UPFS Procedure Book 2021 1
UPFS Procedure Book 2021 1
UPFS Procedure Book 2021 1
Code Description A
1 Injections, Infusions And Inhalation Sedation
1.1 Injections, Infusions, And Inhalation Sedation Treatment
Inhalation Sedation
0203 Use of analgesic nitrous oxide for alcohol and other withdrawal states
0204 Per additional quarter-hour or part thereof (Rule: not applicable to UPFS – not to be charged)
Intravenous Treatment (see Note: How To Charge For Intravenous Infusions)
0205 Intravenous infusions (cutdown or push-in) (patients under two years): Cutdown and/or insertion
of cannula – chargeable once per 24 hours
0206 Intravenous infusions (push-in) (patients over two years): Insertion of cannula - chargeable once
per 24 hours
0207 Intravenous infusions (cutdown) (patients over two years): Cutdown and insertion of cannula -
chargeable once per 24 Hours
Infusional pharmacotherapy: Fee for the treatment of non cancerous conditions with bolus
or infusional pharmacotherapy per treatment day Not to charge with procedure code 0206,
5783 0205 NA
Venesection
0208 Therapeutic venesection (Not to be used when blood is drawn for the purpose of laboratory
investigations)
0209 Umbilical artery cannulation at birth
0211 Exchange transfusion: First and subsequent (including after-care)
Intravenous Treatment With Cytostatic Agents
0213 Chemotherapy: Intramuscular or subcutaneous: per injection.
0214 Chemotherapy: Intravenous bolus technique: per injection.
0215 Chemotherapy: Intravenous infusion technique: per injection.
2 Integumentary System
2.1 Allergy
Patch Tests
0217 First patch
0219 Additional patch
Skin Prick Tests
0218 Skin-prick testing: Insect vemon, latex and drugs
0220 Immediate hypersensitivity testing (Type I reaction): per antigen: Inhalant and food allergens
0221 Delayed hypersensitivity testing (Type IV reaction): per antigen
2.2 Skin (general)
Intralesional Injection Into Areas Of Pathology E.g. Keloids
0222 Single
0223 Multiple
0225 Epilation: per session
Special treatment of severe acne cases, including draining of cysts, expressing of comedones
0227 and/or steaming, abrasive cleaning of skin and UVR per session A
0228 PUVA Treatment
0229 PUVA: Follow-up or maintenance once a week
0230 UVR-Treatment
Code Description A
0231 UVR-Follow-up - for use of ultraviolet lamp (applied personally by the dermatologist) No charge to
be levied if a nurse or physiotherapist applies the ultraviolet lamp
Biopsy Without Suturing
0233 First lesion A
0234 Subsequent lesions A
0235 Maximum for multiple additional lesions A
0237 Deep skin biopsy by surgical incision and suturing A
Treatment Of Benign Skin Lesion By Chemo-cryotherapy
0241 First Lesion A
0242 Subsequent lesions A
0243 Maximum for multiple additional lesions A
0244 Repair of nail bed A
0257 Drainage of major hand or foot infection: drainage of major abscess with necrosis of tissue,
involving deep fascia or requiringdebridement, complete excision of pilonidal cyst or sinus A
0290 Reconstructive procedures (including all stages) and skin graft by myocutaneous or
fasciocutaneous flap B
0291 Reconstructive procedures (including all stages) grafting by microvascular reanastomosis C
0292 Distant flaps: First stage B
0293 Contour grafts B
0294 Vascularised bone graft with or without soft tissue with one or more sets microvascular
anastomoses C
0295 Local skin flaps (large, complicated) B
0296 Other procedures of major technical nature B
0297 Subsequent major procedures for repair of same lesion B
0298 Lower abdominal dermo lipectomy C
0299 Major abdominal lipectomy with repositioning of umbilicus C
2.4 Lacerations, Scars, Tumours, Cysts And Other Skin Lesions
Stitching Of Soft-tissue Injuries
0300 Stitching of wound (with or without local anaesthesia): Including normal after-care A
0301 Multiple stitching of wound stitched at same session A
0302 Deep laceration involving limited muscle damage B
0303 Deep laceration involving extensive muscle damage B
0304 Major debridement of wound, sloughectomy or secondary suture B
0305 Needle biopsy - soft tissue A
0307 Excision and repair by direct suture; excision nail fold or other minor procedures of similar
magnitude A
0308 Each additional small procedure done at the same time A
0310 Radical excision of nailbed A
0311 Excision of large benign tumour (more than 5 cm) A
0313 Extensive resection for malignant soft tissue tumour including muscle B
0314 Requiring repair by large skin graft or large local flap or other procedures of similar magnitude B
0315 Requiring repair by small skin graft or small local flap or other procedures of similar magnitude B
2.5 Breasts (Rule: Only to be charged for medical indicated Procedures; otherwise
cosmetic tariff grouping applies
0316 Fine needle aspiration for soft tissue (all body areas)
0317 Aspiration of cyst or tumour A
0319 Mastotomy with exploration, drainage of abscess or removal of mammary implant A
0321 Biopsy or excision of cyst, benign tumour, aberrant breast tissue, duct papilloma A
0323 Subareola cone excision of ducts or wedge excision of breast A
0324 Wedge excision of breast and axillary dissection C
0325 Total mastectomy C
0327 Total mastectomy with axillary gland biopsy C
0329 Total mastectomy with axillary gland dissection C
0330 Nipple and areola reconstruction B
Subcutaneous Mastectomy For Disease Of Breast; Including Reconstruction But
Excluding Cost
0331 Unilateral B
0333 Bilateral B
0334 Removal of breast implant by means of capsulectomy: Per breast B
0335 Implantation of internal subpectoral mammary prosthesis in post mastectomy patients B
Reduction: Mammoplasty For Pathological Hypertrophy
0337 Unilateral C
0339 Bilateral C
Gynaecomastia
Code Description A
0341 Unilateral A
0343 Bilateral B
2.6 Burns
0351 Major Burns: Resuscitation (including supervision and intravenous therapy - first 48 hours) B
0353 Tangential excision and grafting: Small B
0354 Tangential excision and grafting: Large C
2.7 Hands (skin)
0355 Skin flap in acute hand injuries where a flap is taken from a site remote from the injured finger or
in cases of advancement flap e.g. Cutler C
0357 Small skin graft in acute hand injury C
0359 Release of extensive skin contracture and or excision of scar tissue with major skin graft
resurfacing C
0361 Z-plasty B
0363 Local flap and skin graft B
0365 Cross finger flap (all stages) B
0367 Palmar flap (all stages) B
0369 Distant flap: First stage B
0371 Distant flap: Subsequent stage A
0373 Transfer neurovascular island flap B
0374 Syndactyly: Separation of, including skin graft for one web B
Dupuytren's Contracture
0375 Fasciotomy A
0376 Fasciectomy A
2.8 Acupuncture (Rule: charge Allied Health Professional Fee where applicable)
0377 Standard acupuncture
0378 Laser acupuncture using more than 6 points
0379 Electro-acupuncture
0380 Scalp acupuncture
0381 Micro-acupuncture (ear, hand)
3. Musculo-skeletal System
3.1 Bones
3.1.1 Fractures (reduction – open/closed Under General Anaesthetic)
0383 Scapula A
0387 Clavicle A
0388 Percutaneous pinning of supracondylar fracture: Elbow - stand alone procedure B
0389 Humerus A
0391 Radius and/or Ulna A
0392 Open reduction of both radius and ulna A
0402 Carpal bone A
0403 Bennett's fracture-dislocation A
0405 Metacarpal: Simple A
Finger Phalanx: Distal
0409 Simple A
0411 Compound A
Proximal Or Middle
0413 Simple A
0415 Compound A
Pelvis
0417 Closed B
0419 Operative reduction and fixation B
0421 Femur: Neck or Shaft A
0425 Patella A
Code Description A
0429 Tibia with or without fibula A
0433 Fibula shaft A
0435 Malleolus of ankle A
0437 Fracture-dislocation of ankle A
0438 Open reduction Talus fracture A
0439 Tarsal bones and Os calcis A
0440 Calcanius reduction A
0441 Metatarsal reduction A
Toe Phalanx
0443 Distal: Simple A
0445 Compound A
Other
0447 Simple A
0449 Compound A
Sternum And/or Ribs
0451 Closed C
0452 Open reduction and fixation of multiple fractured ribs for flail chest C
Spine: With Or Without Paralysis
0455 Cervical C
0456 Rest C
Compression Fracture
0461 Cervical C
0462 Rest C
Spinous Or Transverse Processes
0463 Cervical C
0464 Rest C
3.1.1.1 Operations For Fractures
0465 Fractures involving large joints (includes the item for the relative bone) C
0473 Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pins (no after-
care) , modifier 0005 not applicable B
0582 Capsulotomy or arthrotomy or biopsy or drainage of joint: Small joint (including three weeks after-
care) A
0583 Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint (including three weeks after-
care) A
0585 Capsulectomy digital joint A
0586 Multiple percutaneous capsulotomies of metacarpophalangeal joints A
0587 Release of digital joint contracture B
3.2.4 Synovectomy
0589 Digital joint B
0592 Large joint B
0593 Tendon synovectomy B
3.2.5 Arthrodesis
0597 Shoulder B
0598 Elbow B
0599 Wrist B
0600 Digital joint B
Code Description A
0601 Hip B
0602 Knee B
0603 Ankle B
0604 Sub-talar B
0605 Stabilization of foot (triple-arthrodesis) B
0607 Mid-tarsal wedge resection B
3.2.6 Arthroplasty
0614 Dedridement large joints B
0615 Excision medial or lateral end of clavicle B
0617 Shoulder: Acromioplasty B
0619 Shoulder: Partial replacement C
0620 Shoulder: Total replacement C
0621 Elbow: Excision head of radius B
0622 Elbow: Excision B
0623 Elbow: Partial replacement B
0624 Elbow: Total replacement C
0625 Wrist: Excision distal end of ulna B
0626 Wrist: Excision single bone B
0627 Wrist: Excision proximal row B
0631 Wrist: Total replacement B
0635 Digital Joint: Total replacement C
0637 Hip: Total replacement C
0639 Hip: Cup C
0641 Hip: Prosthetic replacement of femoral head C
0643 Hip: Girdlestone C
0645 Knee: Partial replacement C
0646 Knee: Total replacement C
0649 Ankle: Total replacement C
0650 Ankle: Astragalectomy B
3.2.7 Miscellaneous (joints)
0661 Aspiration of joint or intra-articular injection (not including after-care) A
Multiple Intra-articular Injections For Rheumatoid Arthritis (excluding After-care)
