Radiology ii. 2nd digit indicates the sub region within a main region or category eg. Head / Skull and Brain = 10xxx

Transcription

1 Radiology 2007 NATIONAL REFERENCE PRICE LIST FOR RADIOLOGISTS, EFFECTIVE FROM 1 JANUARY 2007 The following reference price list is not a set of tariffs that must be applied by medical schemes and/or providers. It is rather intended to serve as a baseline against which medical schemes can individually determine benefit levels and health service providers can individually determine fees charged to patients. Medical schemes may, for example, determine in their rules that their benefit in respect of a particular health service is equivalent to a specified percentage of the national health reference price list. It is especially intended to serve as a basis for negotiation between individual funders and individual health care providers with a view to facilitating agreements which will minimise balance billing against members of medical schemes. Should individual medical schemes wish to determine benefit structures, and individual providers determine fee structures, on some other basis without reference to this list, they may do so as well. In calculating the prices in this schedule, the following rounding method is used: Values R10 and below rounded to the nearest cent, R10+ rounded to the nearest 10cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed. VAT EXCLUSIVE PRICES APPEAR IN BRACKETS. This schedule is for the exclusive use of registered specialist radiology practices (Pr No "038") and nuclear medicine practices (Pr No "025"). 025 practices may only charge the codes with a 3rd digit of practices may charge all codes except codes with a 3rd digit of 9. Practitioners registered as both radiologists and nuclear physicians may charge all codes. This schedule must be used in conjunction with the Radiological Society of S A Guidelines. Code Structure Framework a. The tariff code consists of 5 digits i. 1st digit indicates the main anatomical region or procedural category. 0 = General (non specific) 1 = Head 2 = Neck 3 = Thorax 4 = Abdomen and Pelvis (soft tissue) 5 = Spine, Pelvis and Hips 6 = Upper limbs 7 = Lower limbs 8 = Interventional 9 = Soft tissue regions (nuclear medicine) eg Head = 1xxxx ii. 2nd digit indicates the sub region within a main region or category eg. Head / Skull and Brain = 10xxx iii. 3rd digit indicates modality 1 = General (Black and White) x-rays 2 = Ultrasound 3 = Computed Tomography 4 = Magnetic Resonance Imaging 5 = Angiography 6 = Interventional radiology 9 = Nuclear Medicine (Isotopes) eg: Head / Skull and Brain / General x-ray = 101xx iv. 4th and 5th digits are specific to a procedure / examination, eg Head / Skull and Brain / General / X-ray of the skull = Guidelines for use of coding structure The vast majority of the codes describe complete procedures / examination and their use for the appropriate studies is self-explanatory. Some codes may have multiple applications and their use is described in notes associated with each code Codes to (Angiography machine codes) may only be used by owners of the equipment and who have registered such equipment with the Board of Healthcare Funders / RSSA. The machine codes 00510, 00520, 00530, 00540, 00550, may not be added to 60540, 60550, 70530, (Antegrade Venography, upper and lower limbs) Where public sector hospital equipment is used for a procedure, the units will be reduced by 33.33%. Consumables Contrast Medium o Prior to the implementation of Act 90, contrast will be billed according to the official 2004 RSSA reimbursement price list, without mark up. o After the implementation of Act 90, contrast medium will be billed according to the suppliers list price, without mark up. Angiography catheters, angioplasty balloons, stents, coils and other embolisation materials, guide wires and drains are to be billed at net acquisition cost, without mark up, until the implementation of Act 90. All other consumables are to be billed at net acquisition price, until the implementation of Act 90. Thereafter Act 90 regulations apply. The cost of film is included in the comprehensive procedure codes and is not billed for separately. Appropriate codes must be provided for consumables. General Comments on Procedural Codes All x-ray tomography codes are stand alone studies and may be used as a unique study or in combination with the appropriate regional study if done simultaneously. May not be added to 20130, 42110, Setting of sterile tray is included in all appropriate procedure codes. Where introduction of contrast is necessary eg. sialography, arthrography, angiography, etc, the codes used for the procedures are comprehensive and include the introduction of contrast or isotopes. The use of Doppler or Colour Doppler as an adjunct to a study (eg small parts thyroid) is included in the code for that study. CT Angiography (10330, 20330, 32300, 32310, 44300, 44310, 44320, 44330, 60310, 70310, 70320) are stand alone studies and may not be added to the regional contrasted studies (see 10335, 20340, 20350, for combined studies). Angiography and interventional procedures include selective and super selective catheterization of vessels as are necessary to perform the procedures. 18 Dec 2006 Page 1 of 44 Version

2 Codes (Ultrasound guidance), (CT guidance) and (MR guidance) are stand alone procedures that include the regional study and may not be added to any of the ultrasound, CT or MR regional studies General Codes Modifiers Radiology and nuclear medicine services rendered to hospital inpatients Radiology and nuclear medicine services rendered to outpatients A reduction of one third (33.33%) will apply to radiological examinations where hospital equipment it used Equipment / Diagnostic Code Description Ver Add Nuclear Medicine Radiology Consumables used in radiology procedures: cost price PLUS 26% (up to a maximum of R26,00). (Where applicable, VAT should be added to the above). Appropriate code to be provided. See separate codes for contrast and isotopes X-ray skeletal survey under five years (349.40) X-ray skeletal survey over five years (580.50) X-ray sinogram any region (607.90) X-ray with mobile unit in other facility (106.10) To be added to applicable procedure codes eg X-ray control view in theatre any region (293.60) X-ray fluoroscopy any region (126.10) May only be added to the examination when fluoroscopy is not included in the standard procedure code. May not be added to: any angiography, venography, lymphangiography or interventional codes. any contrasted fluoroscopy examination X-ray fluoroscopy guidance for biopsy, any region (295.90) Add to the procedure eg , 80605, X-ray C-Arm (equipment fee only, not procedure) per half hour (135.10) Only to be used if equipment is owned by the radiologist X-ray C-arm fluoroscopy in theatre per half hour (procedure only) (128.40) X-ray fixed theatre installation (equipment fee only) (126.10) Only to be used if equipment is owned by the radiologist X-ray examination contrast material Identification code for the use of contrast with a procedure. Appropriate codes to be supplied Ultrasound with mobile unit in other facility (102.70) Add to the relevant ultrasound examination codes eg Ultrasound intra-operative study (408.60) Covers all regions studied. Single code per operative procedure Ultrasound guidance (675.40) Comprehensive ultrasound code including regional study and guidance Guided procedure code to be added eg , 80605, Ultrasound guidance for tissue ablation (627.40) Comprehensive ultrasound code including regional study and guidance Radiologist assistance (01030) may be added if procedure is performed by a non-radiologist. Guided procedure code to be added if performed by a radiologist or Ultrasound limited Doppler study any region (362.80) Stand alone code may not be added to any other code Ultrasound examination contrast material Dec 2006 Page 2 of 44 Version

3 Identification code for the use of contrast with a procedure. Appropriate codes to be supplied CT planning study for radiotherapy ( ) Radiology prosthetic device To be used once per planning session for any region CT guidance (separate procedure) (944.50) Comprehensive CT code including regional study and guidance. Guided procedure code to be added eg 80600, 80605, and CT guidance, with diagnostic procedure (472.20) To be added to the diagnostic procedure code. Guided procedure code to be added eg 80600, 80605, CT guidance and monitoring for tissue ablation ( ) May only be used once per procedure for a region. Radiologist assistance (01030) may be added if procedure is performed by a non-radiologist. If performed by radiologist, add procedural code 80620, or CT examination contrast material Identification code for the use of contrast with a procedure. Appropriate codes to be supplied MR study of the whole body for metastases screening ( ) MR Spectroscopy any region ( ) May be added to the regional study, once only MR guidance for needle replacement ( ) Comprehensive MRI code including region studied and guidance. Guided procedure code to be added eg 80600, 80605, MR low field strength imaging of peripheral joint any region (669.80) MR planning study for radiotherapy or surgical procedure ( ) MR planning study for radiotherapy or surgical procedure, with contrast ( ) MR examination contrast material Identification code for the use of contrast with a procedure. Appropriate codes to be supplied Analogue monoplane screening table ( ) A machine code may be added once per complete procedure / patient visit Analogue monoplane table with DSA attachment ( ) A machine code may be added once per complete procedure / patient visit Dedicated angiography suite: Analogue monoplane unit. Once off charge per patient by owner of equipment. ( ) A machine code may be added once per complete procedure / patient visit Digital monoplane screening table ( ) A machine code may be added once per complete procedure / patient visit Dedicated angiography suite: Digital monoplane unit. Once off charge per patient by owner of equipment. ( ) A machine code may be added once per complete procedure / patient visit Dedicated angiography suite: Digital bi-plane unit. Once off charge per patient by owner of equipment. ( ) A machine code may be added once per complete procedure / patient visit Angiography and interventional examination contrast material Identification code for the use of contrast with a procedure. Appropriate codes to be supplied Nuclear Medicine study - Bone, whole body, appendicular and axial skeleton ( ) Nuclear Medicine study - Bone, whole body, appendicular and axial skeleton and SPECT ( ) Nuclear Medicine study - Venous thrombosis regional ( ) 18 Dec 2006 Page 3 of 44 Version

4 00909 Nuclear Medicine study - Tumour whole body ( ) Nuclear Medicine study - Tumour whole body multiple studies ( ) Nuclear Medicine study - Tumour whole body and SPECT ( ) Nuclear Medicine study - Tumour whole body multiple studies & SPECT ( ) Nuclear Medicine study Infection whole body ( ) Nuclear Medicine study infection whole body with SPECT ( ) Nuclear Medicine study infection whole body multiple studies ( ) Nuclear Medicine study infection whole body with SPECT multiple studies ( ) Nuclear Medicine study - Bone marrow imaging limited area ( ) Nuclear Medicine study - Bone marrow imaging whole body ( ) Nuclear Medicine study - Bone marrow imaging limited area multiple studies ( ) Nuclear Medicine study - Bone marrow imaging whole body multiple studies ( ) Nuclear Medicine study - Spleen imaging only - haematopoietic ( ) Nuclear Medicine therapy Hyperthyroidism (669.30) Nuclear Medicine therapy - Thyroid carcinoma and metastases (361.10) Nuclear Medicine therapy Intra-cavity radio-active colloid therapy (361.10) Nuclear Medicine therapy - Interstitial radio-active colloid therapy (361.10) Nuclear Medicine therapy - Intravascular radio pharmaceutical therapy particulate (361.10) Nuclear Medicine therapy - Intra-articular radio pharmaceutical therapy (361.10) Nuclear Medicine Isotope Identification code for the use of isotope with a procedure. Appropriate codes to be supplied Nuclear Medicine Substrate Call and assistance Emergency call out code only to be used if radiologist is called out to the rooms to report on an examination after normal working hours. May not be used for routine reporting during extended working hours. Emergency call out code only to be used when a radiologist reports on subsequent cases after having been called out to the rooms to report an initial after hours procedure. This code may also be used for home tele-radiology reporting of an emergency procedure. May not be used for routine reporting during normal or extended working hours. Radiologist assistance in theatre code only to be used if the radiologist is actively involved in assisting another radiologist or clinician with a procedure. Radiographer assistance in theatre may not be used for procedures performed in facilities owned by the radiologist; ie only for attendance in hospital theatres etc. Does not apply to Bed Side Unit (BSU) examinations. Second opinion consultations only to be used if a written report is provided as indicated in codes 01050, 01055, Not intended for ad hoc verbal consultations Emergency call out fee, first case (167.50) Emergency call out fee, subsequent cases same trip (111.70) Radiologist assistance in theatre, per half hour (334.90) Radiographer attendance in theatre, per half hour (89.30) Written report on study done elsewhere, short (83.80) Written report on study done elsewhere, extensive (234.50) Written report for medico legal purposes, per hour (542.50) Consultation for pre-assessment of interventional procedure (271.30) X-ray procedure after hours, per procedure Dec 2006 Page 4 of 44 Version

