Services Not Listed in the Schedule

On recommendation of the BCMA Tariff Committee and agreed to by Government, interim listings may be designated by the MSC for new procedures or other services for a limited period of time to allow definitive listings to be established.

Miscellaneous Services

This section relates to services not listed in the MSC Payment Schedule that are:

• new medically necessary services generally considered to be accepted standards of care in the medical community currently and not considered experimental in nature; 

• unusually complex procedures, for established but infrequently performed procedures; 

• for unlisted “team” procedures, or 

• for any medically required service for which the medical practitioner desires independent consideration to be given by MSP

Claims under a miscellaneous fee code will be accepted for adjudication only if the following criteria are fulfilled:

• An estimate of an appropriate fee, with rationale for the level of that fee 

• Sufficient documentation of the services (such as the operative report) to substantiate the claim.  

The Medical Services Plan will review the fee estimate proposed and the supporting documentation and by comparing with the service provided with comparable services listed in the MSC Payment Schedule, determine the level of compensation. While an application for a new fee item is in process (as per Section C. 2.), MSP will pay for the service at a percentage of a comparable fee until the new fee item is effective. Should it be determined that a new listing will not be established due to the infrequency of the unlisted service, payments will be made at 100% of the comparable service.

Miscellaneous (...99) Fee Items

00099 General Services 

00199 General Practice 

00299 Dermatology 

00399 General Internal Medicine 

00499 Neurology 

00599 Pediatrics 

00699 Psychiatry 

00999 Diagnostic Procedures 

01499 Critical Care 

01799 Physical Medicine 

01899 Emergency Medicine 

01999 Anesthesia 

02599 Otolaryngology 

02999 Ophthalmology 

03999 Neurosurgery 

04999 Obstetrics & Gynecology 

06999 Plastic Surgery 

07999 General Surgery/Cardiac Surgery 

08699 X-ray 

08899 Miscellaneous Diagnostic Ultrasound 

08999 Urology 

09899 Nuclear Medicine 

30999 Clinical Immunology and Allergy 

31999 Rheumatology 

32199 Respirology

33199 Cardiology 

33299 Endocrinology and Metabolism

33399 Gastroenterology 

33499 Geriatric Medicine 

33599 Hematology and Oncology 

33699 Infectious Diseases 

33899 Nephrology 

33999 Occupational Medicine 

59999 Orthopaedics 

77799 Vascular Surgery 

79199 Thoracic Surgery 

94999 Laboratory Medicine