasmic Antibody-p (p-ANCA) 25
CPT 86256-03 Antineutrophil Cytoplasmic Antibody-x (x-ANCA) 30
CPT 86038 Antinuclear Antibody (ANA) 15
CPT 86039-01 Antinuclear Antibody (ANA) Panel 40
CPT 86148-01 Antiphospholipid Antibodies IgG+IgM 25
CPT 83516-04 Anti-Saccharomyces cerevisiae Antibodies (ASCA), IgA & IgG 32
CPT 83516-05 Anti-Smooth Muscle Antibody (ASMA) 19
CPT 89325 Antisperm Antibodies, Quantitative 20
CPT 86060 Antistreptolysin O (ASO) 7
CPT 86063 Antistreptolysin O (ASO), Quantitative 12
CPT 83880 B-type Natriuretic Peptide (BNP) 25
CPT 86147-01 Cardiolipin Antibodies, IgG and IgM 30
CPT 82480 Cholinesterase (Psuedocholinesterase, Serum) 18
CPT 86160-01 Complement C3 14
CPT 86160-02 Complement C4 14
CPT 84681 C-Peptide 25
CPT 86140 C Reactive Protein (CRP) 8
CPT 86141 C Reactive Protein, High Sensitivity (hs-CRP) 8
CPT 86343 Diamine Oxidase Test (Histamine intolerance test) 55
CPT 88347 Endomysial Antibody (EMA), IgA 20
CPT 88347-01 Endomysial Antibody (EMA), IgG 28
CPT 86003-07 Food Intolerance Panel 120
System Category Day
CPT 83516-06 Gliadin Antibodies, IgA + IgG 35
CPT 83516-07 Gliadin Antibodies, De-amidated, IgA + IgG 40
CPT 86341-02 Glutamate Decarboxylase (GAD) Antibodies 30
CPT 82784 Immunoglobulin A (IgA) 12
CPT 82785 Immunoglobulin E (IgE) 16
CPT 82784-01 Immunoglobulin G (IgG) 12
CPT 82784-02 Immunoglobulin G4 (IgG 4) 29
CPT 83516 Immunoglobulin M (IgM) 12
CPT 82784-03 Immunoglobulin A, G, M (IgA,IgG,IgM) 29
CPT 84305-01 Insulin-Like Growth Factor Binding Protein-3 (IGFBP-3) 32
CPT 86340 Intrinsic Factor Antibodies 20
CPT 86341 Islet Cell Antibodies 17
CPT 86341-01 Islet Cell Antigen 2 Antibodies (IA-2; ICA 512; Tyrosine Phosphatase Antibody) 19
CPT 86376 Liver Kidney Microsomal Antibodies (LKMA) 19
CPT 85300-02 Lupus Anticoagulant 30
CPT 83880-01 NT- pro BNP 32
CPT 86256-04 Parietal Cell Antibodies 20
CPT 84145 Procalcitonin 13
CPT 86430 Rheumatoid factor; qualitative 15
CPT 86592-01 RPR (VDRL) 8
CPT 84270 Sex Hormone Binding Globulin (SHBG) 26
CPT 86235 SS-A (Anti Ro) Antibodies 20
CPT 86235-01 SS-B (Anti La) Antibodies 20
CPT 84432 Thyroglobulin 20
CPT 84445 Thyroid Stimulating Immunoglobulins (TSIg, TRAb) 40
CPT 83516-01 Tissue Transglutaminase (tTG) Antibody, IgA 20
CPT 83516-02 Tissue Transglutaminase (tTG) Antibody, IgG 23
22.6 Immunology
CPT 87260 Adenovirus Antigen, Stool 14
CPT 86682-01 Bilharzia (Schistosomia) Antibodies 20
CPT 86618 Borrelia burgdorferi (Lyme) IgG Antibodies 15
CPT 86618-01 Borrelia burgdorferi (Lyme) IgM Antibodies 15
CPT 86622 Brucella Antibodies 12
CPT 86317 C diphtheriae, IgG Antibodies 16
CPT 86625-01 Campylobacter, Stool 14
CPT 86790-01 Chikungunya IgM Antibody 14
CPT 86631-01 Chlamydia pneumoniae IgA Antibody 18
CPT 86631 Chlamydia pneumoniae IgG Antibody 17
CPT 86632 Chlamydia pneumoniae IgM Antibody 17
CPT 86632-01 Chlamydia pneumoniae, IgA+IgG Antibodies 25
CPT 86632-02 Chlamydia Rapid Test 5
CPT 86632-03 Chlamydia trachomatis IgG Antibody 18
CPT 86632-04 Chlamydia trachomatis IgM Antibody 25
CPT 87493 Clostridium difficile Toxin, Stool 14
CPT 86638 Coxiella burnetii (Q fever) IgG Antibodies 25
CPT 86638-01 Coxiella burnetii (Q fever) IgM Antibodies 25
CPT 87327 Cryptococcal Antigen 26
CPT 86644-01 Cytomegalovirus (CMV) Avidity 17
System Category Day
CPT 86644 Cytomegalovirus (CMV) IgG Antibody 15
CPT 86645 Cytomegalovirus (CMV) IgM Antibody 15