5 01200 Ultrasound procedure after hours, per procedure CT procedure after hours, per procedure MR procedure after hours, per procedure Angiography procedure after hours, per procedure Interventional procedure after hours, per procedure Consultation for nuclear medicine study (122.80) Monitoring ECG / Pulse oximetry monitoring (02010). Use for monitoring patients requiring conscious sedation during imaging procedure. Not to be used as a routine ECG/pulse Oximeter monitoring (111.70) Head Skull and Brain Codes (skull) and (tomography) may be combined X-ray of the skull (215.40) X-ray tomography of the skull (240.00) X-ray shuntogram for VP shunt (857.40) Ultrasound of the brain Neonatal (411.90) Ultrasound of the brain including doppler (737.90) Ultrasound of the intracranial vasculature, including B mode, pulse and colour doppler (839.60) CT Brain uncontrasted ( ) CT Brain with contrast only ( ) CT Brain pre and post contrast ( ) CT brain pre and post contrast for perfusion studies ( ) Stand alone code may not be added to any other CT studies of the brain, except for code CT angiography of the brain ( ) CT of the brain pre and post contrast with angiography ( ) CT brain for cranio-stenosis including 3D ( ) CT Brain stereotactic localisation ( ) CT base of skull coronal high resolution study for CSF leak ( ) MR of the brain, limited study ( ) MR of the brain uncontrasted ( ) MR of the brain with contrast ( ) MR of the brain pre and post contrast ( ) MR of the brain pre and post contrast, for perfusion studies ( ) MR of the brain plus angiography ( ) MR of the brain pre and post contrast plus angiography ( ) MR angiography of the brain uncontrasted ( ) MR angiography of the brain contrasted ( ) MR of the brain, with diffusion studies ( ) MR of the brain, pre and post contrast, with diffusion studies, ( ) 18 Dec 2006 Page 5 of 44 Version

6 10492 MR study of the brain plus angiography plus diffusion, uncontrasted ( ) MR of the brain pre and post contrast plus angiography and diffusion ( ) Arteriography of intracranial vessels: 1-2 vessels ( ) Arteriography of intracranial vessels: 3-4 vessels ( ) Arteriography of extra-cranial (non-cervical) vessels ( ) Arteriography of intracranial and extra-cranial (non-cervical) vessels ( ) Arteriography of intracranial vessels (4) plus 3 D rotational angiography ( ) Arteriography of intracranial vessels (1) plus 3D rotational angiography ( ) Venography of dural sinuses ( ) Nuclear Medicine study Bone regional, static ( ) Nuclear Medicine study Bone regional, static, with flow ( ) Nuclear Medicine study Bone regional, static with SPECT ( ) Nuclear Medicine study Bone regional, static, with flow, with SPECT ( ) Nuclear Medicine study Brain, planar, complete, static (944.50) Nuclear Medicine study Brain complete static with vascular flow ( ) Nuclear Medicine study Brain, planar, complete, static, with SPECT ( ) Nuclear Medicine study Brain, planar, complete, static, with flow, with SPECT ( ) Nuclear Medicine study - CSF flow imaging cisternography ( ) Nuclear Medicine study Ventriculography Nuclear Medicine study - Shunt evaluation static, planar Nuclear Medicine study - CFS leakage detection and localisation Nuclear medicine study - CSF SPECT Facial bones and nasal bones Codes (facial bones) and (tomography) may be combined X-ray of the facial bones (219.40) X-ray tomography of the facial bones (240.00) X-ray of the nasal bones (133.40) CT of the facial bones ( ) CT of the facial bones with 3D reconstructions ( ) CT of the facial bones/soft tissue, pre and post contrast ( ) MR of the facial soft tissue ( ) MR of the facial soft tissue pre and post contrast ( ) MR of the facial soft tissue plus angiography, with contrast ( ) MR angiography of the facial soft tissue ( ) Orbits, lacrimal glands and tear ducts Code (tomography) may be added to or or (orbits) or (dacrocystography) X-ray orbits less than three views (198.70) 18 Dec 2006 Page 6 of 44 Version

7 12110 X-ray of the orbits, three or more views, including foramina (295.90) X-ray of the orbits for foreign body (198.70) X-ray tomography of the orbits (240.00) X-ray dacrocystography (625.20) Ultrasound of the orbit/eye (286.30) Ultrasound of the orbit/eye including doppler (612.40) CT of the orbits single plane (876.40) CT of the orbits, more than one plane ( ) CT of the orbits pre and post contrast single plane ( ) CT of the orbits pre and post contrast multiple planes ( ) MR of the orbits ( ) MR of the orbitae, pre and post contrast ( ) Nuclear Medicine study Dacrocystography ( ) Paranasal sinuses Code (tomography) may be added to 13100, (paranasal sinuses), (nasopharyngeal) X-ray of the paranasal sinuses, single view (153.00) X-ray of the paranasal sinuses, two or more views (204.30) X-ray tomography of the paranasal sinuses (240.00) X-ray of the naso-pharyngeal soft tissue (153.00) CT of the paranasal sinuses single plane, limited study (401.90) CT of the paranasal sinuses, two planes, limited study (692.20) CT of the paranasal sinuses, any plane, complete study (860.70) CT of the paranasal sinuses, more than one plane, complete study ( ) CT of the paranasal sinuses, any plane, complete study: pre and post contrast ( ) CT of the paranasal sinuses, more than one plane, complete study; pre and post contrast ( ) MR of the paranasal sinuses ( ) MR of the paranasal sinuses, pre and post contrast ( ) Mandible, teeth and maxilla Code (orthopantomogram) may be combined with (mandible) if two separate studies are performed Code (orthopantomogram) may be combined with and / or (TM joint) if complete separate studies are performed. Code (tomography) may be combined with or or (teeth). Code (tomography) may be combined with and / or (TM joint) if complete separate studies are performed. Code and (Dental implants) may be combined if mandible and maxilla are examined at the same visit X-ray of the mandible (204.30) X-ray orthopantomogram of the jaws and teeth (226.70) X-ray maxillofacial cephalometry (154.60) X-ray of the teeth single quadrant (111.70) X-ray of the teeth more than one quadrant (141.20) X-ray of the teeth full mouth (202.10) 18 Dec 2006 Page 7 of 44 Version

8 14160 X-ray tomography of the teeth per side (180.30) CT of the mandible ( ) CT of the mandible, pre and post contrast ( ) CT mandible with 3D reconstructions ( ) CT for dental implants in the mandible ( ) CT for dental implants in the maxilla ( ) MR of the mandible/maxilla ( ) MR of the mandible/maxilla, pre and post contrast ( ) TM Joints Code (TM joint) and (tomography) may be combined Code (TM joint) and (tomography) may be combined. Code (arthrography) and (tomography) may be combined. Code (arthrography) and (tomography)may be combined. Codes (CT arthrogram) and (MR arthrogram) include introduction of contrast (00140 may not be added) X-ray tempero-mandibular joint, left (198.70) X-ray tempero-mandibular joint, right (198.70) X-ray tomography tempero-mandibular joint, left (240.00) X-ray tomography tempero-mandibular joint, right (240.00) X-ray arthrography of the tempero-mandibular joint, left (860.20) X-ray arthrography of the tempero-mandibular joint, right (860.20) Ultrasound tempero-mandibular joints, one or both sides (366.10) CT of the tempero-mandibular joints ( ) CT of the tempero-mandibular joints plus 3D reconstructions ( ) CT arthrogram of the tempero-mandibular joints ( ) MR of the tempero-mandibular joints ( ) MR of the tempero-mandibular joints, pre and post contrast ( ) MR arthrogram of the tempero-mandibular joints ( ) Mastoids and internal auditory canal Code (mastoids) and (tomography) may be combined Code (mastoids bilat) and (tomography) may be combined Code (IAM s) and (tomography) may be combined X-ray of the mastoids, unilateral (200.40) X-ray of the mastoids, bilateral (400.80) X-ray tomography of the petro-temporal bone, unilateral (240.00) X-ray tomography of the petro-temporal bone, bilateral (480.10) X-ray internal auditory canal, bilateral (291.90) X-ray tomography of the internal auditory canal, bilateral (240.00) CT of the mastoids (703.30) CT of the internal auditory canal ( ) CT of the internal auditory canal, pre and post contrast ( ) 18 Dec 2006 Page 8 of 44 Version

9 16330 CT of the ear structures, limited study (748.00) CT of the middle and inner ear structures, high definition including all reconstructions in various planes ( ) MR of the internal auditory canals, limited study ( ) MR of the internal auditory canals, pre and post contrast, limited study ( ) MR of the internal auditory canals, pre and post contrast, complete study ( ) MR of the ear structures ( ) MR of the ear structures, pre and post contrast ( ) Sella turcica Code (sella) and (tomography) may be combined X-ray of the sella turcica (171.90) X-ray tomography of the sella turcica (240.00) CT of the sella turcica/hypophysis (974.00) CT of the sella turcica/hypophysis, pre and post contrast ( ) MR of the hypophysis ( ) MR of the hypophysis, pre and post contrast ( ) Salivary glands and floor of the mouth Code (calculus) and (open mouth) may be combined Codes (sialography) and (CT sialography) include introduction of contrast and fluoroscopy (00140 may not be added) X-ray of the salivary glands and ducts for calculus (158.50) X-ray of the salivary ducts, open mouth for calculus (106.10) X-ray sialography, per gland (786.00) Ultrasound of the salivary glands/floor of the mouth (366.10) CT of the salivary glands, uncontrasted (703.30) CT of the salivary glands/floor of the mouth, pre and post contrast ( ) CT sialography ( ) MR of the salivary glands/floor of the mouth ( ) MR of the salivary glands/floor of the mouth, pre and post contrast ( ) Nuclear Medicine study - Salivary gland imaging ( ) Soft Tissue Nuclear Medicine study - Tumour localisation planar, static ( ) Nuclear Medicine study - Tumour localisation planar, static, multiple studies ( ) Nuclear Medicine study - Tumour localisation planar, static and SPECT ( ) Nuclear Medicine study - Tumour localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study - Infection localisation planar, static ( ) Nuclear medicine study - Infection localisation planar, static, multiple studies ( ) Nuclear medicine study - Infection localisation planar, static and SPECT ( ) Nuclear medicine study - Infection localisation planar, static, multiple studies and SPECT ( ) 18 Dec 2006 Page 9 of 44 Version