0663 First joint A
0665 Additional A
0667 Arthroscopy (excluding after-care) A
0669 Manipulation large joint (shoulder,hip and knee) under general anaesthetic (not including after-
care) A
0670 Rule: The consultation fee should be charged when manipulation of a large joint is performed
with or without local anaesthetic A
0673 Meniscectomy or operation for other internal derangement of knee B
0673 Meniscectomy or operation for other internal derangement of knee B
3.2.8 Joint Ligament Reconstruction Or Suture
0675 Ankle: Collateral B
0677 Knee: Collateral B
0678 Knee: Cruciate B
0679 Ligament augmentation procedure of knee B
0680 Digital joint ligament B
3.3 Amputations
3.3.1 Specific Amputations
0682 Fore-quarter amputation B
0683 Through shoulder B
0685 Upper arm or fore-arm B
Code Description A
0687 Partial amputation of the hand: One ray A
0691 Part of or whole of finger A
0693 Hindquarter amputation B
0695 Through hip joint region B
0697 Through thigh B
0699 Below knee, through knee or Syme B
0701 Trans metatarsal or trans tarsal A
0703 Foot: One ray A
0705 Toe A
3.3.2 Post-amputation Reconstruction
0706 Skin flap taken from a site remote from the injured finger or in cases of an advanced flap e.g.
Cutler A
0707 Krukenberg reconstruction C
0709 Metacarpal transfer B
0711 Pollicization of the finger (to include all stages) B
0712 Toe to thumb transfer B
3.4 Muscles, Tendons And Fasciae
3.4.1 Investigations:
0713 Electromyography A
0714 Electromyographic neuromuscular junctional study, including edrophonium response A
0715 Strength duration curve per session A
0717 Electrical examination of single nerve or muscle A
0718 Oxidative study for mitochondrial function
0721 Voltage integration during isometric contraction A
0723 Tonometry with edrophonium A
0725 Isometric tension studies with edrophonium A
Cranial Reflex Study (both Early And Late Responses) Supra Occulofacial Or Corneo-facial
Or
0727 Unilateral A
0728 Bilateral A
0729 Tendon reflex time A
0730 Limb-brain somatosensory studies (per limb)
0731 Visio and audio-sensory studies
0733 Motor nerve conduction studies (single nerve)
0735 Examinations of sensory nerve conduction by sweep averages (single nerve) A
0737 Biopsy for motor nerve terminals and end plates A
0739 Combined muscle biopsy with end plates and nerve terminal biopsy B
0740 Muscle fatigue studies A
0741 Muscle biopsy B
0742 Global fee for all muscle studies, including histochemical studies
3.4.2 Decompression Operations
0743 Major compartmental decompression A
0744 Fasciotomy only A
3.4.3 Muscle And Tendon Repair
0745 Biceps humeri B
0746 Removal of calcification in Rotator cuff A
0747 Rotator cuff B
0748 Muscle and tendon repair: Debridement rotator cuff A
0749 Muscle and tendon repair: Scapulopexy - stand alone procedure B
0755 Infrapatellar or quadriceps tendon B
0757 Achilles tendon B
0759 Other single tendon A
0763 Tendon or ligament injection A
Code Description A
Flexor Tendon Suture
0767 Primary (per tendon) A
0769 Secondary (per tendon) A
Extensor Tendon Suture
0771 Primary (per tendon) A
0773 Secondary (per tendon) A
0774 Repair of Boutonniere deformity or Mallet finger B
3.4.4 Tendon Graft
0775 Free tendon graft B
0776 Reconstruction of pulley for flexor tendon B
Finger
0777 Flexor B
0779 Extensor B
0780 Two stage flexor tendon graft using silastic rod B
3.4.5 Tenolysis
0781 Tendon freeing operation, except where specified elsewhere B
0782 Carpal tunnel syndrome B
0783 De Quervain B
0784 Trigger finger B
0785 Flexor tendon freeing operation following free tendon graft or suture B
0787 Extensor tendon freeing operation following graft or suture B
0788 Intrinsic tendon release per finger B
0789 Central tendon tenotomy for Boutonniere deformity B
3.4.6 Tenodesis
0790 Digital joint A
3.4.7 Muscle Tendon and Fascia Transfer
0791 Single tendon transfer B
0792 Multiple tendon transfer C
0793 Hamstring to quadriceps transfer C
0794 Pectoralis major or Latissimus dorsi transfer to biceps tendon C
0795 Tendon transfer at elbow C
0796 Iliopsoas at hip C
0797 Knee (Eggers) C
Hand Tendons
0802 Radial club hand repair - stand alone procedure C
0803 Single tendon transfer (first) B
0809 Substitution for intrinsic paralysis of hand C
0811 Opponens transfers C
3.4.8. Muscle Slide Operations and Tendon Lengthening
0812 Percutaneous Tenotomy: All sites A
0813 Torticollis B
0815 Scalenotomy B
0817 Scalenotomy with excision of first rib B
0821 Tennis elbow C
0822 Open release elbow (Mitals) - stand alone procedure B
0823 Excision or slide for Volkmann's Contracture C
0825 Hip: Open muscle release B
0829 Knee: Quadricepsplasty B
0831 Knee: Open tenotomy B
0835 Calf B
0837 Open elongation tendon Achilles B
0838 Percutaneous "Hoke" elongation tendo Achilles A
Code Description A
0845 Foot: Plantar fasciotomy A
0846 Foot: Postero-medial release for club-foot C
3.5 Bursae and Ganglia
Excision
0847 Semimembranosus B
0849 Prepatellar A
0851 Olecranon A
0853 Small bursa or ganglion A
0855 Compound palmar ganglion or synovectomy A
0857 Aspiration or injection (no after-care) A
3.6 Miscellaneous
3.6.1.Leg Equalisation and Congenital Hips and Feet
0859 Leg shortening C
0861 Leg lengthening C
0863 Epiphysiodesis at one level C
Initial Non-operative Reduction and Application of Plastercast
0865 One hip A
0867 Two hips A
0868 Open reduction of congenital dislocation of the hip C
0869 Subsequent plaster
Manipulation and Plaster
0873 One foot A
0874 Ponseti technique assistant
3.6.2. Removal Of Internal Fixatives Or Prosthesis
0883 Removal of internal fixatives or prosthesis: Readily accessible
0884 Removal of internal fixatives or prosthesis: Less accessible
0885 Removal of prosthesis for infection soon after operation
Late removal of infected or not infected total joint replacement prosthesis (including six weeks
aftercare):
0886 ADD to the item for total joint replacement of the specific joint C
3.7. Plasters (exclusive of aftercare)
0887 Limb cast (excluding after-care) A
0889 Spica, plaster jacket or hinged cast brace (excluding after-care) B
0891 Turnbuckle cast (excluding after-care) B
0893 Adjustment or repair of turnbuckle cast (excluding after-care) A
3.8. Special Areas
3.8.1. Foot and Ankle
0895 Club foot: Revision club foot release - stand alone procedure C
0896 Club foot: Posterior release only - stand alone procedure C
0897 One foot C
0900 Excision tarsal coalition - stand alone procedure B
0901 Tenotomy, single tendon C
0903 Hammer toe: one toe C
0905 Fillet of Toe or Ruiz-Mora procedure C
0906 Arthrodesis Hallux B
0907 Silver bunionectomy or similar for Hallux Valgus B
0909 Excision arthroplasty B
0910 Cheilectomy or metatarsophangeal implant Hallux B
0911 Metatarsal osteotomy or Lapidus or similar or Chevron B
5730 Hallux Valgus double osteotomy etc. B
5731 Distal soft tissue procedure for Hallux Valgus B
5732 Aitkin procedure or similar B
5734 Removal bony prominence foot e.g. bunionette (ò Bunionette not applicable to COID) B
Code Description A
5735 Repair angular deformity toe (lesser toes) B
5736 Sesamoidectomy B
5737 Repair major foot tendons e.g. Tib Post B
5738 Repair of dislocating peroneal tendons B
5739 Forefoot reconstruction for rheumatoid arthritis: Clayton or similar: One foot B
5740 Steindler strip - plantar fascia B
5741 Kelikian syndactilly (one web space) B
5742 Tendon transfer foot B
5743 Capsulotomy metatarsophalangeal joints: Foot B
8.8.2. Big Toe (refer to section 3.8.1 for procedures on big toe)
3.8.3 Reimplantations
0912 Replant of amputated upper limb proximal to wrist joint C
0913 Replantation of thumb C
0914 Replantation of a single digit (to be motivated), for multiple digits C
0915 Replantation operation through the palm C
3.8.4.Hands: (note: Skin: See Integumentary System)
Tumours
0919 Epidermoid cysts A
0920 Ganglion or fibroma A
0921 Nodular synovitis (Giant cell tumour of tendon sheath) A
Removal Of Foreign Bodies Requiring Incision
0922 Under local anaesthetic A
0923 Under general or regional anaesthetic A
Crushed Hand Injuries
0924 Initial extensive soft tissue toilet under general anaesthetic (sliding scale) A
0925 Subsequent dressing changes under general anaesthetic B
3.8.5 Spine
0927 Excision of one vertebral body, for a lesion within the body (no decompression) C
0928 Excision of each additional vertebral segment for a lesion within the body (no decompression) C
0929 Manupilation of spine under general anaesthetic: (no after-care) B
0930 Posterior osteotomy of spine: One vertebral segment C
0931 Posterior spinal fusion: One level C
0932 Posterior osteotomy of spine: Each additional vertebral segment C
0933 Anterior spinal osteotomy with disc removal: One vertebral segment C
0936 Anterior spinal osteotomy with disc removal: Each additional vertebral segment C
0938 Anterior fusion base of skull to C2 C
Trans-abdominal anterior exposure of the spine for spinal fusion only if done by a second
0939 surgeon B
0940 Trans-thoracic anterior exposure of the spine if done by a second surgeon B
0941 Anterior interbody fusion: One level C
0942 Anterior interbody fusion: Each additional level C
0944 Posterior fusion: Occiput to C2 C
0946 Posterior spinal fusion: Each additional level C
0948 Posterior interbody lumbar fusion: One level C
0950 Posterior interbody lumbar fusion: Each additional interspace C
0959 Excision of coccyx B
0961 Costo-transversectomy B
0963 Antero-lateral decompression of spinal cord or anterior debridement C
3.8.6 Spinal Deformities
0952 Posterior fusion for spinal deformity: Up to 6 levels C
0954 Posterior fusion for spinal deformity: 7 to 12 levels C
0955 Posterior fusion for spinal deformity: 13 or more levels C
0956 Anterior fusion for spinal deformity 2 or 3 levels C
Code Description A
0957 Anterior fusion for spinal deformity: 4 to 7 levels C
0958 Anterior fusion for spinal deformity: 8 or more levels C
3.8.7 All Spinal Problems
0943 Laminectomy with decompression of nerve roots and disc removal: One level C
0960 Posterior non-segmental instrumentation B
0962 Posterior segmental instrumentation: 2 to 6 vertebrae B
0964 Posterior segmental instrumentation: 7 to 12 vertebrae B
0966 Posterior segmental instrumentation: 13 or more vertebrae B
0968 Anterior instrumentation: 2 to 3 vertebrae B
0969 Skull or skull-femoral traction including two weeks after-care
0970 Anterior instrumentation: 4 to 7 vertebrae B
0971 Halo-splint and POP jacket including two weeks after-care
0972 Anterior instrumentation: 8 or more vertebrae B
0974 Additional pelvic fixation of instrumentation other than sacrum B
5750 Reinsertion of instrumentation B
5751 Removal of posterior non-segmental instrumentation B
5752 Removal of posterior segmental instrumentation B
5753 Removal of anterior instrumentation B
Laminectomy for spinal stenosis (exclude diskectomy, foraminotomy and spondylolisthesis): One
5755 or two levels A
5756 Laminectomy with full decompression for spondylolisthesis (Gill procedure) A
5757 Laminectomy for decompression without foraminotomy or diskectomy more than two levels A
5758 Laminectomy with decompression of nerve roots and disc removal: Each additional level A
5759 Laminectomy for decompression diskectomy etc., revision operation B
Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: One
5760 level A
Laminectomy, facetectomy, decompression for lateral recess stenosis plus spinal stenosis: Each
5761 additional level A
5763 Anterior disc removal and spinal decompression cervical: One level A
5764 Anterior disc removal and spinal decompression cervical: Each additional level A
5765 Vertebral corpectomy for spinal decompression: One level A
5766 Vertebral corpectomy for spinal decompression: Each additional level A
5770 Use of microscope in spinal or intracranial procedures A
3.9 Facial Bone Procedures
0987 Repair of orbital floor (blowout fracture) C
0988 Genioplasty B
Open Reduction And Fixation Of Central Mid-third Facial Fracture With Displacement
0989 Le Fort I B
0990 Le Fort II C
0991 Le Fort III C
0992 Le Fort I Osteotomy C
0993 Palatal Osteotomy C
0994 Le Fort II Osteotomy (team fee) C
0995 Le Fort III Osteotomy (team fee) C
Open reduction and fixation of central mid-third facial fracture with displacement: Fracture of
0996 maxilla without displacement B
Mandible: Fractured Nose and Zygoma
0997 Open reduction and fixation C
0999 Closed reduction by inter-maxillary fixation B
1001 Temporo-mandibular joint: Reconstruction for dysfunction C
1003 Manipulation: Immobilisation and follow-up of fractured nose A
1005 Nasal fracture without manipulation A
Code Description A
1007 Mandibulectomy C
1009 Maxillectomy C
1011 Bone graft to mandible C
1012 Adjustment of occlusion by ramisection C
1013 Fracture of arch of zygoma without displacement B
Fracture of arch of zygoma with displacement requiring operative manipulation but not including
1015 associated fractures, recent fractures (within four weeks) B
Fracture of arch of zygoma with displacement requiring operative manipulation but not including
1017 associated fractures; (after four weeks) B
Respiratory System
Nose and Sinuses
1018 Flexible nasopharyngolaryngoscope examination A
1085 Total reconstruction of the nose: including reconstruction of nasal septum (septumplasty) nasal
pyramid (osteotomies) and nose tip C
1087 Sub-total reconstruction consisting of any two of the following: septumplasty, osteotomies, nasal
tip reconstruction B
1089 Forehead Rhinoplasty Total (all stages) C
1091 Forehead Rhinoplasty Partial (all stages) C
1093 Rhinophyma without skin graft B
1095 Full nasal reconstruction for secondary cleft lip deformity C
1096 Removal of foreign body: Pharynx A
1097 Partial nasal reconstruction for cleft lip deformity B
1099 Columella reconstruction or lengthening B
4.2 Throat
1101 Tonsillectomy (dissection of tonsils) B
1102 Laser tonsillectomy B
1105 Removal of adenoids B
1106 Laser assisted functional reconstruction of palate and uvula B
1107 Opening of quinsy under local anaesthetic B
1108 Laser assisted functional reconstruction of palate and uvula. Follow-up operation performed by
the same surgeon B
1109 Opening of quinsy under general anaesthetic B
1110 Ludwig's Angina: Drainage B
1111 Post tonsillectomy or adenoidectomy haemorrhage B
1112 Pharyngeal pouch operation C
1113 Retropharyngeal abscess internal approach B
1115 Retropharyngeal abscess external approach B
1116 Functional reconstruction of palate and uvula C
4.3 Larynx
1117 Laryngeal intubation
1118 Laryngeal stroboscopy with video capture B
Laryngectomy
1119 Laryngectomy without block dissection of the neck C
1123 Botulinum toxin injection for adductor dysphonia
Operative laryngoscopy with excision of tumour and/or stripping of vocal cords (excluding
