BERMUDA BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2012 BR / 2012

Transcription

1 BERMUDA BERMUDA HOSPITALS BOARD (HOSPITAL FEES) REGULATIONS 2012 BR / 2012 TABLE OF CONTENTS Citation Rates for in-patient treatment of residents in the general hospital Rates for in-patient treatment of non-residents in the general hospital Rates where patient readmitted with related diagnosis Rates for physician charges Rates for treatment of residents in the Mid Atlantic Wellness Institute Rates for treatment of residents in hospices Rates for in-patient treatment of non-residents in the Mid Atlantic Wellness Institute Rates for out-patient treatment Revocation Commencement SCHEDULE 1 In-Patient Treatment Charge by Diagnosis Related Group (DRG) SCHEDULE 2 In-Patient Treatment Per Diem Rates and Room Differentials SCHEDULE 3 Bermuda Hospitals Board Physician Services SCHEDULE 4 Out-Patient Treatment The Bermuda Hospitals Board, in exercise of the power conferred upon it by section 13 of the Bermuda Hospitals Board Act 1970 and with the approval of the Minister responsible for Health, makes the following Regulations: Citation 1 These Regulations may be cited as the Bermuda Hospitals Board (Hospital Fees) Regulations

2 Rates for in-patient treatment of residents in the general hospital 2 (1) The fees payable to the Board by residents for in-patient treatment in public accommodation at the general hospital are (a) (b) in respect of any admission to the hospital with a length of stay of 15 days or less, equal to the amount in Schedule 1 opposite the Diagnosis Related Group to which the patient has been assigned by the attending physician; or in respect of any admission to the hospital with a length of stay of greater than 15 days, equal to the amount referred to in subparagraph (a) plus the product obtained by multiplying the number of days of stay at the hospital greater than 15 days by the per diem rate listed in Part A of Schedule 2 for public accommodation. (2) The fees payable to the Board by residents for in-patient treatment in semiprivate or private accommodation at the general hospital (a) (b) in respect of any admission to the hospital with a length of stay of 15 days or less, are equal to the sum of (i) (ii) the amount in Schedule 1 opposite the Diagnosis Related Group to which the patient is assigned by the attending physician; and the product obtained by multiplying the number of days of stay at the hospital by the room differential for semi-private or private accommodation listed in Part B of Schedule 2; in respect of any admission to the hospital for a length of stay greater than 15 days, are equal to the amount referred to in subparagraph (a) plus the product obtained by multiplying the number of days stay at the hospital greater than 15 days by the per diem rate listed in Part A of Schedule 2 for semi-private or private accommodation, as the case may be. (3) Notwithstanding paragraphs (1) and (2), the fees payable for in-patient treatment at the general hospital to the Board by residents who are long term care patients or patients requiring hospice care are equal to the product obtained by multiplying the number of days of hospital stay by the applicable per diem rate listed in Part A of Schedule 2. Rates for in-patient treatment of non-residents in the general hospital 3 In the case of any person who is not ordinarily resident in Bermuda or who is deemed not to be so resident for the purposes of the Health Insurance Act 1970, the fees payable to the Board for in-patient treatment at the general hospital (a) in respect of any admission to the hospital with a length of stay of 15 days or less, are equal to the sum of (i) the amount in Schedule 1 opposite the Diagnosis Related Group to which the patient has been assigned by the attending physician plus a 50% surcharge based on that amount; and 2

3 (b) (ii) the product obtained by multiplying the number of days of stay at the hospital by the room differential listed in Part C of Schedule 2 for semiprivate or private accommodation, as the case may be; or in respect of any admission to the hospital with a length of stay of greater than 15 days, are equal to the amount referred to in subparagraph (a) plus the product obtained by multiplying the number of days of stay at the hospital greater than 15 days by the per diem rate listed in Part D of Schedule 2 for public, semi-private or private accommodation, as the case may be. Rates where patient readmitted with related diagnosis 4 Where a resident referred to in regulation 2 or a non-resident referred to in regulation 3 is readmitted to the general hospital within three days after discharge and is assigned by the attending physician to a Diagnosis Related Group closely related to the one to which he was assigned before discharge, the fees payable to the Board are calculated as provided in regulation 2 or 3, whichever is applicable, as if (a) (b) the length of stay at the hospital for the admission and readmission were one continuous period, not counting the days between discharge and readmission; and the Diagnosis Related Group to which the patient is assigned were the one determined by the attending physician after readmission to be the most appropriate to apply to the entire period referred to in subparagraph (a). Rates for physician charges 5 (1) The fees payable to the Board for in-patient or out-patient treatment of a resident referred to in regulation 2 or a non-resident referred to in regulation 3 in the general hospital by a physician provided by the Board are as set out in Schedule 3. (2) Part A of Schedule 3 sets out the fees payable for treatment included in standard hospital benefit. (3) Part B of Schedule 3 sets out the fees payable for treatment excluded from standard hospital benefit. Rates for treatment of residents in the Mid Atlantic Wellness Institute 6 (1) The fees payable to the Board in respect of in-patient treatment at the Mid- Atlantic Wellness Institute are equal to the product obtained by multiplying the number of days of stay at the Institute by the applicable per diem rate listed in Part A of Schedule 2. (2) The maximum number of days in any calendar year for which the per diem rate may be charged under paragraph (1) is 40 days. Rates for treatment of residents in hospices 7 The fees payable to the Board for residential hospice care in an establishment under the charge and management of the Board are equal to the product obtained by multiplying 3