10 Neck Code (laryngography) includes fluoroscopy (00140 may not be added) Code (speech) includes tomography and cinematography (00140 may not be added). Code (MR Angiography) may be combined with (MR brain) X-ray of soft tissue of the neck (153.00) X-ray of the larynx including tomography (524.10) X-ray laryngography (462.20) X-ray evaluation of pharyngeal movement and speech by screening and / or cine with or without video recording (463.30) Ultrasound of the thyroid (366.10) Ultrasound of soft tissue of the neck (366.10) Ultrasound of the carotid arteries, bilateral including B mode, pulsed and colour doppler (837.30) Ultrasound of the entire extracranial vascular tree including carotids, vertebral and subclavian vessels with B mode, pulse and colour doppler ( ) Ultrasound study of the venous system of the neck including pulse and colour Doppler (602.80) CT of the soft tissues of the neck ( ) CT of the soft tissues of the neck, with contrast ( ) CT of the soft tissues of the neck, pre and post contrast ( ) CT angiography of the extracranial vessels in the neck ( ) CT angiography of the extracranial vessels in the neck and intracranial vessels of the brain ( ) CT angiography of the extracranial vessels in the neck and intracranial vessels of the brain plus a pre and post contrast study of the brain ( ) Mr of the soft tissue of the neck ( ) MR of the soft tissue of the neck, pre and post contrast ( ) MR of the soft tissue of the neck and uncontrasted angiography ( ) MR angiography of the extracranial vessels in the neck, without contrast ( ) MR angiography of the extracranial vessels in the neck, with contrast ( ) MR angiography of the extra and intracranial vessels with contrast ( ) MR angiography of the intra and extra cranial vessels plus brain, without contrast ( ) MR angiography of the intra and extra cranial vessels plus brain, with contrast ( ) Arteriography of cervical vessels: carotid 1-2 vessels ( ) Arteriography of cervical vessels: vertebral 1-2 vessels ( ) Arteriography of cervical vessels: carotid and vertebral ( ) Arteriography of aortic arch and cervical vessels ( ) Arteriography of aortic arch, cervical and intracranial vessels ( ) Venography of jugular and vertebral veins ( ) Thyroid (Nuclear Medicine) Nuclear Medicine study - Thyroid, single uptake (540.40) Nuclear medicine study - Thyroid, multiple uptake (820.00) Nuclear medicine study - Thyroid imaging with uptake (989.10) Nuclear medicine study - Thyroid imaging (710.00) 18 Dec 2006 Page 10 of 44 Version

11 21940 Nuclear medicine study - Thyroid imaging with vascular flow ( ) Nuclear medicine study - Thyroid suppression/stimulation (710.00) Parathyroid (Nuclear Medicine) Nuclear Medicine study - Parathyroid, planar, static (922.10) Nuclear medicine study - Parathyroid, planar, static, multiple ( ) Nuclear medicine study - Parathyroid, planar, static with subtraction technique ( ) Nuclear medicine study - Parathyroid SPECT Soft Tissue Nuclear Medicine study - Tumour localisation planar, static ( ) Nuclear medicine study - Tumour localisation planar, static, multiple studies ( ) Nuclear medicine study - Tumour localisation planar, static and SPECT ( ) Nuclear medicine study - Tumour localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study - Tumour localisation planar, static ( ) Nuclear medicine study - Infection localisation planar, static, multiple studies ( ) Nuclear medicine study - Infection localisation planar, static and SPECT ( ) Nuclear medicine study - Infection localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study - Regional lymph node mapping, static, planar ( ) Nuclear medicine study - Regional lymph node mapping, static, planar, multiple ( ) Nuclear medicine study Lymph node localisation with gamma probe (691.60) Thorax Chest wall, pleura, lungs and mediastinum Code (tomography) may be combined with or (chest) or or (ribs) or (thoracic inlet) Codes (Sterno-clavicular) and (tomography) may be combined. Code (sternum) and (tomography) may be combined. Code (CT limited high resolution) may be combined with or or (CT chest). Motivation may be required. Code (high resolution) is a stand alone study. Code 30360, (CT chest for pulmonary embolism) is a complete examination and includes the preceding uncontrasted CT scan of the chest, and may not be combined with or (CT abdomen and pelvis). Code (CT pulmonary embolism plus CT venography) may not be combined with (Doppler) X-ray of the chest, single view (169.60) X-ray of the chest two views, PA and lateral (214.40) X-ray of the chest complete with additional views (236.70) X-ray of the chest complete including fluoroscopy (250.10) X-ray tomography of the chest (240.00) X-ray of the ribs (267.40) X-ray of the chest and ribs (358.30) X-ray of the thoracic inlet (142.90) X-ray of the sterno-clavicular joints (235.00) X-ray tomography of the sterno-clavicular joint (240.00) X-ray of the sternum (235.00) X-ray tomography of the sternum (240.00) 18 Dec 2006 Page 11 of 44 Version

12 30200 Ultrasound of the chest wall, any region (366.10) Ultrasound of the pleural space (366.10) Ultrasound of the mediastinal structures (366.10) CT of the chest, limited study (530.30) CT of the chest uncontrasted ( ) CT of the chest contrasted ( ) CT of the chest, pre and post contrast ( ) CT of the chest, limited high resolution study (625.20) CT of the chest, complete high resolution study ( ) CT of the chest, complete high resolution study with additonal prone and expiratory studies ( ) CT of the chest for pulmonary embolism ( ) CT of the chest for pulmonary embolism with CT venography of abdomen, pelvis and lower limbs ( ) MR of the chest ( ) MR of the chest with uncontrasted angiography ( ) MR of the chest, pre and post contrast ( ) Nuclear Medicine study - Lung perfusion ( ) Nuclear Medicine study - Lung ventilation, aerosol ( ) Nuclear Medicine study - Lung perfusion and ventilation ( ) Nuclear Medicine study - Lung ventilation using radio-active gas (791.00) Nuclear Medicine study - Lung perfusion and ventilation using radio-active gas ( ) Nuclear medicine study - Muco-ciliary clearance study dynamic ( ) Nuclear medine study - alveolar permeabillity ( ) Stand alone code. Not to be combined with Nuclear medicine study - quantitative evaluation of lung perfusion and ventilation (336.10) Stand alone code. Not to be combined with Oesophagus Codes 31100, 31110, (swallow) include fluoroscopy (00140 may not be added) X-ray barium swallow (368.40) Xray 3 phase dynamic contrasted swallow (703.30) X-ray barium swallow, double contrast (442.10) X-ray barium swallow with cinematography (562.10) Aorta and large vessels Codes and (Ivus) may be combined Ultrasound intravascular arterial or venous assessment for intervention, once per complete procedure (234.50) Ultrasound intravascular (IVUS) first vessel (471.10) Ultrasound intravascular (IVUS) subsequent vessels (295.90) CT angiography of the aorta and branches ( ) 18 Dec 2006 Page 12 of 44 Version

13 32305 CT angiography of the thoracic and abdominal aorta and branches ( ) CT angiography of the pulmonary vasculature ( ) MR angiography of the aorta and branches ( ) MR angiography of the pulmonary vasculature ( ) Arteriography of thoracic aorta ( ) Arteriography of bronchial intercostal vessels alone ( ) Arteriography of thoracic aorta, bronchial and intercostal vessels ( ) Arteriography of pulmonary vessels ( ) Arteriography of heart chambers, coronary arteries ( ) Venography of thoracic vena cava ( ) Venography of vena cava, azygos system ( ) Venography patency of A-port or other central line ( ) Heart Codes (CT anatomy / function) and (CT Angiography) may be done as stand alone studies or as additive studies if both are performed at the same time Ultrasound study of the heart for foetal or paediatric cases including doppler (686.60) Code is a stand alone study and may not be added to or This code is intended for paediatric and foetal cases only Ultrasound study of the heart, including Doppler (457.70) Ultrasound study of the heart trans-oesophageal (587.20) Ultrasound intravascular imaging to guide placement of intracoronary stent once per vessel (290.30) CT anatomical/functional study of the heart ( ) CT angiography of heart vessels ( ) MR of the heart, anatomical study ( ) MR of the heart, anatomical and functional study ( ) MR of the heart, pre and post contrast ( ) MR angiography of the heart vessels ( ) MR of the heart, anatomical, functional and coronary angiography ( ) Nuclear Medicine study - Cardiac shunt detection ( ) Nuclear Medicine study - Cardiac blood pool imaging, ejection fraction plus wall motion single study ( ) Nuclear Medicine study - Cardiac blood pool imaging, ejection fraction plus wall motion multiple studies ( ) Nuclear Medicine study - Cardiac blood pool imaging, gated SPECT Nuclear medicine study - Cardiac blood pool imaging, first pass technique ( ) Nuclear medicine study - Myocardial perfusion, single, rest (thallium/mibi) planar, non gated (922.10) Nuclear medicine study - Myocardial perfusion, single, stress (thallium/mibi) planar, non gated (922.10) Nuclear medicine study - Myocardial perfusion, single, rest (thallium/mibi), SPECT (non gated) (922.10) Nuclear medicine study - Myocardial perfusion, single, stress (thallium/mibi), SPECT non gated (922.10) Nuclear medicine study - Myocardial perfusion, single, rest (thallium/mibi), SPECT (gated) ( ) 18 Dec 2006 Page 13 of 44 Version

14 33950 Nuclear medicine study - Myocardial perfusion, single, stress (thallium/mibi), SPECT (gated) ( ) Nuclear medicine study - Plus wall movement and ejection fraction, SPECT (336.10) Nuclear medicine study - Cardiac hot spot imaging (infarction) planar ( ) Nuclear medicine study - Cardiac hot spot imaging (infarction) SPECT Nuclear Medicine study - Multi stage treadmill ECG test (371.80) Mamma Codes (localization), (stereo-tactic localization) and (stereo-tactic biopsy) may not be combined Code (stereo-tactic biopsy). Add procedural code (cutting needle) or (mammotome) Code (U/S FNA) includes the procedural code (may not be combined with 34150) X-ray mammography including ultrasound (582.70) X-Ray mammography unilateral, including ultrasound (466.20) Code may not be combined with when these two procedures are done in the same sitting. Code includes ultrasound. In this situation use code (fine needle aspiration) with X-ray mammography galactography (524.70) Once off fee per visit. May be added to X-ray mammography study for localisation (404.10) X-ray stereotactic mammography localisation (580.50) X-ray stereotactic mammography biopsy (647.50) X-ray of biopsy specimen of the mamma (153.00) X-ray Mammotome hand held biopsy apparatus (547.00) Ultrasound study of the breast (441.00) Ultrasound guided aspiration FNA/localisation of the breast (675.40) Computer assisted diagnosis for mammography (78.20) MR study of the breast ( ) MR study of the breast pre and post contrast ( ) Soft Tissue Nuclear medicine study - Tumour localisation planar, static ( ) Nuclear medicine study - Tumour localisation planar, static, multiple studies ( ) Nuclear medicine study - Tumour localisation planar, static and SPECT ( ) Nuclear medicine study - Tumour localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study - Infection localisation planar, static ( ) Nuclear medicine study - Infection localisation planar, static, multiple studies ( ) Nuclear medicine study - Infection localisation planar, static and SPECT ( ) Nuclear medicine study - Infection localisation planar, static, multiple studies, SPECT ( ) Nuclear medicine study - Regional lymph node mapping, static, planar ( ) Nuclear medicine study - Regional lymph node mapping, static, planar, multiple ( ) Nuclear medicine study Lymph node localisation with gamma probe (691.60) 18 Dec 2006 Page 14 of 44 Version