CPT 86790-02 Dengue Antigen(NS1)+ Antibodies(IgG & IgM) 26
CPT 86790-03 Dengue IgG Antibody 17
CPT 86790-04 Dengue IgM Antibody 17
CPT 86682-02 Echinococcus Antibodies 28
CPT 86682-03 Echinococcus IgG Antibodies 17
CPT 86682-04 Entamoeba histolytica Antibodies 14
CPT 86664-01 Epstein Barr Virus (EBV), Antibody Profile 1 38
CPT 86664-02 Epstein Barr Virus (EBV), Antibody Profile 2 40
CPT 86663 Epstein Barr Virus (EBV), IgG Antibodies to Early Antigen 16
CPT 86664 Epstein Barr Virus (EBV), IgG Antibodies to Nuclear Antigen 16
CPT 86665 Epstein Barr Virus (EBV), IgG Antibodies to Viral Capsid Antigen 16
CPT 86664-03 Epstein Barr Virus (EBV), IgM Antibodies to Nuclear Antigen 16
CPT 86665-01 Epstein Barr Virus (EBV), IgM Antibodies to Viral Capsid Antigen 16
CPT 86682-05 Filaria Antibody 18
CPT 86682-06 Filaria Antigen 18
CPT 86677 H pylori Antibody, Blood 11
CPT 87338 H pylori Antigen, Stool 17
CPT 86708-02 Hepatitis A Virus, IgG Antibody (HAV IgG) 25
CPT 86709 Hepatitis A Virus, IgM Antibody (HAV IgM) 12
CPT 86705 Hepatitis B core Antibody (Anti-HBc), IgM 25
CPT 86704 Hepatitis B core Antibody (Anti-HBc), Total 25
CPT 86707 Hepatitis B e Antibody (Anti-HBe) 25
CPT 87350 Hepatitis B e Antigen (HBeAg) 25
CPT 86706 Hepatitis B surface antibody (HBsAb) 20
CPT 87340 Hepatitis B surface Antigen (HBsAg) 16
CPT 86803 Hepatitis C Virus Antibody (Anti-HCV) 16
CPT 86692 Hepatitis Delta Agent, Total Antibody 25
CPT 86790-05 Hepatitis E Virus, IgG Antibody (Anti-HEV IgG) 20
CPT 86790-06 Hepatitis E Virus, IgM Antibody (Anti-HEV IgM) 20
CPT 86695 Herpes Simplex Virus (HSV)-1 and 2, IgG 27
CPT 86695-01 Herpes Simplex Virus (HSV)-1 and 2, IgG, IgM 32
CPT 86695-02 Herpes Simplex Virus (HSV)-1 and 2, IgM 28
CPT 86696 Herpes Simplex Virus (HSV)-1, IgG 20
CPT 86696-01 Herpes Simplex Virus (HSV)-1, IgM 20
CPT 86696-02 Herpes Simplex Virus (HSV)-2, IgG 20
CPT 86696-03 Herpes Simplex Virus (HSV)-2, IgM 20
CPT 86703 HIV 1 & 2, Antigen + Antibody 14
CPT 86689 HIV 1 & 2, Western Blot 55
CPT 87389 HTLV 1 & 2, Antibodies 40
CPT 86689-01 HTLV 1 & 2, Western Blot 68
CPT 86308 Infectious Mononucleosis Screen- Monospot 11
CPT 86710-01 Influenza A & B, IgG Antibodies 40
CPT 86710-02 Influenza A & B, IgM Antibodies 40
CPT 86710-03 Influenza A Antibodies 8
CPT 86710-04 Influenza B Antibodies 8
CPT 87278 Legionella pneumophila, Antigen 22
System Category Day
CPT 86713-01 Legionella pneumophila, IgG Antibody 35
CPT 86713-02 Legionella pneumophila, IgM Antibody 35
CPT 86717 -01 Leishmania IgG Antibody 22
CPT 86723 Listeria Antibodies 27
CPT 86765-01 Measles IgG Antibody 12
CPT 86765-02 Measles IgM Antibody 12
CPT 87641-01 MRSA Screening (Nasal Swab) 5
CPT 86735-01 Mumps IgG Antibody 12
CPT 86735-02 Mumps IgM Antibody 12
CPT 86480 Mycobacterium tuberculosis (MTB), Gamma Interferon 55
CPT 86738-01 Mycoplasma Antibodies IgA, IgG, IgM 38
CPT 86738-02 Mycoplasma pneumoniae IgG 18
CPT 86738-03 Mycoplasma pneumoniae IgM 18
CPT 87279 Parainfluenza 1,2,3 Antibodies 40
CPT 86747-01 Parvovirus B19 IgG Antibody 22
CPT 86747-02 Parvovirus B19 IgM Antibody 22
CPT 87281 Pneumocystis carinii 18
CPT 86757 Rickettsia, Antibodies 80
CPT 87425 Rotavirus Antigen, Stool 15
CPT 86762-02 Rubella IgG Antibody 14
CPT 86762-01 Rubella IgM Antibody 14
CPT 87880 Streptococcal Rapid Test 5
CPT 86774 Tetanus Toxoid Antibody 25
CPT 86762-05 TORCH profile, IgG + IgM 57
CPT 86762-04 TORCH profile, IgG 35