4 the number of days of stay at the hospice by the applicable per diem rate listed in Part A of Schedule 2. Rates for in-patient treatment of non-residents in the Mid Atlantic Wellness Institute 8 The fees payable to the Board by non-residents for in-patient treatment at the Mid- Atlantic Wellness Institute are equal to the product obtained by multiplying the number of days of stay at the Institute by the applicable per diem rate listed in Part D of Schedule 2. Rates for out-patient treatment 9 (1) The fees payable to the Board by residents and non-residents in respect of outpatient treatment at the general hospital or in an establishment under the charge and management of the Board are as set out in Schedule 4. (2) Part A of Schedule 4 sets out the fees payable for treatment included in standard hospital benefit. (3) Part B of Schedule 4 sets out the fees payable for treatment excluded from standard hospital benefit. Revocation 10 The Bermuda Hospitals Board (Hospital Fees) Regulations 2011 are revoked. Commencement 11 These Regulations come into operation on 1 April

5 SCHEDULE 1 (Regulations 2, 3 and 4) IN-PATIENT TREATMENT CHARGE BY DIAGNOSIS RELATED GROUP (DRG) DRG DRG Title $ 1 CRANIOTOMY AGE >17 W CC 24,403 2 CRANIOTOMY AGE >17 W/O CC 13,751 3 CRANIOTOMY AGE ,165 6 CARPAL TUNNEL RELEASE 5,570 7 PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC 18,739 8 PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W/O CC 11,235 9 SPINAL DISORDERS & INJURIES 9, NERVOUS SYSTEM NEOPLASMS W CC 8, NERVOUS SYSTEM NEOPLASMS W/O CC 6, DEGENERATIVE NERVOUS SYSTEM DISORDERS 6, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA 6, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION 8, NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT 6, NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 9, NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC 5, CRANIAL & PERIPHERAL NERVE DISORDERS W CC 7, CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC 5, VIRAL MENINGITIS 9, HYPERTENSIVE ENCEPHALOPATHY 8, NONTRAUMATIC STUPOR & COMA 5, SEIZURE & HEADACHE AGE , TRAUMATIC STUPOR & COMA, COMA >1 HR 9, TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC 9, TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC 5, TRAUMATIC STUPOR & COMA, COMA <1 HR AGE , CONCUSSION AGE >17 W CC 6, CONCUSSION AGE >17 W/O CC 4, CONCUSSION AGE , OTHER DISORDERS OF NERVOUS SYSTEM W CC 7, OTHER DISORDERS OF NERVOUS SYSTEM W/O CC 4, RETINAL PROCEDURES 5, ORBITAL PROCEDURES 8, PRIMARY IRIS PROCEDURES 4, LENS PROCEDURES WITH OR WITHOUT VITRECTOMY 4, EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17 7, EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE ,438 5

6 DRG DRG Title $ 42 INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS 5, HYPHEMA 4, ACUTE MAJOR EYE INFECTIONS 5, NEUROLOGICAL EYE DISORDERS 5, OTHER DISORDERS OF THE EYE AGE >17 W CC 5, OTHER DISORDERS OF THE EYE AGE >17 W/O CC 3, OTHER DISORDERS OF THE EYE AGE , MAJOR HEAD & NECK PROCEDURES 11, SIALOADENECTOMY 6, SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY 6, CLEFT LIP & PALATE REPAIR 4, SINUS & MASTOID PROCEDURES AGE >17 9, SINUS & MASTOID PROCEDURES AGE , MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES 6, RHINOPLASTY 6, T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 7, T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE , TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 4, TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE , MYRINGOTOMY W TUBE INSERTION AGE >17 11, MYRINGOTOMY W TUBE INSERTION AGE , OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES 9, EAR, NOSE, MOUTH & THROAT MALIGNANCY 8, DYSEQUILIBRIUM 4, EPISTAXIS 4, EPIGLOTTITIS 5, OTITIS MEDIA & URI AGE >17 W CC 4, OTITIS MEDIA & URI AGE >17 W/O CC 3, OTITIS MEDIA & URI AGE , LARYNGOTRACHEITIS 5, NASAL TRAUMA & DEFORMITY 5, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17 5, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE , MAJOR CHEST PROCEDURES 21, OTHER RESP SYSTEM O.R. PROCEDURES W CC 19, OTHER RESP SYSTEM O.R. PROCEDURES W/O CC 8, PULMONARY EMBOLISM 8, RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC 11, RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC 6,298 6

7 DRG DRG Title $ 81 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE , RESPIRATORY NEOPLASMS 9, MAJOR CHEST TRAUMA W CC 7, MAJOR CHEST TRAUMA W/O CC 4, PLEURAL EFFUSION W CC 8, PLEURAL EFFUSION W/O CC 5, PULMONARY EDEMA & RESPIRATORY FAILURE 9, CHRONIC OBSTRUCTIVE PULMONARY DISEASE 6, SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC 7, SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC 4, SIMPLE PNEUMONIA & PLEURISY AGE , INTERSTITIAL LUNG DISEASE W CC 8, INTERSTITIAL LUNG DISEASE W/O CC 5, PNEUMOTHORAX W CC 8, PNEUMOTHORAX W/O CC 4, BRONCHITIS & ASTHMA AGE >17 W CC 5, BRONCHITIS & ASTHMA AGE >17 W/O CC 3, BRONCHITIS & ASTHMA AGE , RESPIRATORY SIGNS & SYMPTOMS W CC 5, RESPIRATORY SIGNS & SYMPTOMS W/O CC 3, OTHER RESPIRATORY SYSTEM DIAGNOSES W CC 6, OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC 3, HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM 132, CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W CARD CATH 58, CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O CARD CATH 42, CORONARY BYPASS W PTCA 47, OTHER CARDIOTHORACIC PROCEDURES 40, MAJOR CARDIOVASCULAR PROCEDURES W CC 26, MAJOR CARDIOVASCULAR PROCEDURES W/O CC 17, AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE 22, UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS 12, CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT 9, CARDIAC PACEMAKER DEVICE REPLACEMENT 11, VEIN LIGATION & STRIPPING 10, OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 17, CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE 11,385 7