15 Abdomen and Pelvis Abdomen/stomach/bowel Code (tomography) may be combined with or or (abdomen) Codes to (barium studies) include fluoroscopy (00140 may not be added). Code (intussusception) is a stand alone code and may not be combined with or (barium enema), (00140 may not be added) X-ray of the abdomen (185.40) X-ray of the abdomen supine and erect, or decubitus (299.20) X-ray of the abdomen multiple views including chest (452.10) X-ray tomography of the abdomen (240.00) X-ray barium meal single contrast (495.10) X-ray barium meal double contrast (669.30) X-ray barium meal double contrast with follow through (881.90) X-ray small bowel enteroclysis (meal) ( ) Code excludes duodenal intubation and (Duodenal intubation) may be added X-ray small bowel meal follow through single contrast ( ) X-ray small bowel meal with pneumocolon ( ) X-ray large bowel enema single contrast (723.90) X-ray large bowel enema double contrast ( ) X-ray guided gastro oesophageal intubation (89.30) X-ray guided duodenal intubation (156.30) X-ray defaecogram (723.90) X-ray guided reduction of intussusception (908.20) Ultrasound study of the abdominal wall (309.20) Ultrasound study of the whole abdomen including the pelvis (459.90) CT study of the abdomen ( ) CT study of the abdomen with contrast ( ) CT study of the abdomen pre and post contrast ( ) CT of the pelvis ( ) CT of the pelvis with contrast ( ) CT of the pelvis pre and post contrast ( ) CT of the abdomen and pelvis ( ) CT of the abdomen and pelvis with contrast ( ) CT of the abdomen and pelvis pre and post contrast ( ) CT triphasic study of the liver, abdomen and pelvis pre and post contrast ( ) CT of the chest, abdomen and pelvis without contrast ( ) CT of the chest, abdomen and pelvis with contrast ( ) CT of the chest triphasic of the liver, abdomen and pelvis with contrast ( ) 18 Dec 2006 Page 15 of 44 Version

16 40360 CT of the base of skull to symphysis pubis with contrast ( ) CT colonoscopy ( ) Stand alone study, may not be added to any code between and MR of the abdomen ( ) MR of the abdomen pre and post contrast ( ) MR of the pelvis, soft tissue ( ) MR of the pelvis, soft tissue, pre and post contrast ( ) Nuclear Medicine study - Gastro oesophageal reflux and emptying ( ) Nuclear Medicine study - Gastro oesophageal reflux and emptying multiple studies ( ) Nuclear Medicine study - Gastro intestinal protein loss ( ) Nuclear Medicine study - Gastro intestinal protein loss multiple studies ( ) Nuclear Medicine study Acute GIT bleed static/dynamic ( ) Nuclear medicine study Acute GIT bleed multiple studies ( ) Nuclear medicine study - Meckel's localisation ( ) Nuclear medicine study - Gastric mucosa imaging ( ) Nuclear medicine study - colonic transit multiple studies ( ) Stand alone code Liver, spleen, gall bladder and pancreas Code 41110, and (cholangiography) include fluoroscopy (00140 may not be added) X-ray ERCP including screening ( ) X-ray ERCP reporting on images done in theatre (133.90) X-ray cholangiography intra-operative (471.70) X-ray T-tube cholangiography post operative (784.30) X-ray transhepatic percutaneous cholangiography ( ) Ultrasound study of the upper abdomen (390.70) Ultrasound doppler of the hepatic and splenic veins and inferior vena cava in assessment of portal venous hypertension or thrombosis (547.00) Code is a stand alone study and may not be added to 40200, 40210, or CT of the abdomen triphasic study liver ( ) MR study of the liver/pancreas ( ) MR study of the liver/pancreas pre and post contrast ( ) MRCP ( ) MR study of the abdomen with MRCP ( ) MR study of the abdomen pre and post contrast with MRCP ( ) Nuclear Medicine study - Liver and spleen, planar views only ( ) Nuclear Medicine study - Liver and spleen, with flow study ( ) Nuclear Medicine study - Liver and spleen, planar views SPECT ( ) 18 Dec 2006 Page 16 of 44 Version

17 41915 Nuclear Medicine study - Liver and spleen, with flow study and SPECT ( ) Nuclear Medicine study - Hepatobiliary system planar static/dynamic ( ) Nuclear Medicine study hepatobiliary tract including flow ( ) Nuclear medicine study Hepatobiliary system planar, static/dynamic multiple studies ( ) Nuclear medicine study Hepatobiliary tract including flow multiple studies ( ) Nuclear medicine study - Gall bladder ejection fraction (336.10) Nuclear medicine study Biliary gastric reflux study ( ) Renal tract X-ray tomography of the renal tract (240.00) Code (tomography) may not be added to or (IVP) Codes (IVP), (cystography), (urethography), (MCU), (retrograde), and (prograde) include fluoroscopy (00140 may not be added) X-ray excretory urogram including tomography ( ) X-ray excretory urogram including tomography with micturating study ( ) X-ray cystography (840.10) X-ray urethrography (858.00) X-ray micturating cysto-urethrography ( ) X-ray retrograde/prograde pyelography (699.40) X-ray retrograde/prograde pyelography reporting on images done in theatre (134.60) X-ray prograde pyelogram percutaneous ( ) Ultrasound study of the renal tract including bladder (414.20) Ultrasound doppler for resistive index in vessels of transplanted kidney (212.10) Code is a stand alone study and may not be added to Ultrasound study of the renal arteries including Doppler (591.70) CT of the renal tract for a stone ( ) MR of the renal tract for obstruction ( ) MR of the kidneys without contrast ( ) MR of the kidneys pre and post contrast ( ) Nuclear Medicine study - Renal imaging, static (e.g. DMSA) ( ) Nuclear Medicine study - Renal imaging, static (e.g. DMSA) with flow ( ) Nuclear Medicine study - Renal imaging, static (e.g. DMSA) with SPECT ( ) Nuclear Medicine study - Renal imaging, static (e.g. DMSA), with flow, with SPECT ( ) Nuclear Medicine study - Renal imaging dynamic (renogram) and vascular flow ( ) Nuclear Medicine study Renovascular study, baseline ( ) Nuclear Medicine study Renovascular study, with intervention ( ) Nuclear medicine study - indirect voiding cystogram (336.10) 18 Dec 2006 Page 17 of 44 Version

18 Reproductive system Codes and (hystero-salpingography) include fluoroscopy (00140 may not be added) Codes (U/S ova aspiration) and (amniocentesis) are complete procedure codes. Codes (U/S ova aspiration) and (amniocentesis) are complete procedures and may not be combined with (ultrasound guidance) or (fine needle aspiration). Code may be combined with (second trimester), (third trimester) and (third trimester follow up) X-ray pelvimetry single (223.20) X-ray pelvimetry multiple views (323.80) X-ray hystero-salpingography (559.80) X-ray hystero-salpingography with introduction of contrast (755.30) Ultrasound study of the pelvis transabdominal (318.20) Ultrasound study of the female pelvis transvaginal (402.50) Ultrasound study of the prostate transrectal (411.90) Ultrasound transrectal prostate volume for brachytherapy (580.50) Ultrasound study of the testes (411.90) Ultrasound study for male impotence including doppler and injection of vaso contrictor (837.30) Code is a stand alone study and may not be added to 43200, 43210, or Ultrasound guided transvaginal aspiration for ova (753.60) Ultrasound guided amniocenthesis (326.00) Ultrasound study of the pregnant uterus, first trimester (234.50) Ultrasound study of the pregnant uterus, second trimester (355.00) Ultrasound study of the pregnant uterus, third trimester, first visit (355.00) Ultrasound study of the pregnant uterus, third trimester, follow-up visit (234.50) Ultrasound study of the pregnant uterus, multiple gestation, second or third trimester, first visit (456.10) Ultrasound doppler of the umbilical cord for resistive index (212.10) Code is a stand alone study and may not be added to the following codes: 43250, 43260, 43270, or CT pelvimetry Topogram (367.30) MR study of pelvic reproductive organs - limited study ( ) MR study for pelvimetry ( ) MR study of pelvic reproductive organs - complete uncontrasted ( ) MR study of pelvic reproductive organs - complete pre and post contrast ( ) Nuclear medicine study - Radio pharmaceutical voiding cystogram ( ) Nuclear medicine study - Testicular imaging ( ) Nuclear medicine study - hystero-salpingography ( ) Aorta and vessels Code (MR Angiography) may be combined with (MR abdomen) Ultrasound study of abdominal aorta and branches including doppler ( ) Ultrasound study of the IVC and pelvic veins including Doppler (781.50) This is a stand alone code and may not be added to Dec 2006 Page 18 of 44 Version

19 44300 CT angiography of abdominal aorta and branches ( ) CT angiography of the abdominal aorta and branches and pre and post contrast study of the upper abdomen ( ) CT angiography of the pelvis ( ) CT angiography of the abdominal aorta and pelvis ( ) CT angiography of the abdominal aorta and pelvis and pre and post contrast study of the upper abdomen and pelvis ( ) CT portogram ( ) MR angiography of abdominal aorta and branches ( ) Arteriography of abdominal aorta alone ( ) Arteriography of aorta plus coeliac, mesenteric branches ( ) Arteriography of aorta plus renal, adrenal branches ( ) Arteriography of aorta plus non-visceral branches ( ) Arteriography of coeliac, mesenteric vessels alone ( ) Arteriography of renal, adrenal vessels alone ( ) Arteriography of non-visceral abdominal vessels alone ( ) Arteriography of internal and external iliac vessels alone ( ) Venography of internal and external iliac veins alone ( ) Corpora cavernosography ( ) Vasography, vesciculography ( ) Venography of inferior vena cava ( ) Venography of hepatic veins alone ( ) Venography of inferior vena cava and hepatic veins ( ) Venography of lumbar azygos system alone ( ) Venography of inferior vena cava and lumbar azygos veins ( ) Venography of renal, adrenal veins alone ( ) Venography of inferior vena cava and renal/adrenal veins ( ) Venography of spermatic, ovarian veins alone ( ) Venography of inferior vena cava, renal, spermatic, ovarian veins ( ) Venography indirect splenoportogram ( ) Venography direct splenoportogram ( ) Venography transhepatic portogram ( ) Soft Tissue Nuclear Medicine study Tumour localisation planar, static ( ) Nuclear Medicine study Tumour localisation planar, static, multiple studies ( ) Nuclear Medicine study Tumour localisation planar, static and SPECT ( ) Nuclear medicine study Tumour localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study Infection localisation planar, static ( ) 18 Dec 2006 Page 19 of 44 Version

