14.3A

Base Rate – $1,305.14
Name – A Stereotactic ablation or stimulation of subcortical structures for functional indications, including thalamus and globus pallidus

Category – 14 Major Procedure (pre-operative period: 30 days, post-operative period: 14 days)

Fee Modifiers

Type Code # of calls Explicit Action Amount
BMI
BMI
BMI
ROLE
ROLE
ROLE
ANU
ANU
2MNU
2MNU
SURC
SURC
SURC
SURC
LVP
BMIANE
BMIANT
BMIPRO
ANE
ANEST
MSRGN
ANU
ANU
2MNU
2MNU
EV
NTAM
NTPM
WK
LVP75
 
  
  
  
  
  
 1 
 2 – 120 
 1 – 7 
  
  
  
  
  
 
Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
  
  
  
  
 Yes 
 Yes 
 Yes 
 Yes 
 Yes
Increase By
Increase By
Increase By
Replace Base
Replace Base
Replace Base
For Each Call Pay Base At
For Each Call Increase By
For Each Call Pay Base At
To a Maximum Of
Increase By
Increase By
Increase By
Increase By
Reduce Base To
25%
25%
25%
$368.97
$18.29
$417.75
100%
$18.29
100%
$2,924.25
$48.70
$116.83
$116.83
$48.70
75%

II – Operations On The Nervous System

/ 14 Incision And Excision Of Skull Brain And Cerebral Meninges

// 14.3 Operations on thalamus and globus pallidus (including ansa and cingulus)

/// –

//// 14.3A


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