8 DRG DRG Title $ 122 CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE 6, CIRCULATORY DISORDERS W AMI, EXPIRED 10, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG 9, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG 7, ACUTE & SUBACUTE ENDOCARDITIS 18, HEART FAILURE & SHOCK 7, DEEP VEIN THROMBOPHLEBITIS 5, CARDIAC ARREST, UNEXPLAINED 7, PERIPHERAL VASCULAR DISORDERS W CC 6, PERIPHERAL VASCULAR DISORDERS W/O CC 4, ATHEROSCLEROSIS W CC 4, ATHEROSCLEROSIS W/O CC 3, HYPERTENSION 4, CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC 6, CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/O CC 4, CARDIAC CONGENITAL & VALVULAR DISORDERS AGE , CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 5, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC 3, ANGINA PECTORIS 3, SYNCOPE & COLLAPSE W CC 5, SYNCOPE & COLLAPSE W/O CC 4, CHEST PAIN 3, OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 9, OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC 4, RECTAL RESECTION W CC 19, RECTAL RESECTION W/O CC 10, MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC 10, PERITONEAL ADHESIOLYSIS W CC 19, PERITONEAL ADHESIOLYSIS W/O CC 9, MINOR SMALL & LARGE BOWEL PROCEDURES W CC 13, MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC 7, STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC 9, STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE , ANAL & STOMAL PROCEDURES W CC 9, ANAL & STOMAL PROCEDURES W/O CC 4, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC 10,083 8

9 DRG DRG Title $ 160 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC 6, INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC 8, INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC 4, HERNIA PROCEDURES AGE , APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 15, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC 8, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC 9, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC 6, MOUTH PROCEDURES W CC 9, MOUTH PROCEDURES W/O CC 5, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 21, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC 8, DIGESTIVE MALIGNANCY W CC 10, DIGESTIVE MALIGNANCY W/O CC 5, G.I. HEMORRHAGE W CC 7, G.I. HEMORRHAGE W/O CC 4, COMPLICATED PEPTIC ULCER 7, UNCOMPLICATED PEPTIC ULCER W CC 6, UNCOMPLICATED PEPTIC ULCER W/O CC 4, INFLAMMATORY BOWEL DISEASE 7, G.I. OBSTRUCTION W CC 6, G.I. OBSTRUCTION W/O CC 4, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC 5, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/ O CC 4, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE , DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE >17 6, DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE , DENTAL EXTRACTIONS & RESTORATIONS 5, OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC 7, OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC 4, OTHER DIGESTIVE SYSTEM DIAGNOSES AGE , PANCREAS, LIVER & SHUNT PROCEDURES W CC 27, PANCREAS, LIVER & SHUNT PROCEDURES W/O CC 11, BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC 23,825 9

10 DRG DRG Title $ 194 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC 11, CHOLECYSTECTOMY W C.D.E. W CC 21, CHOLECYSTECTOMY W C.D.E. W/O CC 10, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 17, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC 8, HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY 15, HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY 20, OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES 26, CIRRHOSIS & ALCOHOLIC HEPATITIS 9, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS 9, DISORDERS OF PANCREAS EXCEPT MALIGNANCY 7, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 8, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC 5, DISORDERS OF THE BILIARY TRACT W CC 8, DISORDERS OF THE BILIARY TRACT W/O CC 4, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC 13, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC 9, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE , AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS 14, BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE 13, WND DEBRID & SKN GRFT EXCEPT HAND,FOR MUSCSKELET & CONN TISS DIS 21, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC 12, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC 7, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE , MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC 8, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC 6, FOOT PROCEDURES 8, SOFT TISSUE PROCEDURES W CC 11, SOFT TISSUE PROCEDURES W/O CC 6, MAJOR THUMB OR JOINT PROC,OR OTH HAND OR WRIST PROC W CC 8, HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROC, W/O CC 5, LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP & FEMUR 9, ARTHROSCOPY 6,854 10

11 DRG DRG Title $ 233 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 13, OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC 8, FRACTURES OF FEMUR 5, FRACTURES OF HIP & PELVIS 5, SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH 4, OSTEOMYELITIS 9, PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY 7, CONNECTIVE TISSUE DISORDERS W CC 9, CONNECTIVE TISSUE DISORDERS W/O CC 4, SEPTIC ARTHRITIS 7, MEDICAL BACK PROBLEMS 5, BONE DISEASES & SPECIFIC ARTHROPATHIES W CC 5, BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC 3, NON-SPECIFIC ARTHROPATHIES 4, SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE 4, TENDONITIS, MYOSITIS & BURSITIS 6, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE 5, FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W CC 5, FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W/O CC 3, FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE , FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W CC 5, FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W/O CC 3, FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE , OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 6, TOTAL MASTECTOMY FOR MALIGNANCY W CC 6, TOTAL MASTECTOMY FOR MALIGNANCY W/O CC 5, SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC 7, SUBTOTAL MASTECTOMY FOR MALIGNANCY W/O CC 4, BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION 6, BREAST BIOPSY & LOCAL EXCISION FOR NON-MALIGNANCY 6, SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC 14, SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC 7, SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W CC 11, SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W/O CC 6,434 11

