S.I. No. 84/1996 -- Health Insurance Act (Risk Equalisation Scheme), 1996

S.I. No. 84/1996 -- Health Insurance Act (Risk Equalisation Scheme), 1996 1996 84

S.I. No. 84/1996:

HEALTH INSURANCE ACT (RISK EQUALISATION SCHEME), 1996

The Minister for Health in exercise of the powers conferred on him by sections 3 and 12 of the Health Insurance Act, 1994 (No. 16 of 1994) hereby makes the following Scheme--

PART I GENERAL

1. This Scheme may be cited as the Health Insurance Act, 1994 (Risk Equalisation) Scheme, 1996.

2. Articles 3 to 6, 9 and 10 of this Scheme shall come into operation on the 28th day of March 1996.

Articles 7 and 8 shall come into operation on a day determined in accordance with article 10.

3. In this Scheme--

"the Act" means the Health Insurance Act, 1994 ;

"appropriate health services" means health services in relation to the diagnosis or treatment of the illness or injury of a patient which would be accepted generally by the medical profession as appropriate and necessary having regard to good standards of medical practice and to the nature and cost of any alternative forms of treatment as well as to all of the circumstances relevant to the patient;

"cell" means a group of fully insured persons who belong to both a common gender and a common prescribed age band;

"cell day-patient days" has the meaning assigned to it in Schedule D of this Scheme;

"cell equalised benefits" has the meaning assigned to it in Schedule D of this Scheme;

"cell weighted claim value" has the meaning assigned to it in Schedule D of this Scheme;

"claim" means an application by, or on behalf of, a fully insured person to a registered undertaking for the discharge or reimbursement under the terms of a health insurance contract of all or part of the fees or charges due to a health services provider in respect of:

(a) the provision of prescribed health services during a hospital stay: or

(b) the provision of the prescribed health services listed in Table C.2 of Schedule C while that person was in receipt of out-patient services;

"corrective payment" means a payment made to, or an amount recovered from, a health services provider or an insured person in respect of prescribed health services for which an incorrect payment, other than one arising from a systematic error in the method of processing claims, has been made;

"covered persons" has the meaning assigned to it in Schedule D of this Scheme;

"day-patient day" means a day, including a day upon which an in-patient stay commences and ceases, during the course of which a fully insured person is maintained in private hospital accommodation for the purpose of receiving day-patient services;

"day-patient services" means health services provided in, or by persons attached to, a hospital where the patient is admitted on an elective basis for care and/or treatment which does not require the use of a hospital bed overnight and who is discharged as scheduled;

"data adjustment" has the meaning assigned to it in article 6 of this Scheme;

"dependent person" has the meaning assigned to it by section 1 of the Health (Nursing Homes) Act, 1990 ;

"equalisation contribution" has the meaning assigned to it in Schedule D of this Scheme;

"fully insured person" means an insured person named in a health insurance contract other than a contract which relates solely to one or both of the following--

(a) ancillary health services; or

(b) public hospital daily in-patient charges made under Regulations pursuant to Section 53 of the Health Act, 1970 ;

"the fund" means the risk equalisation fund;

"gross provider payment" means, in respect of a settled claim, a payment or payments, based on proper and correct accounts, due or nominally due from a registered undertaking to a health services provider or in respect of services rendered by that provider disregarding the effect of

(a) any third party recoveries made in respect of that claim;

(b) any corrective payments in respect of that claim; and

(c) any discounts, overall limits or like reductions or bonuses or other additional compensation which may have been agreed between that provider and that undertaking;

"health services provider" means a publicly-funded hospital, private hospital, registered nursing home or hospital consultant, as appropriate;

"hospital consultant" means a registered medical practitioner who holds a current full registration with the Irish Medical Council and is engaged in hospital practice and who, by reason of his or her training, skill and experience in a designated speciality, is consulted by other registered medical practitioners and undertakes full clinical responsibility for patients in his or her care, or that aspect of care on which he or she has been consulted, without supervision in professional matters by any other person;

"hospital stay" means an in-patient stay or a day-patient day;

"in-patient day" means a day during an in-patient stay where the day on which that stay ceased is deemed a whole day and the day on which that stay commenced is disregarded except that if that stay commenced and ceased on the same day then that day shall be deemed a day-patient day;

"in-patient services" means in-patient services within the meaning of the Health Act, 1970 , but excluding day-patient services;

"in-patient stay" means a continuous period during which a fully insured person is maintained in private hospital accommodation for the purpose of receiving in-patient services, such period

(a) to commence on the later of the occurrence of the following events--

(i) the most recent admission or transfer of that person to private hospital accommodation; or

(ii) the cessation of the most recent previous in-patient stay in respect of that person; and

(b) to cease on the occurrence of the earlier of the following events-

(i) the next subsequent discharge or transfer of that person from private hospital accommodation;

(ii) the death of that person; or

(iii) a designation of the cessation of that period by the registered undertaking which effected the health insurance contract under which that person is named

provided that the effect of a designation under sub-paragraph (iii) shall not be to cause such a period to comprise less than five in-patient days or a day-patient day;

"insured person" means a person named in a health insurance contract as an insured person or an infant born to a person named in a health insurance contract provided that in the case of an infant the person who effected the health insurance contract requests that the health insurance contract be altered to name such infant as an insured person, and pays the appropriate premium in respect of such infant, within 13 weeks of the date of birth of the infant;

"market equalised benefits (total)" has the meaning assigned to it in Schedule D of this Scheme;

"net provider payment" has the meaning assigned to it in article 5 of this Scheme;

"nursing home" has the meaning assigned to it in section 2 of the Health (Nursing Homes) Act, 1990 ;

"prescribed age band" means one of the following age groupings

(a) age 17 and under

(b) age 18 to age 29

(d) age 40 to age 49

(e) age 50 to age 59

(f) age 60 to age 69

(g) age 70 to age 79

(h) age 80 and over

where age is attained age (in whole years) of the person;

"prescribed equalised benefit" has the meaning assigned to it in article 5 of this Scheme;

"prescribed health services" means-

(a) in-patient services

(b) day-patient services

(d) health services provided by a hospital consultant whether in a hospital setting or otherwise

which are appropriate health services and the sole purpose of which is the medical investigation, treatment, cure or alleviation of the symptoms, of illness or injury but excluding

(i) treatment directly or indirectly arising from or required in connection with male and female birth control, infertility and any form of assisted reproduction;

(ii) dental, orosurgical or orthodontic treatment or consultation with a dental practitioner, other than those services prescribed in Schedule C of this Scheme;

(iii) cosmetic services or treatment except the correction of accidental disfigurement or significant congenital disfigurement;

(iv) health services relating to eating disorders or weight reduction;

(v) preventive health services such as check-ups or screenings;

(vi) health services provided by a nursing home other than a registered nursing home;

(vii) nursing care, whether provided in an institution or otherwise, to persons who are dependant persons other than such care provided in the course or consequence of the provision of in-patient, day-patient or out-patient services;

(viii) health services received overseas;

(ix) health services, provided other than

(I) as a result of the patient having been referred to the health services provider by registered medical practitioner, or

(II) in an emergency; or

(III) in connection with an obstetric condition

(x) health services necessitated directly or indirectly by war or civil disturbance;

"private hospital" means a hospital, including a facility registered pursuant to the Mental Treatment Act, 1945 , other than a nursing home, which

(a) provides prescribed health services, and

(b) is not a publicly-funded hospital;

"private hospital accommodation" means accommodation in a private hospital or accommodation in a publicly-funded hospital which is designated by the Minister for Health as private or semi-private accommodation;

"private psychiatric hospital" means a facility registered pursuant to the Mental Treatment Act, 1945 ;

"publicly-funded hospital" means a hospital, other than a nursing home, which provides services to a person pursuant to his or her entitlements under Chapter II of Part IV of the Health Act, 1970 ;

"quarterly return" has the meaning assigned to it in article 6 of this Scheme;

"registered nursing home" means a nursing home registered pursuant to the Health (Nursing Homes) Act, 1990 ;

"registered medical practitioner" means a person whose name appears in the General Register of Medical Practitioners maintained under the Medical Practitioners Acts, 1978 and 1993;

"risk equalisation fund" has the meaning assigned to it in article 8 of this Scheme;

"scheme commencement day" has the meaning assigned to it in article 10 of this Scheme;

"scheme undertakings" has the meaning assigned to it in article 10 of this Scheme;

"screening" means a medical examination or test that is not reasonably required for the management of the medical condition of the patient;

"settled accommodation claim" means a settled claim under which all or part of the payments relate to the discharge or reimbursement of fees or charges due to a private hospital or a publicly funded hospital in respect of a hospital stay except that a settled claim shall not be so designated if a previous settled accommodation claim relates to the same hospital stay;

"settled claim" means a claim in respect of which payments due have been made;

"settled hospital claim" means a settled accommodation claim or a settled out-patient claim;

"settled out-patient claim" means a settled claim which is not a settled accommodation claim and under which all or part of the payments relate to out-patient services except that a settled claim shall not be so designated if a previous settled out-patient claim relates to out-patient services provided on the same day;

"single room" means a hospital bedroom designed for and accommodating only one patient;

"special procedure" means a procedure which is listed in Schedule B of this Scheme;

"third party recovery" means a payment made to a registered undertaking as a result of the acceptance by a third party of full or partial liability for fees or charges arising from the provision of prescribed health services to an insured person;

"undertaking equalised benefits" has the meaning assigned to it in Schedule D of this Scheme.

4. In this Scheme a reference to an article means a reference to an article of this Scheme and a reference to a subarticle means a reference to a subarticle in the article to which it is referred.

PART II DETERMINATION OF BENEFITS TO BE EQUALISED

5. (1) Each scheme undertaking shall calculate and record in respect of each settled claim the amount of prescribed equalised benefits in accordance with the provisions of this article and, where appropriate, the Schedules to this Scheme.

(2) In respect of each settled claim and for each health services provider the undertaking shall determine an amount (herein referred to as the "net provider payment") being the gross provider payment in respect of that claim and that provider multiplied by an amount determined in accordance with the formula

where, for the quarter in which that claim was settled,

A is the sum of-

(i) the total of actual amounts which that undertaking has paid or is liable to pay, disregarding the effect of any corrective payments and third party recoveries, in respect of all settled claims which acquired that status during that quarter; and

(ii) the net total of corrective payments relating to that undertaking during that quarter provided that this amount shall not exceed 0.5% of B and shall not be less than -0.5% of B

reduced by the total of third party recoveries made by that undertaking during that quarter

B is the sum of that undertaking's gross provider payments under all settled claims which acquired that status during that quarter.

(3) The prescribed equalised benefits in respect of each settled claim shall be the sum of net provider payments under that claim subject in each case to a maximum limit determined, as appropriate, in accordance with Schedule A (payments in respect of hospital charges (in-patient, day-patient and out-patient)), Schedule B (payments in respect of hospital charges relating to special procedures) or Schedule C (payments in respect of consultants' fees (in-patient, day-patient and out-patient)) as amended from time to time.

PART III SPECIFICATION OF RETURNS

6. (1) Each scheme undertaking shall make a return (to be known for the purposes of this Scheme as the "quarterly return") in accordance with sub section 4 of section 12 of the Act and shall submit a copy of the report of the auditor specified in subarticle (4) in conjunction with the return.

(2) The first quarterly return to be made by a scheme undertaking shall be in respect of the quarter ending on 30th day of June, 1996 in the case of an undertaking which was registered on the date this Scheme comes into operation and shall be, in the case of an undertaking first registered after the date this scheme comes into operation, in respect of the quarter next following that first registration.

(3) The quarterly return shall be in the format set out in Schedule E and shall contain the details specified herein in respect of each cell and separately in respect of all cells combined--

(a) the number of fully insured persons on the first day of that quarter;

(b) the number of fully insured persons on the first day of the next following quarter;

(d) the cell weighted claim value for that quarter;

(e) the cell day-patient days for that quarter;

(f) the total number of settled accommodation claims which acquired that status during that quarter in respect of covered persons and the number of those claims which relate to each of the following-

(i) one in-patient day only

(ii) two in-patient days only

(iii) three in-patient days only

(iv) four in-patient days only

(v) five in-patient days only

(vi) six in-patient days only

(vii) seven in-patient days only

(viii) eight in-patient days only

(ix) nine in-patient days only

(x) ten in-patient days only

(xi) not less than eleven and not more than fifteen in-patient days

(xii) not less than sixteen and not more than twenty in-patient days

(xiii) not less than twenty-one and not more than thirty in-patient days

(xiv) thirty-one or more in-patient days.

(g) the total number of settled out-patient claims which acquired that status during the quarter in respect of covered persons.

(4) Each quarterly return for each scheme undertaking shall be confirmed by two officers of that undertaking who are authorised to sign its accounts under the Companies Acts 1963 to 1990, or otherwise, and shall be audited by a qualified auditor to be appointed by the undertaking.

(5) If a scheme undertaking detects or otherwise becomes aware of an error in a quarterly return which has been made under this Scheme, other than errors which have previously been taken into account as corrective payments in the calculation of a net provider payment under article 5(2), it shall

(a) immediately notify the Authority or the person engaged under sub section 5 of section 12 of the Act; and

(b) within 15 days submit a corrected quarterly return to be known for the purposes of this Scheme as a data adjustment together with a report setting out the reason the error occurred and the steps which have been taken to prevent a recurrence.

PART IV DETERMINATION OF PAYMENTS

7. (1) "contribution" has the meaning assigned to it in subarticle (6);

"current quarter" has the meaning assigned to it in sub-article (3);

"first quarter" has the meaning assigned to it in subarticle (2);

"former equalisation contribution" has the meaning assigned to it in subarticle (4);

"prior quarter adjustment" has the meaning assigned to it in subarticle (5);

"revised equalisation contribution" has the meaning assigned to it in subarticle (4).

(2) Calculations to determine payments under paragraphs (a) and (b) of subsection (3) of section 12 of the Act shall be carried out by, or on behalf of the Authority, in respect of each quarter commencing with the quarter (referred to in this article as the "first quarter") next following the scheme commencement date.

(3) Not more than 30 days following receipt of a quarterly return as specified under article 6 of this Scheme for all scheme undertakings, the Authority shall determine, based on those returns, in respect of the corresponding quarter (referred to in this article as the "current quarter"), an equalisation contribution for each scheme undertaking in accordance with Schedule D.

(4) The Authority shall further, for each previous quarter in respect of which a new data adjustment has been submitted, determine for each scheme undertaking in accordance with Schedule D-

(a) the equalisation contribution for that quarter, based on the quarterly returns or the most recent previous data adjustments received for that quarter, increased by the addition of interest at a rate of 15 percent per annum for the period between the last day of that quarter and the last day of the current quarter (referred to in this article as the "former equalisation contribution"); and

(b) the equalisation contribution for that quarter, based on the information specified in paragraph (a) of this subarticle, but incorporating the newly submitted data adjustment, increased by the addition of interest at a rate of 15 percent per annum for the period between the last day of that quarter and the last day of the current quarter (referred to in this section as the "revised equalisation contribution")

provided that no such determination shall be made for any quarter before the first quarter.

(5) The prior quarter adjustment for the current quarter for each scheme undertaking shall be the sum, for each quarter in respect of which a new determination has been made under subarticle (4), of values determined in accordance with the formula

A - B

where

A is the revised equalisation contribution

B is the former equalisation contribution

(6) The contribution for the current quarter for each scheme undertaking shall be determined as the sum of--

(a) a value determined in accordance with the formula

0.25 x 1.04 x C

where C is the sum of its equalisation contributions for the current quarter and for the three quarters which immediately preceded the current quarter, provided that if an equalisation contribution has not been determined in respect of a quarter specified because that quarter precedes the first quarter then the equalisation contribution for that quarter shall be deemed to be zero; and

(b) that undertaking's prior quarter adjustment.

(7) If the contribution for a scheme undertaking is greater than zero then that amount shall be the payment by that undertaking to the Authority under paragraph (a) of subsection (3) of section 12 of the Act. The Authority shall notify that undertaking accordingly and shall specify in the notification the date on or before which the payment is to be made.

(8) Where a scheme undertaking fails to pay the amount due to the Authority in accordance with a notification under subarticle 7 that amount (or such part of that amount which from time to time remains unpaid) shall be increased by the addition of interest at a rate of 15 percent per annum computed from the day upon which that amount first became payable.

(9) If the contribution for a scheme undertaking is less than or equal to zero then the amount, if any, by which such contribution is less than zero shall be the payment to that undertaking from the Authority under paragraph (b) of subsection (3) of section 12 of the Act. The Authority shall notify that undertaking accordingly.

(10) In the circumstances specified in subarticle 8 the Authority may revise the payment or payments determined under subarticle 9 and notify the scheme undertakings affected accordingly.

PART V ESTABLISHMENT AND OPERATION OF RISK EQUALISATION FUND

8. (1) The Authority shall cause to be established and maintained a fund which shall be known as the risk equalisation fund (referred to in this Scheme as "the fund").

(2) (a) The fund shall be a current bank account which shall be managed and controlled by the Authority.

(b) Moneys payable into the fund shall be paid into the current account of the fund and moneys payable out of the fund shall be paid out of that account. Any interest accruing on moneys held in the account shall be paid out in direct proportion to current liabilities.

(c) (i) Payments due to the Authority under paragraph (a) of subsection (3) of section 12 of the Act shall be paid into the fund,

(ii) Payments due from the Authority under paragraph (b) of subsection (3) of section 12 of the Act shall be paid out of the fund.

(3) The accounts of the fund as audited by the Comptroller and Auditor General together with a copy of the report of the Comptroller and Auditor General thereon shall be furnished by the Authority to the Minister not later than 1 month following the completion of the said report.

PART VI EXEMPTED UNDERTAKINGS

9. Each registered undertaking which effects health insurance contracts which relate solely to one or both of the following--

(a) ancillary health services, or

(b) the public hospital daily in-patient charges made under Regulations pursuant to Section 53 of the Health Act, 1970

shall be excluded from the application of articles 5 to 8 and 10 of this Scheme.

PART VII COMMENCEMENT OF RISK EQUALISATION SCHEME

10. (1) "scheme undertakings" means all registered undertakings excluding those restricted membership undertakings specified in paragraph (b) of sub section 2 of section 12 of the Act.

(2) Articles 7 and 8 shall come into operation with effect from the day (to be known for the purposes of this Scheme as "the scheme commencement day") notified by the Minister to all registered undertakings.

(3) The scheme commencement day shall be the last day of the period of six months next commencing after the last day of the first quarter in respect of which, if the scheme of risk equalisation had been in operation and calculations carried out in accordance with article 7 disregarding the proviso in paragraph (a) of subarticle 6 of that article, at least one of the following conditions would have been satisfied--

(a) the sum of payments by scheme undertakings under subarticle 7 of article 7, would have exceeded 2% of market equalised benefits (total); or

(b) (i) the amount payable to any one scheme undertaking under subarticle 9 of article 7 would have exceeded 2.5% of its undertaking equalised benefits or £125,000 if greater, and

(ii) the undertaking equalised benefits for that undertaking would have exceeded 5 % of market equalised benefits (total).

Schedule A

-- Hospital Charges (In-patient, Day-patient and Out-patient Services)

1. The maximum prescribed equalised payments in this Schedule relate to prescribed health services (other than those special procedures listed in Table B.1 of Schedule B of these Regulations) provided by a private hospital, and prescribed health services (other than out-patient services) provided by a publicly funded hospital, to a fully insured person. Maximum prescribed equalised payments shall be determined as follows--

In respect of:		Maximum Prescribed Equalised Payment
1.	Prescribed health services which are in-patient services provided by a publicly funded hospital while the insured person was maintained in accommodation other than private hospital accommodation.	The public hospital daily in-patient charges made under regulations pursuant to Section 53 of the Health Act 1970 .
2.	Prescribed health services which are in-patient services provided by a public hospital while the insured person was maintained in private hospital accommodation.	The amount of the charge payable under Section 55 of the Health Act 1970 plus the amount of the public hospital daily inpatient charges made under regulations pursuant to Section 53 of the Health Act 1970 .
3.	Prescribed health services (other than special procedures listed in Table B.1 of Schedule B) which are in-patient services provided by a private hospital other than a private psychiatric hospital.	The lesser for each in-patient day of: (a) £250 for each in-patient day, or (b) 100% of (i) the charge made by the private hospital; less (ii) £20 for each day during which the insured person was accommodated in a single room.
4.	Prescribed health services which are day-patient services provided by a publicly-funded hospital while the insured person was maintained in private hospital accommodation.	The amount of the charge payable under Section 55 of the Health Act, 1970 .
5.	Prescribed health services which are day-patient services provided by a private hospital other than a private psychiatric hospital.	£250 for each day-patient day.
6.	Prescribed health services which are in-patient services provided by a private psychiatric hospital.	£100 for each in-patient day.
7.	Prescribed health services which are out-patient services listed in Table C.2 of Schedule C provided by a private hospital other than a private psychiatric hospital.	£100 for each claim.

2. The amount determined under paragraph 1 in respect of hospital charges relating to childbirth by means of a normal vaginal delivery shall not exceed £300.