1125 aftercare) B
1126 Post laryngectomy for voice restoration C
1127 Tracheotomy B
1128 Endolaryngeal operations using a laser B
Code Description A
1129 External laryngeal operation e.g. laryngeal stenosis, laryngocele, abductor paralysis, laryngo-
fissure C
Direct Laryngoscopy
1130 Diagnostic laryngoscopy including biopsy (also to be applied when a flexible fibre-optic
laryngoscope was used) B
1131 Plus foreign body removal B
4.4 Bronchial Procedures
Bronchoscopy
1132 Diagnostic bronchoscopy B
1133 With removal of foreign body B
1134 Bronchoscopy with use of laser B
1135 With bronchography B
1136 Nebulisation (per 24 hrs)
1137 Bronchial lavage B
1138 Thoracotomy: for broncho-pleural fistula (including ruptured bronchus, any cause) C
4.5 Pleura
1139 Pleural needle biopsy: (no after-care) A
1141 Insertion of intercostal catheter (under water drainage) A
1142 Intra-pleural block B
1143 Paracentesis chest: Diagnostic A
1145 Paracentesis chest: Therapeutic A
1147 Pneumothorax: Induction (diagnostic)
1149 Pleurectomy C
1151 Decortication of lung C
1153 Chemical pleurodesis (instillation silver nitrate, tetracycline, talc, etc) A
4.6 Pulmonary Procedures
4.6.1 Surgical
1155 Needle biopsy lung: (no after-care) B
1157 Pneumonectomy D
1159 Pulmonary lobectomy C
1161 Segmental lobectomy C
Excision Tracheal Stenosis
1163 Cervical C
1164 Intra thoracic D
1167 Thoracoplasty associated with lung resection or done by the same surgeon within 6 weeks C
1168 Thoracoplasty: Complete C
1169 Thoracoplasty: Limited/osteoplastic C
1171 Drainage empyema (including six weeks after treatment) B
1173 Drainage of lung abscess (including six weeks after treatment) B
1175 Thoracotomy (limited): For lung or pleural biopsy B
1177 Major: Diagnostic, as for inoperable carcinoma C
1179 Thoracoscopy B
1181 Unilateral lung transplant D
1182 Harvesting donor lung: Unilateral (Rule: donor procedure: please refer to Annexure H and
relevant policies) B
Excision Or Plication Of Emphysematous Cyst
1183 Unilateral C
1184 Bilateral synchronous (Median sternotomy) C
1185 Re-exploration following sternal dehiscence C
4.6.2 Pulmonary Function Tests
1186 Flow volume test: Inspiration/expiration
1187 Exhaled nitric oxide determination (not for under 4-year old children)
1188 Flow volume test: Inspiration/expiration pre- and post-bronchodilator
Code Description A
1189 Forced expirogram only
1190 Determination of resistance to airflow in paediatric patients, impulse oscilimetry
1191 N2 single breath distribution
1192 Peak expiratory flow only
1193 Functional residual capacity or residual volume: helium, nitrogen open circuit, or other method
1195 Thoracic gas volume
1196 Determination of resistance to airflow, oscillatory or plethysmographic methods
1197 Compliance and resistance, using oesophageal balloon
4.7 Intensive Care: (in Intensive Care Or High Care Unit) Respiratory, Cardiac, General
4.7.1 Neonatal Procedures
1202 Insertion of central veneous catheter via peripheral vein in neonates B
4.7.2 Tariff Items For Intensive Care
4.7.3 Procedures
Ventilation
1215 Insertion of arterial pressure cannula A
1216 Insertion of Swan Ganz catheter for haemodynamic monitoring B
1217 Insertion of central venous line via peripheral vein B
1218 Insertion of central venous line via subclavian or jugular veins A
1221 Professional fee for managing a patient-controlled analgesic pump: Once off charge per patient. (
Rule : Not applicable to UPFS - included in the in patient tariff grouping) B
4.8 Hyperbaric Oxygen Therapy
5 Mediastinal Procedures
1222 Mediastinal tumours C
1223 Mediastinoscopy B
1224 Mediastinotomy B
1225 Excision of malignant chest wall tumours involving sternum and multiple ribs C
1226 Removal of single rib with a lesion C
6 Cardiovascular System
6.1 General
1227 Global adult/neonatal resuscitation fee. Rule: Includes intubation, IVI therapy & supervision.
Excludes all other procedures related to resuscitation B
General Practitioner's Fee For The Taking Of An ECG Only
1228 Without effort: 1/2 (item1232).(this rule is not applicable to UPFS – see definition of ambulatory
procedure)
1229 Without and with effort: 1/2 (item 1233) (this rule is not applicable to UPFS – see definition of
ambulatory procedure)
Physician's Fee For Interpreting An ECG
1230 Without effort (this interpretation code is included in procedure 1232)
1231 Without and with effort.(this interpretation code is included in procedure 1233)
Electrocardiogram
1232 Without effort (per 24hrs)
1233 Without and with effort (per 24 hrs)
Effort electrocardiogram with the aid of a special bicycle ergometer, monitoring apparatus and
1234 availability of associated apparatus
1235 Multi-stage treadmill test
1236 ECG without effort: Under 4 years (per 24 hrs)
Code Description A
1239 24 Hour ambulatory ECG monitoring (holter) (per 24 hrs)
1240 Signal averaged electrocardiogram
1241 X-ray Screening: Chest
1242 X-ray screening: Prosthetic valves
1244 Two week event triggered ambulatory ECG monitoring
1245 Angiography cerebral: First two series B
1246 Angiography peripheral: Per limb. B
1247 Cardioversion for arrhythmias (any method) with doctor in attendance B
1248 Paracentesis of pericardium B
1271 Cardiological supervision of Dobutamine magnetic resonance stress testing A
6.2 Invasive Cardiology
6.2.1 Cardiac Catheterisation
1249
Right and left cardiac catheterisation without coronary angio-graphy (with or without biopsy) B
1250 Endomyocardial biopsy B
1251 Transseptal puncture B
1252 Left heart catheterisation with coronary angiography (with or without biopsy) B
1253 Right heart catheterisation (with or without biopsy) B
1254 Catheterisation of coronary artery bypass grafts and/or internal mammary grafts B
1255 Tilt test
6.2.2 Electrophysiological Study
1256 Ventricular stimulation study B
1257 Full electrophysiological study B
6.2.3 Pacemakers
1258 Permanent - single chamber B
1259 Permanent - dual chamber B
1260 AV nodal ablation B
1261 Accessory pathway ablation B
1262 Electrophysiological mapping
1263 Insertion transvenous implantable defibrillator C
1264 Test for implantable transvenous defibrillator B
1265 Renewal of pacemaker unit only, team fee B
1266 Resiting pacemaker generator
1267 Repositioning of catheter electrode B
1268 Threshold testing: Own equipment (Rule: not applicable to UPFS – charge code 1269)
1269 Threshold testing
1270 Programming of atrio-ventricular sequential pacemaker
1273 Insertion of temporary pacemaker B
1275 Termination of arrhythmia - programmed stimulation and lead insertion of temporary pacer B
6.2.4 Percutaneous Transluminal Angioplasty
5008 Percutaneous transluminal angioplasty: Sub-popliteal sub-brachial B
Stent insertion: Iliac/subclavian/AV fistula – including percutaneous transluminal
5060 angioplasty (PTA) B
1276 First cardiologist: single lesion C
1277 Second cardiologist: single lesion (Rule: not applicable to UPFS – charge code 1276) C
1278 First cardiologist: second lesion C
1279 Second cardiologist: second lesion (Rule: not applicable to UPFS – charge code 1278) C
1280 First cardiologist: third or subsequent lesions (each) C
1281 Second cardiologist: third or subsequent lesions (each) (Rule: not applicable to UPFS – charge
code 1280) C
Use of balloon procedures including - first cardiologist
- Atrial septostomy C
- Pulmonary valve valvuloplasty C
Code Description A
- Aortic valve valvuloplasty C
- Coarctation dilation C
1282 - Mitral valve valvuloplasty (1282) C
Use of balloon procedure as in item 1282 - second cardiologist (Rule: not applicable to UPFS –
1283 charge code 1282) C
1284 Atherectomy: single lesion: first cardiologist C
Atherectomy: single lesion: second cardiologist (Rule: not applicable to UPFS – charge code
1285 1284) C
1286 Insertion of intravascular stent: first cardiologist C
1287 Insertion of intravascular stent: second cardiologist (Rule: not applicable to UPFS – charge code
1286) C
Use of balloon procedures including - first paediatric cardiologist
- Arterial septostomy C
- Pulmonary valve valvuloplasty C
- Aortic valve valvuloplasty C
- Coarctation dilation C
- Mitral valve valvuloplasty C
- Closure atrial septal defect C
1290 - Closure of patent ductus arteriousus (1290) C
Use of balloon procedure as in item 1290 - second paediatric cardiologist (Rule: not applicable to
1291 UPFS – charge code 1290)
6.2.5 Paediatric Cardiac Catheterisation
1288 Paediatric cardiac catheterization C
1289 Paediatric cardiac catheterisation: Infants below the age of one year C
6.3 Cardiac Surgery
1294 Patent ductus arteriosus D
1295 Pericardiectomy for constrictive pericarditis D
1297 Coarctation of aorta D
1299 Systemo-pulmonary anastomosis D
1301 Mitral valvotomy: Closed heart technique D
1302 Heart transplant D
Harvesting donor heart. (Rule: donor procedure: please refer to Annexure H and relevant
1303 policies) B
1305 Operative implantation of cardiac pacemaker by thoracotomy C
1307 Re-exploration after cardiac-surgery D
1308 Heart and lung transplant D
1309 Harvesting donor heart and lungs. (Rule: donor procedure: please refer to Annexure H and
relevant policies) B
1311 Pericardial drainage B
6.3.1 Open Heart Surgery
1312 Evaluation of coronary angiogram by cardio-thoracic surgeon (Rule: Charge a consultation fee –
no procedure charge)
1320 Repeat open heart surgery (additional fee above procedure fee ) D
1321 Stand-by fee for coronary angioplasty.(Rule: not applicable to UPFS – not to be charged) B
Attendance at other operations or monitoring at bedside, by physician e.g. heart block etc.: Per
1322 hour. (Rule: not applicable to UPFS – not to be charged)
6.3.1.1 Congenital Conditions
Atrial Septal Defect
1323 Osteum secundum D
1325 Sinus venosus or osteum primum D
1327 Ventricular septal defect D
1329 Fallot's tetralogy D
1330 Pulmonary stenosis D
1331 Transposition of large vessels (venous repair) D
1332 Transposition of great arteries (arterial repair) D
1333 Ebstein's Anomaly D
Code Description A
1334 Aorto-coronary bypass operation as a MidCab procedure (thoracotomy with coronary grafting
without bypass or hypothermal) D
1335 Total anomalous venous drainage D
1336 Aorto-coronary bypass operation as a OpCab procedure (sternotomy with coronary grafting
without bypass or hypothermia D
1337 Creation of atrial septal defect by thoracotomy with or without cardiac bypass D
1338 Fontan type repair D
6.3.1.2 Acquired Conditions
1339 Mitral valve replacement D
1340 Mitral valvuloplasty D
1341 Aortic valve replacement D
1342 Tricuspid annulo plasty D
1343 Double valve replacement D
1344 Acute dissecting aneurysm repair D
1345 Aortic arch aneurysm repair utilising deep hypothermal and circulatory arrest D
Aorta-coronary Bypass Operation (including Interpretation Of Angiogram)
1346 Harvesting of saphenous veins: Unilateral
1347 Harvesting of saphenous veins: Bilateral
1348 Utilizing saphenous veins D
1349 Additional arterial implant: any artery D
1350 Additional double arterial implant: any artery D
1351 Aorta-coronary bypass operation with valve replacement or excision of cardiac aneurysm D
1352 Cardiac aneurysm D
1353 Ascending/descending thoracic aortic aneurysm repair D
1354 Arrhythmia surgery D
1355 Cardiac tumour D
1356 Insertion and removal of intra-aortic balloon pump C
1358 Harvesting of radial artery
6.4 Peripheral Vascular System
6.4.1 Investigations
Skin Temperature Test
1357 Response to reflex heating
1359 Response to reflex cooling
1361 Cold sensitivity test
1363 Oscillometry test
1365 Sweat test
1367 Doppler blood tests
5369 Doppler arterial pressures
5371 Doppler arterial pressures with exercise
5373 Doppler segmental pressures and wave forms
5375 Venous doppler examination (both limbs)
5377 Venous plethysmography
5379 Supra-orbital doppler test
5381 Carotid non-invasive complex tests
Transcutaneous Oximetry
1366 Transcutaneous oximetry - single site
6.4.2 Arterio-venous Abnormalities:
6.4.3 Arteries :
6.4.3.1 Aorta-iliac And Major Branches
Abdominal Aorta And Iliac Artery
1372 Unruptured C
1373 Ruptured D
Code Description A
1375 Grafting and/or thrombo-endarteriectomy for thrombosis C
Aorta bifemoral graft, including proximal and distal endarteriectomy and preparation for
1376 anastomosis C
6.4.3.2 Iliac Artery
1379 Prosthetic grafting and/or Thrombo-endarteriectomy C
6.4.3.3 Peripheral
1385 Prosthetic grafting C
Suture major blood vessel (artery or vein) - trauma (major blood vessel are definde as aorta,
1396 innominate artery, carotid artery and vetebral artery, subclavian artery, axillary artery, illiac artery,
common femoral and popliteal artery. The vertebral and popliteal arteries are included becauses
of the relevant inaccessibility of the arteries and difficult surgical exposure. C
1387 Vein grafting proximal to knee joint C
1388 Distal to knee joint C
1389 Endarterectomy when not part of another specified procedure C
1390 Carotid endarterectomy D
Embolectomy
1393 Peripheral embolectomy transfemoral B
Miscellaneous Arterial Procedures
1395 Arterial suture: trauma B
1397 Profundoplasty B
1399 Distal tibial (Ankle region) C
1401 Femoro-femoral C
1402 Carotid-subclavian C
1403 Axillo-femoral: (Bifemoral + 50%) C
6.4.4 Veins
1407 Ligation of saphenous vein A
1408 Placement of Hickman catheter, Tenckhoff catheter or similar B
Ligation Of Inferior Vena Cava:
1410 Abdominal B
"umbrella" Operation On Inferior Vena Cava :
1412 Abdominal B
Combined Procedure For Varicose Veins: Ligation Of Saphenous Vein, Stripping, Multiple
Ligation
1413 Unilateral B
1415 Bilateral B
1417 Extensive sub-fascial ligation of perforating veins B
1419 Lesser varicose vein procedures A
Compression Sclerotherapy Of Varicose Veins
1421 Per injection to a maximum of nine injections per leg
Thrombectomy
1425 Inferior vena cava (Trans abdominal) C
1427 Ilio-femoral B
6.4.5 Portal Hypertension
1429 Porto-caval shunt D
6.5 Cardiac Rehabilitation
1431 Phase II: Exercise rehabilitation (charge Allied Health Professional fee where applicable)
1432 Phase III: Exercise rehabilitation (charge Allied Health Professional fee where applicable)
7 Lympho-reticular System
7.1 Spleen
Splenectomy
1435 Splenectomy (In all cases) C
1436 Splenorrhaphy C
7.2 Lymph Nodes And Lymphatic Channels
Code Description A
Excision Of Lymph Node For Biopsy
1439 Neck or axilla A
1441 Groin A
1443 Simple excision of lymph nodes for tuberculosis A
Radical Excision Of Lymph Nodes Of Neck: Total
1445 Unilateral. C
1447 Suprahyoid unilateral C
1449 Radical excision of lymph nodes of axilla. C
Radical Excision Of Lymph Nodes Of Groin
1451 Ilio-inguinal C
1453 Inguinal C
1455 Retroperitioneal lymphadenectomy including pelvic, aortic and renal nodes C
Bone Marrow Biopsy
1457 By trephine A
1458 Simple aspiration of marrow by means of trocar or cannula
1459 Staging laparotomy for lymphoma (including splenectomy) B
3719 Bone marrow: Aspiration Paediatric A
3720 Bone marrow Trephine biopsy Paediatric A
Bone Marrow Transplantation
1450 Cryopreservation of bone marrow or peripheral blood stem cells B
1454 Plasma/cell separation using designated cell separator equipment B
Preparation of extra-corporeal equipment by the medical practitioner for plasma, platelet and
1456 leucocyte pheresis (charge for stem cell exchange donor to patient - Plasmapheresis to be
charged as per tariff grouping) B
8 Digestive System
8.1 Oral Cavity
1461 All dental procedures A
8570 Fabrication of computer generated ceramic restoration
8670 Implant screw access closure B
1462 Removal of embedded foreign body: Vestibule of mouth, simple A
