Men P ACWY Meningococcal Polysaccharide ACWY MMR C 7 C … · Rab —Rabies–post– ......
Transcript of Men P ACWY Meningococcal Polysaccharide ACWY MMR C 7 C … · Rab —Rabies–post– ......
Therapeutic Injections and Immunizations
B-26 April 1, 2010
Men–P–ACWY–Meningococcal–Polysaccharide ACWY
8981 single dose ..................................................................................................................................... 8.85
MMR—Measles, Mumps, Rubella
8670 single dose ..................................................................................................................................... 8.85
Pneu–C–7—Pneumococcal Conjugate–7–valent
8681 single dose ..................................................................................................................................... 8.85
Pneu–C–13—Pneumococcal Conjugate–13–valent
8896 single dose ..................................................................................................................................... 8.85
Pneu–P–23—Pneumococcal Polysaccharide–23-valent
8961 single dose ..................................................................................................................................... 8.85
Rab—Rabies–post–exposure
8751 single dose ..................................................................................................................................... 8.85
Rab—Rabies Vaccine–pre–exposure
8761 single dose ..................................................................................................................................... 8.85
Td—Tetanus, Diphtheria–adult
8651 single dose ..................................................................................................................................... 8.85
TdaP—Tetanus, Diphtheria, accellular Pertussis–adult
8907 single dose ..................................................................................................................................... 8.85
Td–IPV—Tetanus, Diphtheria, Inactivated Polio Virus–adult
8805 single dose ..................................................................................................................................... 8.85
Var—Varicella
8674 single dose ..................................................................................................................................... 8.85
PASSIVE IMMUNIZING AGENTS
BAtx—Botulism Antitoxin type A, B, E
8910 single dose ..................................................................................................................................... 8.85
DAtx—Diphtheria Antitoxin
8928 single dose ..................................................................................................................................... 8.85
HBIg—Hepatitis B Immunoglobulin
8916 single dose ..................................................................................................................................... 8.85
Ig—Immune globulin (human)
8920 single dose ..................................................................................................................................... 8.85
RabIg—Rabies Immunoglobulin
8768 single dose ..................................................................................................................................... 8.85
TIg—Tetanus Immunoglobulin
8690 single dose ..................................................................................................................................... 8.85
Digestive System
J-6 April 1, 2010
UNIT VALUE
3631 Inguinal hernia, initial ............................................................................................................... 338.75 20.000
3632 pediatric with negative contralateral exploration ................................................................... 340.70 20.000
3636 with excision of hydrocele and/or orchiectomy ..................................................................... 402.90 20.000
3635 recurrent ................................................................................................................................. 423.30 21.375
3633 Incarcerated hernia without bowel resection ............................................................................. 418.20 21.375
3734 Wound disruption (postop), secondary suture ........................................................................... 368.85 22.750
3591 Peritoneo-venous shunt, placement ........................................................................................... 421.60 21.375
3592 removal for infection.............................................................................................................. 238.05 21.375
3593 removal and replacement of valve for blockage .................................................................... 177.50 21.375
3707 Diaphragm (transabdominal or thoracic), rupture, early repair ................................................. 691.75 24.125
3708 diaphragm hernias excluding anti-reflux surgery ................................................................... 700.40 25.500
3706 with prosthesis, add ................................................................................................................ 250.00
RESECTION
3595 Abdominal lipectomy—small (vertical skin resection up to 15 cm.) ........................................ 608.15 21.375
3596 Abdominal lipectomy—large (vertical skin resection 15 cm. to 30 cm.) .................................. 608.15 21.375
3597 Abdominal lipectomy—massive (vertical skin resection over 30 cm.) ..................................... 979.20 21.375
Note: These procedures have certain restrictions under the Regulations when
done as elective surgery. Written prior approval from the Minister is a
condition for the payment of claims.
3580 Retroperitoneal or transperitoneal tumor or cyst; excision ........................................................ 817.15 22.750
3619 Unlisted or Unusually Complicated .................................................................................. By Report 22.750
ENDOSCOPY
Note: Tariffs 3000, 3002, 3004, 3006, 3008 and 3010 may only be claimed in
addition to gastrointestinal endosopic procedure tariffs.
3000* Balloon dilatation of colonic, pyloric, esophageal or small bowel strictures, add ....................... 83.40 21.375
3002* Botox injection, add..................................................................................................................... 48.50 21.375
3004* Hemostasis G. I. Tract by any endoscopic method or technique (e.g., cautery,
injection, banding), add ............................................................................................................. 110.35 21.375
3006* Hemodynamic instability, add ..................................................................................................... 51.00 24.125
Note: Claim, for Tariff 3006, must indicate that the patient exhibits one (1) or
more of the following: Pulse Rate >100/minute; Blood pressure <80
systolic; hemoglobin <80; On-going bleeding.