Schedule B

-- Special Procedures

1. The maximum prescribed equalised payments in this Schedule relate to prescribed health services which are the special procedures listed herein and which are provided by a private hospital to a fully insured person while that person is maintained in private hospital accommodation for in-patient services or day-patient services.

2. The maximum prescribed equalised payment shall be 90% of the procedure benefit derived from Table B.1 of this Schedule.

TABLE B.1

Procedure Code	Procedure Description	Procedure Benefit (£)
5801	Exploration of mediastinum	940
5802	Endoscopic extirpation of lesion of mediastinum	940
5803	Diagnostic endoscopic examination of mediastinum	940
6675	Angiogram (direct puncture, single vessel study, brachial, femoral)	1,238
5945	Cardiac catheterisation with digital subtraction angiography	1,270
5080	Cardiac catheterisation (left, right or both sides)	1,306
5085	Cardiac angiography (left, right or both sides)	1,306
5090	Cardiac catheterisation and cardiac angiography combined	1,306
2676	Vitroctomy	2,354
5520	Valve shunt (hydrocephalus) - (Brain and Meninges)	2,756
5730	Cervical disc, partial excision of or fusion	2,866
5862	Cardiac Pacemaker System introduced through vein (Single Chamber)	3,032
5067	Cardiac Pacemaker System introduced through vein (Dual Chamber)	3,032
5068	Insertion of antitachycardia pacemaker	3,032
5069	Insertion of automatic implantation cardioverter/defibrillator	3,032
5525	Valve shunt revision - (Brain & Meninges)	3,032
5660	Craniotomy	3,721
3595	Spinal fusion - anterior & posterior	4,410
3596	Spinal fusion, in scoliosis spine, anterior and posterior	4,410
3601	Spinal fusion with instrumentation	4,410
5101	Angioplasty (Coronary)	4,410
5962	Plastic repair of aorta (Coarctation/Interrupted Aortic Arch)	5,181
5957	Revision repair of coarctation of aorta	5,181
5893	Open Operations on pulmonary artery	5,209
5735	Cervical spondylosis, laminectomy, etc.	5,435
5480	Posterior fossa tumours, removal of	5,512
5470	Pituitary gland, hypophysectomy	5,677
5075	Blalock Operation	5,788
5870	Myocardial aneurysmyotomy	5,788
5811	Atrial inversion for transposition of great vessels	5,788
5812	Other correction of transposition of great vessels	5,788
5814	Closure of defect of atrioventricular septum using dual prosthetic patch	5,788
5817	Closure of defect of interventricular septum	5,788
5818	Planned repair of post infraction ventricular septal defect	5,788
5819	Emergency repair of post infraction ventricular septal defect	5,788
5958	Revision closure of defect of intra-ventricular septum	5,788
5813	Correction of total anomalous pulmonary venous connection	5,788
5872	Excision of pericardium	5,788
5809	Correction of tetralogy of fallot	5,788
5871	Open correction of patent ductus arteriosus	5,788
5882	Closed correction of patent ductus arteriosus	5,788
5875	Shoulder replacement prosthesis	6,107
5555	Acoustic neuroma, removal of	6,173
1246	Arterial bypass, popliteal artery	6,284
5865	Repair of ascending aortic aneurysm	6,284
3300	Arthroplasty - (Forearm & Elbow)	7,186
5942	Lobectomy of Lung (including excision of segment)	7,717
5831	Plastic repair of mitral valve	8,268
5833	Replacement of tricuspid valve (includes valvuloplasty)	8,268
5855	Annuloplasty	8,268
5839	Double valves	8,268
5842	Triple valves	8,268
5843	Valve and grafts	8,268
5959	Revision of valve surgery	8,268
5816	Closure of defect of interatrial septum	8,599
5821	Other open operations on the septum of the heart	8,599
5824	Refashioning of atrium (Ebstein's)	8,599
5826	Operations on wall of atrium	8,599
5832	Replacement of aortic valve (includes valvuloplasty)	9,922
5836	Open Valvotomy	9,922
5055	Aortic endarterectomy	9,922
5829	Replacement of mitral valve (includes valvuloplasty)	9,922
5844	Saphenous vein graft bypass for coronary artery(ies)	9,922
5846	Autograft bypass for coronary artery(ies)	9,922
5847	Allograft bypass for coronary artery(ies)	9,922
5848	Prosthetic bypass for coronary artery(ies)	9,922
5849	Connection of mammary artery(ies) to coronary artery(ies)	9,922
5851	Connection of other thoracic artery(ies) to coronary artery(ies)	9,922
5852	Correction of anomalous coronary arteries	9,922
5853	Other open operation(s) on coronary artery(ies)	9,922
5904	Revision of prosthesis of aorta	9,922
5956	Revision coronary artery surgery	9,922
5099	Coronary artery bypass grafts and angiogram	10,970
4283	Allogeneic bone marrow transplantation, (complete procedure)	27,560
4284	Autologous bone marrow transplantation (complete procedure)	27,560

Schedule C

Consultants' Fees (In-Patient, Day-Patient and Out-Patient Services)

1. Definitions

"consultant anaesthetist" means a hospital consultant whose designated speciality is anaesthesia;

"consultant pathologist" means a hospital consultant whose designated speciality is pathology;

"consultant radiologist" means a hospital consultant whose designated speciality is radiology;

"in-patient attendance" means a period during which a hospital consultant is responsible for the care of an insured person;

"pathological procedure" means a service, treatment or procedure listed in Table C.4 of this Schedule;

"radiological procedure" means a service, treatment or procedure listed in Table C.3 of this Schedule and therapeutic/invasive procedures listed in Table C.2 of this Schedule;

"surgical procedure" means a service, treatment or procedure listed in Table C.2 of the Schedule.

2. The maximum prescribed equalised payments in this Schedule relate to prescribed health services which are provided by a hospital consultant to a fully insured person while that person is in receipt of in-patient services, day-patient services or out-patient services.

3. The maximum prescribed equalised payment in respect of the participation by a consultant anaesthetist in a surgical or radiological procedure shall be 90% of the anaesthetic procedure benefit as set out in Table C.2 and C.3 respectively of this Schedule.

4. The maximum prescribed equalised payment in respect of in-patient attendance by a hospital consultant shall be 90% of the in-patient attendance benefit determined in accordance with Table C.1 of this Schedule.

5. The maximum prescribed equalised payment in respect of an in-patient consultation is £63 and arises when the admitting hospital consultant responsible for the care of an insured person refers that person to another hospital consultant for an opinion.

6. The maximum prescribed equalised payment in respect of a surgical procedure performed by a hospital consultant, other than a consultant anaesthetist, shall be 90% of the surgical procedure benefit as set out in Table C.2 of this Schedule.

7. The maximum prescribed equalised payment in respect of a radiological procedure performed by a consultant radiologist shall be 90% of the radiological procedure benefit as set out in Table C.3 of this Schedule or 90% of the surgical procedure benefit set out in Table C.2 of this Schedule as appropriate.

8. The maximum prescribed equalised payment in respect of a pathological procedure performed by a consultant pathologist shall be 90% of the procedure benefit as set out in Table C.4 of this Schedule.

Table C.1

Period of Attendance	In Patient Attendance Benefit
1 day	£ 73
2 days	£ 83
3 days	£ 94
4 days	£100
5 days	£107
6 days	£107
7 days	£122
8 days	£122
9 days	£135
10 days	£135
11 days	£148
12 days	£158
13 days	£168
14 days	£179
15 days	£189
Periods in excess of 15 days	£10 for each day in excess of 15 days plus £189

TABLE C.2

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
	GENERAL SURGICAL OPERATIONS
	ABDOMINAL WALL and PERITONEUM:
5	Abdominal wall, secondary suture of	148	123
15	Laparotomy, division of adhesions	260	133
20	Intra abdominal injury with rupture of viscus	441	256
25	Intra abdominal injury, multiple complicated with rupture of viscus	540	307
30	Laparotomy	196	123
35	Laparoscopy with or without biopsy	148	102
45	Omentopexy (otherwise)	196	154
50	Paracentesis abdominis	49	0
60	Pelvic abscess, drainage of	140	77
61	Percutaneous transabdominal biopsy	89	72
80	Peritoneum, drainage of	196	123
90	Laparotomy, intra-abdominal sepsis	392	184
5835	Peritoneal - venous shunt for ascites	392	184
	ADRENAL GLANDS:
95	Adrenalectomy (unilateral)	450	205
100	Adrenalectomy (bilateral)	600	205
101	Adrenalectomy for phaeochromocytoma	600	512
105	Adrenal glands-any other operations	392	205
106	Neuroblastoma, tru cut biopsy	89	72
107	Neuroblastoma, resection	624	307
	APPENDIX:
110	Appendicectomy (with or without complications)	196	123
	GALL BLADDER and BILE DUCTS:
115	Cholecystojejunostomy	485	205
116	Choledochojejunostomy (Roux - en - Y)	593	205
117	Choledochoduodenostomy	431	205
118	Surgical repair of post-operative bilary stricture	1040	350
129	Hepaticojejunostomy	676	205
132	Cholecystectomy with exploration of common bile duct	540	205
135	Cholecystectomy (including laparoscopic method) and per operative cholangiogram	392	205
136	Percutaneous removal of gallstones from the bile ducts	245	123
140	Cholecystostomy with exploration, drainage or removal of calculus	295	143
145	Hepaticoduodenostomy	490	205
150	Transduodenal sphincteroplasty with or without transduodenal extraction of calculus	539	205
151	Transhepatic insertion of biliary endoprosthesis	294	154
152	Percutaneous insertion of gall bladder catheter for MTBE installation including catheter removal	245	143
153	Insertion of naso biliary tube and administration of CDC/URSO	245	102
	GASTRIC OPERATIONS:
155	Antrectomy and drainage	490	184
165	Duodenal diverticula, excision of	441	184
175	Gastrectomy total or revision	638	256
180	Gastrectomy (sub total)	490	205
190	Gastroenterostomy	392	184
195	Gastroscopy or gastroduodenoscopy (fibroscope)	68	41
196	Upper G.I. endoscopy and biopsies	68	41
197	Upper G.I. endoscopy and polypectomy	68	41
200	Gastrostomy	294	123
201	Percutaneous gastrostomy	148	102
205	Gastrotomy/duodenotomy for haemorrhage	456	154
215	Oversewing perforated peptic ulcer	319	154
230	Rammstedt's operation	294	164
235	Stomach transection	490	256
240	Vagotomy and drainage or highly selective vagotomy	490	184
	HERNIA:
245	Epigastric/Ventral hernia, repair of	196	113
246	Exomphalos, minor	312	123
247	Exomphalos, major	614	358
248	Exomphalos, delayed	614	358
250	Femoral hernia, repair of (bilateral)	368	164
255	Femoral hernia, repair of (unilateral)	245	113

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
270	Hiatus hernia, abdominal repair of	441	184
271	Laparoscopic repair of hiatus hernia	441	225
275	Hiatus hernia, transthoracic, repair of	441	225
280	Incisional hernia, repair of	392	123
285	Inguinal hernia, repair of (bilateral)	294	174
290	Inguinal hernia, repair of (unilateral)	196	123
291	Strangulated inguinal hernia, unilateral	275	123
295	Patent urachus, closure and repair of abdominal muscles	294	113
305	Recurrent hernia, repair of	294	143
310	Umbilical hernia, repair of	196	113
	JEJUNUM and ILEUM:
320	Congenital defects, correction of (including Meckel's diverticulum)	228	123
331	Gastroschisis	728	358
355	Ileostomy	392	123
360	Intestinal obstruction (including bowel resection)	491	154
361	Intestinal atresia, single/multiple	491	236
364	Hydrostatic reduction of intussusception	196	123
370	Jejunostomy	196	123
385	Resection and anastomosis of jejunum or ileum	491	184
	LARGE INTESTINE:
389	Anal canal EUA	45	72
390	Anal canal, plastic repair of (for incontinence)	294	143
395	Anal fissure, dilatation of anus for	49	72
396	Anoplasty for low anorectal anomaly	294	143
397	Anorectal anomaly, (posterior sagittal anorectoplasty PSARP), for high/inter	581	358
400	Lateral internal sphincterotomy	196	72
404	Parks' anal sphincter repair	581	358
405	Anal warts or papillae, removal of	74	72
410	Anus, excision of epithelioma of, with colostomy	392	205
415	Anus, excision of epithelioma of, without colostomy	74	82
420	Caecostomy	392	123
425	Caecostomy or colostomy, closure of	392	123
430	Colectomy, partial	491	184
435	Colectomy, total	664	307
436	Total colectomy and ileal pouch construction with temporary ileostomy	834	358
437	Closure of ileostomy	392	123
438	Total colectomy for toxic megacolon	785	358
450	Colonoscopy, one side	68	41
455	Colonoscopy, both sides	179	41
456	Colonoscopy plus polypectomy	89	41
457	Colonoscopy plus polypectomy full colon	179	41
458	Left colonoscopy and laser photocoagulation of rectum	148	41
459	Colonoscopy, full colon and laser photocoagulation of rectum	294	41
460	Colostomy	392	123
465	Resection of bowel and colostomy or anastomosis for diverticulitis	581	256
470	Faecal fistula, closure or resection	581	256
485	Fistula in ano, excision	245	123
490	Haemorrhoidectomy (external)	122	82
495	Haemorrhoidectomy (external, multiple)	148	92
500	Haemorrhoidectomy (internal)	215	123
506	Haemorrhoids, injection and/or banding	49	0
515	Imperforate anus, simple incision	49	82
520	Imperforate anus, with colostomy or pull through operation	392	225
525	Ischio rectal abscess, incision and drainage	148	92
513	Meconium ileus, open reduction with or without stoma	491	205
514	Meconium ileus reduction	148	154
516	Necrotising enterocolitis, percutaneous drainage	104	72
517	Necrotising enterocolitis, laparotomy resection/stoma	491	205
530	Proctoscopy or sigmoidoscopy	45	41

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
535	Proctoscopy or sigmoidoscopy, with biopsy	45	41
536	Diagnostic flexible sigmoidoscopy and biopsies	45	41
540	Proctoscopy or sigmoidoscopy with biopsy of muscle coats of bowel, for megacolon	68	72
545	Prolapse of rectum, abdominal approach involving laparotomy, colostomy or intestinal anastomosis	639	225
549	Delorme procedure	392	225
550	Prolapse of rectum, perineal repair	245	128
555	Rectal fistula, closure or repair	490	205
556	Balloon dilation of the rectum	99	72
560	Rectal or sigmoid polypi (removal by diathermy, etc)	148	82
565	Rectum, excision of (all forms including perineoabdominal, perineal anterior resection)	686	358
570	Rectum, partial excision of	686	307
574	Presacral teratoma, excision	735	358
575	Rectum (combined synchronous resection)	735	358
576	Revision/refashioning of ileostomy and duodenostomy, complicated reconstruction in - depth	431	123
577	Low anterior resection with coloanal anastomosis for cancer	834	358
578	Soave procedure	834	358
580	Sigmoid myotomy (Reilly's operation)	220	123
581	Sigmoidoscopy including dilatation of intestinal strictures	122	72
585	Stricture of rectum (dilation of)	49	72
590	Volvulus (stomach, small bowel or colon, including resection and anastomosis)	490	236
	LIVER:
595	Hepatotomy for drainage of abscess or cyst, one or two stages	314	184
600	Biopsy of liver (by laparotomy)	179	123
601	Transjugular liver biopsy	179	102
605	Biopsy of liver (needle)	89	77
610	Haemangioma of liver	196	225
611	Major liver resection	1196	512
612	Kasai type liver resection	624	307
616	Wedge resection of liver	323	307
617	Intrahepatic cholangioenteric anastomosis	780	307
618	Resection of hilar bile duct tumour	1196	512
619	Liver trauma	700	410
622	Insertion of hepatic artery catheter and reservoir pump	312	72
625	Left lateral lobectomy	834	358
630	Excision of hydatid cyst	431	307
	MALE GENITAL TRACT:
635	Circumcision (over 6 years)	99	82
640	Circumcision (under 6 years)	99	82
645	Epididymectomy	196	113
650	Hydrocele (tapping)	49	67
655	Hydrocele, radical operation, bilateral	294	123
660	Hydrocele, radical operation, unilateral	196	102
665	Meatotomy	74	72
670	Orchidectomy, bilateral	196	102
675	Orchidectomy, unilateral	148	102
680	Orchidectomy with radical removal of lymph nodes	490	225
681	Injection of corpora cavernosa with pharmacologic agent(s) (e.g. papaverine, phentolamine)	49	72
685	Penis, amputation of partial	245	123
686	Chordee release of	196	123
690	Penis, amputation of-with block dissection of glands	490	225
691	Transcatheter embolosation for relief of priapism	294	123
695	Prepuce, dorsal incision of	74	72
700	Prostatectomy	392	164
701	Radical retropubic nerve sparing prostatectomy (includes bilateral pelvic lymph adenectomy with bladder neck reconstruction and anastomosis to the urethra).	589	333
702	Transurethral microwave thermotherapy to the prostate (TUMT)	294	154
703	Insertion of an endo urethral stent for prostate obstruction	294	123
705	Spermatocele or spermatic cyst, (simple) excision of	196	113
706	Spermatocele or spermatic cyst, (multiloculate) excision of	196	113

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
710	Testes, agenesis of-bilateral exploration of inguinal canals and pelvis	343	184
711	Electro ejaculation procedure	99	72
715	Testicle, imperfectly descended, orchidopexy	148	102
720	Testicle, imperfectly descended bilateral orchidopexy	196	154
725	Testicle, imperfectly descended, associated with inguinal hernia	196	123
730	Testes, imperfectly descended, associated with bilateral inguinal hernia	294	184
735	Testes, unilateral orchidopexy and exploration of opposite side	294	143
740	Testicular biopsy (needle)	68	72
741	Testicular biopsy	134	77
742	Insertion of testicular prosthesis, unilateral	196	87
745	Reduction of torsion of testicle	99	82
749	Transcatheter management of varicocele, including testicular venography	245	123
750	Varicocele, bilateral removal	343	154
755	Varicocele, unilateral removal	245	123
760	Vasotomy or ligation of vas	99	72
765	Vas, reconstruction of (unilateral)	319	184
770	Vas, reconstruction of (bilateral)	441	225
	PANCREAS:
771	ERCP sphincterotomy and extraction of stones	269	123
772	ERCP sphincterotomy and insertion of endoprosthesis	294	102
774	ERCP (endoscopic retrograde cholangiogram of pancreas)	224	123
775	Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); with pancreatojejunostomy	915	512
776	Pancreatic biopsy	268	154
778	Pancreaticojejunostomy	639	307
780	Distal pancreatectomy	646	256
785	Total pancreatectomy, distal gastrectomy, splenectomy, duodenectomy, cholecystectomy and resection of distal bile duct	915	512
786	Simultaneous pancreas/kidney transplant	1008	563
790	Drainage of pancreatic abscess or pseudocyst	520	307
795	Pancreatotomy for drainage of pancreatitis, abscess or cyst with exploration of biliary and pancreatic duct	589	358
	SPLEEN:
800	Splenectomy	392	184
806	Transcatheter ablation of function of spleen	294	128
807	Aspiration of splenic cysts	148	77
	URINARY TRACT:
815	Aberrant vessels, division of	490	246
822	Permacath Hickman catheter for dialysis	245	123
823	Home based haemodialysis self dialysis training (max. 18 sessions)	29	0
824	Haemodialysis, chronic, in patient's home or at hospital out patient department, after completion of training sessions (minimum of three dialysis sessions per week inclusive of all consultant care) monthly benefit	184	0
825	Artificial kidney, use of (pre shunt) (haemodialysis, surgical fee)	122	0
826	Chronic haemodialysis (post shunt) 1st 12th treatment	49	0
827	Chronic haemodialysis (post shunt) 13th treatment onwards	49	0
828	Acute intermittent haemodialysis 1st 12th treatment	74	0
829	Acute intermittent haemodialysis 13th treatment onwards	74	0
830	Artificial kidney, use of (peritoneal dialysis)	122	0
831	Chronic peritoneal dialysis, hospital based establishment of therapy (1st 12th day)	49	0
832	Chronic peritoneal dialysis (hospital based after 12th day)	49	0
833	Peritoneal dialysis, chronic, in the patient's home or at hospital out patient department, after completion of training sessions (minimum of three dialysis sessions per week inclusive of all consultant care) monthly benefit	206	0
834	Tenchkoff catheter for CAPD dialysis	196	123
835	Bladder, implantation of radioactive source	245	92
836	Bladder, instillation of anticarcincgenic agent (BCG)	74	72