12 DRG DRG Title $ 267 PERIANAL & PILONIDAL PROCEDURES 6, SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES 8, OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 12, OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC 5, SKIN ULCERS 7, MAJOR SKIN DISORDERS W CC 7, MAJOR SKIN DISORDERS W/O CC 4, MALIGNANT BREAST DISORDERS W CC 7, MALIGNANT BREAST DISORDERS W/O CC 4, NON-MALIGANT BREAST DISORDERS 5, CELLULITIS AGE >17 W CC 6, CELLULITIS AGE >17 W/O CC 3, CELLULITIS AGE , TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC 5, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC 3, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE , MINOR SKIN DISORDERS W CC 5, MINOR SKIN DISORDERS W/O CC 3, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DISORDERS 15, ADRENAL & PITUITARY PROCEDURES 13, SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DISORDERS 13, O.R. PROCEDURES FOR OBESITY 13, PARATHYROID PROCEDURES 6, THYROID PROCEDURES 6, THYROGLOSSAL PROCEDURES 4, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC 19, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC 9, DIABETES AGE >35 5, DIABETES AGE , NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC 5, NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC 3, NUTRITIONAL & MISC METABOLIC DISORDERS AGE , INBORN ERRORS OF METABOLISM 7, ENDOCRINE DISORDERS W CC 7, ENDOCRINE DISORDERS W/O CC 4, KIDNEY TRANSPLANT 21, KIDNEY AND URETER PROCEDURES FOR NEOPLASM 13, KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC 16,531 12

13 DRG DRG Title $ 305 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC 8, PROSTATECTOMY W CC 9, PROSTATECTOMY W/O CC 4, MINOR BLADDER PROCEDURES W CC 10, MINOR BLADDER PROCEDURES W/O CC 6, TRANSURETHRAL PROCEDURES W CC 8, TRANSURETHRAL PROCEDURES W/O CC 4, URETHRAL PROCEDURES, AGE >17 W CC 8, URETHRAL PROCEDURES, AGE >17 W/O CC 5, URETHRAL PROCEDURES, AGE , OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES 14, RENAL FAILURE 8, ADMIT FOR RENAL DIALYSIS 5, KIDNEY & URINARY TRACT NEOPLASMS W CC 8, KIDNEY & URINARY TRACT NEOPLASMS W/O CC 4, KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC 6, KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC 4, KIDNEY & URINARY TRACT INFECTIONS AGE , URINARY STONES W CC, &/OR ESW LITHOTRIPSY 5, URINARY STONES W/O CC 3, KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC 4, KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W/O CC 3, KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE , URETHRAL STRICTURE AGE >17 W CC 5, URETHRAL STRICTURE AGE >17 W/O CC 3, URETHRAL STRICTURE AGE , OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC 7, OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W/O CC 4, OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE , MAJOR MALE PELVIC PROCEDURES W CC 10, MAJOR MALE PELVIC PROCEDURES W/O CC 7, TRANSURETHRAL PROSTATECTOMY W CC 6, TRANSURETHRAL PROSTATECTOMY W/O CC 4, TESTES PROCEDURES, FOR MALIGNANCY 9, TESTES PROCEDURES, NON-MALIGNANCY AGE >17 8, TESTES PROCEDURES, NON-MALIGNANCY AGE , PENIS PROCEDURES 9, CIRCUMCISION AGE >17 5, CIRCUMCISION AGE ,112 13

14 DRG DRG Title $ 344 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY 8, OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FOR MALIGNANCY 9, MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W CC 7, MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W/O CC 3, BENIGN PROSTATIC HYPERTROPHY W CC 5, BENIGN PROSTATIC HYPERTROPHY W/O CC 3, INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM 5, STERILIZATION, MALE 1, OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES 5, PELVIC EVISCERATION, RADICAL HYSTERECTOMY & RADICAL VULVECTOMY 12, UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC 10, UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC 6, FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 5, UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY 15, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC 8, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC 5, VAGINA, CERVIX & VULVA PROCEDURES 6, LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION 7, ENDOSCOPIC TUBAL INTERRUPTION 2, D&C, CONIZATION & RADIO-IMPLANT, FOR MALIGNANCY 7, D&C, CONIZATION EXCEPT FOR MALIGNANCY 6, OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES 14, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC 8, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC 4, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM 8, MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS 4, CESAREAN SECTION W CC 6, CESAREAN SECTION W/O CC 4, VAGINAL DELIVERY W COMPLICATING DIAGNOSES 3, VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 2, VAGINAL DELIVERY W STERILIZATION &/OR D&C 4, VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C 7, POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE 4, POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 8, ECTOPIC PREGNANCY 5, THREATENED ABORTION 2,914 14