20 49930 Nuclear medicine study Infection localisation planar, static, multiple studies ( ) Nuclear medicine study Infection localisation planar, static and SPECT ( ) Nuclear medicine study Infection localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study Regional lymph node mapping dynamic (279.60) Nuclear medicine study Regional lymph node mapping, static, planar ( ) Nuclear medicine study Regional lymph node mapping, static, planar, multiple ( ) Nuclear medicine study Regional lymph node mapping SPECT Nuclear medicine study Lymph node localisation with gamma probe Spine, Pelvis and Hips Code (CT myelography, cervical), (CT myelography thoracic) and (CT myelography lumbar) are stand alone studies and may not be combined with the conventianla myelography codes viz , 52150, General Code (Lumbar puncture) and (cisternal puncture) include fluoroscopy and introduction of contrast (00140 may not be added) X-ray of the spine scoliosis view AP only (390.70) X-ray of the spine scoliosis view AP and lateral (669.80) X-ray of the spine scoliosis view AP and lateral including stress views ( ) X-ray bone densitometry (643.10) X-ray guided lumbar puncture (267.90) X-ray guided cisternal puncture cisternogram ( ) CT quantitive bone mineral density (660.40) Arteriogram of the spinal column and cord, all vessels ( ) Venography of the spinal, paraspinal veins ( ) Cervical Code (stress) is a stand alone study and may not be added to 51110, (cervical spine), (myelography) and (discography). Code (tomography) may be combined with or (spine). Code 51160s (myelography) and (discography) include fluoroscopy and introduction of contrast (00140 may not be added). Code (CT) limited - limited to a single cervical vertebral body. Code (CT) regional study - 2 vertebral bodies and intervertebral disc spaces. Code (CT) complete study - an extensive study of the cervical spine. Code (CT myelography) post myelographic study and includes all disc levels, includes fluoroscopy and introduction of contrast (00140 may not be added) X-ray f the cervical spine, stress views only (231.10) X-ray of the cervical spine, one or two views (168.00) X-ray of the cervical spine, more than two views (238.90) X-ray of the cervical spine, more than two views including stress views (423.10) X-ray Tomography cervical spine (240.00) X-ray myelography of the cervical spine ( ) X-ray discography cervical spine per level ( ) CT of the cervical spine limited study (530.30) CT of the cervical spine regional study (776.40) CT of the cervical spine complete study ( ) 18 Dec 2006 Page 20 of 44 Version

21 51330 CT of the cervical spine pre and post contrast ( ) CT myelography of the cervical spine ( ) CT myelography of the cervical spine following myelogram ( ) MR of the cervical spine, limited study ( ) MR of the cervical spine and cranio-cervical junction ( ) MR of the cervical spine and cranio-cervical junction pre and post contrast ( ) Nuclear Medicine study Bone regional cervical ( ) Nuclear Medicine study Bone tomography regional cervical Nuclear Medicine study with flow (336.10) Thoracic Code (tomography) may be combined with or (spine) Code (myelography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code (CT) limited study limited to a single thoracic vertebral body. Code (CT) regional study - 2 vertebral bodies and intervertebral disc paces. Code (CT) complete study - an extensive study of the thoracic spine. Code (CT myelography) - post myelographic study and includes all disc levels, fluoroscopy and introduction of contrast (00140 may not be added) X-ray of the thoracic spine, one or two views (179.20) X-ray of the thoracic spine, more than two views (223.20) X-ray tomography thoracic spine (240.00) X-ray of the thoracic spine, more that two views including stress views (370.60) X-ray myelography of the thoracic spine ( ) CT of the thoracic spine limited study (530.30) CT of the thoracic spine regional study (776.40) CT of the thoracic spine complete study ( ) CT of the thoracic spine pre and post contrast ( ) CT myelography of the thoracic spine ( ) CT myelography of the thoracic spine following myelogram ( ) MR of the thoracic spine, limited study ( ) MR of the thoracic spine ( ) MR of the thoracic spine pre and post contrast ( ) Nuclear Medicine study Bone regional dorsal ( ) Nuclear Medicine study Bone tomography regional dorsal Nuclear Medicine study with flow (336.10) Lumbar Code (stress) is a stand alone study and may not be added to 53110, (lumbar spine), (myelography) and (discography). Code (tomography) may be combined with or (spine). Codes (myelography) and (discography) include fluoroscopy and introduction of contrast (00140 may not be added). Code (CT) limited study limited to a single lumbar vertebral body. Code (CT) regional study - 2 vertebral bodies and intervertebral disc spaces. Code (CT) complete study - an extensive study of the lumbar spine. Code (CT myelography) - post myelographic study and includes all disc levels, fluoroscopy and introduction of contrast (00140 may not be added). 18 Dec 2006 Page 21 of 44 Version

22 53100 X-ray of the lumbar spine stress study only (231.10) X-ray of the lumbar spine, one or two views (198.70) X-ray of the lumbar spine, more than two views (248.90) X-ray of the lumbar spine, more that two views including stress views (419.70) X-ray tomography lumbar spine (240.00) X-ray myelography of the lumbar spine ( ) X-ray discography lumbar spine per level ( ) CT of the lumbar spine limited study (530.30) CT of the lumbar spine regional study (776.40) Ct of the lumbar spine complete study ( ) CT of the lumbar spine pre and post contrast ( ) CT myelography of the lumbar spine ( ) CT myelography of the lumbar spine following myelogram ( ) MR of the lumbar spine, limited study ( ) MR of the lumbar spine ( ) MR of the lumbar spine pre and post contrast ( ) Nuclear medicine study Bone regional lumbar ( ) Nuclear medicine study Bone tomography regional lumbar Nuclear medicine study with flow (336.10) Sacrum Code (tomography) may be combined with (sacrum) or (SI joints) Code (CT) limited study - limited to single sacral vertebral body. Code (CT) complete study - an extensive study of the sacral spine X-ray of the sacrum and coccyx (199.80) X-ray of the sacro-iliac joints (228.90) X-ray tomography sacrum and/or coccyx (240.00) CT of the sacrum limited study (424.20) CT of the sacrum complete study uncontrasted ( ) CT of the sacrum with contrast ( ) CT of the sacrum pre and post contrast ( ) MR of the sacrum ( ) MR of the sacrum pre and post contrast ( ) Pelvis Codes (tomography) and (pelvis) may be combined Code (CT) limited study limited to a small region of interest of the pelvis eg. ascetabular roof or pubic ramus X-ray of the pelvis (204.30) X-ray tomography pelvis (240.00) CT of the bony pelvis limited (530.30) CT of the bony pelvis complete uncontrasted ( ) 18 Dec 2006 Page 22 of 44 Version

23 55320 CT of the bony pelvis complete 3D recon ( ) CT of the bony pelvis with contrast ( ) CT of the bony pelvis pre and post contrast ( ) MR of the bony pelvis ( ) MR of the bony pelvis pre and post contrast ( ) Nuclear medicine study Bone regional pelvis ( ) Nuclear medicine study Bone tomography regional pelvis Nuclear medicine study with flow (336.10) Hips Code (tomography) may be combined with or or (hip) Code (stress) may be combined with or or (hip). Code (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code (introduction of contrast into hip joint) to be used with (CT hip) and (MR hip) and includes fluoroscopy. The combination of and and is not supported except in exceptional circumstances with motivation. Code (CT) study limited to small region of interest eg part of femur head X-ray of the left hip (177.50) X-ray of the right hip (177.50) X-ray pelvis and hips (336.10) X-ray tomography hip (240.00) X-ray of the hip/s stress study (244.50) X-ray arthrography of the hip joint including introduction contrast (879.10) X-ray guidance and introduction of contrast into hip joint only (413.60) Ultrasound of the hip joints (362.80) CT of hip limited (530.30) CT of hip complete ( ) CT of hip complete with 3D recon ( ) CT of hip with contrast ( ) CT of hip pre and post contrast ( ) MR of the hip joint/s, limited study ( ) MR of the hip joint/s ( ) MR of the hip joint/s, pre and post contrast ( ) Nuclear medicine study Bone regional pelvis ( ) Nuclear medicine study Bone limited static plus flow ( ) Nuclear medicine study Bone tomography regional Upper limbs General Code (stress only) is a stand alone study and may not be combined with other codes Code (tomography) may be combined with any one of the defined regional x-ray studies of the upper limb. Motivation may be required for more than one regional tomographic study per visit. Code (U/S) may only be used once per visit. Code (CT) limited study limited to a small region of interest eg. part of humeral head. Code (MR limited) may only be used once per visit X-ray upper limbs - any region - stress studies only (252.30) 18 Dec 2006 Page 23 of 44 Version

24 60110 X-ray upper limbs - any region tomography (240.00) Ultrasound upper limb soft tissue - any region (411.90) Ultrasound of the peripheral arterial system of the left arm including B mode, pulse and colour doppler (761.40) Ultrasound of the peripheral arterial system of the right arm including B mode, pulse and colour doppler (761.40) Ultrasound peripheral venous system upper limbs including pulse and colour doppler for deep vein thrombosis (700.00) Ultrasound peripheral venous system upper limbs including pulse and colour doppler (963.40) CT of the upper limbs limited study (530.30) CT angiography of the upper limb ( ) MR of the upper limbs limited study, any region ( ) MR angiography of the upper limb ( ) Arteriogram of subclavian, upper limb arteries alone, unilateral ( ) Arteriogram of subclavian, upper limb arteries alone, bilateral ( ) Arteriogram of aortic arch, subclavian, upper limb, unilateral ( ) Arteriogram of aortic arch, subclavian, upper limb, bilateral ( ) Venography, antegrade of upper limb veins, unilateral ( ) Venography, antegrade of upper limb veins, bilateral ( ) Venography, retrograde of upper limb veins, unilateral ( ) Venography, retrograde of upper limb veins, bilateral ( ) Venography, shuntogram, dialysis access shunt ( ) Nuclear medicine study Venogram upper limb ( ) Shoulder Code (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added) Code (introduction of contrast into the shoulder joint) may be combined with and (CT), or and (MR). The combination of (arthrography) and and (CT) or and (MR) is not supported except in exceptional circumstances with motivation X-ray of the left clavicle (169.60) X-ray of the right clavicle (169.60) X-ray of the left scapula (169.60) X-ray of the right scapula (169.60) X-ray of the left acromio-clavicular joint (175.30) X-ray of the right acromio-clavicular joint (175.30) X-ray of acromio-clavicular joints plus stress studies bilateral (428.70) X-ray of the left shoulder (194.20) X-ray of the right shoulder (194.20) X-ray of the left shoulder plus subacromial impingement views (330.40) X-ray of the right shoulder plus subacromial impingement views (330.40) X-ray of the left subacromial impingement views only (180.90) X-ray of the right subacromial impingement views only (180.90) 18 Dec 2006 Page 24 of 44 Version