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
837	Continuous veno venous haemofiltration dialysis (CVVHD), per day	74	0
840	Bladder- rupture of (simple)	294	154
845	Bladder- rupture of (complicated traumatic)	392	256
850	Bladder neck, transurethral resection of	196	102
855	Bladder tumour, diathermy to, primary resection	294	102
860	Bladder tumour, repeat diathermy	99	77
865	Cystectomy, partial	343	154
870	Cystectomy, with re-implantation of ureters	490	307
875	Cystectomy with ileal or sigmoid loop and bowel anastomosis	662	358
876	Cystectomy with ileal or sigmoid loop and bowel anastomosis including continent catheterizable diversion	735	358
877	Cystectomy with ileal or sigmoid loop and bowel anastomosis including neo bladder with urethral re anastomosis	834	358
880	Cystoscopy with or without biopsy	68	72
881	Cystoscopy and removal of JJ stent	148	72
885	Cystoscopy with intravesical operation (diathermy, etc.)	122	77
886	Therapeutic overdistension of the bladder	74	72
890	Cystoscopy with ureteric catheterisation including retrograde pyelography	89	82
895	Cystoscopy with removal of ureteric calculus	196	82
900	Cystoscopy with ureteric dilatation or meatotomy	148	82
905	Cystotomy	196	92
906	Augmentation cystoplasty (ileo caeco cystoplasty, colocystoplasty)	490	358
910	Diverticulum of bladder, excision or obliteration of	392	154
915	Embolisation of haemangioma of kidney	343	184
920	Hemi nephrectomy	343	205
923	Kidney transplant	686	410
924	Litholapaxy: Crushing or fragmentation of calculus by any means, in the bladder, including ultrasonic destruction	294	123
925	Nephrectomy	441	205
926	Nephrectomy and caval extension below liver	540	225
927	Nephrectomy and caval extension of tumour above liver	712	358
928	Nephrectomy with caval invasion	809	410
930	Nephrolithotomy	490	184
931	Percutaneous nephrolithotomy, unilateral	294	205
932	Percutaneous nephrolithotomy, bilateral	441	205
933	Percutaneous nephrolithotomy, staghom	441	225
934	Percutaneous nephrostomy with or without antegrade pyelogram or stent placement	343	123
935	Peri renal tissues, exploration, open biopsy (no abnormality discovered)	294	154
936	Percutaneous tract formation for renal stone removal	196	102
940	Pyelolithotomy	490	184
945	Pyeloplasty	540	184
950	Pyelotomy	294	154
955	Renal biopsy (needle)	89	72
956	Renal cyst puncture and aspiration	148	77
960	Suprapubic cystostomy	148	72
965	Suprapubic fistula, closure of	294	154
966	Transcatheter ablation of function of kidney	294	154
967	Transcatheter ablation of function of adrenal	294	154
970	Ureteric fistula, closure of (including uretero-vaginal and vesico-vaginal)	392	184
975	Ureterolithotomy	294	143
980	Ureterolithotomy (bilateral)	441	134
981	Ureterolysis (unilateral)	392	143
982	Ureterolysis (bilateral)	589	184
984	STING procedure	294	82
985	Ureters, transplantation of, (bilateral)	589	184
990	Ureter, transplantation of, (unilateral)	441	164
991	Stamey Raz urethropexy	294	123
995	Ureterostomy (unilateral)	294	143
1000	Ureterostomy (bilateral)	441	184
1005	Urethral rupture of (straddle injury), repair of	294	133
1010	Urethra rupture, repair of with fractured pelvis (orthopaedic surgeon)	490	256
1015	Urethral dilatation	49	72
1020	Urethroscopy with treatment (diathermy)	99	72

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
1025	Urethrostomy	196	92
1030	Urethrotomy	99	72
1031	Complex urodynamic evaluation involving cineradiology	89	72
1032	Implantation of artificial urinary sphincter	490	225
1033	Whittaker test for evaluation of upper urinary tract obstruction	179	0
1035	Vesicolic fistula, closure of	392	184
5845	Ileal conduit urinary diversion	589	307
5850	Cystoscopy and ureteroscopy	179	92
5910	Lithotripsy, one or more sessions per hospital stay	294	92
5911	Lithotripsy including placement and removal of J stent and/or push ureteroscopy one or more sessions per hospital stay	343	123
	HEAD AND NECK
	ARTERIES: (See also Neurological Section)
1041	Carotid body tumour greater than 4 cms	735	358
1042	Carotid body tumour less than 4 cms	540	358
	CHEEK:
1045	Cyst or benign tumour of cheek or mouth, excision of	74	82
1050	Malignant growth of cheek, full thickness/wide excision of	392	154
1051	Malignant growth of cheek, superficial, excision of	172	123
	JAWS: See E.N.T. and Plastic Sections. LIPS: (see also Plastic Section)
1055	Cyst or benign tumour on lip, excision of	74	72
1058	Epithelioma of lip, lip shave	99	72
1059	Epithelioma of lip, wedge excision	196	77
1060	Epithelioma of lip, excision and flap reconstruction	392	184
	NECK:
1065	Branchial cyst, pouch or fistula, excision of	392	184
1075	Cysts or tuberculous glands of neck (deep to deep fascia) excision of	294	123
1080	Conservative neck dissection	392	225
1082	Radical neck dissection	468	256
1085	Thyroglossal cyst or fistula, excision of	392	184
1090	Torticollis, partial excision, open correction of	245	113
1095	Tuberculous caseous glands or sinuses, curettage of	104	77
	PALATE: (See also Plastic Section)
1100	Laceration of palate, repair of	99	92
1105	Radical operation for malignant growth of palate	490	256
1104	Biopsy lesion of palate	47	72
	MAXILLA:
1106	Partial maxillectomy including plastic reconstruction	520	256
1107	Total maxillectomy including plastic reconstruction	624	307
	PARATHYROID GLANDS:
1110	Parathyroid adenoma, excision of	500	256
1111	Transcatheter ablation of function of parathyroid glands	294	154
1112	Parathyroid hyperplasia, excision of (4 glands-frozen section)	550	256
1113	Total parathyroidectomy with autotransplant or mediastinal exploration/intra-thoracic	650	256
1114	Parathyroid re-exploration	650	256
	SALIVARY GLANDS:
1115	Abscess of salivary gland, incision and drainage	74	82
1120	Fistula of salivary duct, repair of	343	184
1125	Parotid or submandibular duct, dilatation of	49	82
1126	Submandibular duct, relocation	490	225
1130	Excision of parotid tumour or parotid gland, lateral lobe, (enucleation of)	302	154
1133	Excision of parotid tumour or parotid gland, lateral lobe (superficial parotidectomy) with dissection and preservation of facial nerve	551	276
1134	Excision of parotid tumour or parotid gland, total, en bloc removal with sacrifice of facial nerve	416	184
1135	Excision of parotid tumour or parotid gland, total with dissection and preservation of facial nerve	624	282
1140	Salivary calculus, removal of	99	92
1150	Submandibular salivary gland, excision of	229	92
1151	Excision of sublingual gland	148	92
	THYROID GLAND:
1152	Thyroid cyst(s) aspiration/fine needle biopsy	40	0
1154	Excision of thyroid cyst	345	184

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
1156	Percutaneous core needle biopsy of thyroid gland (for fine needle biopsy use procedure code 1152)	68	72
1155	Total/revision thyroidectomy	500	205
1157	Partial/subtotal thyroidectomy	471	205
	TONGUE:
1165	Excision of epithelioma of tongue with radical operation on glands	490	225
1170	Frenectomy (tongue tie)	49	72
1175	Hemiglossectomy	312	154
1176	Total glossectomy	624	236
1180	Growths of tongue, diathermy to	49	72
1185	Excision biopsy, oral cavity	74	72
1186	Resection of tonsil, tongue base, palate, mandible and radical neck dissection	936	461
	BREAST:
1190	Abscess, incision and drainage of	74	72
1191	Breast cyst(s) aspiration/fine needle biopsy (diagnostic or therapeutic)	40	0
1195	Percutaneous core needle biopsy of breast (for fine needle biopsy use procedure code 1191)	68	92
1200	Cysts or benign tumours, excision of, or segmental resection	142	92
1205	Duct papilloma, excision	148	92
1210	Gynaecomastia (excision for), unilateral	184	102
1211	Gynaecomastia (excision for), bilateral	343	154
1214	Segmental mastectomy with axillary sampling	294	154
1215	Total mastectomy	294	154
1216	Mastectomy with axillary clearance	468	154
1217	Quadrant mastectomy with axillary clearance	468	154
1218	Mammographic wire guided breast biopsy	160	72
	LYMPHATICS:
1310	Axillary/inguinal lymph node(s) superficial dissection of	100	92
1315	Axillary lymph nodes complete dissection of	343	123
1320	Axillary or inguinal lymph nodes, incision of abscess	100	72
1326	Deep cervical node excision biopsy (not needle biopsy)	100	72
1335	Inguinal or pelvic lymph node block dissection, unilateral	368	164
1336	Inguinal or pelvic lymph node block dissection, bilateral	550	256
1355	Lymphatic infusion	245	0
1365	Primary or secondary retroperitoneal, lymphadenectomy complete, transabdominal	589	307
	MUSCLES:
1370	Haemangioma of muscle, excision and repair of	294	123
1375	Muscle, manipulation and stretching of	49	0
1380	Muscle, repair and suture of	196	92
1385	Muscle biopsy	68	72
	NERVES: (See also E.N.T. and Plastic Sections)
1390	Nerve biopsy	134	72
1395	Nerve repairs (primary)	392	133
1400	Nerve suture (secondary, including grafting and anastomosis)	441	184
1405	Neurectomy or local excision of neuroma	294	92
	TENDONS: (See also Orthopaedic and Plastic Sections)
1410	Tendon repairs (primary) single	196	123
1415	Tendon repairs (primary) multiple	392	184
1420	Tendon sheath, incision of	99	77
1425	Tenotomy	99	72
1426	Tenolysis	196	92
	VASCULAR:
1427	Supra-renal aneurysm repair	834	410
1428	Repair of super renal aortic aneurysm rupture	1076	410
1429	Tube graft repair of abdominal aorta	754	410
1431	Repair of ruptured abdominal aortic aneurysm	1034	410
1432	Aorto bi-iliac bypass for atherosclerosis or aneurysm	334	410
1433	Aorto-femoral or bifemoral bypass for atherosclerosis or aneurysm	834	410
1434	Endarterectomy of abdominal aorta and iliac vessels	754	410
1436	Repair of ruptured iliac artery aneurysm	754	410
1437	Endarterectomy of iliac vessels alone	646	410
1438	Visceral artery repair, re-anastomosis or endarterectomy	834	410
1439	Renal artery anastomosis, endarterectomy or re-implantation or bypass	834	410

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
1441	Embolectomy of visceral branches, superior mesenteric or renal arteries	592	184
1442	Removal of infected aortic prosthesis	1076	512
1443	Obturator bypass from aorta or iliac to profunda or distal femoral bypass	834	256
1444	Repair of abdominal aortic trauma	592	256
1446	Aortic exclusion by axillo-femoral bypass	700	256
1447	Endarterectomy of internal/external common carotid artery with or without shunt	1076	410
1448	Patch repair of internal carotid artery	323	184
1449	Vertebral artery bypass or repair	700	256
1451	Open repair of subclavian artery	592	256
1454	Translocation of common carotid to subclavian artery	700	256
1456	Carotid subclavian bypass	700	358
1457	Subclavian/subclavian bypass	592	256
1458	Thoracotomy with repair of vessels of arch of aorta	834	410
1285	Intra arterial injection (excluding arteriography)	74	0
1305	Renal stenosis, repair of	490	256
1306	Transcatheter embolisation	294	184
1307	Transcatheter removal of intravascular thrombus or foreign body	294	184
5866	Percutaneous angioplasty	294	205
	VASCULAR - HEAD, NECK and UPPER LIMBS:
1459	Subclavian to branchial bypass or endarterectomy	592	358
1461	Repair of subclavian aneurysm	539	358
1462	Brachial embolectomy	323	184
1463	Repair or bypass of brachial to radial or ulnar vessel	700	256
1464	Repair of trauma to brachial artery with endarterectomy patch or bypass	592	256
820	Arterial venous fistula in arm under L.A.	196	164
821	Gortex graft placement for AV access for dialysis	441	164
1290	Ligation of major vessels	245	154
1250	Arterial biopsy (temporal artery biopsy bilateral under L.A.)	89	77
	VASCULAR - LOWER LIMBS:
1467	Femoral popliteal bypass, above knee vein	646	256
1468	Femoral to popliteal bypass, above knee synthetic	592	256
1469	Femoral to popliteal bypass, below knee vein	754	256
1471	Femoral to popliteal bypass, below knee synthetic	646	256
1472	Profundaplasty with or without patch or endarterectomy	485	256
1473	Common femoral artery endarterectomy	376	184
1474	Repair of femoral artery aneurysm	539	256
1280	Common femoral artery embolectomy	295	184
1476	Popliteal artery embolectomy	485	256
1477	Tibial artery embolectomy	592	256
1478	Femoral tibial artery bypass, including tibial-peroneal and peroneal artery bypass, or other distal vessels	915	410
1479	Popliteal aneurysm artery repair or bypass	592	256
1481	Femoral/femoral bypass	646	256
1482	Repair of femoral or popliteal vessels due to trauma	700	256
	VARICOSE VEINS:
1483	Ligation and division at the sapheno-femoral junction and complete stripping of the long saphenous vein, ligation and division of the short saphenous vein at the sapheno popliteal junction, ligation and avulsion of multiple varicose veins, for both legs	392	154
1484	As 1483 for one leg	269	123
1486	Ligation and division at the sapheno-femoral junction of the long saphenous vein with complete stripping of the long saphenous vein and ligation and avulsion of multiple varicose veins in the leg (both legs)	294	154
1487	Ligation and division at the sapheno-femoral junction of the long saphenous vein with complete stripping of the long saphenous vein with ligation and avulsion of multiple varicose veins in the leg (one leg)	196	123
1488	Ligation and division of the short saphenous vein at the sapheno popliteal junction with ligation and avulsion of multiple varicose veins in the leg (both legs)	294	154

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
1489	Ligation and division of the short saphenous vein at the sapheno popliteal junction plus ligation and avulsion of multiple varicose veins in the leg (one leg)	196	123
1491	Cockett, Linton or Dodd procedure on perforators	392	154
1492	Ligation and division at the sapheno-femoral junction of the long saphenous vein with ligation and avulsion of multiple varicose veins, one or both legs	196	123
1430	Iliac or femoral veins, removal of thrombus from	245	123
1435	Inferior vena cava, ligation or clipping of, with or without removal of thrombus	392	184
1440	Ligation and division of individual perforator	74	77
1450	Portosystemic shunt	646	358
1455	Sclerosing operation on vein(s), one leg	49	0
1460	Sclerosing operation on veins, both legs	74	0
1465	Splenorenal anastomosis	490	307
1490	Varicose veins, exploration and removal of thrombus, unilateral	245	123
1495	Varicose veins, exploration and removal of thrombus, bilateral	294	154
1500	Venous pressure and blood volume studies	45	0
	SKIN and SUBCUTANEOUS TISSUES:
1505	Abscess, cyst or tumour, aspiration of	49	72
1506	Angioma cauterisation or injection into, under general anaesthetic	49	72
1507	Angioma of skin and subcutaneous tissue or mucous surfaces, small, excision and repair of, under general anaesthetic	74	72
1508	Angioma of skin and subcutaneous tissue or mucous surfaces, large, excision and repair of, under general anaesthetic	148	82
1509	Biopsy of skin, subcutaneous tissue and/or mucous membrane including simple closure	64	0
1510	Excision and biopsy/curettage of a seborrhoeic keratosis / basal cell papilloma (single or multiple)	74	72
1513	Ellipse biopsy of the skin	86	0
1514	Cryotherapy or curettage to solar or actinic keratosis or warts other than plantar (single or multiple)	74	72
1525	Foreign body, removal of	74	72
1540	Skin abscess, (superficial) incision and drainage of	74	72
1545	Keloid or other scar, excision of	74	72
1546	Enucleation of lipoma	99	87
1550	Malignant melanoma, wide excisional biopsy	148	87
1551	Malignant melanoma, wide excisional biopsy and graft	268	113
	(See "LYMPHATICS" for block dissection of glands)
1555	Excision of pigmented naevi	74	72
1560	Incision and drainage of pilonidal abscess	71	72
1561	Pilonidal sinus or cyst, excision of	200	123
1565	Tubed pedicle flap, per stage	294	154
1570	Removal of foreign body from hand or foot under anaesthetic	74	77
1575	Basal cell carcinoma / squamous cell carcinoma, simple excision	148	72
1576	Basal cell carcinoma / squamous cell carcinoma, excision and graft or local flap	294	97
1577	Basal cell carcinoma / squamous cell carcinoma, curettage and/or electrosurgery	172	77
1580	Excision of a sebaceous cyst(s) (single or multiple}	99	72
1586	Laser treatment to naevi, initial patch test	74	72
1587	Laser treatment to naevi, each subsequent treatment session	148	72
1588	Excision of axillary skin for hyperhidrosis	196	92
1591	Hydradenitis suppurativa, excision and suture	122	72
1592	Hydradenitis suppurativa, excision and graft	294	113
1605	Surgical diathermy under general anaesthetic for any condition other than those listed separately	99	72
1610	Interstitial implant with radioactive source	99	72
1615	Wounds and sinuses, curettage of	74	72
1620	Wounds (multiple), suture or excision and suture	148	87
1625	Simple repair of superficial wounds	72	72
	OTHER PROCEDURES
1630	Exchange transfusion	134	0
1635	Exchange transfusion (intra uterine)	196	0

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
1631	Hyperbaric oxygen therapy, initial, including full medical evaluation	148	0
1632	Hyperbaric oxygen therapy, subsequent, per session	49	0
1636	Intravenous immunoglobulin for patients with a haematological malignancy or immune deficiencies	48	0
1637	Blood transfusion for patients with a haematological malignancy or immune deficiencies	48	0
1638	Intravenous antibiotics for patients on cytotoxic chemotherapy regimens for malignant disease	48	0
1639	Electrolyte replacement for patients on cytotoxic chemotherapy regimens for malignant disease	48	0
1641	Therapeutic phlebotomy for patients with polycythemia rubra vera or haemochromatosis	49	0
1642	Isolated limb perfusion including exposure of major limb artery and vein, arteriotomy and venotomy	490	225
1645	Intracaviatory insertion with radioactive source (cranium, chest, abdomen )	294	143
1646	Plasmapheresis.	49	0
1657	Cytotoxic chemotherapy (combination therapy), infusion, for (a) initial day's treatment for a new patient, (b) first day's treatment of a new cycle of therapy, for an established patient, day care or inpatient.	72	0
1658	Succeeding days of cytotoxic chemotherapy (combination therapy) infusion treatment after the first day's treatment, day care or in patient.	48	0
1663	Drainage of abscess or haematoma, (deep tissues) requiring general anaesthetic	99	72
4281	Bone marrow aspiration	45	72
4282	Bone marrow biopsy	68	72
4287	Bone marrow aspiration and biopsy	89	72
4283	Allogeneic bone marrow transplantation, benefit includes all procedures and in-patient care	834	0
4284	Autologous bone marrow transplantation, benefit includes all procedures and in-patient care	686	0
4286	Bone marrow harvesting	148	123
4288	Peripheral blood stem cell harvesting	148	0
4291	Peripheral blood stem re infusion, benefit includes cytotoxic chemotherapy and in patient care	686	0
	EAR, NOSE AND THROAT
	EAR: (See also Plastic Section)
1665	Atresia of auricle, 2 or 3 stages, correction of (per stage)	364	154
1666	Attico antrostomy, unilateral	490	205
1670	Ear polyp, excision of	74	72
1671	Ear toilet requiring use of operating microscope and micro inspection of tympanic membrane with or without general anaesthesia, unilateral or bilateral	74	72
1675	Drainage external ear, abscess or haematoma	74	72
1680	External auditory canal excision of tumour	148	72
1685	External auditory canal removal of exostosis or osteoma	156	72
1686	Reconstruction of external auditory canal (meatoplasty) (e.g. for stenosis due to trauma, infection)	291	143
1690	Facial nerve decompression (in temporal bone)	490	184
1695	Facial nerve graft (in temporal bone)	540	205
1700	Removal of foreign body from ear, under general anaesthetic	99	72
1701	Labyrinthectomy; transcanal	364	184
1710	Mastoidectomy, radical with or without labyrinthectomy	520	239
1715	Mastoidectomy, simple	416	205
1730	Myringoplasty	343	184
1735	Myringotomy	62	72
1740	Myringotomy (bilateral)	104	82
1741	Removal of drain tube(s) under general anaesthetic	49	72
1751	Pinna, total excision	196	102
1752	Pinna, partial excision with flap reconstruction	294	143
1753	Pinna, partial excision and graft	196	123
1755	Preauricular sinus, excision of	196	102
1760	Saccus endolymphaticus for Meniere's Disease	441	225
1765	Sebaceous cyst of ear, removal of	99	72
1770	Stapedectomy	589	225
1771	Stapedectomy with plastic reconstruction of ossicles	589	225
1790	Tympanoplasty	540	225