15 DRG DRG Title $ 380 ABORTION W/O D&C 3, ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY 4, FALSE LABOR 1, OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS 3, OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS 2, NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 9, EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 32, PREMATURITY W MAJOR PROBLEMS 22, PREMATURITY W/O MAJOR PROBLEMS 13, FULL TERM NEONATE W MAJOR PROBLEMS 22, NEONATE W OTHER SIGNIFICANT PROBLEMS 8, NORMAL NEWBORN 1, SPLENECTOMY AGE >17 21, SPLENECTOMY AGE , OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS 13, RED BLOOD CELL DISORDERS AGE >17 5, RED BLOOD CELL DISORDERS AGE , COAGULATION DISORDERS 9, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 7, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC 4, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC 20, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC 8, LYMPHOMA & NON-ACUTE LEUKEMIA W CC 13, LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC 6, ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE , MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W CC 19, MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W/ O CC 8, MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R.PROC 15, RADIOTHERAPY 9, CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS 7, HISTORY OF MALIGNANCY W/O ENDOSCOPY 2, HISTORY OF MALIGNANCY W ENDOSCOPY 6, OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 9, OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC 5, SEPTICEMIA AGE ,269 15

16 DRG DRG Title $ 418 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS 7, FEVER OF UNKNOWN ORIGIN AGE >17 W CC 6, FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC 4, VIRAL ILLNESS AGE >17 5, VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE , OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES 12, O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 15, ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 4, DEPRESSIVE NEUROSES 3, NEUROSES EXCEPT DEPRESSIVE 3, DISORDERS OF PERSONALITY & IMPULSE CONTROL 5, ORGANIC DISTURBANCES & MENTAL RETARDATION 5, PSYCHOSES 5, CHILDHOOD MENTAL DISORDERS 4, OTHER MENTAL DISORDER DIAGNOSES 4, ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA 2, SKIN GRAFTS FOR INJURIES 13, WOUND DEBRIDEMENTS FOR INJURIES 13, HAND PROCEDURES FOR INJURIES 6, OTHER O.R. PROCEDURES FOR INJURIES W CC 17, OTHER O.R. PROCEDURES FOR INJURIES W/O CC 7, TRAUMATIC INJURY AGE >17 W CC 5, TRAUMATIC INJURY AGE >17 W/O CC 3, TRAUMATIC INJURY AGE , ALLERGIC REACTIONS AGE >17 4, ALLERGIC REACTIONS AGE POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC 6, POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC 3, POISONING & TOXIC EFFECTS OF DRUGS AGE , COMPLICATIONS OF TREATMENT W CC 7, COMPLICATIONS OF TREATMENT W/O CC 3, OTHER INJURY, POISONING & TOXIC EFFECT DIAG W CC 6, OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O CC 3, O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES 11, REHABILITATION 6, SIGNS & SYMPTOMS W CC 5, SIGNS & SYMPTOMS W/O CC 3, AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS 4, AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS 5,376 16

17 DRG DRG Title $ 467 OTHER FACTORS INFLUENCING HEALTH STATUS 3, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 28, BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY 21, ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17 23, PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 15, NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 14, OTHER VASCULAR PROCEDURES W/O CC 10, LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT 66, BONE MARROW TRANSPLANT 45, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES 23, CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 35, LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA 24, OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA 34, OTHER MULTIPLE SIGNIFICANT TRAUMA 13, HIV W EXTENSIVE O.R. PROCEDURE 36, HIV W MAJOR RELATED CONDITION 12, HIV W OR W/O OTHER RELATED CONDITION 7, MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY 12, CHEMOTHERAPY W ACUTE LEUKEMIA OR W USE OF HI DOSE CHEMOAGENT 24, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 12, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC 7, LUNG TRANSPLANT 59, COMBINED ANTERIOR/POSTERIOR SPINAL FUSION 44, SPINAL FUSION EXCEPT CERVICAL W CC 26, SPINAL FUSION EXCEPT CERVICAL W/O CC 21, BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC 9, BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC 6, KNEE PROCEDURES W PDX OF INFECTION W CC 18, KNEE PROCEDURES W PDX OF INFECTION W/O CC 10, KNEE PROCEDURES W/O PDX OF INFECTION 8, EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/SKIN GFT 79, EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/O SKIN GFT 18, FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA 26,660 17

18 DRG DRG Title $ 507 FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA 13, FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA 9, FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA 5, NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA 8, NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA 4, SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT 44, PANCREAS TRANSPLANT 28, CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH 36, PERC CARDIO PROC W/O CORONARY ARTERY STENT OR AMI 11, CERVICAL SPINAL FUSION W CC 17, CERVICAL SPINAL FUSION W/O CC 12, ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC 5, ALC/DRUG ABUSE OR DEPEND W REHABILITATION THERAPY W/O CC 4, ALC/DRUG ABUSE OR DEPEND W/O REHABILITATION THERAPY W/ O CC 2, TRANSIENT ISCHEMIA 5, OTHER HEART ASSIST SYSTEM IMPLANT 86, INTRACRANIAL VASCULAR PROC W PDX HEMORRHAGE 49, VENTRICULAR SHUNT PROCEDURES W CC 15, VENTRICULAR SHUNT PROCEDURES W/O CC 8, SPINAL PROCEDURES W CC 21, SPINAL PROCEDURES W/O CC 10, EXTRACRANIAL PROCEDURES W CC 10, EXTRACRANIAL PROCEDURES W/O CC 6, CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK 51, CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK 46, LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT HIP & FEMUR W CC 12, LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT HIP & FEMUR W/O CC 7, LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W CC 22, LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W/O CC 8, ECMO OR TRACH W MV 96+HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 135, TRACH W MV 96+HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 82, CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS 30,675 18