CPT 86762-03 TORCH profile, IgM 38
CPT 86682 Toxocara canis, IgG+IgM Antibodies 75
CPT 86778-03 Toxoplasma Ig Avidity 18
CPT 86778-01 Toxoplasma IgG Antibody 10
CPT 86778-02 Toxoplasma IgM Antibody 10
CPT 83898 Treponema Pallidum Haemagglutination (TPHA) 13
CPT 83898-01 Treponemal Rapid Test 7
CPT 83898-02 Typhoid Rapid Test 5
CPT 86787-01 Varicella zoster Virus, IgG + IgM Antibodies 28
CPT 86787 Varicella zoster Virus, IgG Antibody 18
CPT 86787-02 Varicella zoster Virus, IgM Antibody 18
CPT 86682-07 Viral Pneumonia Panel 80
CPT 86757-01 Weil Felix (Rickettsial) Test 8
CPT 86000 Widal Test 8
22.7 GENE MARKER
CPT 86812 HLA-B27 28
22.8 Tumour Markers
CPT 82105 Alpha Fetoprotein (AFP) 14
CPT 82232-02 Beta-2 Microglobulin, Serum 18
CPT 82378 Carcinoembryonic Antigen (CEA) 14
CPT 86304 CA 125 28
CPT 86300 CA 15-3 28
CPT 86301 CA 19-9 28
System Category Day
CPT 86316 CA 50 32
CPT 86316-01 Chromogranin A 45
CPT 86305 HE4 (Human Epidydimis Protein 4) 18
CPT 84220 M2-PK + Hb 22
CPT 86316-02 NMP 22 14
CPT 84154 Prostate Specific Antigen (PSA), Free 18
CPT 84152 Prostate Specific Antigen (PSA), Free/Total Ratio 32
CPT 84153 Prostate Specific Antigen (PSA), Total
13
CPT 81401 SEPT9 Methylation 48
22.9 Microbiology
CPT 87116 Acid Fast Baccilus (AFB), Culture 15
CPT 87118 Acid Fast Baccilus (AFB), Stain 6
CPT 87073 Anaerobic Culture 15
CPT 87077 Blood Culture (Aerobic) 12
CPT 87075 Body Fluid Culture 8
CPT 87070-11 Ear Swab Culture 8
CPT 87070-12 Eye Swab Culture 8
CPT 87101 Fungal Culture (except blood) 18
CPT 87101-01 Fungal Stain -KOH 10
CPT 87101-02 Hanging Drop Study 8
CPT 87070-06 Gram Stain 5
CPT 87641-02 MRSA Screening 5
CPT 87109 Mycoplasma Culture -Cervical/Vaginal Swab/Urine 16
CPT 89190 Nasal Swab Culture 9
CPT 87070-07 Pus Swab Culture 7
CPT 87252 Rectal Swab Culture 10
CPT 87066 Semen Culutre 8
CPT 87084 Specimen Cultures 8
CPT 87077-01 Sputum Culture 8
CPT 87046 Stool Culture (excl. Campylobacter spp.) 10
CPT 87077-02 Swab Culture 8
CPT 87070-13 Throat Swab Culture 8
CPT 87076 Tissue Culture, Aerobic Bacteria 17
CPT 87106 Tissue Culture, Yeast 20
CPT 87070-14 Urethral Swab Culture 10
CPT 87086 Urine Culture 8
CPT 87070-15 Vaginal Swab Culture 8
22.10 Microbiology-PCR
CPT 87270 Chlamydia trachomatis DNA 25
CPT 87798 Coronavirus (MERS-CoV) RNA 75
CPT 86644-02 Cytomegalovirus (CMV) DNA, Qualitative (Plasma) 50
CPT 86644-03 Cytomegalovirus (CMV) DNA, Quantitative (Plasma) 75
CPT 86790-07 Dengue RNA 45
CPT 86665-02 Epstein Barr Virus (EBV) DNA, Qualitative 40
CPT 86665-03 Epstein Barr Virus (EBV) DNA, Quantitative 55
CPT 87591 Gonococcal DNA 45
CPT 87518 Hepatitis B Virus DNA, Qualitative 50
CPT 87517 Hepatitis B Virus DNA, Quantitative 65
System Category Day
CPT 87912 Hepatitis B Virus, Genotyping 100
CPT 87521 Hepatitis C Virus RNA, Qualitative 60
CPT 87520 Hepatitis C Virus RNA, Quantitative 70
CPT 87902 Hepatitis C Virus, Genotyping 100
CPT 87530 Herpes Simplex Virus (HSV), I/2, DNA Qualitative 55
CPT 86703-02 HIV 1 & 2 RNA, Qualitative 75
CPT 87535 HIV 1 RNA, Qualitative 55
CPT 87536 HIV RNA, Quantitative 100
CPT 87621 Human Papillomavirus (HPV), Genotyping 42
CPT 87502 Influenza A H1N1 (Swine Flu) RNA 80
CPT 86481 Mycobacterium tuberculosis (MTB) DNA 70
CPT 86738 Mycoplasma pneumoniae DNA 70
CPT 87281-01 Pneumocystis carinii DNA 90
CPT 86756-01 Respiratory Panel, Bacterial (RT-PCR) 90
CPT 86756-02 Respiratory Panel, Viral (RT-PCR) 135
