16.09N

Base Rate – $1,318.53
Name – Intervertebral fusion, thoracic & lumbar spine only (anterior lumbar intervertebral fusion (ALIF), posterior lumbar intervertebral fusion (PLIF), or translateral lumbar intervertebral fusion (TLIF))

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
ROLE
ROLE
VANE
VANE
ANEU
ANEU
ANU
ANU
SAU
SAU
SSOU
SSOU
SAQU
CALL
CALL
SURC
SURC
SURC
SURC
LMTS
LVP
BMIANE
BMIANT
BMIPRO
ANE
ANEST
SA
SAQS
SSOS
L30AN
L30AT
ANEU
ANEU
ANU
ANU
SAU
SAU
SSOU
SSOU
SAQU
NBRSER
NBRSER
EV
NTAM
NTPM
WK
L44ANE
LVP75
 
  
  
  
  
  
  
  
  
  
 1 
 2 – 5 
 1 
 2 – 150 
 1 
 2 – 33 
 1 
 2 – 33 
 1 – 36 
 1 
 2 – 5 
  
  
  
  
  
 
Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
  
  
  
  
  
  
  
  
  
  
  
  
  
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes
Increase By
Increase By
Increase By
Replace Base
Replace Base
Replace Base
Replace Base
Replace Base
Increase By
Increase By
For Each Call Pay Base At
For Each Call Increase By
For Each Call Pay Base At
For Each Call Increase By
For Each Call Pay Base At
For Each Call Increase By
For Each Call Pay Base At
For Each Call Increase By
For Each Call Pay Base At
For Each Call Pay Base At
For Each Call Increase By
Increase By
Increase By
Increase By
Increase By
Increase Base By
Reduce Base To
25%
25%
25%
$458.00
$18.29
$147.31
$50.72
$281.29
$107.74
$107.74
100%
$203.35
100%
$18.29
100%
$36.86
100%
$93.76
100%
100%
$263.69
$48.70
$116.83
$116.83
$48.70
$107.74
75%

II – Operations On The Nervous System

/ 16 Operations On Spinal Cord And Spinal Canal Structures

// 16.0 Exploration and decompression of spinal canal

/// 16.09 Other exploration and decompression of spinal canal

//// 16.09N


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