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
5980	Combined approach tympanoplasty	639	256
1785	Myringotomy with insertion of grommet	146	72
1786	Myringotomy, bilateral, with insertion of grommets	202	82
1796	Electrocochleography	27	72
	NOSE:
1800	Epistaxis anterior packing and/or cautery	99	72
1805	Epistaxis posterior anterior packing and/or cautery	134	82
1810	Epistaxis anterior ethmoid and/or internal maxillary ligation	196	102
1815	Foreign body, removal under general anaesthetic	66	72
1820	Polypectomy, single	55	72
1825	Polypectomy, multiple	148	77
	NOSE and ACCESSORY SINUSES: (See also Plastic Section)
1830	Accessory sinuses, open operations on, unilateral (including Caldwell Luc)	245	113
1840	Accessory sinuses, open operations on, bilateral (including Caldwell Luc)	368	164
1850	Antral biopsy	45	77
1855	Antral puncture (antrotomy) and washout unilateral	99	72
1860	Antral puncture (antrotomy) and washout bilateral	148	72
1865	Antral lavage involving insertion of polythene tube (unilateral)	148	72
1870	Antral lavage involving insertion of polythene tubes (bilateral)	196	72
1875	Sinusotomy with or without biopsy, with mucosal stripping or removal of polyp(s)	166	82
1880	Nasal/Sinus endoscopy, surgical, with antrostomy (unilateral)	122	72
1885	Nasal/Sinus endoscopy, surgical, with antrostomy (bilateral)	196	87
1890	Repair of choanal atresia, intranasal	218	102
1895	Repair of choanal atresia, transpalatine	441	205
1896	Crawford tube insertion, unilateral	99	77
1897	Crawford tube insertion, bilateral	148	82
1900	Ethmoid area malignant tumour excision	416	205
1905	Nasal/Sinus endoscopy, with or without biopsy, polypectomy or debridement	94	77
1910	Ethmoidectomy extranasal (unilateral)	196	92
1915	Ethmoidectomy extranasal (bilateral)	364	164
1920	Ethmoidectomy intranasal (unilateral)	239	113
1925	Ethmoidectomy intranasal (bilateral)	231	138
1935	External frontal sinus exploration	490	205
1940	External frontal sinus operation for malignant disease	589	256
1945	External rhinotomy (with drainage of ethmoid frontal, or maxillary sinuses)	490	225
1968	Nasal septum insertion of prosthetic button	122	77
1969	Plastic repair of nasal septum	364	164
1970	Nasal septum, submucous resection of	196	72
1980	Naso pharyngeal tumour, excision of	624	307
1985	Oro antral fistula, closure of	490	205
1990	Cauterisation and/or ablation, mucous of turbinates, unilateral or bilateral, any method, superficial	99	72
1992	Nasal/Sinus endoscopy, surgical with ethmoidectomy (partial or total)	281	133
1993	Nasal/Sinus endoscopy, surgical with frontal sinus exploration with or without removal of tissue from frontal sinus	312	154
1745	Nostril closure for atrophic rhinitis	196	77
4525	Rhinoplasty	441	184
5975	Rhinoplasty, primary, including major septal repair	528	221
	THROAT:
1995	Abscess (retropharyngeal), incision and drainage (internal pharyngotomy)	99	154
1996	Bronchoscopy with bronchoalveolar lavage (includes irrigation of bronchial tree)	115	0
1997	Bronchoscopy with transbronchial biopsy of lung	179	41
2003	Bronchoscopy with combined bronchial and/or transbronchial biopsies and bronchoalveolar lavage	201	41
1999	Bronchoscopy with laser ablation/resection of tumour	294	123
2000	Bronchoscopy with brachytherapy or placement of radium source	294	92
2001	Bronchoscopy with selective bronchography	134	41
2002	Bronchial provocation testing (histamine, methacholine etc.)	179	0

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
2011	Bronchoscopy with or without bronchial biopsy	115	41
2012	Bronchoscopy with or without bronchial biopsy (less than 2 years old)	125	125
2020	Bronchoscopy with removal of foreign body (includes foreign body removal by rigid endoscopy)	140	123
2030	Laryngoscopy	68	82
2040	Laryngectomy, all forms including vertical hemi laryngectomy and tracheostomy	759	358
2045	Larynx, microsurgery of	294	123
2050	Laryngofissure, external operation on	490	205
2055	Lateral pharyngotomy	426	201
2056	Direct operative laryngoscopy with operating microscope with or without biopsy, removal of foreign body, removal of lesion etc.	294	92
2057	Vocal cord augmentation (injection of teflon)	220	102
2060	Oesophagoscopy	68	82
2065	Oesophagoscopy with biopsy and dilatation	112	82
2070	Oesophagoscopy with removal of foreign body	140	92
2074	Upper G.I. endoscopy with oesophageal dilatation and lasertherapy	245	82
2075	Operative peroral endoscopy (including biopsy of larynx, trachea, bronchus, pharynx or oesophagus)	74	82
2077	Oesophageal dilation and insertion of endoprosthesis	245	205
2079	Oesophagoscopy with multiple injection of oesophageal varices	148	123
5840	Oesophageal motility study	68	92
2080	Papilloma or cyst of larynx, excision of	196	123
2081	Balloon, dilatation of the oesophagus (includes endoscopy)	152	82
2085	Pharyngeal pouch or diverticulum, excision of	540	225
2090	Pharyngeal pouch or diverticulum endoscopic diathermy division	343	184
2096	Drainage and marsupialisation of cyst	220	102
2100	Pharyngolaryngectomy	832	404
2115	Incision and drainage, abscess; retropharyngeal or parapharyngeal	83	154
2125	Tonsils and/or adenoids (adults), removal of	230	102
2130	Tonsils and/or adenoids, removal of (children under 12 years)	200	92
2131	Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthetic, following removal	122	154
2132	Tracheoesophageal puncture and insertion of prosthesis	172	123
2136	Transtracheal aspiration	89	0
	OTHER PROCEDURES:
2126	Overnight oximetry	45	0
2133	Kveim test including follow up punch biopsy of skin	64	0
2134	Kveim test including follow-up ellipse biopsy of skin	86	0
2137	Mantoux test, injection and follow up interpretation	64	0
5895	Full pulmonary function studies carried out in a pulmonary function laboratory including report	86	0
2141	Prolonged post-exposure evaluation of bronchospasm after exercise, with multiple spirometric determinations as in 5895 including measurement of thoracic gas volume and expired gas determinations	99	0
2139	Full sleep study (polysomnography)	173	0
	GYNAECOLOGICAL OPERATIONS
	CERVIX:
2140	Cervix, amputation of	99	72
2145	Cervix, biopsy of	45	72
2146	Cervix, cone biopsy of	125	72
2150	Cervical polypi, removal of	49	72
2155	Cervix, dilatation of	49	72
2160	Cervix, local excision of lesion of	49	72
2170	Cervix, suture of	74	72
2171	Cervical cerclage	99	72
2175	Cervix, cautery of	49	72
2180	Cervix, examination under anaesthesia	45	72
2181	Colposcopy	62	72
2182	Colposcopy and biopsy including Lletz procedure and/or laser therapy	104	72
	OBSTETRICAL:

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
2185	Caesarean hysterectomy	589	256
2190	Caesarean section (grant in aid for obstetrician's fees)	215	154
2200	Ectopic pregnancy, surgical management (laparoscopic or open): salpingectomy and/or salpingo oophorectomy (unilateral or bilateral)	245	205
2205	Hydatidiform mole (hysterotomy)	196	154
2206	Vaginal delivery (grant in aid)	144	0
2207	Epidural anaesthesia for vaginal delivery	0	138
	UTERUS and ADNEXA:
2215	Aldridge sling operation	364	123
2220	Broad ligament, excision of cyst of	196	113
2225	Dilatation and curettage (diagnostic or therapeutic)	135	72
2235	Microsurgical repair of extensive tubal and peritubal disease consequent on pelvic inflammatory disease and endometriosis including re-implantation of fallopian tube, unilateral	399	143
2240	Microsurgical repair of extensive tubal and peritubal disease consequent on pelvic inflammatory disease and endometriosis including re-implantation of fallopian tubes, bilateral	598	205
2241	Surgical repair of extensive tubal and peritubal disease consequent on pelvic inflammatory disease or endometriosis, unilateral or bilateral	312	143
2248	Hysteroscopy	74	72
2249	Transcervical endometrial resection	490	123
2250	Total abdominal hysterectomy	489	179
2255	Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)	728	205
2256	Total vaginal hysterectomy combined with anterior and posterior pelvic floor repair	645	179
2257	Total abdominal hysterectomy with unilateral or bilateral salpingo oophorectomy	530	179
2258	Resection of ovarian malignancy with total abdominal hysterectomy, complete procedure	728	256
2259	Debulking of ovarian carcinoma with or without omentectomy, complete procedure	520	205
2260	Sub total abdominal hysterectomy	392	179
2264	Total vaginal hysterectomy with urethropexy or urethroplasty	489	184
2265	Total vaginal hysterectomy	489	179
2267	Total vaginal hysterectomy and anterior or posterior pelvic floor repair	593	179
2270	Induction of radiation menopause	99	72
2273	Marlex sling procedure	196	123
2280	Myomectomy (multiple)	392	154
2285	Myomectomy (simple, single)	343	154
2289	Oophorectomy, unilateral or bilateral (complete or partial)	218	128
2300	Ovarian cystectomy, unilateral or bilateral	245	128
2319	Salpingectomy complete or partial, unilateral or bilateral	218	128
2354	Salpingostomy or salpingolysis, unilateral or bilateral	312	128
2364	Microsurgical tuboplasty (salpingostomy or salpingolysis), unilateral or bilateral	354	154
2365	Salpingo oophorectomy, complete or partial, unilateral or bilateral	245	133
2366	Salpingography and cannulisation for unblocking fallopian tubes, unilateral or bilateral	245	0
2370	Uterus, plastic reconstruction of	392	184
2375	Ventrosuspension/Gilliam's operation	196	123
	VULVOVAGINAL:
2380	Atresia vaginae, relief of (including dilatation of vulva and vagina)	148	92
2385	Bartholin's gland cyst, excision of	125	72
2390	Bartholin's or Skene's gland, abscess of, incision and drainage	74	67
2391	Burch colposuspension	364	154
2395	Caruncle, vulvovaginal, removal of	74	72
2400	Colporrhaphy with amputation of cervix, anterior and posterior (Manchester or Fothergill operation)	392	164
2410	Colpotomy	148	77
2415	Cystocele. repair of	196	128
2420	Cystocele and rectocele, repair of (including colpoperineorraphy)	245	164

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
2425	Cysts or simple tumours of the vulva or vagina, excision of	99	77
2430	Hymenotomy	74	72
2435	Hymenectomy	74	72
2440	Perineal tear complete repair of	294	128
2441	Partial vaginectomy	490	184
2445	Rectocele, repair of	245	128
2450	Stress incontinence, Marshall Marchetti, urethropexy for	364	164
2460	Vaginal fistulae (recto vaginal), repair of	245	154
2465	Vaginal fistulae (vesico vaginal), repair of	392	154
2470	Vaginal wall, suture of	148	77
2475	Vagina, plastic repair for dyspareunia	196	154
2480	Vulvectomy simple, without glands	392	154
2485	Vulvectomy radical, with glands	540	256
2486	Intracaviatory insertion of radioactive source, cervix, vagina or uterus	294	154
2484	Diagnostic laparoscopy with or without biopsy, with or without tubal irrigation/insufflation	148	113
2488	Diagnostic laparoscopy with or without biopsy. This procedure also includes dilatation and curettage (diagnostic or therapeutic), with or without tubal irrigation/insufflation	200	113
2487	Diagnostic laparoscopy with/without biopsy and one or more of: excision of lesions of ovary;pelvic viscera or peritoneal surface: diathermy of endometriosis;division of adhesions; puncture of cysts. With/without tubal irrigation/insufflation.	172	113
2489	As 2467 but including dilatation and curettage (diagnostic/therapeutic)	234	113
	OPHTHALMIC OPERATIONS
	CONJUNCTIVA:
2490	Conjunctival flap	99	72
2493	Conjunctivectomy	74	72
2495	Conjunctival graft	148	77
2498	Conjunctival tumour with or without graft	197	77
2496	Cryotherapy, unilateral	196	72
2497	Cryotherapy, bilateral	295	82
2500	Cyst/Granuloma- excision of	74	72
2505	Foreign body- removal of, from conjunctiva	74	77
2520	Wounds, repair	99	77
2521	Symblepharon division	99	77
2526	Symblephora - division of (includes conjunctival graft)	197	92
2527	Conjunctival biopsy	74	72
	ANTERIOR SEGMENT:
2522	Removal of foreign body from anterior chamber, magnetic	392	184
2523	Removal of foreign body from anterior chamber, non-magnetic	392	184
2524	Removal of implanted material from anterior chamber	392	184
2525	Paracentesis of anterior chamber of eye with or without diagnostic aspiration of aqueous	148	82
2580	Paracentesis of anterior chamber of eye for hyphaema with or without irrigation and/or air injection	245	72
2585	Paracentesis/Saemisch section etc.	245	123
2586	Reform anterior chamber secondary to trabeculectomy or post cataract surgery	245	123
	CORNEA and SCLERA:
2530	Corneal grafting- penetrating/lamellar	589	138
2531	Removal of sutures (late Stage) corneal/sclera	74	72
2532	Keratoprosthesis	603	184
2533	Epikeratophakia	603	184
2535	Corneal surface removed and EDTA application	99	77
2510	Pterygium removal	99	77
2511	Pterygium removal and conjunctival graft	197	92
2540	Corneal tattooing	99	77
2548	Ulcer/Recurrent, erosion, surgical treatment/Cautery with or without pricking, with or without debridement, with or without cryotherapy - one or more treatments, per episode of illness	99	77
2546	Corneal scraping	99	77
2547	Corneal biopsy	99	72
2555	Corneal or scleral tumour, excision	245	123
2556	Perforating injury cornea and/or sclera not involving uveal tissue	246	123

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
2565	Perforating injury cornea and/or sclera with reposition or resection of uveal tissue	420	184
2566	Repair of scleral staphyloma with or without graft	589	184
2575	Foreign body, removal of, from cornea	74	72
2577	Keratotomy (Wedge resections, relaxing incisions etc; for the correction of abnormal refractive errors resulting from cataracts, corneal scars or post traumatic corneal astigmatism)	491	123
2579	Excimer laser therapy for corneal pathology, per course	323	133
	EYELIDS:
2589	Biopsy of eyelids	67	72
2590	Chalazion - incision and curettage, one or more	99	72
2591	Botulinum injection for blepharospasm or to induce ptosis	122	72
2595	Ectropion	196	82
2600	Entropion	172	82
2596	Blepharophimosis - for pathology (not cosmetic)	258	123
2605	Epilation trichiasis	54	72
2606	Cryo to lash/electrolysis/ Removal lash follicle per course of therapy	108	72
2610	Injury to eyelid - repair (superficial)	74	72
2611	Opening of tarsorrhaphy	74	72
2615	Injury to eyelid - repair (deep)	196	92
2620	Lid papilloma	196	72
2625	Superficial dermoid or cyst - excision of	148	72
2626	Canthotomy	43	0
2630	Tarsorrhaphy	148	72
	GLOBE:
2635	Evisceration of eye	295	123
2640	Excision of eye plus implant	343	154
2645	Removal of intraocular foreign body	392	184
2660	Removal of eye	295	143
	IRIS, CILIARY BODY and CHOROID OPERATIONS:
2680	Division of anterior synechiae	245	102
2685	Cyclodialysis	343	154
2696	Cyclocryotherapy/Diathermy	343	154
2700	Goniotomy	392	154
2710	Iridectomy	245	123
2711	Pupil reconstruction post trauma, post surgery	392	184
2725	Iris tumour, removal	392	184
2726	Iris biopsy	245	123
2740	Trabeculectomy/Drainage procedure	539	128
2741	Laser trabeculoplasty, one or more treatments	313	143
2845	Local resection of ciliary body or choroidal tumour	603	154
2742	Trabeculectomy and tubes, etc.	581	143
	LACRIMAL APPARATUS:
2750	Canaliculus repair with or without tube	343	184
2755	Dacryocystorhinostomy with or without tubes	392	184
2756	Removal of D.C.R. tube	43	0
2760	Lacrimal abscess (dacryocystitis) incision	74	72
2761	Lacrimal sac, syringing and probing	99	72
2764	Intubation of nasolacrimal duct	392	154
2766	Punctal closure with cautery or controller	74	72
2768	3 Snip operation of lacrimal punctum	99	72
2769	Correction of everted punctum : cautery only	74	72
2770	Lacrimal sac excision (dacryocystectomy)	392	154
2771	Lacrimal gland tumour excision	431	184
2772	Conjunctivo - dacryocystorhinostomy with Lester Jones tube	409	184
2775	Lacrimal sac, syringing	74	72
	LENS:
2779	Repositioning of intraocular lens	295	128
2780	Intraocular lens insertion not associated with concurrent cataract removal (secondary)	295	128
2785	Capsulotomy, needling (surgical)	148	92
2786	Revision of cataract wound	161	92
2795	Lens extraction	515	164
2802	Cataract extraction plus insertion of artificial lens (includes phacoemulsfication, etc.)	581	164
2803	For cataract extraction operations, all forms, where only monitored anaesthesia care is given, the anaesthetic benefit payable is shown opposite	0	82

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
	LASER / LIGHT COAGULATION:
2644	Argon or Diode laser or Xenon Arc - for treatment of retinal or choridal disease, glaucoma, one or more treatments	295	123
2647	YAG laser - for capsulotomy, pupil formation, iridectomy, membranectomy, ciliary body treatment, glaucoma, one or more treatments	295	0
2806	Argon laser therapy for pan- retinal photocoagulation of diabetic retinopathy (per course of therapy)	431	123
	MUSCLES:
2870	Routine squint operation, horizontal, vertical or oblique	392	123
2871	Transposition surgery - Jansens, Hummelsheim, Knapp procedure	539	184
2872	Adjustment post strabismus operation	129	72
2873	Botulinum toxin injection to extraocular muscles	122	72
2874	Muscle biopsy	108	72
	ORBIT:
2890	Orbit, exenteration of	589	184
2895	Orbit, exploration of, including biopsy	295	143
2900	Orbit, removal of foreign body from	343	154
2905	Orbit, removal of tumour from (Kronlein's operation)	441	205
2910	Orbit, repair of fracture of	392	205
2911	Orbitotomy	603	184
2915	Orbit, repair of fracture of, with plastic implant	491	205
2912	Trans nasal wiring	485	205
2920	Radio Active Source application	196	102
	POSTERIOR SEGMENT:
2665	Prophylactic therapy for retinal detachment	409	184
2506	Removal of silicone oil	603	184
2675	Repair of retinal detachment - retinopexy with scleral buckling, scleral resection or scleral implant, etc. (For diathermy, cryotherapy or photocoagulation, use 2665)	735	256
2676	Vitrectomy	735	256
	MISCELLANEOUS:
2875	Retrobulbar, orbital floor, subconjunctival, subtenons and facial nerve injections	74	72
2880	Examination of eye under general anaesthetic	97	72
2926	Fluorescein angiography	45	0
	DENTAL / ORAL SURGERY
2940	Dental cysts of maxilla or mandible	148	92
2950	Extraction of teeth (more than 6 permanent teeth) with or without alveolectomy	122	92
2980	Labial frenectomy with dissection of tissue	49	72
2985	Odontoma, excision of	122	82
3005	Root resection or apicectomy, single, with or without cyst removal and apical curettage	99	82
3010	Root resection or apicectomy, multiple, with or without cyst removal and apical curettage	148	97
3015	Reimplantation of tooth in socket with splinting	99	82
3020	Simple cysts or epulis, palate or floor of mouth, excision of	99	82
3025	Small tumours of dental origin, removal of, includes biopsy	74	77
3030	Tuberosities, reduction of	99	77
	ORTHOPAEDIC OPERATIONS
	HAND: (See also Plastic Section)
3035	Abscess or infected tendon sheath of palmar spaces, drainage of	104	72
3039	Synovectomy of metacarpophalangeal joints, (more than two joints) with release of ulnar intrinsic tendons	343	154
3040	Arthrodesis of joint	208	92
3045	Arthroplasty using joint prosthesis single	208	92
3050	Arthroplasty using joint prosthesis two joints	309	113
3055	Arthroplasty using joint prosthesis more than two joints	441	143
3060	Bone tumours (benign), excision of	343	154
3070	Bursectomy	104	77
3075	Chondroma, excision of (multiple) with bone graft	343	154
3080	Chondroma, excision (single) with bone graft	245	123
3085	Exostosis, excision of	156	82
3095	Fracture of phalanges and/or metacarpals closed reduction	99	67
3100	Fracture of phalanx single internal fixation	156	82
3105	Fracture of phalanges multiple internal fixation	260	123
3110	Ganglion of hand, surgical removal	148	72