CPT 86703-01 STD Profile (RT-PCR) 90
22.11 Pathology
CPT 88029 Autopsy- Fetal 150
CPT 88141 Cervical Cytology (Liqui Prep PAP) 28
CPT 88142 Cervical Cytology (Thin Prep PAP) 35
CPT 88175 Cervical Pap (LBC) + HPV DNA 35
CPT 88164 Cervical Pap Smear (Conventional) 10
CPT 88305-01 Cytology- Exfoliative 15
CPT 88305-02 Cytology- Fluid 25
CPT 88188-01 Flow Cytometric Study 50
CPT 88188-02 Flow Cytometric Study (Panel) 110
CPT 88300-01 Histopathology 40
CPT 88300 Histopathology - Category 1 80
CPT 88302 Histopathology - Endoscopic biopsies (2)+IHC for H. pylori 75
CPT 88304 Histopathology - Endoscopic biopsies (3)+IHC for H. pylori 100
CPT 88305 Histopathology - Endoscopic biopsy (1)+IHC for H. pylori 40
CPT 88331 Histopathology - Frozen Section 125
CPT 88332 Histopathology - Frozen Section (additional specimen) 100
CPT 88307 Histopathology - Large specimen 70
CPT 88309 Histopathology - Medium specimen 50
CPT 88329 Histopathology - Second opinion 25
CPT 88307-01 Histopathology - Small specimen 35
CPT 88312 Histopathology - Special stain (Each) 5
CPT 88347-02 Immunofluorescent (IF) Stain 18
CPT 88347-03 Immunohistochemistry (IHC) 18
CPT 88173 FNAC 20
22.12 Genetics
CPT 81211 BRCA 1,2 Genes 420
CPT 88271 Chromosome 21 (FISH) -Blood 60
CPT 88285 Chromosome Analysis (Karyotyping) ̶ Amniotic Fluid 110
CPT 88262 Chromosome Analysis (Karyotyping) ̶ Blood 50
CPT 88280 Chromosome Analysis (Karyotyping) ̶ POC 140
CPT 88269 Chromosome Analysis (Karyotyping) + Inter/Metaphase FISH ̶ Amniotic Fluid 180
System Category Day
CPT 88275 Chromosome Analysis (Karyotyping) + Interphase FISH ̶ Amniotic Fluid 275
CPT 88289 Chromosome Analysis (Karyotyping) + PCR ̶ Amniotic Fluid 150
CPT 88267 Chromosome Analysis (Karyotyping) + PCR ̶ Chorionic Villi 150
CPT 81276 Colorectal Cancer, Gene Panel 650
CPT 81342 DNA Descendancy (Paternity) Test 550
CPT 81342-01 DNA Paternity Test 380
CPT 81342-02 DNA Paternity Test (Each additional child) 35
CPT 81403 Familial Hemochromatosis- HFA Gene 90
CPT 81243 Fragile X Syndrome- FMR1 Gene Analysis 200
CPT 88262-01 Fragile X Syndrome- Karyotyping, Blood 125
CPT 81370 HLA A,B,DR Typing 130
CPT 81376 HLA DQ Typing 130
CPT 81404 HNF1 Beta Gene- MLPA Analysis 250
CPT 81420 Paternity Testing, Prenatal 420
CPT 81420-01 Prenatal (Non-invasive) Trisomy Test- NIFTY 280
CPT 85041-01 Prenatal Screen, for Thalassemia, SCD 800
CPT 81408-01 Progressive Myoclonic Epilepsy, Gene Panel 450
CPT 81401-01 Spinal Muscular Atrophy- SMN1 Gene Analysis 230
CPT 81401-02 Spinal Muscular Atrophy- SMN2 Gene Analysis 350
CPT 81401-03 Spinocerebellar Ataxia (SCA) Panel 125
CPT 81417 UMOD Gene- Coding Exon Sequencing 580
22.13 Other Studies
CPT 84630-01 Blood Element Analysis 32
CPT 85730-01 Deep Vein Thrombosis (DVT) Panel 85
CPT 84704-02 Double Marker Test (First Trimester) 40
CPT 84704-01 First Trimester Screen 60
CPT S3620 Metabolic Screen 40
CPT 99000 Newborn Screen, Panel 1 41
CPT 84591-01 OAT + IgG Food Allergy Test 200
CPT 81313 Prostate Panel 35
CPT 81515-01 Quadruple Test 40
CPT 81515-02 Second Trimester Screen (Quadruple Test) 65
CPT 81515-03 Second Trimester Screen (Triple Test) 50
CPT 83090-01 Thrombophilia Profile (Maxi) 150
CPT 81510-01 Triple Test 35
23 PHYSIOTHERAPY
CPT 97001 PHYSICAL THERAPY EVALUATION 10 0 0
CPT 97005 ATHLETIC TRAINING EVALUATION 10 0 0
CPT 97010 SINGLE PROBLEM THERAPY 12 0 0
CPT 97026 LASER THERAPY 20 0 0