25 61160 X-ray arthrography shoulder joint including introduction of contrast (883.60) X-ray guidance and introduction of contrast into shoulder joint only (413.60) Ultrasound of the left shoulder joint (362.80) Ultrasound of the right shoulder joint (362.80) CT of the left shoulder joint uncontrasted ( ) CT of the right shoulder joint uncontrasted ( ) CT of the left shoulder complete with 3D recon ( ) CT of the right shoulder complete with 3D recon ( ) CT of the left shoulder joint - pre and post contrast ( ) CT of the right shoulder joint - pre and post contrast ( ) MR of the left shoulder ( ) MR of the right shoulder ( ) MR of the left shoulder pre and post contrast ( ) MR of the right shoulder pre and post contrast ( ) Humerus X-ray of the left humerus (164.10) X-ray of the right humerus (164.10) CT of the left upper arm ( ) CT of the right upper arm ( ) CT of the left upper arm contrasted ( ) CT of the right upper arm contrasted ( ) CT of the left upper arm pre and post contrast ( ) CT of the right upper arm pre and post contrast ( ) MR of the left upper arm ( ) MR of the right upper arm ( ) MR of the left upper arm pre and post contrast ( ) MR of the right upper arm pre and post contrast ( ) Nuclear medicine study Bone limited/regional static ( ) Nuclear medicine study Bone limited static plus flow ( ) Nuclear medicine study Bone tomography regional Elbow Code (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added) Code (introduction of contrast) may be combined with and (CT) or and (MR). The combination of (arthrography) and and or and (MR) is not supported except in exceptional circumstances with motivation X-ray of the left elbow (175.30) X-ray of the right elbow (175.30) X-ray of the left elbow with stress (242.30) 18 Dec 2006 Page 25 of 44 Version

26 63115 X-ray of the right elbow with stress (242.30) X-ray arthrography elbow joint including introduction of contrast (886.90) X-ray guidance and introduction of contrast into elbow joint only (413.60) Ultrasound of the left elbow joint (362.80) Ultrasound of the right elbow joint (362.80) CT of the left elbow ( ) CT of the right elbow ( ) CT of the left elbow complete with 3D recon ( ) CT of the right elbow complete with 3D recon ( ) CT of the left elbow contrasted ( ) CT of the right elbow contrasted ( ) CT of the left elbow pre and post contrast ( ) CT of the right elbow pre and post contrast ( ) MR of the left elbow ( ) MR of the right elbow ( ) MR of the left elbow pre and post contrast ( ) MR of the right elbow pre and post contrast ( ) Nuclear medicine study Bone limited/regional static ( ) Nuclear medicine study Bone limited static plus flow ( ) Nuclear medicine study Bone tomography regional Forearm X-ray of the left forearm (164.10) X-ray of the right forearm (164.10) X-ray peripheral bone densitometry (109.40) CT of the left forearm ( ) CT of the right forearm ( ) CT of the left forearm contrasted ( ) CT of the right forearm contrasted ( ) CT of the left forearm pre and post contrast ( ) CT of the right forearm pre and post contrast ( ) MR of the left forearm ( ) MR of the right forearm ( ) MR of the left forearm pre and post contrast ( ) MR of the right forearm pre and post contrast ( ) Nuclear medicine study Bone limited/regional static ( ) Nuclear medicine study Bone limited static plus flow ( ) 18 Dec 2006 Page 26 of 44 Version

27 64910 Nuclear medicine study Bone tomography regional Hand and Wrist Code (finger) may not be combined with or (hands) Codes and (wrists) may be combined with or (scaphoid) respectively if requested and additional views done. Code (arthrography) includes fluoroscopy and the introduction of contrast (00140 may not be added). Code (contrast) may be combined with and (CT) or and (MR). The combination of (arthrography) and and or and is not supported except in exceptional circumstances with motivation X-ray of the left hand (171.90) X-ray of the right hand (171.90) X-ray of the left hand bone age (171.90) X-ray of a finger (149.00) X-ray of the left wrist (177.50) X-ray of the right wrist (177.50) X-ray of the left scaphoid (184.20) X-ray of the right scaphoid (184.20) X-ray of the left wrist, scaphoid and stress views (422.00) X-ray of the right wrist, scaphoid and stress views (422.00) X-ray arthrography wrist joint including introduction of contrast (889.20) X-ray guidance and introduction of contrast into wrist joint only (413.60) Ultrasound of the left wrist (362.80) Ultrasound of the right wrist (362.80) CT of the left wrist and hand ( ) CT of the right wrist and hand ( ) CT of the left wrist and hand - complete with 3D recon ( ) CT of the right wrist and hand - complete with 3D recon ( ) CT of the left wrist and hand contrasted ( ) CT of the right wrist and hand contrasted ( ) CT of the left wrist and hand pre and post contrast ( ) CT of the right wrist and hand pre and post contrast ( ) MR of the left wrist and hand ( ) MR of the right wrist and hand ( ) MR of the left wrist and hand pre and post contrast ( ) MR of the right wrist and hand pre and post contrast ( ) Nuclear Medicine study bone limited/regional static ( ) Nuclear Medicine study bone limited static plus flow ( ) Nuclear Medicine study bone tomography regional Soft Tissue Nuclear medicine study Tumour localisation planar, static ( ) 18 Dec 2006 Page 27 of 44 Version

28 69905 Nuclear medicine study Tumour localisation planar, static, multiple studies ( ) Nuclear medicine study Tumour localisation planar, static and SPECT ( ) Nuclear medicine study Tumour localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study Infection localisation planar, static ( ) Nuclear medicine study Infection localisation planar, static, multiple studies ( ) Nuclear medicine study Infection localisation planar, static and SPECT ( ) Nuclear medicine study Infection localisation planar, static, multiple studies and SPECT ( ) Nuclear medicine study Regional lymph node mapping dynamic (336.10) Nuclear medicine study Regional lymph node mapping, static, planar ( ) Nuclear medicine study Regional lymph node mapping, static, planar, multiple ( ) Nuclear medicine study Regional lymph node mapping SPECT Nuclear medicine study Lymph node localisation with gamma probe Lower Limbs General Code (stress) is a stand alone study and may not be combined with other codes Code (tomography) may be combined with any one of the defined regional x-ray studies of the lower limb. Motivation may be required for more than one regional tomographic study per visit. Code (U/S) may only be billed once per visit. Code ((CT) limited study limited to a small region of interest eg part of condyle of the knee. Codes and (CT angiography) may not be combined. Code (MR limited) may only be used once per visit. Code and (MR angiography) may not be combined X-ray lower limbs - any region- stress studies only (252.30) X-ray lower limbs - any region-tomography (240.00) X-ray of the lower limbs full length study (360.60) Ultrasound lower limb soft tissue - any region (411.90) Ultrasound of the peripheral arterial system of the left leg including B mode, pulse and colour Doppler (761.40) Ultrasound of the peripheral arterial system of the right leg including B mode, pulse and colour Doppler (761.40) Ultrasound peripheral venous system lower limbs including pulse and colour doppler for deep vein thrombosis (761.40) Ultrasound peripheral venous system lower limbs including pulse and colour doppler in erect and supine position including all compression and reflux manoeuvres, deep and superficial systems bilaterally ( ) CT of the lower limbs limited study (530.30) CT angiography of the lower limb ( ) CT angiography abdominal aorta and outflow lower limbs ( ) MR of the lower limbs limited study ( ) MR angiography of the lower limb ( ) MR angiography of the abdominal aorta and lower limbs ( ) Angiography of pelvic and lower limb arteries unilateral ( ) Angiography of pelvic and lower limb arteries bilateral ( ) Angiography of abdominal aorta, pelvic and lower limb vessels unilateral ( ) Angiography of abdominal aorta, pelvic and lower limb vessels bilateral ( ) 18 Dec 2006 Page 28 of 44 Version

29 70520 Angiography translumbar aorta with full peripheral study ( ) Venography, antegrade of lower limb veins, unilateral ( ) Venography, antegrade of lower limb veins, bilateral ( ) Venography, retrograde of lower limb veins, unilateral ( ) Venography, retrograde of lower limb veins, bilateral ( ) Lymphangiography, lower limb, unilateral ( ) Lymphangiography, lower limb, bilateral ( ) Nuclear medicine study Venogram lower limb ( ) Femur X-ray of the left femur (164.10) X-ray of the right femur (164.10) CT of the left femur ( ) CT of the right femur ( ) CT of the left upper leg contrasted ( ) CT of the right upper leg contrasted ( ) CT of the left upper leg pre and post contrast ( ) CT of the right upper leg pre and post contrast ( ) MR of the left upper leg ( ) MR of the right upper leg ( ) MR of the left upper leg pre and post contrast ( ) MR of the right upper leg pre and post contrast ( ) Nuclear Medicine study bone limited/regional static ( ) Nuclear Medicine study Bone limited static plus flow ( ) Nuclear Medicine study Bone tomography regional Knee Codes and (patella) may not be added to 72100, 72105, 72110, 72115, 72130, (knee views) Code (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code (introduction of contrast) may be combined with and (CT) or and (MR). The combination of (arthrography) and and (CT) or and (MR) is not supported except in exceptional circumstances with motivation X-ray of the left knee one or two views (154.60) X-ray of the right knee one or two views (154.60) X-ray of the left knee, more than two views (185.40) X-ray of the right knee, more than two views (185.40) X-ray of the left knee including patella (257.90) X-ray of the right knee including patella (257.90) X-ray of the left knee with stress views (324.80) X-ray of the right knee with stress views (324.80) X-ray of left patella (154.60) 18 Dec 2006 Page 29 of 44 Version

30 72145 X-ray of right patella (154.60) X-ray both knees standing single view (156.30) X-ray arthrography knee joint including introduction of contrast (882.50) X-ray guidance and introduction of contrast into knee joint only (413.60) Ultrasound of the left knee joint (362.80) Ultrasound of the right knee joint (362.80) CT of the left knee ( ) CT of the right knee ( ) CT of the left knee complete study with 3D reconstructions ( ) CT of the right knee complete study with 3D reconstructions ( ) CT of the left knee contrasted ( ) CT of the right knee contrasted ( ) CT of the left knee pre and post contrast ( ) CT of the right knee pre and post contrast ( ) MR of the left knee ( ) MR of the right knee ( ) MR of the left knee pre and post contrast ( ) MR of the right knee pre and post contrast ( ) Nuclear Medicine study Bone limited/regional static ( ) Nuclear Medicine study Bone limited static plus flow ( ) Nuclear Medicine study Bone tomography regional Lower Leg X-ray of the left lower leg (164.10) X-ray of the right lower leg (164.10) CT of the left lower leg ( ) CT of the right lower leg ( ) CT of the left lower leg contrasted ( ) CT of the right lower leg contrasted ( ) CT of the left lower leg pre and post contrast ( ) CT of the right lower leg pre and post contrast ( ) MR of the left lower leg ( ) MR of the right lower leg ( ) MR of the left lower leg pre and post contrast ( ) MR of the right lower leg pre and post contrast ( ) Nuclear Medicine study bone limited/regional static ( ) Nuclear Medicine study bone limited static plus flow ( ) 18 Dec 2006 Page 30 of 44 Version

