The listings under the “Diagnostic Procedures and Selected Therapeutic
Procedures” section of the MSC Payment Schedule may be claimed in addition to
a consultation or other assessment/visit, when performed during that visit.
If, however, the procedure takes place on a subsequent visit arranged to perform the
procedure, then that visit may not be claimed in addition to the procedure unless the fee
code for the latter is prefixed by the letter “Y”.
A subsequent visit fee will be paid in addition to the procedure if more than thirty (30) days
has elapsed between the initial visit or service and the diagnostic procedure.
b. Diagnostic procedures may be claimed in addition to surgical procedures, when applicable.
c. For multiple diagnostic procedures performed at the same sitting, the procedure having the
largest fee may be claimed in full and the remaining procedure(s) at 50 percent of the listed
fee(s), unless otherwise specifically indicated in the Payment Schedule.
d. When two diagnostic/therapeutic procedures are performed by separate medical practitioners
at the same sitting and both procedures are or should be within the competence of either
medical practitioner, the total fee claimed should be no greater than that which would be
payable if both procedures had been performed by one medical practitioner, plus one
assistant’s fee (if applicable).
e. When a medical practitioner performs a diagnostic procedure, s/he must be allowed to
appropriately perform a full or limited consultation for which s/he charges and is paid,
regardless of what consultations and procedures have been performed by other specialists or
sub-specialists. The consultation would require a written report in addition to the report of the
diagnostic procedure.
If the diagnostic procedure is done on an initial visit, and the initial visit is for the specific
purpose of performing the diagnostic procedure, and this visit occurs on an out-patient basis
in a procedure facility (including endoscopy suites and cardiac catheterization suites), then a
limited consultation would normally be billed rather than a full consultation.
f. Procedures designated as “extra” will be paid at 100 percent for the first “extra” and
50 percent for any additional procedures designated as “extra”. Should all procedures be
designated as “extra” then the first procedure will be deemed a regular procedure and
payment for the first subsequent “extra” will be at 100 percent and all others at 50 percent.
Minor Diagnostic and Therapeutic Procedures
a. Minor Diagnostic and Therapeutic Procedures are defined as procedures which have a fee
value that is less than that of the office visit. .
Note: To determine the service with the greatest value when a tray fee is applicable, the
amount of the tray fee will be added to the value of the procedure fee in the calculation
process.
b. When minor diagnostic or therapeutic procedures are performed in conjunction with an
assessment/visit (not a consultation) either the visit or the procedure may be claimed, but not
both. Includes fee items identified as “isolated procedures”.