CPT 28890 SHOCK WAVE THERAPY 15 0 0
CPT 99251 INPATIENT VISIT 10 0 0
CPT 99350 HOME VISIT 25 0 0
System Category Day
24 Medical Reports
CPT 99080 INSURANCE FULL MEDICAL REPORT 10 0 0 0
CPT 25 EMERGENCY
CPT 99060 ER CONSUMABLES MINIMUM 5
CPT 99061 ER CONSUMABLES REGULAR 10
26 OPD Procedures
26.1 OPD OTRTHOPEDIC PROCEDURES
CPT 29065 APPLICATION CAST ABOVE ELBOW 35
CPT 29075 APPLICATION CAST BELOW ELBOW 30
CPT 29345 APPLICATION CAST ABOVE KNEE 37
CPT 29405 APPLICATION CAST BELOW KNEE 35
CPT 29125 APPLICATION SHORT ARM SPLINT 25
CPT 29515 APPLICATION SHORT LEG SPLINT 30
CPT 29105 APPLICATION LONG ARM SPLINT 25
CPT 29505 APPLICATION LONG LEG SPLINT 32
CPT 29131 APPLICATION FINGER SPLINT 15
CPT 29365 APPLICATION CYLINDER CAST THIGH ANKLE 45
CPT 29435 APPLICATION PATELLAR TENDON BEARING CAST 45
CPT 29450 APPLICATION CLUBFOOT CAST 60
CPT 29305 APPLICATION HIP SPICA CAST 75
CPT 29705 REMOVAL/BIVALVING CAST LEG/FOREARM 20
ARTHROCENTESIS,ASPIRATION/INTRA-ARTICULAR INJECTION OF SMALL
CPT 20600
JOINT 20
ARTHROCENTESIS,ASPIRATION /INTRA-ARTICULAR INJECTION OF BIG JOINT
CPT 20610
20
CPT 20526 INJECTION THERAPEUTIC CARPAL TUNNEL 27
CPT 20552-01 INJECTION OF TRIGGER FINGER 17
CPT 20612 ASPIRATION AND INJECTION OF GANGLION CYST 20
CPT 24640 CLOSED REDUCTION OF PULLED ELBOW 30
CPT 26720 CLOSED REDUCTION OF INTERPHALANGEAL JOINT DISLOCATION 45
CPT 25520 CLOSED REDUCTION OF COLLES FRACTURE 50
CPT 26010 INCISION /DRAINAGE FINGER ABSCESS 50
CPT 28190 REMOVAL FOREING BODY UNDER LOCAL ANESTHESIA 50
CPT 2007911 SUTURE OF WOUND < 5 CM 25
CPT 2007912 SUTURE OF WOUND > 5 CM 35
CLOSED TREATMENT SHOULDER DISLOCATION W/MANIPULATION W/O
CPT 23650
ANESTHESIA 70
CPT 26.2 OPD GENERAL SURGERY PROCEDURES
CPT 10021 FINE NEEDLE ASPIRATION 60
CPT 11422 EPIDERMOID CYST EXCISIN SCALP 80
CPT 11423 MULTIPLE CYST EXCISION SCALP (2-3 ) 120
CPT 11402 LIPOMA EXCISION 80
CPT 12001 SKIN SUTURE 40
CPT 10180 DRAINAGE OF POSTOPERATIVE WOUND INFECTION 50
CPT 11042 WOUND DEBRIDMENT AND CLOSURE 80
CPT 97597 WOUND DEBRIDMENT 40
CPT 10120 REMOVAL OF SUBCUTANEOUS FOREIGN BODY 90
CPT 15851 GENERAL SURGERY WOUND DRESSING; SMALL 10
System Category Day
CPT 15852 GENERAL SURGERY WOUND DRESSING; MEDIUM 20
CPT 15853 GENERAL SURGERY WOUND DRESSING; LARGE 30
CPT 11446 SCAR EXCISION AND CLOSURE 105
CPT 11441 EXCISION OF SKIN LESION 80
CPT 11642 LYMPH NODE EXCISION AND BIOPSY 180
CPT 11730 IN-GROWING BIG TOE NAIL AVULSION 70
CPT 11765 IN-GROWING BIG TOE NAIL WEDGE EXCISION 120
CPT 11750 IN-GROWING BIG TOE NAIL ABLATION 160
CPT 11300 PLANTER CORN EXCISION 120
CPT 10060 INCISION AND DRAINAGE OF ABSCESS 75
CPT 45300 SEGMOIDOSCOPY 80
CPT 45305 SEGMOIDOSCOPY BIOPSY 120
CPT 12021 SECONDARY WOUND CLOSURE 65
CPT 10080 INCISION AND DRAINAGE OF PILONEDAL ABSCESS OR CYST 130
CPT 19100 CORE NEEDLE BIOPSY BREAST 90
CPT 54160 CIRCUMCISION FOR NEONATE 40 DAYS MINUS 60
CPT 11900 KILOID SCAR INJECTION 80
CPT 45307 ANAL FOREIGN BODY REMOVAL 90
CPT 45308 SKIN AND SUBCUTANOUS TISSUE OPEN BIOPSY 150
CPT 17110 KILOID SCAR REMOVAL 120
CPT 15850 SUTURE REMOVAL 10
CPT 46050 PERIANAL ABSCESS DRAINAGE 60
All Procedural Packages total amount are excluding Radiology, Lab, Post-operative Medications and Hospice.
Hospice which will be charged as per patient stay (60 BD per day All Inclusive) except for the Antenatal Packages which the Hospics will be included
The Delivery Packages are for those who have at least 4 antenatal visits.