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
3115	Manipulation for treatment of dislocation of metacarpophalangeal joint	78	72
3120	Nail, removal of	49	72
3125	Nails, removal of all	99	72
3130	Application of plaster of Paris casts	49	72
3135	Synovioma, excision of	148	72
3136	Tendon repair - flexor-double (hand)	338	154
3140	Traumatic amputation of finger - single - reconstructive operation	208	102
3145	Amputation of two or more fingers	392	184
3150	Trigger finger, correction of	99	77
3155	Whitlow incision and drainage	49	0
	WRIST:
3159	Arthroscopy of the wrist	179	123
3160	Arthrodesis, using bone graft	441	184
3165	Arthroplasty	490	184
3170	Aspiration, wrist joint	49	72
3175	Bone grafting operation on scaphoid	343	123
3176	Herbert screw fixation, scaphoid	260	123
3180	Carpal bone (lunate scaphoid trapezium), excision of	196	92
3181	Trapezial joint replacement	589	225
3185	Carpal tunnel, decompression	148	92
3190	Carpus or peri carpal dislocations, manipulation	156	77
3195	Corrective osteotomy of lower end of radius	294	123
3200	Dislocation open reduction of	294	143
3205	Fracture (Colles') internal fixation of	229	123
3210	Fracture (Colles') manipulation and plaster of Paris	135	87
3211	Fracture of distal radius, external fixation of	148	72
3215	Injection, wrist joint	49	0
3220	Ganglion, removal of aspiration	49	72
3225	Ganglion, removal of surgical	148	72
3229	Intercarpal fusion	260	123
3230	Nerve block for pain control	49	0
3235	Nerve median and ulnar nerve repair of	520	205
3240	Nerve median or ulnar nerve repair of	392	184
3245	Radial styloid, excision of	156	82
3250	Sympathetic block	99	0
3255	Synovectomy of wrist joint	294	123
3260	Tendon repair at wrist single	208	102
3265	Tendons repair at wrist multiple	312	143
3270	Tendon transfer about the wrist, single	258	123
3271	Tendon transfer about the wrist, multiple	387	154
3275	Ulna, lower end of (malunited Colles), excision of	172	87
3276	Smith's or Barton's fractures, internal fixation of	276	143
	FOREARM and ELBOW:
3280	Amputation through forearm	392	184
3285	Annular ligament, repair of	294	143
3290	Anterior capsulotomy and excision myositis ossificans	294	143
3295	Arthrodesis	490	205
3296	Arthroscopy, elbow, diagnostic, with or without synovial biopsy, removal of loose body or foreign body, synovectomy, debridement	208	123
3300	Arthroplasty	593	225
3305	Aspiration and injection forearm/elbow	49	72
3315	Drainage of joint	99	72
3316	External fixation, upper limb	148	87
3320	Fracture forearm (complete) closed reduction and plaster of Paris	164	87
3325	Fracture forearm (greenstick) closed reduction and plaster of Paris	135	87
3330	Fracture about elbow, closed manipulation of	166	87
3335	Fracture dislocation, open reduction	392	154
3340	Fracture of forearm bones, open reduction of	446	154
3341	Open reduction, internal fixation and bone grafting (forearm & elbow)	572	225
3345	Fracture of lateral condyle, open reduction of	361	154
3350	Fracture of medial condyle, open reduction of	364	123
3355	Fracture (supracondylar), closed reduction of	229	77
3360	Fracture olecranon, screwing of	260	87
3365	Closed treatment of elbow dislocation	104	72

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
3370	Nerve ulnar transplant	312	123
3375	Olecranon bursa, removal of	148	82
3380	Radius excision of head of	208	92
3381	Silastic interposition of radial head	364	184
3385	Synovectomy of elbow joint	392	184
3390	Tendon transplants about the elbow	260	113
3395	Tendon sheaths, removal of in forearm	245	113
3400	Tennis elbow advancement of extensor muscles	196	102
	HUMERUS and SHOULDER:
3401	Arthroscopy, shoulder, surgical, with removal of loose body or foreign body, synovectomy, debridement	294	154
3402	Arthroscopic suture capsulorrhaphy for anterior shoulder instability	589	225
3403	Arthroscopy, shoulder, diagnostic with or without synovial biopsy	192	123
3404	Acromioplasty	294	143
5875	Shoulder replacement prosthesis	589	225
3405	Acromio clavicular joint, excision of	208	102
3410	Acromio clavicular joint, open reduction of	294	143
3411	Arthroscopic subacromial decompression	312	143
3412	Arthroscopic excision outer end clavicle	260	143
3413	Arthroscopic excision outer end of clavicle/subacromial decompression	364	184
3415	Amputation through arm	392	184
3420	Arthrodesis, humerus/shoulder	589	225
3425	Aspiration of joint, humerus/shoulder	49	72
3430	Biopsy, synovial, humerus/shoulder	68	72
3435	Capsulotomy (acute capsulitis)	166	72
3440	Disarticulation, humerus/shoulder	589	282
3445	Dislocation, open reduction, humerus/shoulder	490	225
3450	Dislocation, acute, manipulation under general anaesthetic, humerus/shoulder	125	72
3455	Dislocation recurrent operation for, humerus/shoulder	490	225
3464	Forequarter amputation	624	282
3465	Fractured clavicle, closed reduction	122	77
3470	Fractured clavicle, open reduction	294	123
3475	Fractured humerus, open reduction with internal fixation	392	184
3480	Fractured humerus, open reduction and bone graft	490	184
3485	Fractured humerus, closed reduction	156	77
3490	Injection of joint, humerus/shoulder	49	72
3495	Manipulation of humerus/shoulder under general anaesthetic	78	72
3500	Repair of capsule (in rotator cuff injuries) humerus/shoulder	441	184
3509	Saucerising humerus in chronic osteomyelitis	312	143
3510	Subacromial bursectomy	343	154
3515	Tendon transplant about shoulder	343	154
	SPINAL REGION:
3520	Anterior drainage of paravertebral abscess with bone graft	832	256
3521	Anterior release and fusion for scoliosis/kyphosis	1040	461
3525	Antero lateral decompression	540	256
3526	Antero lateral decompression involving two or more levels	1040	307
3530	Coccyx, excision of	294	102
3540	Epidural injection	125	0
3541	Caudal injection	125	0
3545	Epidural infusion with cannula	148	0
3550	Fracture or fracture dislocation of spine traction, reduction and plaster cast	567	256
3555	Fractured spine, open reduction of	936	256
3559	Chemonucleolysis for intervertebral disc	239	102
3560	Intervertebral disc, removal	526	205
3561	Needle aspiration of intervertebral disc	196	102
3563	Excision of thoracic intervertebral disc	735	307
3565	Laminectomy and exploration	490	205
3566	Neuralarch biopsy	125	72
3571	Posterior spinal fusion with instrumentation for scoliosis	1040	451
3580	Spina bifida closure	546	236
3585	Spina bifida lumbar spinal osteotomy	1040	236
3586	Spinal fusion, simultaneous combined anterior and posterior - one level, with instrumentation	1040	461
3587	Spinal fusion, simultaneous combined anterior and posterior - multiple level with instrumentation	1144	461

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
3588	Spinal fusion, simultaneous combined anterior and posterior fusion - one level without instrumentation	832	461
3589	Spinal fusion, simultaneous combined anterior and posterior fusion - multiple level, without instrumentation	1040	461
3590	Spinal manipulation, under general anaesthetic	99	72
3592	External fixature of the spine	437	205
3593	Synthetic fusion (GRAF) one level	728	307
3594	Synthetic fusion (GRAF) two level	936	461
3598	Spinal fusion, multiple level, with internal fixation	1040	461
3595	Spinal fusion	639	256
3596	Spinal fusion, in scoliosis spine, anterior and posterior	639	461
3597	Spinal fusion involving two or more levels	1040	307
3600	Vertebral body biopsy	268	123
3601	Spinal fusion, one level with instrumentation	936	461
3602	Removal of instrumentation	312	184
3603	Spinal stenosis decompression, one level	468	236
3604	Spinal stenosis decompression, two levels	520	236
	SACRO - ILIAC JOINT REGION:
3605	Arthrodesis, sacro iliac joint	540	225
3610	Aspiration, sacro iliac joint	49	72
3615	Biopsy of sacro iliac joint region	94	72
3620	Injection, sacro iliac joint region	52	72
3625	Pelvic osteotomy (bilateral) in ectopia vesica	624	225
	HIP and FEMUR:
3630	Acetabuloplasty shelf operation	397	164
3631	Internal fixation of acetabular fractures	834	307
3635	Acute dislocation manipulation for	166	77
3636	Congenital dislocation of hip, E.U.A. and P.O.P.	125	77
3640	Acute dislocation or fracture dislocation open reduction, hip/femur	490	225
3645	Above knee amputation	592	205
3650	Arthrodesis, hip/femur	686	307
3660	Arthroplasty of hip using prosthesis	624	225
3661	Revision of total hip arthroplasty, acetablar and femoral components with or without autograft or allograft	832	328
3665	Arthrotomy for loose body	416	164
3670	Colonna's arthroplasty	589	256
3675	Corrective osteotomy with or without internal fixation	520	205
3680	Curetting of greater trochanter and bursectomy	196	102
3685	Decompression operations or hanging hip operations	312	133
3690	Hind quarter amputation	807	358
3695	Drainage of hip joint for acute infection	208	102
3700	Exostosis of femoral neck in slipped femoral epiphysis, excision of	490	205
3705	Femoral condyle, osteotomy of	416	184
3709	Fractured femur, hemiarthroplasty	589	225
3710	Fracture shaft of femur open reduction with internal fixation	520	184
3715	Fracture shaft of femur closed reduction with traction	312	102
3720	Fracture femur (supracondylar) open reduction of	520	184
3723	Fractured shaft of femur, closed intramedullary nailing	489	184
3724	Fractured shaft of femur closed intramedullary - interlocking nail	624	307
3725	Fracture of neck of femur intramedullary nail fixation of	468	184
3730	Fracture of femur (pertrochanteric or introchanteric) intramedullary nail fixation of	489	184
3731	Open treatment of anterior ring fracture and/or dislocation with internal fixation, (includes pubic symphysis and/or rami)	490	184
3732	Open treatment of posterior ring fracture and/or dislocation with internal fixation, (includes ilium, sacroiliac joint and/or sacrum)	645	256
3733	Pelvic fracture, external fixation	208	102
3735	Hip deformity, soft tissue operations for correction of	312	143
3740	Injection or aspiration of the hip	49	72
3745	Manipulation of hip closed, requiring general anaesthetic	62	72
3750	Open reduction and/or rotation osteotomy	520	205
3751	Open reduction, pelvic osteotomy and femoral shortening	686	307
3755	Pelvic osteotomy	490	256
3756	Modified innominate osteotomy including bone graft	686	307
3760	Pseudoarthroplasty of hip (Girdlestone operation)	458	205
3765	Slipped femoral epiphysis intramedullary nail. fixation of	458	184

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
3770	Slipped femoral epiphysis lower end stapling of	294	154
3775	Synovectomy of hip joint and debridement	441	205
3785	Transplantation of psoas muscle to greater trochanter (Mustard's or Sherrard's operation)	441	205
	KNEE and LOWER LEG:
3790	Below knee amputation	374	205
3795	Arthrodesis, knee	490	205
3810	Aspiration, knee/lower leg	49	72
3815	Baker's cyst excision of	294	113
3816	Bone transportation	437	205
3817	Removal of fixator device tibia	122	72
3819	Arthroscopy, knee, diagnostic, with or without synovial biopsy	166	123
3820	Cartilage(s), removal of, knee	294	143
3821	Arthroscopy and removal of cartilage, knee	343	154
3822	Arthroscopy of the knee for removal of loose body or foreign body, synovectomy, debridement	269	154
5890	Ligament reconstruction at the knee joint	490	225
5891	Ligament reconstruction of the knee joint using autogenous graft	490	225
3825	Corrective osteotomy of tibia in region of knee	441	184
3830	Corrective osteotomy of tibia in region of ankle	343	164
3835	Cruciate ligaments repair	392	184
3836	Arthroscopic anterior cruciate ligament reconstruction	490	225
3837	Arthroscopic anterior cruciate ligament reconstruction and menisectomy	603	225
3838	Arthroscopic anterior cruciate ligament reconstruction and menisceal repair	645	225
3839	Arthroscopic menisceal repair	385	154
3840	Drainage of joint in acute infection	171	72
3845	Exploration of joint, knee/lower leg	245	123
3850	Fixed flexion of knee soft tissue operations for	392	184
3855	Fracture dislocation of knee joint, operations for	540	225
3860	Fracture of tibia (condylar) open reduction of	490	205
3865	Fracture of tibial shaft open reduction and internal fixation	490	205
3870	Fracture of tibial shaft closed reduction	166	82
3875	Injection of joint, knee/lower leg	49	72
3880	Lateral ligaments, repair	343	154
3885	Manipulation under general anaesthetic, knee/lower leg	62	72
3890	Osteochondritis dissecans Smillies operation for	208	102
3895	Patellectomy or open reduction of fractured patella	343	154
3900	Pre patellar bursa, removal of	196	92
3905	Plication of vastii, etc.	208	92
3910	Prosthetic replacement (total) of knee joint	624	225
3911	Revision of arthroplasty of knee joint with or without allograft one or more components	728	307
3912	Reconstruction of knee, (anterior cruciate)	490	225
3915	Quadriceps mechanism repair	343	164
3920	Slipped epiphysis, stapling of, or epiphysiodesis	453	184
3925	Slipped epiphysis (tibial and femoral combined) stapling of, or epiphysiodesis	490	225
3930	Slipped epiphyses (bilateral tibial), stapling of	416	184
3931	Slocum's or similar procedure	490	225
3935	Synovectomy	392	184
3940	Synovial biopsy, knee/lower leg	78	72
3945	Tendon transplants about knee joint	392	184
3950	Transplant of tibial tubercle	392	184
	ANKLE:
3955	Arthrodesis of ankle joint	441	184
3956	Arthroscopy, ankle, with or without removal of loose body or foreign body, with or without synovectomy, debridement	232	123
3957	Arthroplasty (ankle)	291	143
3960	Aspiration and injection, ankle	49	72
3965	Fracture of medial or lateral malleolus (1st degree Pott's fracture) internal fixation of	312	133
3970	Fracture of posterior malleolus (with or without fracture of other malleolus) internal fixation of	343	143
3971	Fracture of medial and lateral malleolus open reduction and internal fixation of	364	154
3975	Fracture Pott's closed reduction	196	102
3980	Synovectomy and debridement	343	154

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
3985	Synovial biopsy, ankle	68	72
3986	Talar fracture, open reduction and internal fixation of	343	143
3990	Tendo achillis, elongation of	294	154
3995	Tendo achillis, repair of	392	154
4000	Tendon transplants about the ankle joint and foot (multiple)	392	179
4005	Tendon transplants about the ankle joint and foot (single)	294	128
4010	Traumatic fracture and dislocation, open reduction of	392	133
4015	Unstable ankle Watson Jones operation for,	392	184
	CONGENITAL TALIPES EQUINOVARUS:
4019	Astragalectomy	343	164
4020	Dwyer's Valgus osteotomy	312	143
4025	Manipulation and plaster fixation	74	82
4030	Manipulation and strapping	74	72
4035	Rotation osteotomy of tibia	406	184
4040	Soft tissue release	416	128
4045	Tarsal osteotomy	343	154
4050	Tendon transplant -single	294	143
4051	Tendon transplant -multiple	416	205
	FOOT:
4060	Arthrodesis of all inter phalangeal joints (Lambrinudi) unilateral	294	143
4065	Arthrodesis of all inter phalangeal joints (Lambrinudi) bilateral	441	205
4070	Arthrodesis of first metatarso phalangeal joint	196	92
4075	Arthrodesis triple, in all its forms	490	205
4080	Arthrodesis, pantalar	589	225
4085	Claw foot (Steindlar) muscle stripping operations for	196	102
4090	Exostosis of first metatarsal (unilateral), removal of	171	77
4095	Exostosis of first metatarsal (bilateral), removal of	229	92
4100	Flat foot involving joint fusion, operation for	341	143
4101	Flexor tenotomy, single (foot)	104	77
4102	Flexor tenotomy, multiple (foot)	156	92
4103	Fracture of hindfoot, internal fixation, unilateral	312	143
4104	Fracture of hindfoot, internal fixation, bilateral	468	205
4105	Fracture of phalanges and/or metatarsals (closed reduction)	99	77
4110	Fracture of phalanx and/or metatarsal (single) internal fixation of	148	92
4115	Fracture of phalanges and/or metatarsals (multiple) internal fixation of	294	123
4120	Ganglion of foot, excision of	104	72
4125	Hallux valgus and follow up, other than simple removal of exostosis (unilateral) operation for	294	123
4130	Hallux valgus and follow up, other than simple removal of exostosis (bilateral) operation for	392	123
4135	Hammertoe unilateral, correction of	148	92
4140	Hammertoe bilateral, correction of	220	113
4145	Grice's operation, subtalar bone block	148	72
4150	Ingrowing toe nail hemiphalangectomy	148	72
4155	Avulsion of nail plate, partial or complete, simple	48	0
4160	Ingrowing toe nail, removal of nail and nail bed	134	72
4165	Injection and manipulation, foot	49	72
4170	Laprau's operation to correct position of toe	171	92
4175	Metatarsal heads, excision of all, and plastic correction of sole (unilateral)	232	113
4180	Metatarsal heads, excision of all, and plastic correction of sole (bilateral) (Hoffman's)	364	164
4181	Metatarsal joint replacement with prosthesis	490	205
4182	Metatarsal osteotomy, unilateral	208	113
4183	Metatarsal osteotomies, bilateral	312	164
4184	Chevron osteotomy-single	312	143
4185	Os calcis, osteotomy of (Dwyer)	312	143
4190	Os calcis and bursa, posterior exostosis of (unilateral) removal of	196	92
4195	Os calcis and bursa, posterior exostosis of (bilateral) removal of	294	143
4200	Plantar fascia, excision or division of (unilateral)	196	92
4205	Plantar fascia, excision or division of (bilateral)	294	143
4210	Plantar warts, surgical excision, one or more (not local application, cryotherapy etc.)	72	72
4211	Plantar warts, one or more, local application, per complete course of therapy	16	0

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
4215	Stamm's operation, unilateral	392	164
4220	Stamm's operation, bilateral	441	205
4225	Talectomy	392	184
4230	Tarsal osteotomy	245	113
4235	Tendon transplantation about the foot, multiple	392	184
4240	Tendon transplantation about the foot, single	294	123
4245	Tendon transplantation flexor and extensor all toes, unilateral	441	184
4250	Tendon transplantation flexor and extensor all toes, bilateral .	540	225
4255	Trans metatarsal amputation of foot	295	113
4260	Trans metatarsal amputation of one toe	177	72
4261	Trans metatarsal amputation of two or more toes	295	113
	MISCELLANEOUS:
4264	Arthroscopy	104	123
4265	Arthrotomy for removal of loose bodies	196	92
4270	Biopsy of tumour of long bones open	104	82
4271	Costotransversectomy	281	102
4272	Excision of large malignant bone tumours for limb conservation	884	256
4273	Excision of large malignant bone tumours for limb conservation including prosthetic insertion	988	307
4275	Body plaster application	196	92
4270	Bone cysts excision	245	92
4285	Bursectomy large joints	196	92
4290	Chondroma removal	441	184
4295	Exostosis of long bones removal	208	92
4300	Fracture sternum and ribs operative reduction	245	205
4301	Limb lengthening (upper or lower limb) including osteotomy procedure and application of fixator devices	589	225
4305	Long bones, sequestrectomy, decortication or bone graft	441	184
4310	Osteomyelitis drilling of bones	232	92
4315	Osteomyelitis, marsupialisation and bone grafting	490	184
4320	Removal of plates, pins, screws, etc. (superficial)	122	92
4325	Removal of plates, pins, screws, etc. (deep)	268	123
4330	Trimming of stump following amputation of limb	171	77
	PLASTIC SURGERY
	(See also Orthopaedic, E.N.T. and General Sections) Benefit is not payable for cosmetic treatment except the correction of accidental disfigurement or significant congenital disfigurement.
	BURNS:
4335	Burns and scalds, treatment under anaesthesia, second degree or more (depending on extent)	196	123
4340	Burns, over 10% body surface (equivalent of whole upper limb), excision and graft of	490	184
4350	Graft of extensive areas beyond 10%	589	225
4355	Graft of granulating areas less than 10%	245	123
4360	Major burns of face, excision and graft of	490	164
4365	Major burns of hands, excision and graft of	490	143
4370	Smaller areas, excision and graft of	294	92
	BURNS - LATE DEFORMITIES:
4385	Inlay grafts (ankle)	392	184
4390	Inlay grafts (elbow)	245	123
4395	Inlay grafts (fingers)	245	123
4400	Inlay grafts (knee)	392	184
4405	Scar excisions (per scar) flexion, elbows, fingers, groin, knees	196	92
4410	Z plasty (per scar) flexion, fingers, elbows, groin, knees	196	92
	CLEFT LIP and PALATE:
4415	Adjustment of lip margin	99	72
4420	Adjustment of scars, secondary	99	72
4425	Cleft palate reconstruction	392	174
4430	Complete cleft tip and anterior palate repair	490	225
4431	Primary repair, unilateral cleft lip	490	174
4432	Primary repair, bilateral cleft lip	515	225
4433	Secondary repair, unilateral cleft lip	490	174
4434	Secondary repair, bilateral cleft lip	515	225
4440	Fistula, secondary closure of	392	174
4460	Maxillary bone graft	490	225
4465	Nostril margin, secondary correction of	294	123
4466	Total cleft rhinoplasty	441	205
4470	Pharyngoplasty (not for snoring)	392	184