1463 Surgical biopsy of tongue or palate: Under general anaesthetic A
1464 Removal of embedded foreign body: Vestibule of mouth; complicated A
1465 Surgical biopsy of tongue or palate: Under local anaesthetic A
1466 Removal of embedded foreign body: Dentoalveolar structures, soft tissues A
1467 Drainage of intra-oral abscess A
1469 Local excision of mucosal lesion of oral cavity A
Resection of malignant lesion of buccal mucosa including radical neck dissection (Commando
1471 operation), but not including reconstructive plastic procedures C
1473 Complicated reconstruction following major ablative procedure for head and neck cancer C
1475 Cleft palate: Repair primary deformity with or without pharyngoplasty C
1477 Cleft palate: Secondary repair C
1478 Velopharyngeal reconstruction with myoneurovascular transfer (dynamic repair) C
1479 Velopharyngeal reconstruction with or without pharyngeal flap (static repair) C
1480 Repair of oronasal fistula (large) e.g. distant flap C
1481 Repair of oronasal fistula (small) e.g. trapdoor: One stage or first stage C
1482 Repair of oronasal fistula (large): Second stage C
1483 Alveolar periosteal or other flaps for arch closure B
1486 Closure of anterior nasal floor C
8.2 Lips
1485 Local excision of benign lesion of lip A
1487 Resection for lip malignancy B
Cleft Lip
1484 Lip adhesion (cleft lip) B
Code Description A
1489 Repair unilateral cleft lip (with muscle reconstruction) B
1490 Repair bilateral cleft lip (with muscle reconstruction) (one of two stages) B
1491 Repair bilateral cleft lip (with muscle reconstruction) (one stage) B
1492 Repair bilateral cleft lip (second stage ) B
1493 Total revision of secondary cleft lip deformities B
1494 Partial revision of secondary cleft lip deformity B
1495 Abbé or Estlander type flap (all stages included) B
1497 Vermilionectomy B
1499 Lip reconstruction following an injury: Direct repair B
Lip Reconstruction Following An Injury Or Tumour Removal
1501 Flap repair B
1503 Total reconstruction (first stage) B
1504 Subsequent stages (see item 0299) B
8.3 Tongue
1505 Partial glossectomy B
1507 Local excision of lesion of tongue A
8.4 Palate, Uvula And Salivary Glands
1509 Wide excision of lesion of palate B
1511 Radical resection of palate (including skin graft) C
1513 Excision of granula B
1515 Excision of sublingual salivary gland B
1517 Excision of submandibular salivary gland B
1519 Excision of submandibular salivary gland with suprahyoid dissection C
1521 Excision of submandibular salivary gland with radical neck dissection C
1523 Local resection of parotid tumour B
1525 Partial parotidectomy C
1526 Total parotidectomy with preservation of facial nerve C
1527 Total parotidectomy C
1529 Extracapsular Parotidectomy C
1531 Drainage of parotid abscess A
1533 Closure of salivary fistula B
1535 Dilatation of salivary duct B
1537 Operative removal of salivary calculus B
1539 Meatotomy: Salivary duct B
1541 Branchial cyst and/or fistula: Excision B
1543 Excision of cystic hygroma B
1544 Ludwig's Angina: Drainage B
8.5 Oesophagus
1545 Oesophagoscopy with rigid instrument: First and subsequent B
1547 Oesophageal acid perfusion test
1549 Oesophagoscopy with dilatation of stricture B
1550 With removal of foreign body. B
1551 With insertion of indwelling oesophageal tube B
1552 Injection of oesophageal varices (endoscopy inclusive) B
1553 Subsequent injection of oesophageal varices (endoscopy inclusive) B
1554 Per-oral small bowel biopsy B
1555 Repair of tracheal oesophageal fistula and oesophageal atresia C
1557 Oesophageal dilatation B
Oesophagectomy
1559 Two stage C
1560 Three stage C
1561 Thoraco-abdominal oesophagogastrectomy C
Code Description A
Hiatus Hernia And Diaphragmatic Hernia Repair
1563 With anti-reflux procedure C
1565 With Collis Nissen oesophageal lengthening procedure C
1566 Private fee: Gastroplasty B
1567 Bochdalek hernia repair in newborn C
1568 Hiatus hernia and diaphragmatic repair: Revision after previous repair C
1569 Heller's operation C
1575 Insertion of indwelling oesophageal tube – laparotomy B
1578 Oesophageal motility (4 channel + pneumograph) C
1579 Oesophageal substitution (without oesophagectomy) using colon, small bowel or stomach C
1580 Oesophageal motility (6 Channel + pneumograph + pH pull-through) C
1581 Removal of benign oesophageal tumours C
1582 Oesophageal motility (4 or 6 channel + pneumograph - ECG + provocative tests for oesophageal
spasm vs. myocardial ischeamia C
1583 Excision of intrathoracic oesophageal diverticulum C
1584 24 Hour oesophageal pH studies
1585 24 Hour oesophageal pH studies: Interpretation (Rule: not applicable in UPFS – included in code
1584)
8.6 Stomach
1587 Upper gastro-intestinal fibre-optic endoscopy B
1588 Plus polypectomy B
Endoscopic control of gastrointestinal haemorrhage from upper gastrointestinal tact, intestines or
1589 large bowel by injection of vasoconstrictors and/or schleroses (endoscopic haemostasis) to be
added to gastroscopy (item 1587) or colonoscopy (item 1663) B
1591 Upper gastro-intestinal endoscopy with removal of foreign bodies (stomach) B
1593 Augmented histamine test: Gastric intubation with x-ray screening
1597 Gastrostomy or Gastrostomy B
1598 Gastrostomy with suture repair of bleeding ulcer B
1599 Pyloromyotomy (Rammstedt) B
1601 Local excision of ulcer or benign neoplasm B
Vagotomy
1603 Abdominal B
1604 Thoracic B
1605 Truncal or selective with drainage procedures B
1607 Vagotomy and antrectomy B
1609 Highly selective vagotomy B
1611 Pyloroplasty B
1613 Gastroenterostomy B
1615 Suture of perforated gastric or duodenal ulcer or wound or injury B
1617 Partial gastrectomy C
1619 Total gastrectomy C
1621 Revision of gastrectomy or gastro-enterostomy C
1625 Gastro-oesophageal operation for portal hypertension (Tanner) C
8.7 Duodenum
1626 Endoscopic examination of the small bowel beyond the duodenojejunal flexure with biopsy with
or without polypectomy with or without arrest of haemorrhage (enteroscopy) B
1627 Duodenal intubation (under X-ray screening)
1629 Duodenal intubation with biliary drainage after gall bladder stimulation
1631 Duodenal intubation: Under three years A
8.8 Intestines
1632 H2 breath test (intestines)
1633 Complete test using lactose or lactulose
1634 Enterotomy or Enterostomy B
Code Description A
1635 Intestinal obstruction of the newborn C
1637 Operation for relief of intestinal obstruction C
1639 Resection of small bowel with enterostomy or anastomosis C
1641 Entero-enterostomy or entero-colostomy for bypass C
Gastrointestinal tract imaging, intraluminal (e.g. video capsule endoscopy) ADD to e.g.
1642 1587 ( gastroscopy), 1653 (colonoscopy) B
1643 Gastrointestinal tract imaging, intraluminal (e.g. video capsule endoscopy), oesophagus through
ileum: Doctor interpretation and report B
1645 Suture of intestine (small or large): Perforated ulcer, wound or injury B
1647 Closure of intestinal fistula B
1649 Excision of Meckel's diverticulum B
1651 Excision of lesion of mesentery B
1652 Laparotomy for mesenteric thrombosis C
Total Fibre-optic Colonoscopy
1653 With own equipment (including biopsy) B
1654 Fibre-optic colonoscopy with removal of polyps B
1656 Left sided fibre-optic colonoscopy B
1657 Right or left hemicolectomy or segmental colectomy C
1658 Reconstruction of colon after Hartman's procedure B
1661 Colotomy: Including removal of tumour or foreign body B
1663 Total colectomy C
1665 Colostomy or ileostomy isolated procedure B
1666 Continent ileostomy pouch (all types) C
1667 Colostomy Closure B
1668 Revision of ileostomy pouch C
1669 Total proctocolectomy and ileostomy C
1670 Proctocolectomy, ileostomy and ileostomy pouch C
1671 Colomyotomy (Reilly operation) B
8.9 Appendix
1673 Drainage of appendix abscess B
1675 Appendicectomy B
8.10 Rectum And Anus
1676 Fibre-optic sigmoidoscopy (rectum and anus ) A
1677 Sigmoidoscopy: First and subsequent, with or without biopsy A
1678 Fibre-optic sigmoidoscopy, plus polypectomy A
1679 Sigmoidoscopy with removal of polyps, first and subsequent A
Proctoscopy With Removal Of Polyps
1681 First time A
1683 Subsequent times A
1685 Endoscopic fulguration of tumour B
1687 Anterior resection of rectum performed for carcinoma of rectum including excision of any part of
proximal colon necessary C
1688 Total mesarectal excision with colo-anal anastomosis and defunctioning enterostomy or
colostomy B
1689 Perineal resection of rectum C
Abdomino-perineal Resection Of Rectum
1691 Abdominal surgeon C
1692 Perineal surgeon
1693 Local excision of rectal tumour (posterior approach) B
1695 Combined abdomino-anal pull-through procedure for Hirschsprung's disease, rectal agenesis or
tumour C
Repair Of Prolapsed Rectum: Abdominal
1697 Roscoe Graham Moskovitz C
1699 Ivalon sponge C
Code Description A
1701 Perineal C
1703 Thierisch suture B
1705 Incision and drainage of peri-anal abscess A
1707 Drainage of submucous abscess A
1709 Drainage of ischio-rectal abscess A
1711 Excision of pelvi-rectal fistula B
1713 Excision of fistula-in-ano A
1715 Operation for fissure-in-ano A
1719 Rubber band ligation of haemorrhoids: per haemorrhoid A
1721 Sclerosing injection for haemorroids: per injection
1723 Haemorrhoidectomy A
1725 Drainage of external thrombosed pile A
1727 Multiple procedures (haemorrhoids, fissure, etc.) A
1728 Biopsy of ano-rectal wall, for congenital megacolon B
1729 Excision of anal skin tags A
1731 Operation for low imperforate anus C
1733 Anoplasty: Y-V-plasty C
1735 Anal sphincteroplasty for incontinence C
1737 Dilation of ano-rectal stricture A
1739 Closure of recto-vesical fistula C
1741 Closure of recto-urethral fistula C
1742 Bio-feedback training for faecal incontinence during anorectal manometry performed by doctor
(Rule : not applicable to UPFS -no charge )
8.11 Liver
1743 Needle biopsy of liver A
1745 Biopsy of liver by laparotomy B
1747 Drainage of liver abscess or cyst B
1748 Body composition measured by bio-electrical impedance A
Hemi-hepatectomy
1749 Right C
1751 Left C
1752 Extended right or left hepatectomy C
1753 Partial or segmental hepatectomy C
1754 Hepatico-jejunostomy C
1755 Liver transplant D
1756 Harvesting donor hepatectomy. (Rule: donor procedure: please refer to Annexure H and relevant
policies) B
1757 Suture of liver wound or injury B
Billiary Tract
1759 Cholecystostomy B
1761 Cholecystectomy (1761) C
1762 Cholecystectomy and operative cholangiogram C
1763 With exploration of common bile duct C
1765 Exploration of common bile duct: Secondary operation C
1767 Reconstruction of common bile duct C
1768 Resection bile duct tumour with reconstruction C
1769 Cholecysto-enterostomy or gastrostomy B
1770 Endoscopic placement of biliduodenal endoprosthesis C
1772 Endoscopic placement of a nasobiliary stent C
1773 Transduodenal sphincteroplasty C
1774 Balloon dilatation of common bile duct strictures C
1775 Excision choledochal cyst with reconstruction C
1777 Porto-enterostomy for biliary atresia C
Code Description A
8.12 Pancreas
1778 Pancreas: ERCP: Endoscopy + catheterisation of pancreas duct or choledochus C
1779 Endoscopic exploration of the common vile duct performed following endoscopic retrograde
choangiography to be added to ERCP (item 1778) ADD C
1780 Gastric and duodenal intubation
1781 Procedure (excluding laboratory tests) (Rule: not applicable to UPFS)
1782 Endoscopic sphincterotomy C
1783 Drainage of pancreatic abscess B
1784 Debridement pancreatic necrosis C
1785 Internal drainage of pancreatic cyst B
1786 Internal drainage of pancreatic cyst with Roux-Y C
1787 Operative pancreatogram: Add
1788 Biopsy of pancreas A
1789 Pancreatico-duodenectomy C
1791 Local, partial or subtotal pancreatectomy C
1793 Distal pancreatectomy with internal drainage C
1795 Triple anastomosis for carcinoma of pancreas C
8.14 Peritoneal Cavity
Pneumo-peritoneum
1797 First B
1799 Repeat B
1800 Peritoneal lavage
1801 Diagnostic paracentesis: Abdomen
1803 Therapeutic paracentesis: Abdomen
1807 Add to open procedure where procedure was performed through a laparoscope B
1809 Laparotomy B
1810 Radical removal of retro-peritoneal malignant tumours: including sacro-coccygeal and pre-sacral C
1811 Suture of burst abdomen B
1812 Laparotomy for control of surgical haemorrhage B
1813 Drainage of subphrenic abscess B
Drainage Of Other Intraperitoneal Abscess (excluding Appendix Abscess)
1815 Drainage of other intraperitoneal abscess (excluding appendix abscess): Transabdominal B
1817 Transrectal drainage of pelvic abscess A
9 Hernia
Inguinal Or Femoral Hernia
1819 Adult B
1821 Child, under 14 years B
1823 Inguinal hernia: Infant under one year B
1825 Recurrent inguinal or femoral hernia B
1827 Strangulated hernia requiring resection of bowel C
1829 Epigastric hernia B
Umbilical Hernia
1831 Adult B
1833 Child under 14 years B
1835 Incisional hernia B
Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in
1836 addition to item for the incisional or ventral hernia repair) B
1837 Repair of omphalocele in new-born (one or more procedures) B
10 Urinary System
10.1 Kidney
1839 Renal biopsy ,per kidney, open B
1841 Renal biopsy (needle) A
Nephrectomy:
Code Description A
1853 Primary nephrectomy C
1855 Secondary nephrectomy C
1857 Radical nephrectomy with regional lymphadenectomy for tumour C
1859 Partial C
1861 Symphysiotomy for horse-shoe kidney B
1863 Nephro-ureterectomy C
1865 Nephrotomy with drainage nephrostomy B
1869 Nephrolithotomy B
1870 Nephrolithotomy: Multiple calculi: repeat open operation + 25%
1871 Staghorn stone – surgical B
1873 Suture renal laceration (renorraphy) B
1875 Percutaneous aspiration cyst: Nephrostomy, pyelostomy A
1877 Operation for renal cyst: Marsupialisation or excision B
1879 Closure renal fistula B
1881 Pyeloplasty C
1883 Pyelostomy B
1885 Pyelolithotomy C
1887 Complicated pyelolithotomy (e.g. solitary, ectopic, horse-shoe kidney or secondary operation) C
1889 Nephrectomy for Allograft: Living or dead C
1891 Perinephric abscess or renal abscess: Drainage B
1893 Aberrant renal vessels: Repositioning with pyeloplasty C
1894 Auto transplantation of kidney D
1895 Allo transplantation of kidney D
10.2 Ureter
1897 Ureterorrhaphy: Suture of ureter B
1898 Lumbar approach B
1899 Ureteroplasty B
1901 Ureterolysis B
1902 Lumbar approach B
1903 Ureterectomy only B
1905 Ureterolithotomy B
Cutaneous Ureterostomy:
1907 Unilateral B
1909 Bilateral B
Uretero-enterostomy:
1911 Unilateral C
1913 Bilateral C
1915 Uretero-ureterostomy C
1917 Transuretero-ureterostomy C
1919 Closure of ureteric fistula C
1921 Immediate deligation of ureter B
1923 Ureterolysis for retrocaval ureter with anastomosis B
1925 Uretero-pyelostomy B
Uretero-neo-cystostomy:
1927 Unilateral C
1929 Bilateral C
1931 With Boariplasty C
1933 Uretero-sigmoidostomy with rectal bladder and colostomy C
1935 Uretero-ileal conduit C
Replacement Of Ureter By Bowel Segment:
1937 Unilateral C
1939 Bilateral C
Code Description A
Ureterostomy-in-situ:
1941 Unilateral B
1943 Bilateral B
10.3 Bladder
1945 Instillation of radio-opaque material for cystography or urethrocystography A
1947 Instillation of anti-carcinogenic agent, excluding hydrodilatation of bladder A
1949 Cystoscopy: A
1951 And retrograde pyelography or retrograde ureteral catheterisation: Unilateral or bilateral B
1952 J J Stent catheter B
1953 With hydrodilatation of the bladder for interstitial cystitis B
1954 Urethroscopy B
1955 And bilateral ureteric catheterisation with differential function studies requiring additional attention
time B
1957 With dilatation of the ureter or ureters B