31 73910 Nuclear Medicine study bone tomography regional Ankle and Foot Code (toe) may not be combined with or (foot) Code (sesamoid bones) may be combined with or (foot) if requested. Codes and (foot) may only be combined with and (calcaneus) if specifically requested. Code (arthrography) includes fluoroscopy and introduction of contrast (00140 may not be added). Code (introduction of contrast) may be combined with and (CT) or and (MR). The combination of (arthrography) and and (CT) or and (MR) are not supported except in exceptional circumstances with motivation X-ray of the left ankle (185.40) X-ray of the right ankle (185.40) X-ray of the left ankle with stress views (252.30) X-ray of the right ankle with stress views (252.30) X-ray of the left foot (156.30) X-ray of the right foot (156.30) X-ray of the left calcaneus (153.00) X-ray of the right calcaneus (153.00) X-ray of both feet standing single view (156.30) X-ray of a toe (149.00) X-ray of the sesamoid bones one or both sides (156.30) X-ray arthrography ankle joint including introduction of contrast (888.10) X-ray guidance and introduction of contrast into ankle joint (413.60) Ultrasound of the left ankle (362.80) Ultrasound of the right ankle (362.80) Ultrasound of the left foot (362.80) Ultrasound of the right foot (362.80) Ultrasound bone densitometry (113.90) CT of the left ankle/foot ( ) CT of the right ankle/foot ( ) CT of the left ankle/foot complete with 3D recon ( ) CT of the right ankle/foot complete with 3D recon ( ) CT of the left ankle/foot contrasted ( ) CT of the right ankle/foot contrasted ( ) CT of the left ankle/foot pre and post contrast ( ) CT of the right ankle/foot pre and post contrast ( ) MR of the left ankle ( ) MR of the right ankle ( ) MR of the left ankle pre and post contrast ( ) MR of the right ankle pre and post contrast ( ) 18 Dec 2006 Page 31 of 44 Version

32 74420 MR of the left foot ( ) MR of the right foot ( ) MR of the left foot pre and post contrast ( ) MR of the right foot pre and post contrast ( ) Nuclear Medicine study Bone limited/regional static ( ) Nuclear Medicine study Bone limited static plus flow ( ) Nuclear Medicine study Bone tomography regional Soft Tissue Nuclear Medicine study Tumour localisation planar, static ( ) Nuclear Medicine study Tumour localisation planar, static, multiple studies ( ) Nuclear Medicine study Tumour localisation planar, static and SPECT ( ) Nuclear Medicine study Tumour localisation planar, static, multiple studies & SPECT ( ) Nuclear Medicine study Infection localisation planar, static ( ) Nuclear Medicine study Infection localisation planar, static, multiple studies ( ) Nuclear Medicine study Infection localisation planar, static and SPECT ( ) Nuclear Medicine study Infection localisation planar, static, multiple studies and SPECT ( ) Nuclear Medicine study Regional lymph node mapping dynamic (336.10) Nuclear Medicine study Regional lymph node mapping, static, planar ( ) Nuclear Medicine study Regional lymph node mapping, static, planar, multiple studies ( ) Nuclear Medicine study Regional lymph node mapping and SPECT Nuclear Medicine study Lymph node localisation with gamma probe Intervention General Codes 80600, 80605, 80610, 80620, 80630, 81660, 81680, 82600, 84660, 85640, 85645, 86610, 86615, 86620, 86630, (aspiration / biopsy / ablations etc) may be combined with the relevant guidance codes (fluoroscopy, ultrasound, CT, MR) as previously described. The machine codes 00510, 00520, 00530, 00540, 00550, may not be combined with these codes. If ultrasound guidance (00230) is used for a procedure which also attracts one of the machine codes (00510, 00520, 00530, 00540, 00550, 00560), it may not be billed for separately. Codes 80640, 80645, 87682, include fluoroscopy. Machine fees may not be added. All other interventional procedures are complete unique procedures describing a whole comprehensive procedure and combinations of different codes will only be supported when motivated Percutaneous abscess, cyst drainage, any region (523.10) Fine needle aspiration biopsy, any region (235.50) Cutting needle, trochar biopsy, any region (355.00) Tumour/cyst ablation chemical ( ) Tumour ablation radio frequency, per lesion ( ) Insertion of CVP line in radiology suite (501.80) Peripheral central venous line insertion (676.50) Infiltration of a peripheral joint, any region (357.30) May be combined with relevant guidance (fluoroscopy, ultrasound, CT and MR). May not be combined with machine codes 00510, 00520, 00530, 00540, 00550, or (facet joint or SI joint) or arthrogram codes Dec 2006 Page 32 of 44 Version

33 Neuro intervention Intracranial aneurysm occlusion, direct ( ) Intracranial arteriovenous shunt occlusion ( ) Dural sinus arteriovenous shunt occlusion ( ) Extracranial arteriovenous shunt occlusion ( ) Extracranial arterial embolisation (head and neck) ( ) Caroticocavernous fistula occlusion ( ) Intracranial angioplasty for stenosis, vasospasm ( ) Intracranial stent placement (including PTA) ( ) Temporary balloon occlusion test ( ) Code does not include the relevant preceding diagnostic study and may be combined with codes 10500, 10510, 10530, 10540, Permanent carotid or vertebral artery occlusion (including occlusion test) ( ) Intracranial aneurysm occlusion with balloon remodelling ( ) Intracranial aneurysm occlusion with stent assistance ( ) Intracranial thrombolysis, catheter directed ( ) Code may be combined with any of the other neuro interventional codes to Nerve block, head and neck, per level (427.50) Neurolysis, head and neck, per level ( ) Nerve block, head and neck, radio frequency, per level ( ) Nerve block, coeliac plexus or other regions, per level (518.00) Thorax Chest drain insertion (492.40) Trachial, bronchial stent insertion ( ) Gastrointestinal Oesophageal stent insertion ( ) GIT balloon dilation ( ) GIT stent insertion (non-oesophageal) ( ) Percutaneous gastrostomy, jejunostomy ( ) Hepatobiliary Percutaneous biliary drainage, external ( ) Percutaneous external/internal biliary drainage ( ) Permanent biliary stent insertion ( ) Drainage tube replacement ( ) Percutaneous bile duct stone or foreign object removal ( ) Percutaneous gall bladder drainage ( ) Percutaneous gallstone removal, including drainage ( ) Transjugular liver biopsy ( ) 18 Dec 2006 Page 33 of 44 Version

34 84640 Transjugular intrahepatic Portosystemic shunt ( ) Transhepatic Portogram including venous sampling, pressure studies ( ) Transhepatic Portogram with embolisation of varices ( ) Percutaneous hepatic tumour ablation (875.30) Percutaneous hepatic abscess, cyst drainage (736.80) Hepatic chemoembolisation ( ) Hepatic arterial infusion catheter placement ( ) Urogenital Percutaneous nephrostomy, external drainage ( ) Percutaneous double J stent insertion including access ( ) Percutaneous renal stone, foreign body removal including access ( ) Percutaneous nephrostomy tract establishment ( ) Change of nephrostomy tube (887.50) Percutaneous cystostomy (922.10) Urethral balloon dilatation (794.80) Urethral stent insertion ( ) Renal cyst ablation (665.40) Renal abscess, cyst drainage (846.20) Fallopian tube recanalisation ( ) Spinal Spinal vascular malformation embolisation ( ) Vertebroplasty per level ( ) Facet joint block per level, uni- or bilateral (532.50) Code may only be billed once per level, and not per left and right side per level Spinal nerve block per level, uni- or bilateral (455.50) Epidural block (525.80) Chemonucleolysis, including discogram ( ) Spinal nerve ablation per level (647.50) Vascular Code (Thrombolysis follow up) may only be used on the days following the initial procedure, (thrombolysis) If a balloon angioplasty and / or stent placement is performed at more that one defined anatomical site at the same sitting the relevant codes may be combined. However multiple balloon dilatations or stent placements at one defined site will only attract one procedure code Percutaneous transluminal angioplasty: aorta, IVC ( ) Percutaneous transluminal angioplasty: iliac ( ) Percutaneous transluminal angioplasty: femoropopliteal ( ) Percutaneous transluminal angioplasty: subpopliteal ( ) Percutaneous transluminal angioplasty: brachiocephalic ( ) Percutaneous transluminal angioplasty: subclavian, axillary ( ) 18 Dec 2006 Page 34 of 44 Version

35 87606 Percutaneous transluminal angioplasty: extracranial carotid ( ) Percutaneous transluminal angioplasty: extracranial vertebral ( ) Percutaneous transluminal angioplasty: renal ( ) Percutaneous transluminal angioplasty: coeliac, mesenteric ( ) Aorta stent-graft placement ( ) Stent insertion (including PTA): aorta, IVC ( ) Stent insertion (including PTA): iliac ( ) Stent insertion (including PTA): femoropopliteal ( ) Stent insertion (including PTA): subpopliteal ( ) Stent insertion (including PTA): brachiocephalic ( ) Stent insertion (including PTA): subclavian, axillary ( ) Stent insertion (including PTA): extracranial carotid ( ) Stent insertion (including PTA): extracranial vertebral ( ) Stent insertion (including PTA): renal ( ) Stent insertion (including PTA): coeliac, mesenteric ( ) Stent-graft placement: iliac ( ) Stent-graft placement: femoropopliteal ( ) Stent-graft placement: brachiocephalic ( ) Stent-graft placement: subclavian, axillary ( ) Stent-graft placement: extracranial carotid ( ) Stent-graft placement: extracranial vertebral ( ) Stent-graft placement: renal ( ) Stent-graft placement: coeliac, mesenteric ( ) Thrombolysis in angiography suite, per 24 hours ( ) Code may be combined with any of the relevant non neuro interventional angiography and interventional codes 10520, 20500, 20510, 20520, 20530, 20540,32500,32530,44500, 44503, 44505, 44507, 44510, 44515, 44517, 44520, 60500, 60510, 60520, 60530, 70500, 70505, 70510, 70515, to Aspiration, rheolytic thrombectomy ( ) Atherectomy, per vessel ( ) Percutaneous tunnelled / subcutaneous arterial or venous central or other line insertion ( ) Thrombolysis follow-up ( ) Percutaneous sclerotherapy, vascular malformation ( ) Embolisation, mesenteric ( ) Embolisation, renal ( ) Embolisation, bronchial, intercostal ( ) Embolisation, pulmonary arteriovenous shunt ( ) 18 Dec 2006 Page 35 of 44 Version

