17.92A

Base Rate – $129.29
Name – Sacral nerve root stimulator, peripheral nerve evaluation, first full 30 minutes or major portion thereof for the first call when only one call is claimed

Category – M Minor Procedure

Fee Modifiers

Type Code # of calls Explicit Action Amount
BMI
BMI
ROLE
ROLE
ROLE
ROLE
ROLE
ANU
ANU
SAU
SAU
SAQU
CALL
CALL
SURC
SURC
SURC
SURC
LVP
BMIANE
BMIANT
ANE
ANEST
SA
SAQS
SSST
ANU
ANU
SAU
SAU
SAQU
M30M15
M30M15
EV
NTAM
NTPM
WK
LVP75
 
  
  
  
  
  
  
 1 
 2 – 150 
 1 
 2 – 33 
 1 – 36 
 1 
 2 – 7 
  
  
  
  
 
Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
 Yes 
  
  
  
  
  
  
  
 Yes 
 Yes 
 Yes 
 Yes 
 Yes
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
For Each Call Pay Base At
For Each Call Increase By
Increase By
Increase By
Increase By
Increase By
Reduce Base To
25%
25%
$109.92
$18.29
$147.31
$50.72
$278.77
100%
$18.29
100%
$36.86
100%
100%
$62.06
$48.70
$116.83
$116.83
$48.70
75%

II – Operations On The Nervous System

/ 17 Operations On Cranial And Peripheral Nerves

// 17.9 Other operations on cranial and peripheral nerves

/// 17.92 Implantation or replacement of peripheral neurostimulator

//// 17.92A


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