1959 With manipulation of ureteral calculus B
1961 With removal of foreign body or calculus from urethra or bladder B
1963 With fulguration or treatment of minor lesions, with or without biopsy B
1964 And control of haemorrhage and blood clot evacuation B
1965 And catheterisation of the ejaculatory duct B
1967 With ureteric meatotomy: Unilateral or bilateral B
1969 And cold biopsy B
1971 With cryosurgery for bladder or prostatic disease B
1973 With incision fulguration, or resection of bladderneck and/or posterior urethra for congenital
valves or obstructive hypertrophic bladderneck in a child B
1975 Ultraviolet cystoscopy for bladder tumour B
1976 Optic urethrotomy A
1977 Transuretheral resection of ejaculatory duct B
Internal Urethrotomy:
1979 Female A
1981 Male A
1983 Transuretheral resection of bladder tumour C
1984 Transuretheral resection of bladder tumours: Large multiple tumours C
Transuretheral Resection Of Bladderneck:
1985 Female or child C
1986 Male C
1987 Litholapaxy C
1989 Cystometrogram C
1991 Flowmetric bladder, studies with videocystograph C
1992 Without videocystograph C
1993 Voiding cysto-urethrogram C
1994 Rigiscan examination
1995 Percutaneous aspiration of bladder A
1996 Bladder catheterisation - male
1997 Bladder catheterisation - female
1999 Percutaneous cystostomy A
Total Cystectomy:
2001 After previous urinary diversion C
2003 With conduit construction and ureteric anastomosis C
2005 Cystectomy with substitute bowel bladder construction with anastomosis to urethra or trigone C
2006 Cystectomy with continent urinary diversion (e.g. Kocks Pouch) C
2007 Partial cystectomy C
2008 Continent urinary diversion without cystectomy (e.g. Kocks Pouch) C
2009 Radical total cystectomy with block dissection, ileal conduit and transplantation of ureters C
Code Description A
2010 Reversion of temporary conduit B
2011 Partial cystectomy with uretero-neo-cystostomy C
2012 Reversion of conduit with major urinary tract reconstruction B
2013 Diverticulectomy (independent procedure): Multiple or single B
2015 Suprapubic cystostomy B
2016 Abdomino-neo-urethrostomy B
2017 Open loop fulguration or excision of bladder tumour B
2019 Operation for vesico-vaginal or urethra- vaginal fistula C
2020 Repair of vesico vaginal fistula: Abdominal approach C
2021 Vesico-plication (Hamilton Stewart) C
2023 Vesico-urethrapexy for correction or urinary incontinence: Abdominal approach C
2025 Vesico-urethrapexy with rectus sling C
Open Operation For Ureterocele:
2027 Unilateral C
2029 Bilateral C
2207 Vasectomy: Unilateral or bilateral (no extra fee to be charged if done in combination with
prostatectomy A
2209 Vasotomy: Unilateral or bilateral A
Vasogram, Seminal Vesiculogram:
2210 Unilateral B
2211 Bilateral B
2212 Insertion of testicular prosthesis: Independent procedure B
2213 Suture or repair of testicular injury B
2215 Incision and drainage of testis or epididymis e.g. abscess or haematoma B
2217 Excision of local lesion of testis or epididymis B
Vaso-vasostomy:
2219 Unilateralm A
2221 Bilateral A
Epididymo-vasostomy:
2223 Unilateral A
2225 Bilateral A
2227 Incision and drainage of scrotal wall abscess A
2228 Removal of foreign body: Scrotum A
2229 Excision of Mullerian duct cyst B
2231 Excision of lesion of spermatic cord A
2233 Seminal Vesiculectomy B
11.3 Prostate
Code Description A
2235 Biopsy prostate: Needle or punch, single or multiple, any approach A
Interstitial device(s): Single or multiple placement (via needle, any approach), of for
2236 radiation therapy guidance (eg., fiducial markers, dosimeter), prostate A
2237 Biopsy, prostate, incisional, any approach B
2239 Transurethral drainage of prostatic abscess B
2241 Perineal drainage of prostatic abscess B
2243 Trans-urethral cryo-surgical removal of prostate B
2245 Trans-urethral resection of prostate C
2247 Trans-urethral resection of residual prostatic tissue 90 days post-operative or longer B
2249 Trans-urethral resection of post-operative bladder neck contracture B
Prostatectomy: Perineal:
2251 Sub-total C
2253 Radica C
2254 Pelvic lymphadenectomy C
2255 Supra-pelvic, transvesical C
Retropubic:
2257 Sub-total C
2259 Radical C
2260 Prostate brachytherapy B
12. Female Genital System
12.1 Vulva And Introitus
2271 Removal of tag or polyp A
2272 Removal of small superficial benign lesions A
2273 Biopsy with suture in theatre (excluding after-care) A
2274 Laser therapy of vulva and/or vagina (colposcopically directed) A
2275 Reduction labial hypertrophy B
2277 Removal of extensive benign vulva tumour B
Secondary Perineal Repair
2279 Repair second degree tear B
2280 Repair third degree tear B
2281 Excision of inclusion cyst B
2283 Hymenectomy B
2285 Drainage haematocolpos A
2287 Clitoris repair for injury: Including skin graft if required B
2288 Clitoral reduction B
2289 Denervation or alcohol infiltration vulva (Woodruff) A
2291 Vulva: Undercutting skin (ball) B
2293 Vulva and introitus: Drainage of abscess A
Bartholin Gland
2295 Bartholin abscess marsupialization A
2297 Bartholin gland excision A
2299 Bartholin radical excision for malignant lesion B
Operation For Enlarging Introitus
2301 Fenton plasty B
2303 Bilateral Z-plasty B
Vulvectomy
2305 Partial vulvectomy B
2307 Vulvectomy B
2309 Radical vulvectomy with bilateral lymphadenectomy C
2311 Radical vulvectomy with bilateral lymphadenectomy, plus deep lymph gland dissection C
12.2 Vaginal Procedures And Operations
2312 Artificial insemination
Code Description A
2313 Examination under anaesthetic when no other procedures are performed (rule: for gynaecology
procedures only) A
2314 Intra uterine insemination
2315 Simms Huhner test plus wet smear
Destruction Of Condylomata By Chemo-, Cryo- Or Electrotherapy, Or Harmonic Scalpel:
2316 First lesion A
2317 Limited repeat A
2318 Widespread A
2319 Excision of cysts or tumours A
2321 Drainage of vaginal abscess A
2322 Pudendal nerve block
2323 Reconstruction of vagina after atresia C
Construction Of Artificial Vagina:
2325 Construction of artificial vagina: Labial fusion C
2327 Construction of artificial vagina: Macindoe type C
2473 Total abdominal hysterectomy plus vaginal cuff with or without unilateral or bilateral salpingo-
oophorectomy B
2475 Radical abdominal hysterectomy with bilateral lymphadenectomy (Wertheim) B
2477 Abdominal hysterotomy with or without sterilization B
2478 Non-surgical endometrial destruction, any method, not utilising hysteroscopic instrumentation or
assistance B
2690
Total fee for full evaluation of visual tracts, including bilateral electroretinography and V.E.P.
2703 Somatosensory evoked potentials (S.E.P.) single nerve examination to brachial- or lumbosacral
plexus, spinal cord and cortex
2705 Transcutaneous nerve stimulation in the treatment of post-operative and chronic intractable pain,
per treatment
2707 Full fee for complete neurological evoked potential evaluation including neurological A.E.P.,
bilateral V.E.P., and bilateral median and/or posterior tibial stimulation
2708 Evaluation of cognitive evoked potential with visual or audiology stimulus
2709 Full spinogram including bilateral median and posterior-tibial studies
2711 Electro-encephalography
Monitoring for localisation of cerebral seizure focus: Cable or radio, 16 or more channel
telemetry, combined electroencephalographic (EEG). Includes video recording and
6018 interpretation (eg., for presurgical localisation), each 24 hours B
Functional cortical and subcortical mapping: Stimulation and/or recording of electrodes on
brain surface or depth electrodes, to provoke seizures or identify vital brain structures;
6024 initial hour of attendance A
Functional cortical and
Electronic analysis: subcortical
Implanted mapping: Stimulation
neurostimulator and/orsystem
pulse generator recording ofrate,
(eg., electrodes
pulse on
brain surface or depth electrodes, to provoke seizures or identify vital brain
amplitude, pulse duration, configuration of wave form, battery status, electrode structures:
6025 Each 60 minutes
selectability, of attendance
output modulation,(ADD to item
cycling, 6024 when
impedance andappropriate)
patient compliance A
measurements), simple or complex brain/spinal cord/peripheral (ie., cranial nerve,
peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse
6026 generator/transmitter, without reprogramming A
Electronic analysis: Implanted neurostimulator pulse generator system (eg., rate, pulse
amplitude and duration, battery status, electrode selectability and polarity, impedance and
patient compliance measurements), complex, deep brain neurostimulator/ pulse
6027 generator/transmitter, with initial or subsequent programming: First 60 minutes B
Sleep Electro-encephalography
2713 Lumbar puncture and/or intrathecal injections
2714 Cisternal puncture and/or intrathecal injections
2716 8 Hour ambulatory EEG monitoring (Holter)
6001 Sleep electro-encephalography - infants that fit into a perambulator
6003 Sleep electro-encephalography - adults and children over infant age
Electroencephalogram monitoring: Monitoring for localisation of cerebral seizure pre-operative
6010 localisation): Each full 24 hour period
A
6011 Interpretation of item 6010: Electro-encephalogram monitoring: To be charged once only for each
full 24 hour period of monitoring
Electromyography.
2717 First
2718 Subsequent
2720 Overnight polysomnogram and sleep staging
2722 Daytime polysomnogram
2723 Multiple sleep latency test
2724 Overnight continuous positive airways pressure (CPAP) titration – charge per 24 hrs
Angiography Carotis
2725 Unilateral B
2726 Bilateral B
2727 Vertebral artery: Direct needling B
2729 Vertebral catheterization B
2730 Neostigmine Test, the diagnostic test for Myasthenia Gravis under the supervision of a
neurologist ('20') (not to be used with item 0714) A
Air Encephalography And Posterior Fossa Tomography
2731 Injection of air (independent procedure) B
2733 Cortical Stimulation A
2734 Sodium Amytal Testing (WADA test) A
Code Description A
2735 Posterior fossa tomography attendance by clinician (Rule: included in imaging professional fee)
2737 Visual field charting on Bjerrum Screen
Ventricular Needling Without Burring
2739 Tapping only B
2741 Plus introduction of air and/or contrast dye for ventriculography B
Subdural Tapping:
2743 First sitting A
2745 Subsequent A
14.2 Introduction Of Burr Holes For
2747 Ventriculography B
2748 Twist drill hole: Subdural or ventricular puncture B
2749 Catheterisation for ventriculography and/or drainage B
Twist drill hole(s): Includes subdural, intracerebral, or ventricular puncture for implanting
2750 ventricular catheter, pressure recording device or other intracerebral monitoring device B
2751 Biopsy of brain tumor B
Twist drill hole(s): Includes subdural, intracerebral or ventricular puncture for evacuation
2752 and/or drainage of subdural haematoma B
2753 Subdural haematoma or hygroma D
Burr hole(s) or trephine: Includes subsequent tapping (aspiration) of intracranial abscess
2754 or cyst C
2755 Subdural empyema D
2757 Brain abscess D
Insertion: Subcutaneous reservoir, pump/continuous infusion system. Includes
2758 connection to ventricular catheter B
2760 Burr hole(s) or trephine: Supratentorial, exploratory, not followed by other surgery B
2761 Burr hole(s) or trephine: Infratentorial, unilateral or bilateral B
14.3 Nerve Procedures:
Nerve Biopsy:
2759 Peripheral A
2763 Cranial nerves: Extra-cranial A
2765 Nerve conduction studies (see item 0733 and 3285) B
Botulinum Toxin Injections
6005 For blepharospasm
6006 For hemifacial spasm
6007 For adductor dysphonia
6008 In extra-ocular muscles
6009 For spasmodic torticollis and/or cranial dystonia
14.3.1 Nerve Repair Or Suture:
2767 Suture brachial plexus (see also items 2837 and 2839) C
Suture: Large Nerve:
2769 Primary B
2771 Secondary B
Digital Nerve:
2773 Primary B
2775 Secondary B
Nerve Graft:
2777 Simple C
Fascicular:
2779 First fasciculus C
2781 Each additional fasciculus C
2783 Nerve flap: To include all stages B
2785 Facio-accessory or facio-hypoglossal anastomosis C
Code Description A
2787 Grafting of facial nerve C
2888 Micro vascular decompression of trigeminal, facial and glossopharyngeal nerve (release of D
pressure on the sensory root of the gasserion ganglion) (subtemporal). If indicated, the
nerve or a nerve branch is sectioned, bone flap is replaced and fastened (total procedure
14.3.2 Neurectomy:
Trigeminal Ganglion:
2789 Injection of alcohol A
2791 Injection of cortisone A
2793 Coagulation through high frequency A
Procedures For Pain Relief:
2799 Intrathecal injections for pain A
2800 Plexus nerve block B
2801 Epidural injection for pain
2802 Peripheral nerve block A
Alcohol Injection In Peripheral Nerves For Pain:
2803 Unilateral A
2804 Inserting an indwelling nerve catheter (includes removal of catheter) (not for bolus technique) A
2805 Bilateral A
6046 Cranioplasty: Skull defect, with reparative brain surgery: With/without prosthesis C
2859 Major B
2860 Small B
With Brain Lacerations:
2861 Small B
2862 Major B
2863 Cranioplasty D
2864 Encephalocoele (excluding frontal) D
Craniostenosis:
2865 Few sutures D
2867 Multiple sutures D
14.5 Shunt Procedures:
2869 Ventriculo-cisternostomy B
2871 Ventriculo-caval shunt C
2873 Ventriculo-peritoneal shunt B
2875 Theco-peritoneal C.S.F. Shunt B
Neuroendoscopy: Intracranial placement or replacement of ventricular catheter and
6055 attachment to shunt
Neuroendoscopy: system or with
Intracranial, external drainage.
dissection ADD to main
of adhesions, procedure of septum
fenestration A
pellucidum or intraventricular cysts (includes placement, replacement, or removal of
6056 ventricular catheter) C
Neuroendoscopy: Intracranial with fenestration or excision of colloid cyst (includes
6057 placement of external ventricular catheter for drainage) D
6066 Reprogramming of programmable cerebrospinal shunt, at the time of a routine office visit NA
Removal: Complete cerebrospinal fluid shunt system only (non-neuroendoscopic
6067 procedure) A
Cerebrospinal fluid (CSF) shunt system: Complete removal, with replacement by similar or
6068 other shunt at same operation C
2886 Posterior fossa decompression with or without laminectomy with or without dural insertion for
Arnold Chiari malformation or obstructive cysts e.g. Dandy Walker or parasites D
2887 Vestibular nerve C
2893 Abscess C
2895 Intracranial C
2897 Extracranial C
2898 Hemispherectomy C
14.7.1 Supratentorial Procedures:
2899 Craniectomy for extra-dural haematoma or empyema C
Craniectomy: Extensive for multiple cranial suture craniosynostosis (eg., cloverleaf skull);
6037 not requiring bone grafts (total procedure) C
Craniectomy: Extensive for multiple cranial suture craniosynostosis (eg., cloverleaf skull);
recontouring with multiple osteotomies and bone autografts (eg., barrel-stave procedure)
6038 (includes obtaining grafts) (total procedure) D
2901 Osteoplastic Flap for removal of: Meningioma, basal extracerebral mass, intra ventricular
tumours, Pineal tumours, pituitary adenoma, total excision cranio-pharyngioma/ pharyngioma D
2903 Abscess, Glioma C
6120 Decompression of (roof of) orbit only: Transcranial approach (total procedure) D
6136 Craniotomy with elevation of bone flap: Partial or subtotal (functional) hemispherectomy D
6137 Craniotomy with elevation of bone flap: Excision or coagulation of choroid plexus D
Transection or ligation, carotid artery in petrous canal; without repair. ADD to main
6193 procedure B
Transection or ligation, carotid artery in petrous canal; with repair by anastomosis or graft.