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
4475	Soft palate partial cleft, reconstruction of	343	143
	BREAST RECONSTRUCTION:
4479	Nipple reconstruction	269	128
4480	Breast reduction	686	225
4481	Breast augmentation (implants)	269	128
4482	Plastic repair of inverted nipple	294	154
4483	Transverse flap (TAIF or TRAM), reconstruction of breast, post mastectomy	589	307
4484	Mastopexy including full thickness graft from other areas	490	225
4485	Breast reconstruction, vertical rectus flap, post mastectomy	565	307
4486	Breast reconstruction, latissimus dorsi flap, with or without implant, post mastectomy	466	256
4487	Breast reconstruction, other flap, with or without implant, post mastectomy	466	256
4488	Breast reconstruction, implant only, post mastectomy	172	128
	TISSUE EXPANDERS:
4551	Insertion of expander including any subsequent injections of expander	441	184
4552	Removal of expander	148	92
4553	Removal of expander and inserting of expanded skin	319	154
	EYELIDS:
4490	Eyelid bags, repair of	343	123
	FACIAL TRAUMA:
4489	Facial trauma, suturing of facial nerve	392	184
4491	Facial trauma, suturing of facial nerve branch	343	154
4492	Facial trauma, grafting of facial nerve, sural nerve, greater auricular nerve	490	225
	FACIAL TUMOURS:
4493	Excision of facial nerve and graft, sural nerve, greater auricular nerve	565	256
	DELAYED FACIAL REANIMATION - SKIN and DERMAL HITCHES:
4494	Wedge excision of lower lip	343	154
4496	Nasolabial skin/dermal hitch	245	113
	STATIC SLINGS:
4497	Temporalis fascial sling, oral, nasolabial, ocular	639	307
4498	Orbicularis oris hitch	639	307
	DYNAMIC SLINGS:
4499	Masseter to oral angle, digastric to lower lip or temporalis to fascial slings	639	307
	NERVE TRANSFERS:
4500	Facial nerve graft (in face) (see E.N.T. operations for facial nerve graft in facial canal	589	282
4501	Cross facial nerve grafting, hypoglossal/facial nerve reanimation	834	358
	COMPLEX FREE TISSUE TRANSFER:
4502	Free muscle transfer, pectoralis minor, gracilis or extensor digitorum brevis as a second stage to 4501	834	358
4510	Facial reanimation in facial paralysis (unilateral)	639	307
	OTHER PROCEDURES:
4520	Moles or cysts, excision and suture (Plastic)	99	72
4530	Facial scars, dermabrasion, per scar	99	72
4535	Scars on face excision or Z plasty (3 or more)	343	102
4540	Scars on trunk excision or Z plasty	343	123
4545	Wounds of face suture (per wound)	99	72
	EAR:
4555	Accessory auricles, removal	99	72
4560	Epithelioma of ear, excision and reconstruction, lobule placement	196	92
4561	Cartilage graft(s). reconstruction of ear	441	184
4562	Ear reconstruction, further minor procedures	196	92
4575	Protruding ears correction with reconstruction of folds (bilateral)	368	123
4530	Protruding ears, correction of with reconstruction of folds (unilateral)	245	92
	EYES:
4585	Contracted socket	539	154
4590	Cyst of eyelids, excision of	99	72
4595	Enophthalmos bone graft	441	205
4605	Decompression, orbit	491	205

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
4610	Eyebrow graft	196	92
4615	Eyelids, repair of, for avulsion	196	92
4620	Eyelid, inlay grafts (one lid)	343	154
4625	Eyelid operations in facial paralysis	294	123
4630	Eyelid, total reconstruction of	490	225
4635	Muscle advancement for ptosis (unilateral)	368	164
4640	Naso lacrimal duct, reconstruction of	245	123
	GENITO URINARY:
4645	Ectopia vesica (reconstruction of bladder)	490	256
4650	Ectopia vesica (reconstruction of urethra) (per stage)	245	123
4655	Epispadias, correction of dorsal curvature	294	133
4660	Epispadias, reconstruction of urethra	294	133
4665	Hypospadias, correction of ventral curvature or chordee	294	133
4670	Hypospadias, fistula closure	294	133
4675	Hypospadias, reconstruction of urethra	343	154
4676	One stage hypospadias or epispadias repair with or without chordee, urethroplasty with skin graft repair	760	358
4680	Urethra, plastic reconstruction of	392	143
4681	Insertion of Jonas penile prosthesis	294	154
4882	Insertion of inflatable (multi component) penile prosthesis, including placement of pump, cylinders and/or reservoir	416	205
4685	Urethra, second stage, reconstruction of	490	205
4686	Cliteroplasty	416	205
4690	Vaginal reconstruction with skin graft	490	205
4691	Young Dee's Leadbetter operation	735	307
	HANDS:
4695	Congenital hand deformities reconstruction on each hand (per stage)	343	164
4700	Congenital hand deformities moderate repairs on each hand (per stage)	196	102
4705	Contractures extensive straightening of hand and inlay grafts	343	164
4710	Contractures, localised, division and graft	196	102
4711	Dermofasciectomy, removal of flexor skin, full thickness skin graft including distal or full palm, one finger	392	184
4712	Dermofasciectomy, removal of flexor skin, full thickness skin graft including distal or full palm, one finger including simple fasciectomy to another finger	540	246
4715	Dupuytren's contracture fasciectomy (one or two fingers)	294	123
4720	Dupuytren's contracture fasciectomy (three or more fingers)	416	154
4721	Dupuytren's contracture, palm and fingers	416	154
4730	Injury to hand major multiple repair of tendons, nerves and skin	540	205
4735	Injury to hand, moderate, wound repair or graft	294	123
4740	Island grafting, for sensory loss, finger and/or thumb	540	256
4745	Neoplasm, major excision and repair with tendon grafts and flaps	589	256
4750	Neoplasm, localised excision and graft	294	143
4760	Nerve repair, primary, single or multiple	343	174
4765	Nerve repair in extensively scarred hand	490	225
4770	Opposition strut graft to thumb	392	205
4775	Palmar ganglion, compound, synovectomy of	392	184
4780	Policisation (finger replacement of lost thumb)	639	307
4785	Syndactyly, repair of (single)	392	154
4790	Syndactyly, repair of (multiple)	392	184
4795	Tendon grafting, single	343	164
4800	Tendon grafting, multiple	490	205
4805	Tendon repair, single	294	92
4810	Tendon repair, multiple	392	184
4815	Tendon transplants, for restoration of opposition	392	184
4820	Tendon transfers for paralysis, multiple	540	256
4825	Tube pedicle or flap reconstructions, first stage	441	205
4830	Tube pedicle or flap reconstructions, second stage	368	184
4835	Tube pedicle or flap reconstructions, final stage	490	225
4840	Wound suture of	99	72
	MAXILLA and MANDIBLE:
4845	Facial bone, simple fixation of undisplaced fracture (e.g. jaw sling)	148	102
4850	Facial bones, tumours of, major resection and/or reconstruction	589	307
4855	Fracture of maxilla or mandible, open reduction and fixation	392	184
4860	Fracture of maxilla or mandible, fixation of undisplaced	245	154
4865	Fracture of maxilla or mandible, malar bone or part of these, reduction without fixation	245	123
4870	Hypertelorism correction, sub cranial	686	358
4875	Mandible, excision of	490	256
4880	Maxilla or mandible, advancement or recession osteotomy of	392	256
4881	Maxillary and mandibular osteotomy	589	307
4885	Orbital floor, fracture of, reduction, direct wiring and build up from antrum	490	256
4890	Orbital floor, secondary bone grafting	392	205
4895	Osteomyelitis or abscess of facial bones, operation for	245	123
4900	Temporo mandibular joint, reduction of dislocation under general anaesthetic	99	82
4901	Arthroscopy, temporo mandibular joint for release of adhesions or arthroplasty, with or without biopsy	196	184
4905	Temporo mandibular joint, condylectomy for ankylosis	343	307
	NOSE:
4910	Bone graft	441	205
4915	Nasal tip deformities, correction of	343	154
4920	Fracture of nose, digital closed reduction	49	72
4925	Fracture of nose, instrumental closed reduction	74	82
4926	Fracture of nose, instrumental closed reduction with plaster of Paris fixation	99	82
4927	Fracture of nose, instrumental closed reduction with reduction of septum and plaster of Paris fixation	148	82
4930	Fracture of nose, open reduction	99	102
4935	Fracture of nose, open reduction with internal or external fixation	220	123
4940	Fracture of nose, open reduction with open reduction of fractured septum	343	184
4945	Reconstruction with imported flaps, partial	441	205
4950	Reconstruction with imported flaps, total	540	256
4955	Re fracture and open corrective rhinoplasty	490	205
	SKIN REPLACEMENT AND RECONSTRUCTIONS
	LOCAL GRAFTS and FLAPS:
4956	Excision of lesion and split skin graft	196	102
4957	Excision of lesion and full thickness (Wolfe) skin graft	196	102
4958	Excision of lesion, local flap face	294	102
4959	Excision of lesion, local flap hand	294	102
4961	Excision of lesion, local flap limb	245	102
4962	Excision of lesion, local flap trunk	245	102
	CUTANEOUS FLAPS:
4963	Excision of lesion including scalp rotation flap	245	102
4964	Excision of lesion including cheek rotation flap	368	154
4966	Excision of lesion including ceivicofacial rotation flap	368	154
4967	Excision of lesion including forehead flap	392	184
4968	Excision of lesion including deltopectoral flap	466	205
4969	Excision of lesion including groin flap	466	205
	FASCIOCUTANEOUS FLAPS:
4971	Fasciocutaneous flap upper limb	368	184
4972	Fasciocutaneous flap lower limb	368	184
4973	Fasciocutaneous flap trunk	368	184
	(Flap repair is payable in addition to the primary operation for procedures 4974 to 4989
	MYOCUTANEOUS FLAPS:
4974	Myocutaneous flap, pectoralis	343	164
4976	Myocutaneous flap, latissimus dorsi	343	164
4977	Myocutaneous flap, latissimus dorsi with serratus and rib	368	184
4978	Myocutaneous flap, vertical rectus	368	184
4979	Myocutaneous flap, transverse rectus (TRAM)	343	164
4981	Myocutaneous flap, tensor fascia lata	368	184
4982	Myocutaneous flap, gluteal	368	184
	FREE MICROVASCULAR FLAPS:
4963	Free microvascular flap, radial forearm without bone	565	256
4964	Free microvascular flap, radial forearm with bone	614	256
4966	Free microvascular flap, latissimus dorsi	565	256
4987	Free microvascular flap, latissimus dorsi with serratus and rib	614	256
4988	Free microvascular flap, scapular	565	256
4989	Free microvascular flap, para scapular	565	256
	(Flap repair is payable in addition to the primary operation for procedures 4953 and 4954)
4953	Free microvascular flap, fibula	565	256
4954	Free microvascular flap, deep circumflex iliac (DCIA)	565	282
	REPLANTATION:
4991	Replantation, per digit	565	256
4992	Replantation, hand (mid palm)	834	358
4993	Replantation, hand (wrist)	712	328
4994	Replantation, forearm	785	358
4996	Replantation, foot	785	358
4997	Replantation, scalp	565	282
4998	Replantation, ear	565	282
	TRAUMA:
4990	Major degloving injuries of limbs, excision and graft of	589	256
	THORACIC OPERATIONS:
	LUNGS:
5015	Lung abscess with thoracotomy, drainage of	540	307
5025	Pneumonolysis	343	225
5038	Refilling and maintenance of implantable pump or reservoir including access to pump port (see 5039)	74	0
5039	Implantation of catheter system and reservoir for administration of pain control therapy and/or chemotherapy	245	72
	MEDIASTINUM:
5041	Myocardial biopsy	224	205
5055	Aortic endarterectomy	686	358
5065	Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter	110	0
5801	Exploration of mediastinum	313	307
5802	Endoscopic extirpation of lesion of mediastinum	313	307
5803	Diagnostic endoscopic examination of mediastinum	313	179
5804	Operation on lymphatic duct	500	307
5863	Thymectomy	540	358
5075	Blalock operation	589	410
5080	Cardiac catheterisation (left, right or both sides)	179	0
5090	Cardiac catheterisation and coronary angiography with or without ventriculography	301	0
5112	Cardiac catherisation and coronary angiography with or without ventriculography (including opacifaction of coronary bypass grafts)	320	0
5091	Cardioversion	122	61
5092	Venotomy and insertion of filter into the inferior vena cava	368	256
5093	Paediatric cardiac catheterisation (left, right or both sides)	268	205
5094	Paediatric cardiac catheterisation and cardiac angiography combined	404	225
5101	Coronary angioplasty, single or multiple vessel(s), with or without angiography with or without pacing	538	256
5098	Recatheterisation post angioplasty/angiography (within 6 months)	100	72
5855	Annuloplasty	589	307
5103	Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method one or more vessel(s)	600	358
5104	Intra coronary stent placement, post coronary angioplasty	540	307
5108	Cardiac ultrasound, (echocardiography) m-mode, 2D including ventricular function, chamber dimensions, wall motion, doppler exam (pulse, continuous wave, colour flow) assessment of valve areas, pressure gradients, regurgitant fractions	125	0
5109	Cardiac ultrasound, transoesophageal	60	0
5110	Heller's operation	392	256
5113	Pericardial drainage	112	154
5114	Continuous pericardial drainage	202	154
5118	Atherectomy	839	410
5120	Mediastinum (cysts, etc.) and contents, any operation on (excluding biopsy)	686	307
5135	Mediastinoscopy and biopsy	313	179
5136	Percutaneous transthoracic biopsy	89	102
5137	Percutaneous transthoracic biopsy under CAT guidance	215	205
5151	Percutaneous trans septal mitral valvuloplasty	839	410
5152	Valvuloplasty (other than mitral valvuloplasty)	588	307

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
5160	Oesophageal anastomosis	639	358
5870	Myocardial aneurysmyotomy	589	614
5161	Trachea oesophageal fistula repair of	639	512
5162	Repair, tracheo-oesophageal atresia	664	358
5163	Repair, tracheo-oesophageal fistula (TOF) atone (H-fistula)	581	358
5164	Repair, tracheo-oesophageal fistula (TOF) and atresia, replacement	834	410
5165	Oesophagectomy (all forms including three stage)	900	410
5170	Oesophagus, repair and short circuit	639	358
5171	Transection of oesophagus with repair, for oesophageal varices	491	358
5172	Oesophageal devascularisation	572	358
5180	Pott's operation	441	143
5190	Rashkind septostomy	392	256
5195	Resuscitation including electrical defibrillation and open cardiac massage	490	0
5200	Transeptal left heart catheterisation	196	100
5205	Vagotomy (through chest)	392	307
5217	Needle biopsy, transthoracic	89	102
5218	Needle biopsy, abdominal	89	72
5219	Trans thoracic electro - cautery of subclavian chain for arm	466	256
	HEART:
5808	Transplantation of heart	2002	922
5809	Correction of tetralogy of fallot	1231	717
5811	Atrial inversion for transposition of great vessels	1231	717
5812	Other correction of transposition of great vessels	1308	717
5813	Correction of total anomalous pulmonary venous connection	1231	717
5814	Closure of defect of atrioventricular septum using dual prosthetic patches	1231	563
5816	Closure of defect of interatrial septum	1078	563
5817	Closure of defect of interventricular septum	1078	563
5818	Planned repair of post infarction ventricular septal defect	1078	717
5819	Emergency repair of post infarction ventricular septal defect	1308	819
5821	Other open operations on the septum of the heart	1231	563
5822	Creation of valved cardiac conduit	1231	563
5823	Creation of other cardiac conduit	1231	563
5824	Refashioning of atrium (Ebstein's)	1231	563
5826	Operations on wall of atrium	1231	563
5827	Excision of cardiac tumour	1231	563
5828	Staged correction of hypoplastic left heart syndrome per stage	769	614
5829	Replacement of mitral valve (includes valvuloplasty)	1078	563
5831	Plastic repair of mitral valve	1078	563
5832	Replacement of aortic valve (includes valvuloplasty)	1078	538
5833	Replacement of tricuspid valve (includes valvuloplasty)	1078	563
5834	Replacement of pulmonary valve includes valvuloplasty valvotomy	1078	563
5836	Open valvotomy	1078	538
5837	Closed valvotomy	769	358
5838	Other open operation(s) on heart valves	1078	563
5839	Double valves	1231	717
5841	Removal of obstruction from structure adjacent to valve of heart	1078	563
5842	Triple valves	1386	717
5643	Valve and grafts	1386	717
5844	Saphenous vein graft bypass for coronary artery(ies)	1231	538
5846	Autograft bypass for coronary artery(ies)	1231	538
5847	Allograft bypass for coronary artery(ies)	1231	533
5848	Prosthetic bypass for coronary artery(ies)	1231	538
5849	Connection of mammary artery(ies) to coronary artery(ies)	1231	538
5851	Connection of other thoracic artery(ies) to coronary artery(ies)	1231	538
5852	Correction of anomalous coronary arteries	1231	538
5853	Other open operation(s) on coronary artery(ies)	1231	538
5854	Map guided surgery for ventricular arrhythmias	1231	614
5856	Exploration of heart	1154	512
5857	Left ventricular aneurysmectomy	1078	614
5858	Open operations on heart	1078	512
5859	Insertion management and removal of ventricular assist device	769	410
5861	Insertion, maintenance and removal of aortic conterpulsation balloon pump	309	256

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
5862	Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial (single or dual chamber)	240	154
5864	Insertion or replacement of pacemaker pulse generator	170	102
5064	Insertion, replacement or repositioning of permanent transvenous electrode(s), single or dual chamber (15 days or more after initial insertion)	160	102
5867	Removal of pacing system with bypass	769	410
5868	Removal of permanent pacing system	185	154
5069	Insertion of automatic implantable cardioverter/defibrillator	430	130
5872	Excision of pericardium	769	358
5873	Decompression of cardiac tamponade (re operation for bleeding)	385	358
5874	Pericardiocentesis	153	205
5876	Transthoracic drainage of pericardium	309	205
5877	Incision of pericardium	309	205
5878	Rewiring of sternum	385	205
	GREAT VESSELS:
5879	Correction of truncus arteriosus	1308	614
5871	Open correction of patent ductus arteriosus	577	307
5882	Closed correction of patent ductus arteriosus	540	307
5883	Creation of shunt to pulmonary artery from aorta using interposition tube prosthesis	577	307
5886	Connection to pulmonary artery from aorta	577	307
5887	Creation of shunt to pulmonary artery from subclavian artery using interposition tube prosthesis	577	307
5888	Connection to pulmonary artery from subclavian artery	577	307
5889	Repair of pulmonary, artery/ PA De Banding	1078	614
5884	Pulmonary artery banding	577	307
5892	Pulmonary embolectomy	1154	614
5893	Open operations on pulmonary artery	577	307
5894	Extra anatomic bypass of aorta	925	410
5896	Replacement of ascending aorta	1008	512
5897	Replacement of arch of aorta	1008	614
5898	Replacement of aneurysmal segment of thoracic aorta	1008	512
5899	Planned replacement of ascending aorta	1308	512
5901	Planned replacement of arch of aorta	1386	614
5902	Replacement of aneurysm of aorta	1154	512
5903	Other bypass of segment of aorta	1008	512
5904	Revision operation of prosthetic aortic grafts	1008	512
5962	Plastic repair of aorta (coarctation/ interrupted aortic arch)	1008	563
	CHEST WALL:
5963	Repair of diaphragmatic hernia using thoracic approach	463	307
5907	Repair of congenital diaphragmatic hernia (anaesthetist benefit includes all pre-operative and post-operative intensive care for the child. The consultant anaesthetist should report all intensive care services using the Special Reporting Process, see pa	463	0
5908	Thoracoplasty one stage	616	307
5909	Excision of chest wall tumour	616	307
5912	Correction of pectus deformity of chest wall	639	307
5913	Reconstruction of chest wall	616	307
5914	Exploratory thoracotomy	269	205
5916	Resection of rib and open drainage of pleural cavity	343	205
5917	Repair of rupture of diaphragm	577	307
5918	Plication of paralysed diaphragm	463	307
	TRACHEA:
5919	Partial excision of trachea	1000	563
5920	Reconstruction of trachea	1078	563
5921	Tracheostomy permanent	245	123
5922	Insertion of mini tracheostomy	77	72
5923	Destruction of lesion of trachea by rigid endoscopy	115	154
5924	Dilatation of tracheal stricture by rigid endoscopy	115	154
5928	Therapeutic operations on bronchus or lung using rigid bronchoscopy	115	154
	FIBREOPTIC ENDOSCOPIC PROCEDURES UNDER TOPICAL ANAESTHESIA:
5931	Destruction of lesion of trachea	115	154
5932	Dilatation of tracheal stricture	115	154

