17.02A

Base Rate – $968.41
Name – Trans-labyrinthine resection of acoustic neuroma

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
ANU
ANU
SAU
SAU
SAQU
SURC
SURC
SURC
SURC
LVP
BMIANE
BMIANT
BMIPRO
ANE
ANEST
SA
SAQS
SSST
ANU
ANU
SAU
SAU
SAQU
EV
NTAM
NTPM
WK
LVP75
 
  
  
  
  
  
  
  
 1 
 2 – 150 
 1 
 2 – 33 
 1 – 36 
  
  
  
  
 
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
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
Increase By
Increase By
Increase By
Increase By
Reduce Base To
25%
25%
25%
$344.23
$18.29
$147.31
$50.72
$278.77
100%
$18.29
100%
$36.86
100%
$48.70
$116.83
$116.83
$48.70
75%

II – Operations On The Nervous System

/ 17 Operations On Cranial And Peripheral Nerves

// 17.0 Incision division and excision of cranial and peripheral nerves

/// 17.02 Acoustic neurotomy

//// 17.02A


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