19 DRG DRG Title $ 544 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 13, REVISION OF HIP OR KNEE REPLACEMENT 17, SPINAL FUSION EXC CERV WITH CURVATURE OF THE SPINE OR MALIG 37, CORONARY BYPASS W CARDIAC CATH W MAJOR CV DX 43, CORONARY BYPASS W CARDIAC CATH W/O MAJOR CV DX 32, CORONARY BYPASS W/O CARDIAC CATH W MAJOR CV DX 35, CORONARY BYPASS W/O CARDIAC CATH W/O MAJOR CV DX 25, PERMANENT CARDIAC PACEMAKER IMPL W MAJ CV DX OR AICD LEAD OR GNRTR 21, OTHER PERMANENT CARDIAC PACEMAKER IMPLANT W/O MAJOR CV DX 14, OTHER VASCULAR PROCEDURES W CC W MAJOR CV DX 21, OTHER VASCULAR PROCEDURES W CC W/O MAJOR CV DX 14, PERCUTANEOUS CARDIOVASCULAR PROC W MAJOR CV DX 16, PERCUTANEOUS CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MAJ CV DX 12, PERCUTANEOUS CARDIOVASCULAR PROC W DRUG-ELUTING STENT W MAJOR CV DX 19, PERCUTANEOUS CARDIOVASCULAR PROC W DRUG-ELUTING STENT W/O MAJ CV DX 14, ACUTE ISCHEMIC STROKE WITH USE OF THROMBOLYTIC AGENT 15, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 20, NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS 15, SEIZURE AGE > 17 W CC 7, SEIZURE AGE > 17 W/O CC 4, HEADACHES AGE >17 4, RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 96+ HOURS 36, RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT < 96 HOURS 16, STOMACH, ESOPHAGEAL & DUODENAL PROC AGE > 17 W CC W MAJOR GI DX 36, STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES PROC AGE > 17 W CC W/O MAJOR GI DX 23, MAJOR SMALL & LARGE BOWEL PROCEDURES W CC W MAJOR GI DX 30, MAJOR SMALL & LARGE BOWEL PROCEDURES W CC W/O MAJOR GI DX 19, MAJOR ESOPHAGEAL DISORDERS 7,823 19

20 DRG DRG Title $ 572 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS 9, MAJOR BLADDER PROCEDURES 23, MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL 8, SEPTICEMIA W MV96+ HOURS AGE >17 42, SEPTICEMIA W/O MV96+ HOURS AGE >17 11, CAROTID ARTERY STENT PROCEDURE 12, INFECTIOUS & PARASITIC DISEASES W OR PROCEDURE 34, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W OR PROCEDURE 20,006 Standard Dollar Amount 7,042 20

21 SCHEDULE 2 (Regulations 2, 3, 4, 6, 7 and 8) IN-PATIENT TREATMENT PER DIEM RATES AND ROOM DIFFERENTIALS PART A Residents Per Diem Rates 1. The per diem rate for public accommodation is $1, The per diem rate for semi-private accommodation is $1, The per diem rate for private accommodation is $1, The per diem rate for long term care patients is $ The per diem rate for newborn infants is $ The per diem rate for hospice care is $ The per diem rate for patients at the Mid-Atlantic Wellness Institute is $725. PART B Room Differentials for Residents 1. The room differential for semi-private accommodation is $ The room differential for private accommodation is $487. PART C Room Differentials for Non-Residents 1. The room differential for semi-private accommodation is $ The room differential for private accommodation is $729. PART D Non-Residents Per Diem Rates 1. The per diem rate for public accommodation is $1, The per diem rate for semi-private accommodation is $2, The per diem rate for private accommodation is $2, The per diem rate for long term care patients is $ The per diem rate for newborn infants is $ The per diem rate for patients at the Mid-Atlantic Wellness Institute is $1,

22 SCHEDULE 3 BERMUDA HOSPITALS BOARD PHYSICIAN SERVICES (Regulation 5) PHYSICIAN CATEGORY ANESTHESTIST CARDIOLOGIST GYNECOLOGIST HOSPITALIST INTENSIVIST INTERVENTIONAL RADIOLOGY OBSTETRICS ONCOLOGIST PALLIATIVE CARE PROCEDURALIST PHYSIATRIST REMOTE CONSULTATION ROBOTICS VASCULAR SURGERY PART A (Fees payable for treatment included in standard hospital benefit) CPT PHYSICIAN SERVICES $ ANESTHETIST FEE PER 15 MINUTE INTERVAL 100 Anesth, salivary gland Anesth, repair of cleft lip Anesth, blepharoplasty Anesth, electroshock Anesth, ear surgery Anesth, ear exam Anesth, tympanotomy Anesth, procedures on eye Anesth, lens surgery Anesth, corneal transplant Anesth, vitreoretinal surg Anesth, iridectomy 92 22