Prostheses and Surgical Kits will be charged separately as they are not included in the procedure package.
This Price list is prepared based on Diagnosis Related Group (DRG®) , Current Procedural Terminology (CPT®) and Current Dental Terminology (CDT®) coding systems
Total Package disscount % disscount Net amount
10.00 0 10
15.00 0 15
20.00 0 20
20.00 0 20
20.00 0 20
15.00 0 15
50.00 0 50
75.00 0 75
200.00 0 200
150.00 0 150
225.00 0 225
200.00 0 200
125.00 0 125
150.00 0 150
125.00 0 125
125.00 0 125
125.00 0 125
125.00 0 125
175.00 0 175
125.00 0 125
125.00 0 125
225.00 0 225
75.00 0 75
25.00 0 25
100.00 0 100
200.00 0 200
150.00 0 150
75.00 0 75
150.00 0 150
75.00 0 75
25.00 0 25
100.00 0 100
175.00 0 175
125.00 0 125
75.00 0 75
75.00 0 75
25.00 0 25
2.00 0 2
30.00 0 30
30.00 0 30
15.00 0 15
35.00 0 35
60.00 0 60
20.00 0 20
25.00 0 25
30.00 25
15.00 0 15
10.00 0 10
15.00 0 15
25.00 0 25
30.00 0 30
10.00 0 10
5.00 0 5
250.00 0 250
60.00 0 60
110.00 0 110
120.00 0 120
50.00 0 50
300.00 0 300
40.00 0 40
40.00 0 40
10.00 0 10
80.00 0 80
25.00 0 25
30.00 0 30
30.00 0 30
20.00 0 20
50.00 0 50
50.00 0 50
50.00 0 50
30.00 0 30
25.00 0 25
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
275.00 0 275
1450.00 0 1450
275.00 0 275
275.00 0 275
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
25.00 0 25
1050.00 0 1050
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
275.00 0 275
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
275.00 0 275
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
200.00 0 200
600.00 0 600
1050.00 0 1050
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
600.00 0 600
275.00 0 275
275.00 0 275
50.00 0 50
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
600.00 0 600
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
275.00 0 275
90.00 0 90
75.00 0 75
600.00 0 600
2100.00 0 2100
150.00 0 150
275.00 0 275
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
1450.00 0 1450
600.00 0 600
600.00 0 600
1450.00 0 1450
600.00 0 600
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
1050.00 0 1050
120.00 0 120
30.00 0 30
60.00 0 60
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
1450.00 0 1450
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
1450.00 0 1450
600.00 0 600
1050.00 0 1050
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
1450.00 0 1450
1450.00 0 1450
600.00 0 600
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
2100.00 0 2100
600.00 0 600
600.00 0 600
200.00 0 200
200.00 0 200
600.00 0 600
600.00 0 600
275.00 0 275
200.00 0 200
200.00 0 200
1450.00 0 1450
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
75.00 0 75
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
200.00 0 200
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
1050.00 0 1050
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
1050.00 0 1050
275.00 0 275
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
275.00 0 275
1050.00 0 1050
1450.00 0 1450
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
275.00 0 275
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
600.00 0 600
275.00 0 275
275.00 0 275
100.00 0 100
275.00 0 275
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
600.00 0 600
1050.00 0 1050
100.00 0 100
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
1050.00 0 1050
1050.00 0 1050
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