36 87664 Embolisation, abdominal, other vessels ( ) Embolisation, thoracic, other vessels ( ) Embolisation, upper limb ( ) Embolisation, lower limb ( ) Embolisation, pelvis, non-uterine ( ) Embolisation, uterus ( ) Embolisation, spermatic, ovaria veins ( ) Inferior vena cava filter placement ( ) Intravascular foreign body removal ( ) Revision of access port (tunnelled or implantable) (788.20) Removal of access port (tunnelled or implantable) (620.70) Superior petrosal venous sampling ( ) Pancreatic stimulation test ( ) Transportal venous sampling ( ) Adrenal venous sampling ( ) Parathyroid venous sampling ( ) Renal venous sampling ( ) 18 Dec 2006 Page 36 of 44 Version

37 ANNEXURE A Radiology tariff Contrast price effective 1 Jan 2004 PER VIAL For use in conjuction with codes: Radiology X-ray examination contrast material Ultrasound examination contrast material CT examination contrast material MR examination contrast material Angiography and interventional examination contrast material Note to Funders: The following contrast items may be grouped into various categories e.g. Ionic, non-ionic, and several items may be appropriate for use within a category. Funders may either reimburse as per identified item or may choose to apply a reference price within a category. For detail of methodology refer to Annexure B. ANNEXURE B Radiology tariff Contrast price effective 1 Jan 2004 PER VIAL Supplier Product Name Produc t Size Tyco Conray x 50 Tyco Conray x 50 Tyco Optiray x 30 Tyco Optiray x 50 Tyco Optiray x 100 Tyco Optiray 300 prefills Tyco Optiray 300 H/Pressure Tyco Optiray 300 H/Pressure 10 x x x 125 Tyco Optiray x 50 NAPPI Full Product Description (Exc VAT ) Inc VAT Tyco - Conray x Tyco - Conray x Tyco - Optiray x Tyco - Optiray x Tyco - Optiray x Tyco - Optiray 300 prefills - 10 x Tyco - Optiray 300 H/Pressure x 100 Tyco - Optiray 300 H/Pressure x 125 Tyco - Optiray x Tyco Optiray x Tyco - Optiray x Dec 2006 Page 37 of 44 Version

38 Tyco Optiray x 50 Tyco Optiray x 100 Tyco Optiray 350 prefills Tyco Optiray 350 H/Pressure Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan 10 x x 125 Jopamiron x 10 Jopamiron x 10 Jopamiron x 20 Jopamiron x 50 Jopamiron x 100 Jopamiron x 50 Jopamiron x 100 Imeron x 50 Imeron x 50 Imeron x Tyco - Optiray x Tyco - Optiray x Tyco - Optiray 350 prefills - 10 x 50 Tyco - Optiray 350 H/Pressure - 10 x 125 Pharmaplan - Jopamiron x 10 Pharmaplan - Jopamiron x 10 Pharmaplan - Jopamiron x 20 Pharmaplan - Jopamiron x 50 Pharmaplan - Jopamiron x 100 Pharmaplan - Jopamiron x 50 Pharmaplan - Jopamiron x 100 Pharmaplan - Imeron x 50 Pharmaplan - Imeron x 50 Pharmaplan - Imeron x Pharma Imeron x Pharmaplan - Imeron x Dec 2006 Page 38 of 44 Version

39 plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Pharma plan Imeron x 50 Imeron x 100 Imeron x 200 Imeron x 50 Imeron x 100 Imeron x 200 Axim Hexabrix x 50 Axim Hexabrix x 100 Axim Hexabrix x 200 Axim Dotarem 10 x 10 Axim Dotarem 10 x 15 Axim Dotarem 10 x 20 Axim Xenetix x 50 Axim Xenetix x Pharmaplan - Imeron x 50 Pharmaplan - Imeron x 100 Pharmaplan - Imeron x 200 Pharmaplan - Imeron x 50 Pharmaplan - Imeron x 100 Pharmaplan - Imeron x 200 Axim - Hexabrix x 50 Axim - Hexabrix x 100 Axim - Hexabrix x Axim - Dotarem - 10 x Axim - Dotarem - 10 x Axim - Dotarem - 10 x Axim - Xenetix x Axim - Xenetix x Axim Xenetix x Axim - Xenetix x Dec 2006 Page 39 of 44 Version

40 001 Axim Xenetix x 500 Axim Xenetix x 50 Axim Xenetix x 100 Axim Xenetix x 200 Axim Xenetix x 500 Schering Ultravist x 20 Schering Ultravist x 50 Schering Ultravist x 75 Schering Ultravist x 100 Schering Ultravist x 50 Schering Ultravist x 100 Schering Ultravist x 200 Schering Isovist x 10 Schering Magnevist PF 10 5 x Axim - Xenetix x Axim - Xenetix x Axim - Xenetix x Axim - Xenetix x Axim - Xenetix x Schering - Ultravist x 20 Schering - Ultravist x 50 Schering - Ultravist x 75 Schering - Ultravist x 100 Schering - Ultravist x 50 Schering - Ultravist x 100 Schering - Ultravist x 200 Schering - Isovist x 10 Schering - Magnevist PF 10-5 x Schering Magnevist PF 15 5 x Schering - Magnevist PF Dec 2006 Page 40 of 44 Version

41 008 5 x 15 Schering Magnevist PF, 20 5 x 20 Schering Magnevist x Schering Gadovist Schering Urografin 30% 1 x 250 Schering Urografin 60% 10 x 20 Schering Urografin 60% 10 x 100 Schering Urografin 76% 10 x 20 Schering Gastrografin 1 x 100 Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Omnipaque 240 mg Omnipaque 300 mg Omnipaque 300 mg Omnipaque 300 mg Omnipaque 300mg Plastic Omnipaque 300mg Plastic Schering - Magnevist PF, 20-5 x 20 Schering - Magnevist x 20 Schering - Gadovist Schering - Urografin 30% - 1 x 250 Schering - Urografin 60% - 10 x 20 Schering - Urografin 60% - 10 x 100 Schering - Urografin 76% - 10 x 20 Schering - Gastrografin - 1 x 100 Amersham - Omnipaque 240 mg - 15 Amersham - Omnipaque 300 mg - 20 Amersham - Omnipaque 300 mg - 50 Amersham - Omnipaque 300 mg Amersham - Omnipaque 300mg Plastic Amersham - Omnipaque 300mg Plastic Amersha Omnipaque Amersham - Omnipaque Dec 2006 Page 41 of 44 Version

42 m mg 005 mg - 50 Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Amersha m Pharma plan Pharma plan Omnipaque 350 mg Omnipaque 350mg Plastic Omnipaque 350mg Plastic Omniscan Omniscan Omniscan Prefilled 10 Omniscan Prefilled 15 Omniscan Prefilled Visipaque 320 mg Visipaque 320 mg Visipaque 320 mg Visipaque 320 mg MultiHance MultiHance Amersham - Omnipaque 350 mg Amersham - Omnipaque 350mg Plastic Amersham - Omnipaque 350mg Plastic Amersham - Omniscan Amersham - Omniscan Amersham - Omniscan Prefilled Amersham - Omniscan Prefilled Amersham - Omniscan Prefilled Amersham - Visipaque 320 mg Amersham - Visipaque 320 mg Amersham - Visipaque 320 mg Amersham - Visipaque 320 mg Pharmaplan MultiHance Pharmaplan MultiHance Pharma MultiHance Pharmaplan MultiHance Dec 2006 Page 42 of 44 Version

43 plan Contrast Index Price Range contrast prices Product Type Iodine Concentration Vial Size Avg Range NAPPI CODES OF PRODUCTS IN THE CATEGORY Ionic mg % % % % Gastrografin Ionic Low Osmolality 320mg mg mg Non Ionic 250mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg Dec 2006 Page 43 of 44 Version

44 Non Ionic High Pressure syringes 300mg mg mg Non Ionic Iso osmolality 320mg mg mg mg Myelography mg mg mg mg Gadolinium (MRI) standard standard standard high ANNEXURE C Recommended Isotope and Kit Prices for Nuclear Medicine for 2004 by the Association of Nuclear Medicine Physicians For use in conjuction with codes: Nuclear Medicine Isotope Nuclear Medicine Substrate Supplier Product Name Nappi code Product size PRICE (excl. VAT) (Patient dosage) PRICE (incl. VAT) Amersham Tc-99m GENERATOR(10gBq) / mCi Amersham CHROMIUM /002 1mCi Amersham CHROMIUM /005 1mCi Dec 2006 Page 44 of 44 Version

45 Amersham CHROMIUM /001 5mCi Amersham GALLIUM /007 5mCi Amersham GALLIUM /004 10mCi Amersham INDIUM /006 2mCi Amersham INDIUM /006 1mCi Amersham IODINE / kBq Amersham IODINE / kBq Amersham IODINE / kBq Amersham IODINE / kBq Amersham IODINE /004 1 x 9250kBq On Request Amersham IODINE-131 BENZYLGUANIDIN / Bq37MBq On Request Amersham IODINE-131 BENZYLGUANIDIN /007 37MBq Amersham IODINE-131 BENZYLGUANIDIN / MBq Amersham IODINE-131 BENZYLGUANIDIN / MBq On Request Amersham IODINE-131 BENZYLGUANIDIN // MBq On Request Amersham IODINE-131 BENZYLGUANIDIN / MBq1850MBq Amersham IODINE-131 BENZYLGUANIDIN / MBq On Request Amersham IODINE /004 37MBq Amersham SODIUM IODIDE /004 37MBq Amersham SODIUM IODIDE /007 74MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Dec 2006 Page 45 of 44 Version

46 Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / Mbq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Dec 2006 Page 46 of 44 Version

47 Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham SODIUM IODIDE / MBq Amersham IRON / uCi (9.25MBq) Amersham PHOSPHOROUS /004 5mCi Amersham PHOSPHOROUS /001 10mCi Amersham STRONTIUM /004 4mCi (4mm) Amersham HEPATATE /003 1vial Amersham NANOCOLL /005 1vial Amersham PYROPHOPHATE /005 1vial Amersham TIN COLLOID /003 1vial Amersham DTPA COMPLEX /006 1vial Amersham RBC /002 1vial Amersham DISIDA /006 1vial Amersham MDP /005 1vial Amersham PULMOTEK /005 1vial Amersham CERETEC(brain) /006 1vial Amersham MYOVIEW /001 1vial Amersham THALLIUM /007 2mCi Amersham THALLIUM /003 3mCi Amersham THALLIUM /006 5mCi Amersham XENON /002 50mCi Amersham XENON / mCi Amersham YTTRIUM /005 10mCi Amersham YTTRIUM /001 25mCi Amersham DMSA (KIDNEY AGENT) /006 1vial Amersham RADID STRAND /001 1STRAND (10 SEED:) Dec 2006 Page 47 of 44 Version

48 Amersham ONCOSEED /001 EACH Amersham ONCOSEED /001 EACH Amersham ONCOSEED /001 EACH SYNCOR CARDIOLITE /003 1vial NECSA I-123 MIBG /006 1 capsule Amersham MAG / mCi Dec 2006 Page 48 of 44 Version