23 CPT PHYSICIAN SERVICES $ 148 Anesth, eye exam Anesth, nose/sinus surgery Anesth, nose/sinus surgery Anesth, biopsy of nose Anesth, procedure on mouth Anesth, cleft palate repair Anesth, pharyngeal surgery Anesth, pharyngeal surgery Anesth, face/skull bone surg Anesth, facial bone surgery Anesth, open head surgery Anesth, skull drainage Anesth, skull drainage Anesth, skull repair/fract Anesth, head vessel surgery Anesth, special head surgery Anesth, intrcrn nerve Anesth, head nerve surgery Anesth, head/neck/ptrunk Anesth, neck organ, 1 & over Anesth, biopsy of thyroid Anesth, larynx/trach, < 1 yr Anesth, neck vessel surgery Anesth, neck vessel surgery Anesth, skin, ext/per/atrunk Anesth, surgery of breast Anesth, surgery of breast Anesth, surgery of breast Anesth, correct heart rhythm Anesth, surgery of shoulder Anesth, surgery of shoulder Anesth, collar bone biopsy Anesth, removal of rib Anesth, chest wall repair Anesth, surgery of rib(s) Anesth, esophageal surgery Anesth, chest procedure Anesth, chest lining biopsy Anesth, chest drainage Anesth, chest partition view

24 CPT PHYSICIAN SERVICES $ 529 Anesth, chest partition view Anesth, pacemaker insertion Anesth, vascular access Anesth, cardioverter/defib Anesth, cardiac electrophys Anesth, trach-bronch reconst Anesth, chest surgery Anesth, release of lung Anesth, one lung ventilation Anesth, lung,chest wall surg Anesth, trachea,bronchi surg Anesth, sternal debridement Anesth, heart surg w/o pump Anesth, heart surg < age Anesth, heart surg w/pump Anesth, heart surg w/arrest Anesth, cabg w/o pump Anesth, heart/lung transplnt Anesth, spine, cord surgery Anesth, sitting procedure Anesth, spine, cord surgery Anesth, removal of nerves Anes spine tranthor w/o vent Anes, spine transthor w/vent Anesth, spine, cord surgery Anesth, removal of nerves Anesth for chemonucleolysis Anesth, lumbar puncture Anesth, spine manipulation Anesth, spine, cord surgery Anesth, abdominal wall surg Anesth, for liver biopsy Anesth, abdominal wall surg Anesth, upper gi visualize Anesth, repair of hernia Anesth, repair of hernia Anesth, repair of hernia Anesth, repair of hernia Anesth, blood vessel repair Anesth, surg upper abdomen

25 CPT PHYSICIAN SERVICES $ 792 Anesth, hemorr/excise liver Anesth, pancreas removal Anesth, for liver transplant Anesth, surgery for obesity Anesth, abdominal wall surg Anesth, fat layer removal Anesth, low intestine scope Anesth, abdominal wall surg Anesth, repair of hernia Anesth, repair of hernia Anesth, hernia repair< 1 yr Anesth hernia repair preemie Anesth, surg lower abdomen Anesth, amniocentesis Anesth, pelvis surgery Anesth, hysterectomy Anesth, pelvic organ surg Anesth, tubal ligation Anesth, surgery of abdomen Anesth, kidney/ureter surg Anesth, removal of bladder Anesth, removal of prostate Anesth, removal of adrenal Anesth, kidney transplant Anesth, bladder stone surg Anesth kidney stone destruct Anesth kidney stone destruct Anesth, abdomen vessel surg Anesth, major vein ligation Anesth, anorectal surgery Anesth, perineal surgery Anesth, removal of vulva Anesth, removal of prostate Anesth, bladder surgery Anesth, bladder tumor surg Anesth, removal of prostate Anesth, bleeding control Anesth, stone removal Anesth, genitalia surgery Anesth, vasectomy 69 25

26 CPT PHYSICIAN SERVICES $ 922 Anesth, sperm duct surgery Anesth, testis exploration Anesth, removal of testis Anesth, removal of testis Anesth, testis suspension Anesth, amputation of penis Anesth, penis, nodes removal Anesth, penis, nodes removal Anesth, insert penis device Anesth, vaginal procedures Anesth, surg on vag/urethral Anesth, vaginal hysterectomy Anesth, repair of cervix Anesth, vaginal endoscopy Anesth, hysteroscope/graph Anesth, bone aspirate/bx Anesth, pelvis surgery Anesth, body cast procedure Anesth, amputation at pelvis Anesth, pelvic tumor surgery Anesth, pelvis procedure Anesth, pelvis surgery Anesth, fx repair, pelvis Anesth, pelvis nerve removal Anesth, pelvis nerve removal Anesth, hip joint procedure Anesth, arthroscopy of hip Anesth, hip joint surgery Anesth, hip disarticulation Anesth, hip arthroplasty Anesth, revise hip repair Anesth, procedure on femur Anesth, surgery of femur Anesth, amputation of femur Anesth, radical femur surg Anesth, upper leg surgery Anesth, upper leg veins surg Anesth, thigh arteries surg Anesth, femoral artery surg Anesth, femoral embolectomy

27 CPT PHYSICIAN SERVICES $ 1320 Anesth, knee area surgery Anesth, knee area procedure Anesth, knee area surgery Anesth, knee joint procedure Anesth, dx knee arthroscopy Anesth, knee area procedure Anesth, knee area surgery Anesth, knee joint surgery Anesth, knee arthroplasty Anesth, amputation at knee Anesth, knee joint casting Anesth, knee veins surgery Anesth, knee vessel surg Anesth, knee arteries surg Anesth, knee artery surg Anesth, knee artery repair Anesth, lower leg procedure Anesth, ankle/ft arthroscopy Anesth, lower leg surgery Anesth, achilles tendon surg Anesth, lower leg surgery Anesth, lower leg bone surg Anesth, radical leg surgery Anesth, lower leg revision Anesth, ankle replacement Anesth, lower leg casting Anesth, leg arteries surg Anesth, lwr leg embolectomy Anesth, lower leg vein surg Anesth, lower leg vein surg Anesth, surgery of shoulder Anesth, shoulder procedure Anes dx shoulder arthroscopy Anesth, surgery of shoulder Anesth, surgery of shoulder Anesth, shoulder joint amput Anesth, forequarter amput Anesth, shoulder replacement Anesth, shoulder artery surg Anesth, shoulder vessel surg

