17.1A

Base Rate – $162.92
Name – Injection of alcohol, Trigeminal

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
ROLE
ROLE
ANU
ANU
SURC
SURC
SURC
SURC
LVP
BMIANE
BMIANT
ANE
ANEST
ANU
ANU
EV
NTAM
NTPM
WK
LVP75
 
  
  
  
 1 
 2 – 150 
  
  
  
  
 
Yes 
 Yes 
 Yes 
 Yes 
  
  
 Yes 
 Yes 
 Yes 
 Yes 
 Yes
Increase By
Increase By
Replace Base
Replace Base
For Each Call Pay Base At
For Each Call Increase By
Increase By
Increase By
Increase By
Increase By
Reduce Base To
25%
25%
$109.82
$18.29
100%
$18.29
$48.70
$116.83
$116.83
$48.70
75%

II – Operations On The Nervous System

/ 17 Operations On Cranial And Peripheral Nerves

// 17.1 Destruction of cranial and peripheral nerves

/// –

//// 17.1A


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