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
5936	Dilatation of bronchial stricture by fibreoptic bronchoscopy	115	123
	BRONCHI/LUNGS/PLEURA:
5941	Total pneumonectomy	700	307
5942	Lobectomy of lung (including excision of segment)	688	307
5947	Removal of lung, with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy)	832	410
5948	Removal of lung, with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)	780	358
5943	Thoracoscopic lung resections	686	307
5944	Open excision of lesion of lung	688	307
5946	Decortication of pleura or lung	686	307
5949	Pleurectomy for pneumothorax, open	539	307
5951	Endoscopic examination of pleura	231	154
5952	Insertion of tube drain into pleural cavity	100	0
5953	Introduction of substance into pleural cavity with chest aspiration	100	0
5954	Introduction of substance into pleural cavity with chest drain	100	0
	REVISION SURGERY:
5956	Revision coronary artery surgery	1354	538
5957	Revision repair of coarctation of aorta	1109	563
5958	Revision closure of defect of intra ventricular septum	1186	563
5959	Revision of valve surgery	1186	717
	PLEURA:
5220	Apicolysis	343	205
5221	Closed pleural biopsy	89	0
5230	Empyema, drainage	343	256
5231	Percutaneous drainage of empyema	99	0
5234	Paracentesis thoracis	45	0
5235	Paracentesis thoracis with intercostal drain	134	0
5240	Paracentesis thoracis with infusion of cytotoxic drugs	148	0
5245	Phrenic avulsion	148	154
5250	Pleurodesis	245	154
5251	Closed drainage of pneumothorax	148	0
5260	Thoracoscopy	224	205
5265	Thoracoscopy with intrapleural procedure	343	256
5270	Thoracotomy including lung or pleural biopsy	313	256
5274	Exploration for post operative haemorrhage or thrombosis, chest	392	358
	ULTRASOUND/VASCULAR STUDIES:
5926	Full mapping	1008	512
5930	Lower limb arterial ultrasound examination	68	0
5935	Venous ultrasound examination	68	0
5940	Duplex ultrasound scan	134	0
5960	Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement	347	110
5961	Intracardiac catheter ablation of arrhythmogenic focus for treatment of supraventricular of ventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combinatio	500	200
5502	Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, HIS bundle recording, including insertion and repositioning of multiple electrode catheters	240	0
	NEUROSURGICAL OPERATIONS:
	BRAIN and MENINGES:
5290	Aneurysms (direct operations)	1248	461
5292	Detachable balloon occlusion of carotico cavernous aneurysms and fistulae	973	358
5295	Anomalies (direct operations) including haemangioma	1040	461
5305	Biopsy of brain	520	307
5320	Brain tumour (all forms not otherwise listed)	832	358
5325	Brain wounds, open	832	307
5330	Calcified subdural haematoma, excision of	540	358
5345	Carotid ligation, neck	294	154
5350	Carotid ligation, removal	196	123
5360	Cisternal puncture	245	123
5365	Convexity meningioma, excision of	1040	410

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
5370	C.S.F. Rhinorrhea repair	728	358
5376	Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery	785	410
5377	Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array)	993	410
5380	Glioma biopsy	515	307
5385	Glioma (lobectomy)	1040	358
5390	Glioma (part removal)	1040	358
5400	Hemispherectomy	1040	461
5410	Intra cerebral haemorrhage, open operation	712	307
5415	Intra cerebral and intracerebellar tumours not otherwise listed	973	358
5420	Intracranial abscess (open operation)	758	307
5425	Intracranial abscess (tapping)	490	256
5430	Intraventricular tumours, excision of	1040	358
5435	Leucotomy	490	307
5440	Meningocele, repair of	832	307
5446	Direct lateral cervical puncture of c1 and c2 levels as for cervical myelogram	148	102
5450	Myelomeningocele, repair of	490	307
5455	Other extra cerebral intracranial tumours, excision of	1040	358
5460	Parasagittal meningioma, repair of	1040	358
5465	Pinealoma, excision of	1040	358
5470	Pituitary gland, hypophysectomy all approaches	1008	358
5480	Posterior fossa tumours, removal of	1008	461
5484	Stereotactic computer assisted volumetric intracranial procedure (List separately in addition to code for primary procedure)	122	0
5490	Subdural haematoma (burr hole drainage)	490	256
5495	Subdural haematoma (open operation)	712	307
5500	Subdural tap (infant)	245	123
5505	Tentorial decompression	589	358
5510	Third ventriculostomy	589	358
5515	Torkilsden shunt	589	358
5520	Valve shunt (hydrocephalus)	426	205
5525	Valve shunt revision	392	205
5535	Ventricle puncture (fontanelle)	245	123
5540	Ventriculography (adult)	224	123
5545	Ventriculography (child under 12)	224	154
	CRANIAL NERVES:
5555	Acoustic neuroma, removal of	1040	461
5560	Auditory nerve, etc. (section)	589	358
5565	Differential section, facial nerve	441	256
5575	Injection trigeminal branch (peripheral)	99	0
5580	Injection trigeminal division	245	0
5585	Injection trigeminal ganglion	392	0
5590	Intracranial sensory root division (trigeminal)	589	358
5600	Peripheral nerve repairs	392	184
5605	Peripheral nerve tumour, excision of	343	128
5610	Sensory nerve neurectomy	294	123
5611	Rhizolysis, one or more facet joints	196	123
5615	Nerve block for pain control	99	0
5620	Sympathetic block including coeliac ganglion and stellate ganglion	148	0
5621	Intravenous block (Biers technique)	148	0
5622	E.C.T. (each session)	49	51
	SCALP:
5630	Cirsoid aneurysm scalp, repair of	490	307
5635	Laceration, suture of (per laceration)	74	72
	SKULL:
5645	Burr holes (diagnostic)	515	154
5650	Burr holes (therapeutic)	490	256
5660	Craniotomy	735	358
5665	Depressed skull fracture (dural involvement)	624	256
5670	Depressed skull fracture, (simple) operation for	392	256
5675	Extradural haematoma, evacuation of	540	307
5690	Osteoma calvarium, excision of	490	256
5691	Consultant plastic surgeon cranio facialplasty, including the correction of craniosynostoses and facial synostoses	686	461

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
5692	Consultant neurosurgeon neurosurgical involvement with cranio facialplasty (for Anaesthetist Benefit see 5691)	490	0
5693	Skull bone grafting to facial skeleton	466	256
5695	Platybasia, repair of	1008	461
5700	Skull biopsy	224	123
5705	Skull defect repair	490	307
5710	Subtemporal decompression	441	225
5715	Suture splitting	441	225
	SPINAL CORD:
5719	Chemical lumbar sympathectomy	148	0
5725	Anomalies of cord vascular, operation for	1040	410
5730	Cervical disc, partial excision of or fusion	783	256
5731	Cervical disc, excision of two or more levels	991	256
5732	Microneurosurgical subarticular fenestration and foraminal decompression including microdisectomy	672	205
5740	Chordoma (spinal), removal of	1040	307
5745	Cord tumours, removal of	764	358
5746	Dumbbell tumours, transthoracic or abdominal removal	832	358
5755	Haematomyelia, aspiration of	540	256
5756	Intrathecal cytotoxic, chemotherapy infusion	172	77
5760	Lumbar puncture	68	72
5761	Cervical sympathectomy (unilateral)	441	184
5762	Cervical sympathectomy (bilateral)	515	205
5763	Exploration of the brachial plexus with removal of tumours	639	307
5765	Lumbar sympathectomy	441	205
5770	Lumbar sympathectomy (bilateral)	515	225
5771	Nerve root tumours, transthoracic or abdominal removal	490	358
5775	Spinal posterior rhizotomy	441	256
5785	Syringomyelia, aspiration of	572	307
	NEUROLOGICAL ASSESSMENT:
5880	EMG	89	0
5881	Electromyography study rectal mucosal sensitivity testing	89	0
5905	Video telemetric EEG recordings including full clinical evaluation and placement of sphenoidal electrodes	343	123
5906	Video telemetric EEG recordings including full clinical evaluation following placement of sub dural electrodes.	245	0
	UROLOGY PROCEDURES
	KIDNEY:
925	Simple Nephrectomy	441	205
920	Hemi nephrectomy	468	205
921	Radical nephrectomy (includes adrenalectomy and para-aortic lymph nodes)	520	225
926	Radical nephrectomy and caval extension below liver	624	225
927	Radical nephrectomy and caval extension of tumour above liver	832	358
929	Nephroureterectomy including bladder cuff	650	225
930	Nephrolithotomy	624	184
931	Percutaneous nephrolithotomy	312	205
935	Peri renal tissues, exploration, open biopsy (no abnormality discovered)	294	154
940	Pyelolithotomy	490	184
945	Pyeloplasty	540	184
955	Renal biopsy (needle)	89	72
5910	ESWL, one or more sessions per hospital stay or as an outpatient, up to 3 months	294	92
	ADRENAL GLANDS:
95	Adrenalectomy (unilateral)	450	205
100	Adrenalectomy (bilateral)	600	205
101	Adrenalectomy for phaeochromocytoma	600	512
106	Neuroblastoma, tru cut biopsy	89	72
107	Neuroblastoma, resection	624	307
	TRANSPLANTATION:
923	Kidney transplant	686	410
	URETER:
5850	Ureteroscopy, diagnostic, with or without biopsy	150	92
5911	Ureteroscopy & contact lithotripsy with placement/removal of J stent, one or more sessions per hospital stay	343	123
975	Open ureterolithotomy	302	143
981	Ureterolysis (unilateral)	392	143
982	Ureterolysis (bilateral)	624	184

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
983	Ureteric reimplantation, unilateral for reflux, stricture or fistula	468	184
986	Ureteric reimplantation, bilateral for reflux, stricture or fistula	624	184
984	STING procedure (initial)	294	82
987	STING procedure (repeat)	146	72
995	Ureterostomy (unilateral)	294	143
1000	Ureterostomy (bilateral)	441	184
996	Ureteric substitut ion (with bowel segment)	520	184
	BLADDER:
836	Bladder, instillation of anticarcinogenic agent (BCG)	57	72
898	Percutaneous suprapubic cystostomy	62	72
1031	Complex urodynamic evaluation, involving cineradiography	89	72
884	Cystoscopy with or without overdistension, with or without biopsy	83	72
890	Cystoscopy with ureteric catheterisation	104	82
885	Cystoscopy with diathermy to bladder tumour(s)	125	77
887	Cystoscopy with insertion of JJ stent	125	77
881	Cystoscopy with removal of JJ stent	104	72
895	Cystoscopy with or without ureteroscopy and removal of ureteric calculus	196	82
960	Open suprapubic cystostomy	148	72
924	Litholapaxy	294	123
897	Open cystolithotomy	208	92
855	Primary transurethral resection of bladder tumour(s), one or more	364	102
910	Excision of bladder diverticulum	392	154
901	Closure of ruptured bladder (intraperitoneal)	392	154
865	Cystectomy, partial	416	154
875	Cystectomy with ileal or sigmoid conduit and bowel anastomosis	811	358
877	Cystectomy with continent diversion with or without construction of neobladder	936	358
906	Augmentation cystoplasty	624	358
899	Substitution cystoplasty	780	358
5845	Ileal conduit and bowel anastomosis	500	307
4645	Closure of bladder exstrophy	850	358
4691	Young - Dees operation	650	307
902	Bladder, implantation of radioactive sources, simple, one to four sources	120	72
903	Bladder, implantation of radioactive sources, intermediate, five to ten sources	180	82
904	Bladder, implantation of radioactive sources, complex, greater than ten sources	265	92
	PROSTATE:
713	Biopsy of prostate (perineal or transrectal)	62	72
711	Electro ejaculation procedure	99	72
907	Bladder neck, transurethral incision of	208	82
850	Bladder neck, transurethral resection of	260	102
700	Transurethral prostatectomy	468	164
708	Open prostatectomy	500	225
701	Radical retropubic nerve sparing prostatectomy (includes bilateral pelvic lymph adenectomy with bladder neck reconstruction and anastomosis to the urethra)	728	333
	URETHRA:
1015	Urethral dilatation	49	72
665	Meatotomy	74	72
664	Meatoplasty	196	102
1030	Optical urethrotomy	156	72
666	Urethroplasty for penile or bulbar urethral stricture	392	184
667	Acute repair of rupture of membranous urethra	392	184
668	Urethroplasty for repair of prostatic or membranous urethral stricture, complete procedure	624	256
703	Insertion of an endo urethral stent for urethral stricture	148	72
1032	Implantation of artificial urinary sphincter	490	225
676	Removal of artificial urinary sphincter	208	92
4670	Hypospadias, fistula closure	294	133
677	Hypospadias-MAGPI procedure	294	133
4675	Hypospadias, reconstruction of urethra	392	154
4660	Epispadias, reconstruction of urethra	392	133

Code	Surgical Procedure	Procedure	Benefit IR£
		Surgical	Anaesthetic
4676	One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap	650	358
	MALE GENITAL TRACT:
681	Injection of corpora cavernosa with pharmacologic agent(s) (e.g. papaverine, phentolamine)	49
688	Biopsy of penis	62	72
695	Prepuce, dorsal incision of	74	72
696	Release of priapism (needle drainage)	74	72
683	Circumcision	99	82
686	Chordee release of	196	123
693	Nesbit procedure (plastic operation on penis to correct angulation)	291	133
4681	Insertion of malleable penile prosthesis	294	154
4682	Insertion of inflatable penile prosthesis	416	205
694	Removal of penile prosthesis	291	133
685	Penis, amputation of partial	245	123
687	Penis, amputation of -total	490	225
650	Hydrocele (tapping)	49
655	Hydrocelectomy, bilateral	253	123
660	Hydrocelectomy, unilateral	177	102
698	Excision of epididymal cyst(s) unilateral or bilateral	229	113
645	Epididymectomy, unilateral	198	113
699	Epididymectomy, bilateral	291	123
755	Varicocelectomy	245	123
704	Epididymovasostomy, bilateral	364	184
715	Orchidopexy, unilateral	196	102
720	Orchidopexy, bilateral	244	154
735	Orchidopexy, unilateral for torsion and exploration of opposite side	244	143
740	Testicular biopsy (needle)	68	72
741	Testicular biopsy (open surgical)	134	77
742	Testicular prosthesis, insertion /replacement/removal of, unilateral	196	87
743	Testicular prosthesis, insertion/replacement/removal of, bilateral	244	123
675	Orchidectomy, unilateral	148	102
670	Orchidectomy, bilateral	208	102
672	Drainage of intra-scrotal abscess	62
	FEMALE GENITAL TRACT:
2415	Cystocele, repair of	196	128
991	Urethropexy for genuine stress incontinence (Stamey, Raz, Burch, Marshall-Marchetti)	364	123
992	Pubovaginal sling urethropexy	420	164
2465	Vaginal fistula (vesico vaginal), repair of	392	154
4690	Vaginal reconstruction with skin graft	491	205
993	Vesico colic fistula-excision of, and sigmoid colectomy	491	205
	MISCELLANEOUS:
820	Arterial venous fistula in arm under L.A.	196	164
821	Gortex graft placement for AV access for dialysis	441	164
822	Permacath Hickman catheter for dialysis	245	123
834	Insertion/replacement of Tenchkoff catheter for dialysis	198	123
838	Removal of Tenchkoff catheter	196	123
	LYMPHATICS:
1310	Axillary/inguinal lymph node(s) superficial dissection of	100	92
1320	Axillary or inguinal lymph nodes, incision of abscess	100	72
1326	Deep cervical node excision biopsy (not needle biopsy)	100	72
1315	Axillary lymph nodes complete dissection of	343	123
1335	Inguinal or pelvic lymph node block dissection, unilateral	368	164
1336	Inguinal or pelvic lymph node block dissection, bilateral	550	256
1355	Lymphatic infusion	245
1365	Primary or secondary retroperitoneal lymphadenectomy complete, transabdominal	589	307

TABLE C.3

Code	Radiological Procedure	Procedure	Benefit IR£
		Radiological	Anaesthetic
	ALIMENTARY TRACT
6000	Plain film, abdomen	22
6001	Plain film abdomen complete, including decubitus and/or erect views	29
	SINGLE CONTRAST STUDIES(BARIUM OR WATER SOLUBLE)
6005	Ba. enema	43
6015	Ba. meal	29
6020	Ba. meal and follow through or small bowel study	43
6025	Ba. swallow	29
6060	Small bowel enema	74
6066	Defaecating proctogram	107
	DOUBLE CONTRAST STUDIES
6010	Ba. enema, double contrast	75
6011	Ba. enema, therapeutic forreduction of intussusception	107
6021	Ba. meal (double contrast)	43
6030	Ba. swallow and meal	43
6035	Cholecystogram	29
6040	Screening crosbie capsule	29
6045	Screening diaphragm	29
6070	T - tube cholangiogram	29
6055	IV cholangiogram	43
	CHEST
6075	Chest and ribs	22
6079	Chest, PA and lateral	22
6080	Chest, PA and lateral with flouroscopy	29
6085	Chest, PA lateral and apical	22
6086	Chest, complete, minimum of four views	29
6090	Larynx	22
6095	Sternum and chest	22
6100	Thoracic inlet	22
	C.T. SCANS
6102	Brain, without contrast	85	102
6103	Brain, with contrast material	132	102
6104	Orbit, sella or outer, middle, or inner ear, without contrast (except if done at same time as 6102 or 6103)	85	102
6106	Orbit, sella or outer, middle, or inner ear, with contrast material (except if done at same time as 6102 or 6103)	132	102
6107	Maxillofacial area, without contrast material (except if done at same time as 6102 or 6103)	85	102
6108	Maxillofacial area, with contrast material (except if done at same time as 6102 or 6103)	132	102
6109	Thorax, without contrast material	85	102
6112	Thorax, with contrast material	132	102
6111	CAT scanning for biopsy or drainage	132	256
6113	High resolution, lungs	132	102
6114	Abdomen, without contrast material	85	102
6116	Abdomen, with contrast material	132	102
6117	I.V. dynamic sequential scanning	132	102
6118	I.V. dynamic non-incremental scanning	132	102
	SKELETAL
6224	C.T. of spine with contrast material	132	102
6226	Long bones	64	102
6227	Joints	85	102
6228	Spine	85	102
6229	Feet/Hands	85	102
	JOINTS AND LONG BONES
6115	Ankle	22
6119	Ankle, complete, minimum of three views including inversion/eversion	29
6121	Acromioclavicular joints, bilateral, with or without weight distraction	29
6122	Knee, complete, including oblique(s), and tunnel, and/or patellar and/or standing views	29
6120	Bone age	29

Code	Radiological Procedure	Procedure	Benefit IR£
		Radiological	Anaesthetic
6125	Calcaneum	22
6130	Clavicle	22
6135	Elbow	22
6140	Femur	22
6145	Finger/toe	22
6150	Foot	22
6155	Hand	22
6160	Hip	22
6165	Humerus	22
6170	Knee	22
6175	Limb length/orthopaedicmeasurement	29
6180	Pelvis (inc. hips)	22
6185	Radius and ulna	22
6190	Sacro-Iliac joints	22
6195	Scaphoid	22
6200	Scapula	22
6205	Scoliosis series	22
6210	Shoulder	22
6215	Sternoclavicular joint	22
6220	Tibia and fibula	22
6225	Wrist	22
	MAGNETIC RESONANCE IMAGING (M.R.I.)
6230	Magnetic resonance imaging	97	154
6231	Magnetic resonance imaging with contrast enhancement	132	154
	NUCLEAR MEDICINE IMAGING
	MUSCULO SKELETAL SYSTEM
6270	Limited joint scan	29
6275	Multiple joint scan	43
6280	Sacro-iliac joint uptake	29
6290	Partial body bone scan	29
6295	Whole body bone scan	43
6300	3-Phase bone scan	43
6305	SPECT (tomo) bone scan	61
6340	Gallium scan	43
	CENTRAL NERVOUS SYSTEM
6310	Static brain	29
6315	Dynamic brain scan	43
6320	SPECT brain (CBF, ceretec, ECD, blood pool)	61
6325	Static - planar cysternogram	61
6330	SPECT cysternogram	85
	CARDIOVASCULAR SYSTEM
6260	Aortogram	29
6265	Arteriogram	29
6360	Angiocardiogram (1st pass)	43
6365	Blood pool scan (MUGA)	61
6370	Exercise blood pool scan (EX. MUGA)	97
6375	Dipyridamole thallium	97
6380	Exercise thallium	97
6385	P.Y.P. infarct scan	43
6390	Anti-myosin scan	43
6395	SPECT anti-myosin scan	61
6400	SPECT thallium	97
6570	Venogram, unilateral	43
6575	Venogram, bilateral	61
	GENITOURINARY SYSTEM
6415	Renogram	43
6420	Combined renogram/GFR	61
6425	Captopril renogram	61
6430	Diuretic renogram	61
6435	DMSA renal scan	43
6440	Micturating cystogram	61