3008* Placement of jejunal or small bowel feeding tube beyond pyloris, add....................................... 50.00 20.000
3010 Insertion of small bowel or colonic stent (s) (includes dilatation if necessary), add ................. 137.00 21.375
Note: Tariff 3000 may not be claimed in addition to Tariff 3010.
Digestive System
April 1, 2010 J-7
0005 Endoscopic Tray Fee .................................................................................................................. 100.00
May only be claimed in addition to Tariffs 3055, 3060, 3065 , 3095, 3121, 3122, 3123,
3185, 3186, 3187 and 3189 when the service is rendered in the physician’s office.
Note: Tray Fee tariff 0005 is claimable only in instances where expenses are
directly incurred by the physician for medical/surgical supplies. Tray Fee
tariff 0005 is not claimable in relation to services performed at a hospital,
personal care home or other publically funded facility or a facility on
contract with a Regional Health Authority to perform such insured services.
ESOPHAGUS
UNIT VALUE
3055* Esophagoscopy, diagnostic, with or without biopsy .................................................................. 102.00 21.375
3063* subsequent, same hospital admission ........................................................................................68.00 21.375
3060* with bronchoscopy ....................................................................................................................99.85 22.750
3057 with foreign body removal...................................................................................................... 175.95 21.375
3065* with injection of varices or band ligation ............................................................................... 191.40 21.375
STOMACH
3121* Gastroscopy, diagnostic with or without biopsy ........................................................................ 110.95 21.375
3122* with polypectomy ................................................................................................................... 180.65 21.375
3123* Esophagogastroduodenoscopy (EGD) with or without biopsy .................................................. 114.55 21.375
SMALL INTESTINE
3190* Small bowel enteroscopy by mouth using designated enteroscope or colonoscope ................... 204.00 21.375
Note: Pathology report may be required.
3192 Capsule Endoscopy–Includes the review of imaging of the small bowel and report to
the referring physician ................................................................................................................ 412.10
Note: 1) A visit cannot be claimed at the same sitting as the initiation of capsule
endoscopy.
2) Minimum time for the service is one (1) hour including the assessment
of referrals to determine indication for procedure.
3) Patients will have previously undergone some or all of the following:
Esophagogastroduodenoscopy (EGD), colonoscopy, small bowel
enteroscopy and/or small bowel series–radiography & fluoroscopy.
4) Payable only for services provided by a Gastroenterologist at a facility
to be designated by Manitoba Health (Health Science Centre and
Brandon Regional Health Centre).
Audio-Vestibular System
April 1, 2010 S-1
S
AUDIO-VESTIBULAR SYSTEM
These benefits cannot be correctly interpreted without reference to the Rules of Application.
DIAGNOSTIC PROCEDURES
Automated impedance tympanometer with hand-held micro tympanometer
(included in visit fee) ...................................................................................................................... F/S
Audiogram—screening ................................................................................................................... F/S
9745* Audiogram—puretone—air & bone (bilateral), total ...................................................................20.40
9740* professional portion ................................................................................................................8.55
9746* air & bone with speech tests (bilateral), total ...........................................................................26.50
9742* professional portion ..............................................................................................................11.40
9749* air & bone with speech tests and suprathreshold tests (bilateral), total ....................................24.00
9744* professional portion ..............................................................................................................13.90
9770* Automated impedance tympanometer with or without ipsilateral or contralateral
reflexes, total ................................................................................................................................10.20
9786* professional portion ....................................................................................................................7.10
~9752 Vestibular Evoked Myogenic Potential Test, professional fee for interpretation .........................50.00
Note: 1) Tariff ~9752 is payable only for tests provided in a facility designated
by Manitoba Health.
2) Tariff ~9752 may only be claimed by physicians designated as
specialists in Otolaryngology by the College of Physicians and
Surgeons of Manitoba.
ADVANCED TESTING
Note: 1) A maximum of three (3) advanced tests are payable at the same sitting.
2) When performed at the same sitting as Tariffs 9770 and 9786, a
maximum of two (2) advanced tests are payable in addition.
3) When performing contralateral reflexes as a single test, claim
Tariff 9770 or 9786.
4) The benefit amounts listed are for unilateral or bilateral testing.
5) These tariffs are payable only to physicians with appropriate training
in advanced testing as determined by The College of Physicians and
Surgeons.
9788* Four (4) frequency acoustic reflex thresholds to test the integrity across brain stem
pathways, total .............................................................................................................................15.00
9797* professional portion ....................................................................................................................6.35
9709* to assist in diagnosis of recruitment, total .................................................................................15.00
9712* professional portion ................................................................................................................6.35