6194 ADD to main procedure C
Chordotomy:
2923 Unilateral C
2925 Open C
Rhizotomy:
2927 Extradural, but intraspinal C
2928 Intradural: C
Removal Of Spinal Cord Tumour: Intramedullar:
2929 Posterior approach C
2930 Anterio-lateral approach C
Extramedullary, But Intradural:
2931 Posterior approach C
2932 Anterio-lateral approach C
2933 Intraspinal, but extradural: Posterior approach C
2935 Transcutaneous chordotomy C
2937 Repair of meningocele, involving nerve tissue C
2938 Simple C
2939 Excision of arterial vascular malformations and cysts of the spinal cord C
2940 Lumbar osteophyte removal C
2941 Cervical or thoracic osteophyte removal C
14.10 Arterial Ligations:
Carotis:
2951 Trauma C
2953 For aneurysm (A.V. anomaly) D
2955 Removal of carotid body tumour (without vascular reconstruction) D
Aneurysm: Surgical, for vascular malformation or carotid- cavernous fistula with
6083 intracranial and cervical occlusion of carotid artery D
14.11 Medical Psychotherapy
2973 Psychometry (specify examination): Per session (Maximum of 3 sessions per examination)
(Rule: Charge as a Consultation – no procedure charge)
15 Endocrine System
15.1 Thyroid:
2983 Partial lobectomy C
2985 Total lobectomy C
2987 Subtotal thyroidectomy C
2989 Total thyroidectomy C
2991 Thyroglossal cyst or fistula excision B
15.2 Parathyroid:
2993 Exploration of parathyroid glands for hyperparathyroidism including removal C
15.3 Adrenals:
2995 Adrenalectomy: Unilateral C
2997 Bilateral exploration of adrenal glands: Including removal C
15.4 Hypophysis:
2999 Transethmoidal hypophysectomy C
3000 Transnasal hypophysectomy (see item 2915) C
Code Description A
15.5 General:
3001 Implantation of pellets (excluding after-care)
16 Eye
16.1 Procedures
3002 Gonioscopy
3003 Fundus contact lens or 90 D lens examination
3004 Peripheral fundus examination with indirect ophthalmoscope
3005 Endothelial cell count
3006 Keratometry
3007 Potential acuity measurement
3008 Contrast sensitivity test
3010 Orthoptic consultation.(to be charged as a consultation tariff)
3011 Orthoptic subsequent sessions. (Rule: Charge as a consultation tariff – no procedure charge)
3012 Pre-surgical retinal examination before retinal surgery
3013 Ocular motility assessment comprehensive examination
3014 Tonometry per test with maximum of 2 tests for provocative tonometry (one or both eyes)
3015 Charting of visual field with manual perimeter
3016 Retinal threshold test without storage facilities
3017 Retinal threshold test inclusive of computer disc storage for Delta or Statpak programs
3018 Retinal threshold trend evaluation (additional to item 3017)
3019 Ocular muscle function with Hess screen or perimeter
Special Eye Investigations:
3020 Pachymetry: per eye. Only in addition to corneal surgery
3021 Retinal function assessment including refraction after ocular surgery (within four months),
maximum two examinations
3022 Digital fluorescein video angiography B
3026 Digital Tomography of optic nerve with Scanning Laser Ophthalmoscope (SLO). Limited to two
exams per annum A
3027 Fundus photography
3028 Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye A
3029 Anterior segment microphotography
3031 Fluorescein angiography, for one or both eyes in one sitting (excluding colour photography)
3032 Eyelid and orbit photography
3033 Interpretation of items 3022, 3023 and 3031 referred by other clinician (not applicable to UPFS –
not to be charged)
3034 Determination of lens implant power per eye
Where a minor procedure usually done in the consulting rooms requires a general anaesthetic or
3035 use of an operating theatre, an additional fee may be charged (not applicable to UPFS – not to
be charged)
3036 Corneal topography: For pathological corneas only on special motivation. For refractive surgery -
may be charged once pre-operative and once post-operative per sitting (for one or both eyes)
16.2 Retina:
3037
Surgical treatment of retinal detachment including vitreous replacement but excluding vitrectomy C
Code Description A
Prophylaxis and treatment of retina and choroid by cryotherapy and/or diathermy and/or
3039 photocoagulation and/or laser per eye B
3059 Insertion of lenticulus when item 3045 or item 3047 was not executed (cost of lens excluded) B
Diamond Knife: Use of Diamond knife during intraocular surgery ADD to Occular surgery
3196 procedure code A
16.4 Glaucoma:
3061 Drainage operation B
3062 Implantation of aqueous shunt device/seton in glaucoma, e.g. Ahmed or Molteno valve or
Collagen implants. Additional to item 3061 B
3063 Cyclocryotherapy or cyclodiathermy B
3064 Laser trabeculoplasty B
3065 Removal of blood from anterior chamber B
3067 Goniotomy B
16.5 Intra-ocular Foreign Body:
3071 Anterior to Iris B
3073 Posterior to Iris (including prophylactic thermal treatment to retina) B
16.6 Strabismus:
3074 Adjustment of sutures if not done at the time of the operation
3075 Operation on one or two muscles B
3076 Operation on three or four muscles B
3077 Subsequent operation one or two muscles B
3078 Subsequent operation on three or four muscles B
16.7 Globe:
3079 Transcleral biopsy B
3080 Examination of eyes under general anaesthetic where no surgery is done A
3081 Treatment of minor perforating injury B
3083 Treatment of major perforating injury B
3085 Enucleation or Evisceration B
3087 Enucleation or Evisceration with mobile implant: Excluding cost of implant and prosthesis B
3088 Hydroxyapetite insertion (additional to item 3087): A
3089 Subconjunctival injection if not done at time of operation A
3090 Intra vitreal injection drug A
3091 Retrobulbar injection (if not done at time of operation) A
3092 External laser treatment for superficial lesions
Treatment of tumors of retina or choroid by radioactive plaque and/or diathermy and/or
3093 cryotherapy and/or laser therapy and/or photocoagulation B
3094 Implantation of intra vitreal drug delivery system B
3095 Biopsy of vitreous body or anterior chamber contents B
3096 Adding of air or gas in vitreous as a post-operative procedure or pneumoretinopexy B
3097 Anterior vitrectomy B
3098 Removal of silicon from globe B
3099 Posterior vitrectomy including anterior vitrectomy, encircling of globe and vitreous replacement C
Code Description A
3100 Lensectomy done at time of posterior vitrectomy B
16.8 Orbit:
3101 Drainage of orbital abscess B
3103 Removal of tumour B
3104 Removal orbital prosthesis B
3105 Exenteration C
3107 Orbitotomy requiring bone flap B
3108 Eye socket reconstruction B
3109 Hydroxyapetite implantation in eye cavity when evisceration or enucleation was done previously
C
3110 Second stage hydroxyapetite implantation B
16.9 Cornea:
Fitting of contact lenses and instuctions to patient: Includes eye examination, first fitting of the
3113 contact lenses and further post-fitting visits for 1 year. Rule: Charge included in consultation – no
additional procedure to be charged.
3114 Wavefront analysis (Aberometry) for customized ablation of pathological corneas prior to LASIK
surgery A
Fitting of only one contact lens and instructions to the patient: eye examination, first fitting of the
3115 contact lens and further post- fitting visits for one year included. Rule: Charge included in
consultation – no additional procedure to be charged.
3116 Astigmatic correction with T cuts or wedge resection following intra ocular surgery, penetrating
keratoplasty or trauma B
3117 Removal of foreign body: Rule: Charge included in consultation – no additional procedure to be
charged. A
3118 Curettage of cornea after removal of foreign body
3119 Tattooing. Rule: Charge as per cosmetic tarrif groupng B
3120 Excimer laser (per eye) for refractive keratectomy or Holmium laser thermo keratoplasty (LTK)
3121 Graft (Lamellar of fullthickness) C
3122 Epikeratophakia
3123 Insertion of intra-corneal or intrascleral prosthesis for refractive surgery B
3124 Removal of corneal stitches under microscope (maximum of 2 procedures)
3125 Keratectomy or conjuctival flap B
3127 Cauterization of cornea (by chemical, thermal or cryotherapy methods) A
3128 Radial keratotomy or keratoplasty for astigmatism (Rule: cosmetic unless medical reasons can
be proved) B
3130 Pterygium or conjunctival cyst or conjunctival tumor B
3131 Paracentesis B
3132 Lamellar keratectomy (per eye) for refractive surgery (LK, ALK, MLK) B
3134 Pterygium or conjunctival cyst or conjunctival tumour. Conjunctival flap or graft used – stand
alone procedure A
3136 Conjunctival flap or graft (not for use with pterigium surgery) A
3138 Removal corneal epithelium and chelating agent for band keratopathy A
4980 Corneal transplant: Endothelial B
4981 Preparation of corneal endothelial allograft prior to transplantation (backbench) A
4983 Lamellar corneal surgery keratome and equipment A
4985 Corneal Cross linking A
4986 Corneal Cross linking equipment hire
4988 Endothelial specular microscope for donor corneas NA
4989 Endothelial specular microscope for clinical use NA
16.10 Ducts:
3133 Probing and/or syringing, per duct A
3135 Insertion of polythene tubes (additional): Unilateral B
3137 Excision of lacrimal sac: Unilateral B
3139 Dacryocystorhinostomy (Single) with or without polythene tube B
Code Description A
3141 Sealing of punctum A
3142 Sealing Punctum with plugs: Per eye A
3143 Three-snip operation A
Repair Of Canaliculus:
3145 Primary procedure B
3147 Secondary procedure B
16.11 Iris:
3149 Iridectomy or iridotomy by open operation as isolated procedure B
3151 Excision of iris tumour B
3153 Iridectomy or iridotomy by laser or photo-coagulation as isolated procedure (maximum one
procedure) B
3155 Iridocyclectomy for tumour C
3157 Division of anterior synechiae as isolated procedure B
3158 Repair iris: Anterior chamber reconstruction A
16.12 Lids:
3161 Tarsorrhaphy B
3163 Excision of superficial lid tumour B
3165 Repair of skin lacerations of the lid B
3167 Diathermy to wart on lid margin A
3168 Removal of foreign body: Embedded, per eyelid A
3169
Electrolysis of any number of eyelashes (per eye) (Rule: Charge as per cosmetic tariff groupng)
3171 Excision of Meibomian cyst A
3173 Epicanthal folds B
3174 Botulinum toxin injection for blepharospasm
3175 Botulinum toxin injection in extra-ocular muscles
3176 Lid operation for facial nerve paralysis including tarsorrhaphy but excluding cost of material B
16.12.1 Entropion Or Ectropion By:
3177 Cautery A
3179 Suture B
3181 Open operation B
3183 Free skin, mucosal grafting or flap B
16.12.2 Reconstruction Of Eyelid:
Staged Procedures For Partial Or Total Loss Of Eyelid
3185 First stage B
3187 Subsequent stage B
3189 Full thickness eyelid laceration for tumour or injury: Direct repair B
3191 Blepharoplasty: upper lid for improvement in function B
3172 Blepharoplasty lower eyelid plus fat pad A
16.13 Ptosis:
3193 Repair by superior rectus, levator or frontalis muscle operation B
Ptosis: By Lesser Procedure E.g. Sling Operation:
3195 Unilateral B
3197 Bilateral B
16.14 Conjunctiva:
3199 Repair of conjunctiva by grafting B
3200 Repair of lacerated conjunctiva B
16.15 General:
17 Ear
17.1 External Ear (pinna):
Major Congenital Deformity Reconstruction Of External Ear:
3204 External ear canal: Removal of foreign body with use of microscope NA
Code Description A
3267 Unilateral C
3269 Bilateral C
3270 Excision of superficial pre-auricular fistula B
3272 Excision of complicated pre-auricular fistula B
17.2 External Ear Canal:
3205 Removal of foreign body under general anaesthetic A
Meatus Atresia:
3215 Repair of stenosis of cartilaginous portion B
3217 Congenital B
3219 Removal of osteoma from meatus: Solitary B
3221 Removal of osteoma from meatus: Multiple B
17.3 Middle Ear:
3206 Microscopic examination of tympanic membrane including microsuction
3207 Unilateral myringotomy B
3209 Bilateral myringotomy B
3211 Unilateral myringotomy with insertion of ventilation tube B
3212 Bilateral myringotomy with insertion of unilateral ventilation tube B
3213 Bilateral myringotomy with insertion of bilateral ventilation tubes B
3214 Reconstruction of middle ear ossicles (ossiculoplasty) C
3237 Exploratory tympanotomy B
3243 Myringoplasty B
3245 Functional reconstruction of tympanic membrane C
3249 Stapedotomy and stapedectomy B
3257 Cortical mastoidectomy C
3259 Radical mastoidectomy (excluding minor procedures) C
3261 Muscle grafting to mastoid cavity without tympanoplasty C
3263 Autogenous bone graft to mastoid cavity C
3264 Tympanomastoidectomy C
3265 Reconstruction of posterior canal wall, following radical mastoid C
3266 Gentamycin instillation into the middle ear for Méniére's disease (myringotomy excluded) B
17.4 Facial Nerve:
17.4.1 Facial Nerve Tests:
3223 Percutaneous stimulation of the facial nerve B
3224 Electroneurography (ENOG) B
17.4.2 Facial Nerve Surgery:
Exploration Of Facial Nerve:
3227 Exploration of tympanomastiod segment C
3228 Grafting of the tympanomastoid segment (including item 3227) C
3230 Extratemporal grafting of the facial nerve C
3232 Facio-accessory or facio-hypoglossal anastomosis C
17.5 Inner Ear:
17.5.1 Audiometry: (Rule: charge Allied Health ProfessionalFee where applicable)
2691 Short latency brainstem evoked potentials (A.E.P.) neurological examination, single decibel
unilateral
2692 Bilateral
17.5.2 Balance Tests: (Rule: charge Allied Health Professional Fee where applicable)
3251 Minimal caloric test (excluding consultation fee)
Facial nerve surgery inside the internal auditory canal (if grafting required and harvesting of graft
5222 included) C
5229 Facial nerve surgery in the internal auditory canal, translabyrinthine (if grafting and graft removal
included) C
17.6.3 Transotic Approach To The Cerebellopontine Angle:
5232 Removal of acoustic neuroma or cyst of the internal auditory cana C
17.6.4 Infratemporal Fossa Approach Type A:
Removal of tumour for the jugular foramen, internal carotid artery, petrous apex and large
5235 intratemporal tumours C
17.6.5 Infratemporal Fossa Approach Type B:
18 PhysicalorTreatment:
Domiciliary nursing home treatment (only applicable where a patient is physically incapable of
attending the rooms, and the equipment has to be transported to the patient) (not applicable to
3279 UPFS – not to be charged)
Consultation units for specialists in physical medicine when treatment is given (per treatment)