1050.00 0 1050
1450.00 0 1450
275.00 0 275
1050.00 0 1050
1050.00 0 1050
600.00 0 600
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
275.00 0 275
0 0
1450.00 0 1450
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
1050.00 0 1050
1050.00 0 1050
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
2100.00 0 2100
1050.00 0 1050
600.00 0 600
1050.00 0 1050
275.00 0 275
275.00 0 275
275.00 0 275
50.00 0 50
275.00 0 275
275.00 0 275
600.00 0 600
1450.00 0 1450
7.00 0 7
10.00 0 10
5.00 0 5
15.00 0 15
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
600.00 0 600
275.00 0 275
275.00 0 275
2100.00 0 2100
1450.00 0 1450
1050.00 0 1050
1450.00 0 1450
275.00 0 275
1050.00 0 1050
275.00 0 275
275.00 0 275
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
275.00 0 275
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
25.00 0 25
600.00 0 600
275.00 0 275
2100.00 0 2100
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
600.00 0 600
275.00 0 275
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
1050.00 0 1050
275.00 0 275
275.00 0 275
600.00 0 600
1050.00 0 1050
1050.00 0 1050
275.00 0 275
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
275.00 0 275
2100.00 0 2100
1450.00 0 1450
600.00 0 600
1050.00 0 1050
1450.00 0 1450
275.00 0 275
2100.00 0 2100
275.00 0 275
5.00 0 5
2100.00 0 2100
1450.00 0 1450
275.00 0 275
1050.00 0 1050
1050.00 0 1050
275.00 0 275
1050.00 0 1050
275.00 0 275
100.00 0 100
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
600.00 0 600
2100.00 0 2100
275.00 0 275
2100.00 0 2100
600.00 0 600
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
2100.00 0 2100
1050.00 0 1050
2100.00 0 2100
1050.00 0 1050
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
600.00 0 600
275.00 0 275
600.00 0 600
600.00 0 600
2100.00 0 2100
600.00 0 600
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
275.00 0 275
275.00 0 275
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
600.00 0 600
600.00 0 600
1450.00 0 1450
600.00 0 600
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
275.00 0 275
1450.00 0 1450
1050.00 0 1050
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
1050.00 0 1050
600.00 0 600
1450.00 0 1450
275.00 0 275
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
600.00 0 600
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
2100.00 0 2100
275.00 0 275
1450.00 0 1450
2100.00 0 2100
600.00 0 600
1050.00 0 1050
10.00 0 10
15.00 0 15
25.00 0 25
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
600.00 0 600
275.00 0 275
275.00 0 275
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
2050.00 0 2050
2050.00 0 2050
2050.00 0 2050
2050.00 0 2050
2050.00 0 2050
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
600.00 0 600
600.00 0 600
1050.00 0 1050
2100.00 0 2100
275.00 0 275
600.00 0 600
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
2100.00 0 2100
600.00 0 600
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
600.00 0 600
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1050.00 0 1050
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
275.00 0 275
1450.00 0 1450
1050.00 0 1050
275.00 0 275
275.00 0 275
275.00 0 275
275.00 0 275
275.00 0 275
600.00 0 600
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
600.00 0 600
1450.00 0 1450
1050.00 0 1050
1450.00 0 1450
1050.00 0 1050
1050.00 0 1050
600.00 0 600
600.00 0 600