28 CPT PHYSICIAN SERVICES $ 1654 Anesth, shoulder vessel surg Anesth, arm-leg vessel surg Anesth, shoulder vein surg Anesth, shoulder casting Anesth, airplane cast Anesth, elbow area surgery Anesth, uppr arm tendon surg Anesth, uppr arm tendon surg Anesth, biceps tendon repair Anesth, uppr arm procedure Anesth, dx elbow arthroscopy Anesth, upper arm surgery Anesth, humerus surgery Anesth, humerus repair Anesth, radical humerus surg Anesth, humeral lesion surg Anesth, elbow replacement Anesth, uppr arm artery surg Anesth, uppr arm embolectomy Anesth, upper arm vein surg Anesth, uppr arm vein repair Anesth, lower arm surgery Anesth, lower arm procedure Anesth, dx wrist arthroscopy Anesth, lower arm surgery Anesth, wrist replacement Anesth, lwr arm artery surg Anesth, lwr arm embolectomy Anesth, vascular shunt surg Anesth, lower arm vein surg Anesth, lwr arm vein repair Anesth, lower arm casting Anesth, dx arteriography Anesth, catheterize heart Anesth, cat or MRI scan Anes, ther interven rad, art Anes, ther interven rad, car Anes, tx interv rad hrt/cran Anes, ther interven rad, vei Anes, ther interven rad, tip

29 CPT PHYSICIAN SERVICES $ 1932 Anes, tx interv rad, th vein Anes, tx interv rad, cran v Anesth, perc img dx sp proc Anesth, perc img tx sp proc Anesth, burn, less 4 percent Anesth, burn, 4-9 percent Anesth, burn, each 9 percent Anesth, antepartum manipul Anesth, vaginal delivery Anesth, cs delivery Anesth, emer hysterectomy Anesth, cs hysterectomy Anesth, cs hysterectomy Anesth, inc/missed ab proc Anesth, induced ab procedure Anesth/analg, vag delivery Anes/analg cs deliver add-on Anesth/analg cs hyst add-on Support for organ donor Anesth, nerve block/inj Anesth, n block/inj, prone Anesth, n block/inj, prone Hosp manage cont drug admin Unlisted anesth procedure Ther injection, carp tunnel Inj tendon sheath/ligament Inj tendon origin/insertion Inj trigger point, 1/2 muscl Inject trigger points, =/> Drain/inject, joint/bursa Drain/inject, joint/bursa Drain/inject, joint/bursa Inject sacroiliac joint Insert emergency airway Bl draw < 3 yrs fem/jugular Non-routine bl draw > 3 yrs Vein access cutdown < 1 yr Vein access cutdown > 1 yr Insert non-tunnel cv cath Insert non-tunnel cv cath

30 CPT PHYSICIAN SERVICES $ Withdrawal of arterial blood Insertion catheter, artery Insertion catheter, artery Insertion catheter, artery Epidural lysis mult sessions 1, Epidural lysis on single day 1, Spinal fluid tap, diagnostic Drain cerebro spinal fluid Inject epidural patch Treat spinal cord lesion Treat spinal cord lesion Treat spinal canal lesion Inject spine c/t Inject spine l/s (cd) Inject spine w/cath, c/t Inject spine w/cath l/s (cd) Implant spinal canal cath 1, Remove spinal canal catheter 1, Insert spine infusion device Implant spine infusion pump 1, Implant spine infusion pump 1, Remove spine infusion device 1, Analyze spine infusion pump Analyze spine infusion pump Implant neuroelectrodes 1, Revise/remove neuroelectrode 1, Insrt/redo spine n generator 1, Revise/remove neuroreceiver 1, N block inj, trigeminal N block inj, facial N block inj, occipital N block inj, vagus N block inj, phrenic N block inj, spinal accessor N block inj, cervical plexus N block inj, brachial plexus N block cont infuse, b plex N block inj, axillary N block inj, suprascapular N block inj, intercost, sng

31 CPT PHYSICIAN SERVICES $ N block inj, intercost, mlt N block inj, ilio-ing/hypogi N block inj, pudendal N block inj, paracervical N block inj, sciatic, sng N blk inj, sciatic, cont inf N block inj fem, single N block inj fem, cont inf N block inj, lumbar plexus N block, other peripheral Inj paravertebral c/t Inj paravertebral c/t add-on Inj paravertebral l/s Inj paravertebral l/s add-on Inj foramen epidural c/t Inj foramen epidural add-on Inj foramen epidural l/s Inj foramen epidural add-on N block, spenopalatine gangl N block, carotid sinus s/p N block, stellate ganglion N block inj, hypogas plxs N block, lumbar/thoracic N block inj, celiac pelus Injection treatment of nerve Injection treatment of nerve 1, Injection treatment of nerve 1, Injection treatment of nerve Destr paravertebrl nerve l/s Destr paravertebral n add-on Destr paravertebrl nerve c/t Destr paravertebral n add-on Injection treatment of nerve Injection treatment of nerve Injection treatment of nerve Injection treatment of nerve Epidurography X-ray exam, sacroiliac joint Fluoroscope exam, extensive Us guide, vascular access 69 31