3280 (not applicable to UPFS – not to be charged)
A
A
B
A
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D
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A
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D
D
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A
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A
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C
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B
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A
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A
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D
D
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D
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A
A
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D
D
D
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A
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A
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A
A
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A
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P
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A
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A
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A
A
B
B
B
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A
D
D
D
D
D
D
P
D
D
D
D
D
D
A
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
B
UPFS CODE BOOK 2021
Minor Theatre - Annexure E
1. The Code Book serves as a guideline and there may be exceptions to the rule in the application th
2. The UPFS schedule does not prescribe the scope of practice of a particular health service / categ
3. Neither does it confine the performing of procedures or services to the attending practitioner only e
Code: Description:
3138 Removal corneal epithelium and chelating agent for band keratopathy
3142 Sealing Punctum with plugs: Per eye
3163 Excision of superficial lid tumour
3165 Repair of skin lacerations of the lid
3167 Diathermy to wart on lid margin
3224 Electroneutrography (ENOG)
3248 Otoacoustic emission performed as a screening test
3255 Caloric test done with electronystagmography
3287 Spinal joint and ligament injection
3288 Epidural injection
3294 Paracervical nerve block
3295 Paravertebral root block – unilateral
3296 Paravertebral root block – bilateral
3303 Electromyography
3719 Bone marrow: Aspiration Paediatric
3720 Bone marrow Trephine biopsy Paediatric
4985 Corneal Cross Linking
Code: Description:
4988 Endothelial specular microscope for donor corneas
4989 Endothelial specular microscope for clinical use
6010 Electroencephalogram monitoring: Monitoring for localisation of cerebral
seizure pre-operative localisation): Each full 24 hour period
6011 Interpretation of item 6010: Electro-encephalogram monitoring: To be
charged once only for each full 24 hour period of monitoring
Ana P
A
B
A A
A A
A A
A A
A A
A A
A A
A A
A A
A A
A A
A A
A A
A B
A B
B C
A
A
A A
B B
B B
A A
A A
Ana P
A A
A A
B D
A A
A A
A A
A A
A B
A B
A B
A A
A A
A A
B C
B C
B C
A B
A A
A
A
A A
B A
C
A B
A C
A A
A
B A
A A
A A
B
B
A A
B A
A
B A
A A
A A
Ana P
A
A B
B B
B B
B A
B B
B B
B A
B B
B B
B B
B B
B B
B B
A A
B A
B A
A A
B A
B C
A A
B A
B A
A A
B C
B B
B A
B C
B D
D
B B
B
A
A A
B B
B C
B A
Ana P
B A
A A
A B
A A
A A
A A
A A
B A
B A
A
B B
B B
B B
B B
B B
B A
B A
B B
B C
B B
B B
A
A
A A
B B
B B
B B
B C
B B
A B
A A
A B
A A
A A
A A
B A
A A
A A
A
Ana P
A
A A
A A
A A
B A
B A
B A
B A
B B
B A
B A
B A
B A
B A
A A
A A
B B
A A
A A
B
A A
A A
A A
A A
A A
A A
A A
A A
A A
A B
A
A
A
A
A
A
B A
Ana P
B A
B A
A
A B
A
A B
A
B
A
A B
A A
A A
A
A
A
B
B
A B
A B
A B
B A
A
A A
A A
A A
A A
A A
B A
B B
B B
Ana P
A A
A A
A A
NA B
A
A A
A
A B
A
A
A A
A A
A B
A A
B A
B A
A A
B B
A A
B
A
A
A
A
A
B
A A
A A
A A
Ana P
NA B
NA B
A D
B D
A B
A B
A B
B C
NA A
UPFS CODE BOOK 2021
Ambulatory Proceduers - Annexure D
1. The Code Book serves as a guideline and there may be exceptions to the rule in the application th
2. The UPFS schedule does not prescribe the scope of practice of a particular health service / categ
3. Neither does it confine the performing of procedures or services to the attending practitioner only e
Code: Description:
0202 Setting of sterile tray (Stand alone) Limited to 1 charge per 24h
0205 Insertion of I.V. line children under two years (per 24 hour)
0206 Insertion of I.V. line adult (per 24 hour)
0208 Therapeutic venesection (Not to be used when blood is drawn for the
purpose of laboratory investigations)
0213 Chemotherapy: Intramuscular or subcutaneous: per injection
0214 Chemotherapy: Intravenous bolus technique: per injection
0215 Chemotherapy: Intravenous infusion technique: per injection
0217 Patch Tests first patch
0218 Skin-prick testing: Insect venom, latex and drugs
0219 Each additional patch
Immediate hypersensitivity testing (Type I reaction): per antigen: Inhalant
0220 and food allergens
0221 Delayed hypersensitivity testing (Type IV reaction): per antigen
0222 Intralesional Injection Into Areas Of Pathology E.g. Keloids Single
0223 Multiple
0225 Epilation: per session
0227 Special treatment of severe acne cases, including draining of cysts,
expressing of comedones and/or steaming, abrasive cleaning of skin and
UVR per session
0228 PUVA Treatment
0229 PUVA: Follow-up or maintenance once a week.
0230 UVR-Treatment
0231 UVR-Follow-up
0280 Laser Treatment For Small Skin Lesions First lesion
0281 Subsequent lesions
0282 Maximum for multiple additional lesions
Code: Description:
0283 Laser Treatment For Large Skin Lesions Limited area
0286 Photo-dynamic therapy for malignant skin lesions
0287 Scanning of pigmented skin lesions: Molemax or similar device
0300 Stitching of wound
0305 Needle biopsy - soft tissue
0316 Breasts Fine needle aspiration for soft tissue (all areas)
0377 Acupuncture Standard acupuncture
0378 Laser acupuncture using more than 6 points
0379 Electro-acupuncture
0380 Scalp acupuncture
0381 Micro-acupuncture (ear, hand)
Aspiration of joint or intra-articular injection (not including after-care),
0661 modifier 0005 not applicable
1187 Exhaled nitric oxide determination (not for under 4-year old children)
Flow volume test: Inspiration/expiration pre- and post bronchodilator (first
1188 consultation)
1189 Forced expirogram only
1191 N2 single breath distribution
1192 Peak expiratory flow only
Functional residual capacity or residual volume: helium, nitrogen open
1193 circuit, or other method
1195 Thoracic gas volume
Determination of resistance to airflow, oscillatory or plethysmographic
1196
methods
1197 Compliance and resistance, using oesophageal balloon
Prolonged postexposure evaluation of bronchospasm with multiple
1198 spirometric determinations after antigen, cold air, methacholine or other
chemical agent, with subsequent spirometrics
2694 Bilateral
2695 Audiology 40Hz response: unilateral
2696 Bilateral
2697 Mid- and long latency auditory evoked potentials: unilateral
2698 Bilateral
2699 Electro-cochleography: unilateral
2700 Bilateral
Transcutaneous nerve stimulation in the treatment of post-operative and
2705 chronic intractable pain, per treatment
2708 Evaluation of cognitive evoked potential with visual or audiology stimulus
2709 Full spinogram including bilateral median and posterior-tibial studies
2711 Electro-encephalography
2716 8 Hour ambulatory EEG monitoring (Holter)
2720 Overnight polysomnogram and sleep staging
2722 Daytime polysomnogram
2723 Multiple sleep latency test
Code: Description:
2731 Air Encephalography And Posterior Fossa Tomography Injection of air
(independent procedure)
2737 Visual field charting on Bjerrum Screen
2765 Nerve conduction studies
2799 Intrathecal injections for pain
2803 Alcohol Injection In Peripheral Nerves For Pain: Unilateral
2805 Bilateral
Diagnostic/Therapeutic nerve block (unassociated with surgery) - either
2853 intercostal, or brachial, or peripheral, or stellate ganglion
3204 External ear canal: Removal of foreign body with use of microscope
3206 Microscopic examination of tympanic membrane including microsuction
3223 Percutaneous stimulation of the facial nerve
3251 Balance Tests: Minimal caloric test (excluding consultation fee)
3252 Bithermal Halpike caloric test (excluding consultation fee)
3253 Electro-nystagmography for spontaneous and positional nystagmus
P
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
B
B
P
B
B
B
B
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
A
A
A
B
B
B
B
B
B
B
B
P
A
A
B
A
A
B
B
A
B
B
A
A
A
A
A
B
A
A
A
A
A
A
P
A
A
B
A
B
B
A
A
A
A
A
A
A
B
A
B
B
B
A
A
A
A
B
A
B
B
B
B
B
A
A
A
A
B
P
B
B
B
A
A
A
B
B
B
B
B
B
B
B
B
A
B
A
A
A
A
A
B
A
B
B
B
B
B
B
B
P
A
B
B
A
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
P
A
A
A
A
A
B
B
B
B
A
A
A
A
B
B
B
A
A
A
A
A
A
A
B
B
A
A
A
A
A
A
A
A
P
A
B
B
B
B
B
B
B
UPFS CODE BOOK 2021
Cosmetic Surgery - Annexure O
B
I
A
B
B
B
B
A
B
A
B
B
B
B
I
B
B
C
A
I
I
I
I
I
I
I
I
I
I
A
B
B
B
B
A
I
B
A
I
I
I
I
UPFS CODE BOOK 2021
Dental Lab - Annexure F1
Code: Description
Casting and trimming of model in plaster (yellow/white), per
9301 model
Casting and trimming of model in super-hard stone (die-stone)
9303 per model
9305 Casting and trimming of study model, per model
9307 Casting and trimming of gnathostatic model, per model.
9309 New trimmed base to supplied model, per model
9311 Trimming of supplied model, per model
9312 Gingival tissue mask per implant
9313 Duplicating model, per model
9314 Refractory model, per unit
Models and duplicate models (virgin model) for crown and
9315 bridge, work inclusive of one removable die
Sectional models for crown and bridge, work inclusive of one
9317 removable die
Each additional removable die for items 9315 and 9317 per
9319 die
9320 Indexed or model tray per die (not more than 9319)
9321 Occlusion block, per block
9323 Occlusion block on baseplate, per block
Infection control per impression, denture (wax or acrylic) or
9327 any item in contact with body fluids
9329 Fit and supply of disposable articulator
Delivery / Collection fee per completed procedure (maximum
9330 4)
The tariff under all sections excludes the fees for models -
occlusion blocks and delivery charge.
2 Prosthetic Services Using Acrylic
The tariff under this section excludes the fees for models and
occlusion blocks.
The following section includes consumables, however it
excludes materials
A Full Dentures
9331 Full upper and lower dentures
9333 Full upper or lower denture
9335 Set-up and waxing of full upper and lower dentures
9337 Set-up and waxing of full upper or lower denture
9339 Waxing and finishing of full upper and lower dentures
9341 Waxing and finishing of full upper or lower denture
Additional fee for dentures on fully adjustable articulator at
9343 request of dentist
9345 Additional fee for immediate dentures, or tooth socketed
9346 Additional fee for immediate dentures, per tooth not socketed.
Additional fee for each retry from the third and upwards at an
9347 agreed quantum of time to be calculated at hourly rate
B Partial Dentures
9351 Set-up and finish of one-tooth denture
9352 Set-up and finish of two-tooth denture
9353 Set-up and finish of three-tooth denture
9354 Set-up and finish of four-tooth denture
9355 Set-up and finish of five-tooth denture
9356 Set-up and finish of six-tooth denture
9357 Set-up and finish of seven-tooth denture
9358 Set-up and finish of eight-tooth denture
9359 Set-up and finish nine or more tooth denture
9361 Set-up and waxing of one-tooth denture
9362 Set-up and waxing of two-tooth denture
9363 Set-up and waxing of three-tooth denture
9364 Set-up and waxing of four-tooth denture
9365 Set-up and waxing of five-tooth denture
9366 Set-up and waxing of six-tooth denture
9367 Set-up and waxing of seven-tooth denture
9368 Set-up and waxing of eight-tooth denture
9369 Set-up and waxing of nine or more tooth denture
9371 Waxing and finishing of one-tooth denture
9372 Waxing and finishing of two-tooth denture
9373 Waxing and finishing of three-tooth denture
9374 Waxing and finishing of four-tooth denture
9375 Waxing and finishing of five-tooth denture
9376 Waxing and finishing of six-tooth denture
9377 Waxing and finishing of seven-tooth denture
9378 Waxing and finishing of eighth-tooth denture
9379 Waxing and finishing of nine or more tooth denture
Additional fee for finishing denture in tooth colour material, per
9383 tooth
Additional fee for supplying finished denture on duplicate
9385 model
C Repair Service
Basic charge which includes repair of one fracture, or addition
9391 of one tooth, or addition of one clasp
Additional charge for each additional fracture, or tooth, or
9393 clasp
9395 Additional fee for using wire strengthener
9397 Additional fee for using pre-formed strengthener
9471 Additional charge for saddle without finishing line, per tooth
9473 Additional charge for horseshoe saddle, per tooth
9475 Additional charge for fitting of tooth to metal backing, per tooth
9479 Additional charge for fitting one distal-extension hinge
9480 Additional charge per milled edge per tooth
9481 Additional charge for each soldering joint
9483 Additional charge for soldering retention
9526 Additional fee for one piece casting of crown or inlay on post
9531 Pin-ledge inlay
9533 Full metal pontic
9535 Abutment thimble cast
9537 Precision lock and rest cast
9538 Lock and rest cast
9539 Casting of rest only
9541 Metal inlay or post, cast direct
9543 Gold/pre-solder invested joint
9545 Cast post with thimble, indirect
9546 Multiple Post
9547 Manufacture cast post and core to existing crown
9549 C.S.P. attachment (Steiger)
9550 Milling milled edge per unit
9551 Telescope crown
9553 Composite/acrylic veneer crown/pontic, indirect
9557 Composite/acrylic jacket crown, indirect
9559 Composite/acrylic veneer post crown
9560 Indirect Composite Resin Veneer
9561 Composite/acrylic jacket crown, direct
9563 Temporary acrylic/composite crown per unit
Heat formed template supplied to dentist for the manufacture
9564 of temporary restorations
9565 Composite/acrylic-facing replaced
9566 Porcelain/ Ceromer facing replaced
9569 Waxing of crown to existing denture
Additional fee for each remake at an agreed quantum of time
9570 to be calculated at an hourly rate
5 Orthodontic Appliances
The tariffs under this section excludes the tariff for
models.