3000.00 0 3000
3000.00 0 3000
3000.00 0 3000
3400.00 0 3400
3000.00 0 3000
3000.00 0 3000
3000.00 0 3000
2890.00 0 2890
2890.00 0 2890
1790.00 0 1790
3000.00 0 3000
1625.00 0 1625
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1050.00 0 1050
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
600.00 0 600
1050.00 0 1050
1050.00 0 1050
2100.00 0 2100
600.00 0 600
1050.00 0 1050
2100.00 0 2100
275.00 0 275
600.00 0 600
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1050.00 0 1050
600.00 0 600
2100.00 0 2100
600.00 0 600
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
2100.00 0 2100
1050.00 0 1050
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
275.00 0 275
275.00 0 275
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
1450.00 0 1450
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
600.00 0 600
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
2100.00 0 2100
1050.00 0 1050
1450.00 0 1450
275.00 0 275
1450.00 0 1450
1450.00 0 1450
1450.00 0 1450
600.00 0 600
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
600.00 0 600
600.00 0 600
600.00 0 600
275.00 0 275
1050.00 0 1050
1450.00 0 1450
600.00 0 600
275.00 0 275
275.00 0 275
600.00 0 600
600.00 0 600
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
1050.00 0 1050
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8.00 0 8
8.00 0 8
0 0
25.00 0 25
75.00 0 75
50.00 0 50
75.00 0 75
45.00 0 45
40.00 0 40
55.00 0 55
45.00 0 45
50.00 0 50
65.00 0 65
100.00 0 100
60.00 0 60
70.00 0 70
100.00 0 100
55.00 0 55
75.00 0 75
55.00 0 55
100.00 0 100
42.00 0 42
80.00 0 80
70.00 0 70
70.00 0 70
90.00 0 90
90.00 0 90
135.00 0 135
90.00 0 90
0 0
150.00 0 150
28.00 0 28
35.00 0 35
35.00 0 35
10.00 0 10
15.00 0 15
25.00 0 25
50.00 0 50
110.00 0 110
40.00 0 40
80.00 0 80
75.00 0 75
100.00 0 100
40.00 0 40
125.00 0 125
100.00 0 100
70.00 0 70
50.00 0 50
25.00 0 25
35.00 0 35
5.00 0 5
18.00 0 18
18.00 0 18
20.00 0 20
0 0
420.00 0 420
60.00 0 60
110.00 0 110
50.00 0 50
140.00 0 140
180.00 0 180
275.00 0 275
150.00 0 150
150.00 0 150
650.00 0 650
550.00 0 550
380.00 0 380
35.00 0 35
90.00 0 90
200.00 0 200
125.00 0 125
130.00 0 130
130.00 0 130
250.00 0 250
420.00 0 420
280.00 0 280
800.00 0 800
450.00 0 450
230.00 0 230
350.00 0 350
125.00 0 125
580.00 0 580
0 0
32.00 0 32
85.00 0 85
40.00 0 40
60.00 0 60
40.00 0 40
41.00 0 41
45.00 0 45
35.00 0 35
75.00 0 75
30.00 0 30
35.00 0 35
200.00 0 200
35.00 0 35
40.00 0 40
65.00 0 65
50.00 0 50
150.00 0 150
35.00 0 35
0 0
10.00 0 10
10.00 0 10
12.00 0 12
20.00 0 20
15.00 0 15
10.00 0 10
25.00 0 25
0 0
10.00 0 10
0 0
5.00 0 5
10.00 0 10
0 0
0 0
35.00 0 35
30.00 0 30
37.00 0 37
35.00 0 35
25.00 0 25
30.00 0 30
25.00 0 25
32.00 0 32
15.00 0 15
45.00 0 45
45.00 0 45
60.00 0 60
75.00 0 75
20.00 0 20
20.00 0 20
20.00 0 20
27.00 0 27
17.00 0 17
20.00 0 20
30.00 0 30
45.00 0 45
50.00 0 50
50.00 0 50
50.00 0 50
25.00 0 25
35.00 0 35
70.00 0 70
0 0
60.00 0 60
80.00 0 80
120.00 0 120
80.00 0 80
40.00 0 40
50.00 0 50
80.00 0 80
40.00 0 40
90.00 0 90
10.00 0 10
20.00 0 20
30.00 0 30
105.00 0 105
80.00 0 80
180.00 0 180
70.00 0 70
120.00 0 120
160.00 0 160
120.00 0 120
75.00 0 75
80.00 0 80
120.00 0 120
65.00 0 65
130.00 0 130
90.00 0 90
60.00 0 60
80.00 0 80
90.00 0 90
150.00 0 150
120.00 0 120
10.00 0 10
60.00 0 60
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

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