Code	Radiological Procedure	Procedure	Benefit IR£
		Radiological	Anaesthetic
6445	SPECT DMSA renal scan	61
6550	Testicular scan	43
	GASTROINTESTINAL SYSTEM
6235	Abdominal scan (Meckel's)	29
6335	Duodenal/gastric reflux	29
6345	Gastric emptying	43
6350	G.I. bleed	43
6355	G.F.R. (Tc-99m DTPA, Cr-51 EDTA)	29
6525	Oesophageal motility study	43
6450	Colloid liver scan	43
6455	HIDA liver scan	43
6460	SPECT liver scan	61
6465	Hepatic (liver) blood flow	43
6540	Salivary scan	29
6545	Spleen scan	29
	RESPIRATORY SYSTEM
6470	Aerosol lung scan	43
6475	Gallium lung scan	43
6480	Lung perfusion scan	43
6485	Lung ventilation scan	43
6490	SPECT lung scan	61
6495	Ventilation/perfusion lung scan	85
	ENDOCRINE SYSTEM
6410	Whole body iodine scan	43
6520	MIBG scan	61
6530	Parathyroid scan	43
6555	Technetium scan of thyroid	29
6560	Iodine scan of thyroid	29
6565	Thallium scan of thyroid	29
	OTHER SCANS
6255	Cholesterol scan	43
6285	Bile salt malabsorption scan	43
6500	Lymphoscintigram	43
6505	Marrow scan	61
6240	White blood cell scan (WBC)	43
6510	Monoclonal antibody scan-SPECT	61
6515	Monoclonal antibody scan - static	43
6535	Platelet scan	43
	NUCLEAR MEDICINE IN-VIVO NON-IMAGING TESTS
	GENERAL TESTS
6566	Bile salt absorption (ScHCAT)	29
6567	Bile salt breath test	22
6568	Exchangeable body sodium	29
6569	I-131 Uptake (thyroid uptake)	29
6571	I-131 Therapy (thyroid therapy)	43
6572	Oestrogen receptor assay	22
6573	Red cell survival	29
6574	Red cell mass	22
6576	Schilling test (urine)	29
6577	Schilling test (whole body monitor)	29
6578	Total body water	29
6579	Total body potassium	29
	OBSTETRIC
6580	Abdomen	22
6585	Pelvimetry	29
	SKULL
6590	Facial bones	22
6595	Foramina optic	22
6600	Internal auditory canals	22
6605	Mandible	22
6610	Mastoid	22

Code	Radiological Procedure	Procedure	Benefit IR£
		Radiological	Anaesthetic
6615	Maxilla	22
6620	Nasal bones	22
6625	Nasal sinuses	22
6630	Orbital views	22
6635	Parotid gland	22
6640	Pituitary fossa	22
6645	Skull	22
6650	Temporomandibular joint	29
	SOFT TISSUES
6655	F.B. in eye and localisation	29
6660	Mammogram	43
6665	Soft tissue neck	22
	SPECIAL PROCEDURES
6675	Angiogram (direct puncture, single vessel study, branchial, femoral) includes introduction of needles or catheter injection of contrast media and necessary pre and post injection care specifically related to the injection procedure	97
6680	Angiogram (selective catheter, single/multiple vessel study, coeliac, mesenteric, renal, subclavian etc) includes introduction of needles/catheter injection of contrast media and necessary pre & post injection care specifically related to injection procedure	132
6681	Single selective carotid angiography and/or vertebral study	142
6682	Bilateral carotid angiography study	245
6683	Bilateral carotid angiography and vertebral study	368
6685	Aortogram (arch/TLA, etc.)	97
6690	Cavernosogram	97
6705	Facet arthrogram (single level)	61
6706	Hepatic needle puncture/ catheterisation for biliary procedures	132
6710	Portogram	85
6720	Orbital venogram	85
6721	Spinal arteriogram	442
6725	Splenoportogram	85
6730	Venous sampling - adrenal, parathyroid, renal, etc.	132
6735	Venogram, peripheral, single limb	61
6740	Venography (selective, catheter, single vessel study and/or venous sampling, I.V.C., S.V.C., adrenal, renal, hepatic)	132
	SPINE
6745	Cervical	22
6750	Coccyx	22
6755	Complete spine	29
6760	Dorsal (thoracic)	22
6765	Lumbar	22
6770	Sacrum	22
6775	Scoliosis views	29
6780	Skeletal survey	43
	TEETH
6785	Occlusal (Intra-Oral)	22
6790	Pantomogram	29
6795	Tooth, single	22
6800	Total Upper and Lower Jaw	29
	ULTRASOUND
6805	Biliary	29
6810	Breast	29
6811	Chest	43
6825	Doppler (carotid, cerebral, peripheral, abdominal, renal, etc.)	61
6835	Eye	29
6840	Hip	43
6841	Knee	43
6845	Obstetrical	29
6846	Obstetrical (with full foetal assessment)	61
6850	Paediatric cranial	61
6855	Pelvic	43

Code	Radiological Procedure	Procedure	Benefit IR£
		Radiological	Anaesthetic
6856	Parotid gland	43
6857	Pleural space (for localisation)	43
6860	Prostate - transrectal	61
6865	Renal (kidneys)	43
6870	Shoulder	43
6875	Testicular	43
6880	Transvaginal	61
6885	Thyroid	29
6890	Upper abdominal (includes liver, pancreas, aorta and kidneys)	61
6895	Ultrasound guidance during investigations or therapeutic procedure	85
	URINARY TRACT
6905	Cystogram	43
6910	I.V.P.	43
6915	Micturating cystogram	43
6920	Straight renal tract (KUB)	22
6925	Urethrogram	43
6930	Vesiculogram	43
	OTHERS
6950	Antegrade pyelogram	61
6955	Arthrogram	61
6960	Bronchial brushing	97
6965	Bronchogram	61
6970	Dacrocystogram	43
6975	Discogram	85
6985	Hysterosalpingogram	43
6990	Laryngogram	43
6995	Lymphangiogram	132
7000	Myelogram	85
7005	Myelogram (direct lateral puncture, thoracic or cervical)	132
7010	Needle biopsy (trans-thoracic, bone, abdominal)	85
7011	Nephrostogram	61
7020	Percutaneous transhepaticcholangiogram	85
7025	Per-operative cholangiogram	43
7034	Imaging supervision, interpretation and report for injection procedures during cardiac catheterisation; ventricular and/or atrial angiography	36
7036	Radiological guidance during investigations or therapeutic procedure (use code 7034 for cardiology procedures)	85
7037	Radiological guidance for mammographic wire guided biopsy	36
7040	Retrograde pyelogram	43
7051	Sialgram, Parotid	64
7052	Sialogram, Submandibular	86
7055	Sinogram	29
7065	Tomograms (+ area films)	29
7070	Ventriculogram	85
	THERAPEUTIC/INVASIVEPROCEDURES
	Please note that therapeutic/invasive procedures are listed in Table C.2

TABLE C.4

Code	Pathological Investigation	Procedure Benefit IR£
8900	CATEGORY 1	17
	HAEMATOLOGY
	APTT, PT+INR, Blood Gp+uncomplicated crossmatch, Cold Aggluts,
	FBC without film, HbH, (in)/direct Coomb's test, Monospot.
	BIOCHEMISTRY
	Single analytes
	IMMUNOLOGY
	a-1--AT, C3, C4, Igs, RA Screen, Thyroid Abs
	MICROBIOLOGY
	Pregnancy test, Stool O/B
	CATEGORY 1(A)	17
	HAEMATOLOGY
9230	Coag. Factor Assay
8930	Ferritin
8910	Fibrinogen
8935	Iron
9220	RBC autohaemolysis
9215	RBC osm frag.
9225	Platelet Aggregation
8920	Protein C
	BIOCHEMISTRY
9185	All nuclear medicine in-vitro investigations (except for those investigations listed in category 5)
	All Profiles:
	Biochemical Investigations of,
9000	-Renal (one or more)
9005	-Hepatic (one or more)
9010	-Cardiac (one or more)
9015	-Thyroid (one or more)
9020	-Bone (not PTH) (one or more)
9025	-Lipids (one or more)
9310	Biochemistry of hypertension
9165	GTT
9165	HbA1C
9166	Drug levels (including RIA)
9167	HPLC
	IMMUNOLOGY
9285	Allurgens
9168	Caeruloplasmin
9169	CRP
9171	Cryoglobulins
9275	IgE
9172	PFB
8945	Streptolysin
8936	Transferrin
	ENDICRINOLOGY
8937	Hormone Levels(except for those investigations listed in Category 5)
	CATEGORY 3	7
	HAEMATOLOGY
8905	FBC + manual film ± eosinophil count
9040	Kliehauer
8915	LAP
9035	Reticulocyte count
	MICROBIOLOGY
8970	MSU + culture
9045	Stool O+P
	BIOCHEMISTRY
9030	Sweat investigation
	IMMUNOLOGY
9050	IF - single antibody e.g. ANF (except if this investigation gives rise to the investigations listed in Categories 4 or 5)
	CATEGORY 4	13
	BIOCHEMISTRY
9160	All electrophoresis\|serum, lipoprotein, urine
9175	CSF including oligoclonal bands
9180	Myeloma Screen including electrophoresis
9181	Trace metals
9182	Vits A & E
	HAEMATOLOGY
9205	Ab indentification (transfusion)
9200	Bleeding time
8925	HbA₂
9210	Hb electrophoresis
9226	Thrombophilia screen - this consists of three or more of the following items:
	Antithrombin 3, protein C, protein S, factor 7, factor 12, platelet aggregation (spontaneous, second wave of aggregation with weak ADP, and response to dilutions of epinephrine)
8940	U. haemosiderin
9507	Flow cytometry
	MICROBIOLOGY
9100	Interpretive review of culture result from wounds, joint fluids,sputum, intestine and other body sites including 1 TB Culture

Code	Pathological Investigation	Procedure Benefit IR£
9385	Interpretative review of viral, bacterial or fungal serology or viral culture
9202	Antibiotic assay - maximum payable, any combination, three per claim
9203	MBC - maximum payable, any combination, three per claim
9204	MIC - maximum payable, any combination, three per claim
9206	Cidal levels
9207	Toxin levels
	IMMUNOLOGY
9221	ANCA-for single antibody
9222	AGBM-for single antibody
9280	Gel electrophoresis
9223	HIV, VD or Hepatitis screen
9224	Teicoic acid
9228	Cardiolipin
9227	CH50-functional assay
	ALL DISCIPLINES
9694	Gene rearrangement studies
	CATEGORY 5(A)	27
	BIOCHEMISTRY
9301	- Diabetic KA/hyperosmolar coma
9302	- Acute Renal failure
9303	- Acute hepatic failure
9306	- Porphyria investigation
9308	- Diabetes insipidus
	ENDOCRINOLOGY
9304	- Dynamic endocrine function tests (IST, Synact, TRH, Dex supp)
9307	- Full endocrinological investigation of infertility
9309	- Full investigations for inborn errors of metabolism in paediatric patients.
	Benefit is only payable once per patient at time of initial investigation (diagnosis).
	CATEGORY 5 (B)	27
	HISTOPATHOLOGY
9360	Small (1-2 blocks) include cytology and neuropathology
	MICROBIOLOGY
9381	Interpretive review of culture of CSF, blood
	IMMUNOLOGY
9391	Infertility screen
9270	Paraprotein typing
9392	IF - autoantibody screen and/or DNA Abs and/or subtyping
9605	Immune complex assays (except for those investigations listed in Category 1)
	All DISCIPLINES
9393	Polymerase chain reaction
	CATEGORY 6	40
	HAEMATOLOGY
9501	Marrow aspirate (except immunocytochemistry)
9502	Marrow trephine
	HISTOPATHOLOGY
9530	Medium (e.g. description + 3-5 blocks)
9540	Colonoscopic series
9550	Clinical (i.e. non screening) cytology (not including smear + section)
9535	Lymph node
9545	Parathyroid
	IMMUNOLOGY
9503	HLA typing
	MICROBIOLOGY
9504	Immunofluorescence
9506	Electron microscopy
	CATEGORY 7	73
	HISTOPATHOLOGY
9601	Liver, renal biopsies including special stains
9602	Fine needle aspiration biopsy, cell block and smear done together
9650	Large (5 + blocks and all major dissections)
9651	Breast screening, localisation segments with review of radiographs
	HAEMATOLOGY
9603	Marrow aspirate and trephine done together
	IMMUNOLOGY
9670	IF-frozen section direct or indirect
9610	WBC function tests
	CATEGORY 8 (A)	96
	HISTOPATHOLOGY
9693	Frozen section or rapid intraoperative diagnosis
9691	Immunohistology (include fluorescence)
	CATEGORY 8 (B)	96
	HAEMATOLOGY
9505	Immunocytochemistry
9700	CATEGORY 9	39
	All tests associated with Obstetrics, including normal delivery, caesarean section and miscarriage

SCHEDULE D

RISK EQUALISATION CALCULATIONS

1. The period (referred to in this Schedule as the "specified period") in respect of which the calculations specified in this Schedule are to be carried out shall be a period determined in accordance with article 7 of this Scheme.

2. General Definitions

"claim group" means in respect of a settled hospital claim any previous claim which is either

(a) a linked claim of that claim; or

(b) is a constituent of or gave rise to a previous claim group which includes a claim which is so linked provided that no claim may be included in a claim group more than once;

"covered persons" means in relation to a scheme undertaking

(a) fully insured persons who on the last day of a specified period were named in a health insurance contract effected by that scheme undertaking and who belonged on that day to a specified cell or combination of cells, or

(b) fully insured persons not already included under paragraph (a) of this definition who were formerly named in a health insurance contract effected by that scheme undertaking and who, but for the cessation of their health insurance contract, would have belonged to that cell or those cells on the last day of that period;

"current claim" has the meaning assigned to it under the definition of linked claim;

"first day" means in relation to a settled hospital claim either, as appropriate,

(a) the day upon which the hospital stay to which a settled accommodation claim relates commenced; or

(b) the day of the provision of outpatient services to which a settled out-patient claim relates;

"last day" means in relation to a settled hospital claim either, as appropriate,

(a) the day upon which the hospital stay to which a settled accommodation claim relates ceased; or

(b) the day of the provision of outpatient services to which a settled outpatient claim relates;

"linked claim" means 'in respect of a settled hospital claim (referred to in this Schedule as the "current claim") a previous settled hospital claim relating to the same fully insured person (referred to in this Schedule as the "previous claim") which satisfies one or more of the following conditions

(a) that the first day of the previous claim

(i) is after or coincides with the first day of the current claim; and

(ii) is before or not more than seven days after the last day of the current claim; or

(b) that the last day of the previous claim

(i) is before or coincides with the last day of the current claim; and

(ii) is after or not more than seven days before the first day of the current claim; or

(c) that the first day of the previous claim is before the first day of the current claim and the last day of the previous claim is after the last day of the current claim.

"weighted claim value" means, for a settled hospital claim

(a) if that claim is a settled accommodation claim

(i) a value determined in accordance with the following table

Total number of in-patient days in respect of the hospital stay to which that claim relates	Value

1	0.20
2	0.30
3	0.40
4	0.50
5 or more	1.00

or as appropriate

(ii) a value calculated in accordance with the following formula

0.20 x Y

where Y is the total number of day- patient days in respect of the hospital stay to which that claim relates,

(b) if that claim is a settled out-patient claim 0.10

(c) the value determined in accordance with paragraphs (a) or (b) as appropriate in respect of that claim shall be reduced by an amount calculated in accordance with the following formula

Z - 1

where Z is the greater of

(i) one; and

(ii) the sum of

(A) the value determined in accordance with paragraphs (a) or (b) as appropriate; and

(B) the sum of the weighted claim values for the claim group associated with the claim;

"specified period" has the meaning assigned to it by paragraph 1 of this Schedule;

"previous claim" has the meaning assigned to it under the definition of linked claim;

"previous claim group" means a claim group given rise to by a previous claim.

3. Cell Definitions (with respect to a specified period, a specified scheme undertaking and a specified cell)

"cell day-patient days" means the sum of all day-patient days in respect of settled accommodation claims which acquired that status during that period in respect of covered persons;

"cell insured population" and "CIP" means the sum of

(a) the total number of fully insured persons in that cell on the first day of that period, and

(b) the total number of fully insured persons in that cell on the first day of the next following period

with the result being divided by two;

"cell equalised benefits" and "CEB" means the sum of all prescribed equalised benefits paid, in respect of settled claims which acquired that status during that period, to or on behalf of covered persons;

"cell weighted claim value" and "CWCV" means the sum of all weighted claim values, in respect of settled hospital claims which acquired that status during that period, in respect of covered persons;

"cell equalised benefits average" and "CEBA" means an amount determined in accordance with the following formula

4. Scheme Undertaking Definitions (with respect to a specified period and a specified scheme undertaking)

"undertaking insured population" and "UIP" means the sum for all cells of

CIP

"undertaking equalised benefits" and "UEB" means the sum for all cells of

CEB

"undertaking adult lives" and "UAL" means the sum, for all cells other than the cell or cells which comprise, the prescribed age band "age 17 and under", of

CIP

"undertaking child lives" and "UCL" mean the value, for the cell or cells which comprise the prescribed age band "age 17 or under", of

CIP

"undertaking equivalent adult lives" and "UEAL" means a value determined in accordance with the formula

"undertaking equivalent adult ratio" and "UEAR" means a value determined in accordance with the formula

5. Market Specific Definitions (with respect to a specified period)

"market insured population(cell)" and "MIP(Cell)" means the sum, for all scheme undertakings for a specified cell, of

CIP

"market insured population(total)" and "MIP(Total)" means, the sum, for all cells, of

MIP(Cell)

"market equalised benefits(cell)" and "MEB(Cell)" means the sum, for all scheme undertakings for a specified cell, of

CEB

"market equalised benefit(total)" and "MEB(Total)" means the sum, for all cells, of

MEB(Cell)

"market weighted claim value" and "MWCV(Cell)" means the sum, for all scheme undertakings for a specified cell, of

CWCV

"market equalised benefits average" and "MEBA(Cell)" mean an amount, for a specified cell, calculated in accordance with the formula

"market utilisation" and "MU(Cell)" means a value, for a specified cell, calculated in accordance with the formula

"market proportion" and "MP(Cell)" means a value calculated in accordance with the formula

"market equivalent adult lives" and "MEAL" means, the sum for all scheme undertakings of

UEAL

"market equivalent adult ratio" and "MEAR" means a value determined in accordance with the formula

6. With respect to a specified period, a specified scheme undertaking and a specified cell

"cell standardised benefits" and "CSB" mean an amount calculated in accordance with the formula

CEBA x MP(Cell) x MU(Cell) x UIP

provided that if for that cell the CWCV is less than 10, CSB instead shall be calculated in accordance with the formula

MEBA(Cell) x MP(Cell) x MU(Cell) x UIP

7. With respect to a specified period and a specified scheme undertaking

"undertaking standardised benefits - first calculation" and "USB1" means the sum for all cells of

CSB

"undertaking standardised benefits - second calculation" and "USB2" means a value determined in accordance with the formula

8. With respect to a specified period

"market standardised benefits" and "MSB" means the sum, for all scheme undertakings, of

USB2

9. With respect to a specified period and a specified scheme undertaking

"undertaking standardised benefits" and "USB" means an amount determined in accordance with the formula

10. The contribution (to be known for the purposes of this Scheme as the "equalisation contribution") for a specified period for a scheme undertaking shall be determined in accordance with the formula

USB - UEB

SCHEDULE E

Quarter ending ......................... Gender ............. Scheme Undertaking....................

Cell

Number of fully insured persons on first day of that quarter

Number of fully insured persons on first day of the next following quarter

Cell equalised benefits for that quarter

Cell weighted claim value for that quarter

Cell day-patient days for that quarter

Number of settled out-patient claims in respect of covered persons for that quarter

Number of settled in-patient claims in respect of covered persons for that quarter

Total

Which relate to one in-patient day only

Which relate to two in-patient days only

Which relate to three in-patient days only

Which relate to four in-patient days only

Which relate to five in-patient days only

Which relate to six in-patient days only

Which relate to seven in-patient days only

Which relate to eight in-patient days only

Which relate to nine in-patient days only

Which relate to ten in-patient days only

Which relate to not less than eleven and not more than fifteen in-patient days

Which relate to not less than sixteen and not more than twenty in-patient days

Which relate to not less than twenty one and not more than thirty in-patient days

Which relate to thirty one or more in-patient days

Age 17 and under

Age 18 to age 29

Age 30 to age 39

Age 40 to age 49

Age 50 to age 59

Age 60 to age 69

Age 70 to age 79

Age 80 and over

All cells for that gender combined

All cells for both genders combined

Confirmed by	NAME	..................	NAME	..................
	Position	..................	Position	..................
	SIGNATURE	..................	SIGNATURE	..................
	Date	..................	Date	..................

GIVEN under the Official Seal of the Minister for Health this 28th day of March, 1996.

Michael Noonan

________________

Minister for Health

EXPLANATORY NOTE

These Regulations provide for the implementation of a scheme of risk equalisation. They set out the details for operation of the scheme, including the conditions which will give rise to the introduction of risk equalisation, the establishment of a risk equalisation fund and other arrangements. They provide for registered undertakings to make statistical returns relating to risk equalisation.

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	Irish Statutory Instruments
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Irish Statutory Instruments

S.I. No. 84/1996 -- Health Insurance Act (Risk Equalisation Scheme), 1996