The following section includes consumables, however it
excludes materials
A Orthodontic Services
9571 Basic charge which includes acrylic base
9572 Basic charge non acrylic base
9573 Additional charge for fitting first expansion screw
9575 Additional fee for fitting subsequent expansion screws
9576 Additional fee for full aclusal bite plate
9577 Additional fee for bite plate anterior
9578 Additional fee for bite plate posterior
9579 Additional fee for fitting tongue guard
9581 Additional fee for flat or inclined plane
9583 Additional fee for Adams Crib
9585 Additional fee for Jackson Crib
9587 Additional fee for ball clasp
9589 Additional fee for single arm clasp
9591 Additional fee for double arm clasp
A.1 Springs
9593 Additional fee for fitting single loop finger spring
9595 Additional fee for fitting double loop finger spring
9597 Additional fee for fitting Buccal retraction spring
9599 Additional fee for fitting apron spring
9603 Additional fee for fitting coffin spring
9605 Additional fee for fitting Quad Helix
9607 Additional fee for fitting flapper or “T”-spring
9609 Additional fee for fitting all springs with tubing, each
A.2 Arches
9611 Additional fee for fitting labial arch
9613 Additional fee for fitting buccal arch
9615 Additional fee for fitting Roberts retractor
9617 Invisible Retainer
9619 Additional fee for fitting twin wire arch extra-oral arch
9620 Additional fee Lip bumper
9621 Additional fee for fitting extra-oral arch
9622 Additional fee for fitting space maintainer arch
A.3 Welding And Soldering
9623 Additional fee for each spot-welding joint
9625 Additional fee for each soldering joint
9627 Additional fee for each invested soldering joint
9629 Additional fee for each hook for elastic traction
6 Materials
A Prosthetic/Restorative Services
9700 Diatorics 1 X 6/8
9702 Diatorics, odds, anterior
9704 Diatorics, odds, posterior
9706 Cost of Bleaching tray material
9720 Soft base material per denture
l u NG
l u NG
9741 Cost of Cobalt Chrome casting alloy
ia I
er UR
s
Cost of specialised Cobalt Chrome casting metal e g Vitallium,
at CT
rm A
9742 Titanium
fo F
s NU
9744 Cost of precious casting alloy
an A
ci M
9746 Cost of semi-precious casting alloy
ni R
ch PE
9748 Cost of non-precious casting alloy
Te S
A
9752 Cost of platinum foil
9754 Cost of gold solder, per gram
9755 Etching For bonding (metal or Ceramic)
9756 Cost of silver solder, per gram
9757 Ceromer material - per unit
9758 Fiber re-enforced material per unit
9760 Composite restoration material
a NG
9761 Ceramic material
rm I
fo UR
C Orthodontic Services
ns T
ia AC
9762 Cost of anterior orthodontic attachment, per attachment
ic F
hn NU
9763 Orthodontic material
ec A
lT M
9764 Cost of posterior orthodontic attachment, per attachment
t a ER
en P
9765 Preformed components
D S
A
9766 Cost of expansion screw, per screw
9767 Soldering material
9768 Cost of buccal tube/transfer tube, per tube
9770 Cost of J-hook, per hook
9772 Cost of lingual buttons, per button
9774 Cost of invisible retainer material
9775 R/A case
9776 Cost of mouth protector material
9778 Cost of arch wire
9779 Dual laminate material
7 Precision Attachments and Implant Services
The following section includes consumables, however it
excludes materials
Positioning and finishing of complete (male and female) pre
9780 fabricated burn-out attachment
Positioning and soldering of complete (male and female)
9782 precision attachment
9783 Implant stent per unit
9784 Alignment of dolder bar and clips
Trimming, waxing and finishing of implant abutment - crown
9786 and bridge work only, per abutment
9787 Waxing, milling and finishing of a custom abutment
Implant superstructure (edentulous cases) including placing of
9788 preformed parts, per section cast
9789 Finishing of prosthesis on implant structure per arch
A
Te S
ch PE
ni R
ci M
an A
s NU
fo F
rm A
at CT
er UR
ia I
l u NG
se C
d O
ST
D
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by
D
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D S Te S
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lT M ci M
ec A an A
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ic F fo F
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fo UR er UR
-
-
-
-
-
-
-
-
-
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Nuclear Medicine 2021
Radiopharmaceuticals and Isotopes
Substrate
Code Radiopharmaceuticals
X4774 HMPAO
X4775 ECD
X4235 MDP
X4776 Mebrofenin
X4222 DISIDA
X4234 MAG-3
X4223 DMSA
X4224 DTPA
X4237 MIBI
X4238 Nanocolloid
X4777 Tc-99m Octreotide
X4778 Tin colloid
X4779 MAA
X4244 RBC
X5049 Technescan
X5050 HSA (Vasculocis)
Isotope Code
X4220 Cr-51 chromate
X4221 Cr-51 EDTA
X4376 F-18 FDG
X4793 F-18 fluoride
X5058 F-18 DOPA
X4225 Fe-59 citrate
X4780 Ga-67 citrate
X5059 Ga-68 DOTANOC
X5060 Ga-68 PSMA
X4781 Ga-67 resin
X4377 I-123 DaTSCAN
X4782 I-123 iodide (diagnostic thyroid)
X4783 I-123 iodide (diagnostic – whole body)
X4784 I-123 MIBG (diagnostic)
X4794 I-131 MIBG (diagnostic)
X4785 I-131 MIBG (therapy)
X4227 I-125 albumin
Rb-81/Kr-81m
X4245 Tc-99m
X4787 I-131 (therapy for hyperthyroidism)
X4788 I-131 (therapy for thyroid Ca)
X4230 In-111 chloride
X4231 In-111 Octreotide
X4232 In-111 oxine
X5057 Lu-177 DOTANOC (therapy)
X5061 Lu-177 PSMA (therapy)
Mbq Y-90 (therapy)
Mbq Re-186 (therapy)
X4246 Tl-201 chloride
1010 /1012 Outpatient consultation
NB: Refer to the Nuclear Medicine code book in respect of procedures
Soft Tissue
Thorax
30900 Nuclear Medicine study - Lung perfusion
30910 Nuclear Medicine study - Lung ventilation, aerosol
30920 Nuclear Medicine study - Lung perfusion and ventilation
Nuclear Medicine study - Lung ventilation using radio-active
30930 gas
Nuclear Medicine study - Lung perfusion and ventilation using
30940 radio-active gas
Nuclear medicine study - Muco-ciliary clearance study
30950 dynamic
41900 Nuclear Medicine study - Liver and spleen, planar views only
41905 Nuclear Medicine study - Liver and spleen, with flow study
Nuclear Medicine study - Liver and spleen, planar views
41910 SPECT
Nuclear Medicine study - Liver and spleen, with flow study
41915 and SPECT
Nuclear Medicine study - Hepatobiliary system planar
41920 static/dynamic
41925 Nuclear Medicine study – hepatobiliary tract including flow
D
C
B
D
D
C
B
A
P I
Varies
Varies
E
E
E
E
E
E
C
C
D
B
C
A
A
B
A
B
P I
A
A
B
B
B
A
B
P I
A
C
B
B
P I
D
P I
C
D
C
B
B
B
C
B
C
C
C
D
A
B
B
C
C
B
C
A
P I
C
A
A
A
A
A
A
P I
A
A
C
C
A
C
C
A
C
C
A
C
C
A
C
C
A
D
P I
C
C
A
C
C
A
C
C
A
C
C
A
D
P I
A
UPFS CODE BOOK 2021
Radiology - Annexure N
Neck
20100 X-ray of soft tissue of the neck
20110 X-ray of the larynx including tomography
20120 X-ray laryngography
X-ray evaluation of pharyngeal movement and
20130 speech by screening and / or cine with or without
video recording
20200 Ultrasound of the thyroid
20210 Ultrasound of soft tissue of the neck
20220 Ultrasound of the carotid arteries, bilateral including B B
mode, pulsed
Ultrasound andentire
of the colourextracranial
doppler vascular tree
20230 including carotids, vertebral and subclavian vessels B
with B mode, pulse and colour doppler
Ultrasound study of the venous system of the neck
20240 including pulse and colour Doppler B
20300 CT of the soft tissues of the neck B
20310 CT of the soft tissues of the neck, with contrast B
20320 CT of the soft tissues of the neck, pre and post B
20330 contrast
CT angiography of the extracranial vessels in the B
20340 neck
CT angiography of the extracranial vessels in the B
neck and intracranial
CT angiography of thevessels of thevessels
extracranial brain in the
20350 neck and intracranial vessels of the brain plus a pre B
and post contrast study of the brain
20400 Mr of the soft tissue of the neck B
MR of the soft tissue of the neck, pre and post
20410 contrast B
MR of the soft tissue of the neck and uncontrasted
20420 angiography B
MR angiography of the extracranial vessels in the
20430 neck, without contrast B
Mamma
34100 X-ray mammography including ultrasound
34101 X-Ray mammography unilateral, including ultrasound
34105 X-ray mammography galactography
34110 X-ray mammography study for localisation
34120 X-ray stereotactic mammography – localisation
34130 X-ray stereotactic mammography – biopsy B
Code Description Ana P
34140 X-ray of biopsy specimen of the mamma
34150 X-ray Mammotome hand held biopsy apparatus
34200 Ultrasound study of the breast
34205 Ultrasound guided aspiration FNA/localisation of the B
34300 breast
Computer assisted diagnosis for mammography
34400 MR study of the breast B
MR study of the breast pre and post contrast
34410 B
Abdomen and Pelvis
Abdomen/stomach/bowel
40100 X-ray of the abdomen
40105 X-ray of the abdomen supine and erect, or decubitus
40110 X-ray of the abdomen multiple views including chest
40120 X-ray tomography of the abdomen
40140 X-ray barium meal single contrast
40143 X-ray barium meal double contrast
40147 X-ray barium meal double contrast with follow through
40150 X-ray small bowel enteroclysis (meal)
40153 X-ray small bowel meal follow through single contrast
40157 X-ray small bowel meal with pneumocolon
40160 X-ray large bowel enema single contrast
40165 X-ray large bowel enema double contrast
40170 X-ray guided gastro oesophageal intubation
40175 X-ray guided duodenal intubation
40180 X-ray defaecogram
40190 X-ray guided reduction of intussusception
40200 Ultrasound study of the abdominal wall
Ultrasound study of the whole abdomen including the
40210 pelvis
40300 CT study of the abdomen B
40310 CT study of the abdomen with contrast B
40313 CT study of the abdomen pre and post contrast B
40320 CT of the pelvis B
40323 CT of the pelvis with contrast B
40327 CT of the pelvis pre and post contrast B
40330 CT of the abdomen and pelvis B
40333 CT of the abdomen and pelvis with contrast B
40337 CT of the abdomen and pelvis pre and post contrast B
CT triphasic study of the liver, abdomen and pelvis
40340 pre and post contrast B
Code Description Ana P
CT of the chest, abdomen and pelvis without contrast
40345 B
40365 CT colonoscopy B
40400 MR of the abdomen B
40410 MR of the abdomen pre and post contrast B
40420 MR of the pelvis, soft tissue B
40430 MR of the pelvis, soft tissue, pre and post contrast B
Liver, spleen, gall bladder and pancreas
41100 X-ray ERCP including screening B
41110 X-ray cholangiography intra-operative B
41120 X-ray T-tube cholangiography post operative B
41130 X-ray transhepatic percutaneous cholangiography B
41200 Ultrasound study of the upper abdomen
Ultrasound doppler of the hepatic and splenic veins
41210 and inferior vena cava in assessment of portal venous B
hypertension or thrombosis
41300 CT of the abdomen triphasic study – liver B
41400 MR study of the liver/pancreas B
41410 MR study of the liver/pancreas pre and post contrast B
41420 MRCP B
41430 MR study of the abdomen with MRCP B
MR study of the abdomen pre and post contrast with
41440 B
MRCP
Renal tract
42100 X-ray tomography of the renal tract
42110 X-ray excretory urogram including tomography
42115 X-ray excretory urogram including tomography with
micturating study
42120 X-ray cystography
42130 X-ray urethrography
42140 X-ray micturating cysto-urethrography
42150 X-ray retrograde/prograde pyelography A
42155 X-ray retrograde/prograde reporting and imaging
42160 done
X-ray in theatre pyelogram – percutaneous
prograde A
42200 Ultrasound study of the renal tract including bladder
Ultrasound unnele for resistive index in vessels of
42205 transplanted kidney
Ultrasound study of the renal arteries including
42210 Doppler
Code Description Ana P
42300 CT of the renal tract for a stone B
42400 MR of the renal tract for obstruction B
42410 MR of the kidneys without contrast B
42420 MR of the kidneys pre and post contrast B
Reproductive system
43100 X-ray pelvimetry single
43110 X-ray pelvimetry multiple views
43120 X-ray unneled-salpingography A
43130 X-ray unneled-salpingography with introduction of A
43200 contrast
Ultrasound study of the pelvis transabdominal
43205 Ultrasound study of the female pelvis transvaginal
43210 Ultrasound study of the prostate transrectal B
Ultrasound transrectal prostate volume for
43215 brachytherapy B
A
A
Vary
A
B
C
C
B
D
C
C
D
Vary
E
D
D
B
D
D
D
D
I
Vary
A
B
C
B
C
C
D
D
D
D
E
E
D
C
D
D
E
E
E
E
E
E
E
E
I
E
D
E
D
E
E
D
D
A
B
A
D
D
E
E
E
E
A
B
A
B
A
B
C
C
D
D
D
E
E
A
A
I
B
A
B
C
C
D
D
E
E
A
A
A
A
A
A
A
D
D
D
D
D
E
E
A
A
A
A
B
D
D
I
E
E
E
A
B
A
A
B
B
B
D
E
E
E
A
B
C
D
D
E
A
A
A
B
C
D
D
E
I
A
A
A
B
B
B
B
C
D
D
E
E
D
I
D
E
D
A
B
B
B
B
A
B
A
A
B
A
B
B
B
B
B
D
D
D
B
D
E
E
E
B
C
C
I
C
B
B
E
E
E
E
D
D
E
E
D
D
E
C
B
B
D
E
E
E
E
E
B
B
C
B
C
B
I
A
C
B
B
A
E
A
B
C
B
B
C
C
B
C
D
B
C
A
A
B
B
B
B
D
D
D
D
D
D
D
D
D
D
I
D
E
E
E
E
B
B
B
B
B
D
E
E
D
E
E
B
B
B
B
B
B
B
A
D
B
C
I
D
D
E
E
B
B
A
C
B
B
B
C
I
C
E
E
E
E
E
E
D
E
E
E
E
D
E
E
E
D
D
D
E
E
D
E
D
E
D
E
D
D
D
B
C
I
C
C
B
D
B
E
E
A
A
B
B
B
B
C
C
D
D
D
D
D
E
A
B
B
B
B
C
C
D
E
D
D
D
I
E
E
A
A
B
B
B
B
B
C
C
D
D
D
D
D
E
E
A
B
B
B
D
D
D
E
E
A
B
C
D
D
D
D
E
E
I
A
A
B
B
B
B
B
C
D
D
D
D
D
E
E
A
B
B
C
E
D
E
E
I
A
A
A
A
A
A
B
A
A
B
B
B
D
D
I
D
D
D
D
E
E
E
E
A
A
D
D
D
D
D
D
E
E
E
E
A
A
B
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