Therapeutic Injections and Immunizations Immunizations Immunizations are an excluded service for purposes of travel, employment and emigration, and may only be claimed if the injection is for a publicly funded vaccine administered in accordance with the eligibility criteria as is determined from time to time by the Communicable Disease Control Branch of Manitoba Health. The eligibility criteria for most publicly funded vaccines can be found on Manitoba Health s website at www.gov.mb.ca/health/publichealth/cdc/index.html ACTIVE IMMUNIZING AGENTS BCG Bacillus Calmette Guérin 8731 single dose... 10.65 DTaP IPV Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus paediatric 8924 single dose... 10.65 DTaP IPV Hib Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenza type b paediatric 8802 single dose... 10.65 HA Hepatitis A 8904 single dose... 10.65 HAHB Hepatitis A and B 8899 single dose... 10.65 HB Hepatitis B 8913 single dose... 10.65 Hib Haemophilus influenzae type b 8901 single dose... 10.65 HPV 9 Human Papillomavirus type 6, 11, 16, 18, 31, 33, 45, 52, 58 8971 single dose... 10.65 Inf(s) Influenza seasonal 8791 single dose... 10.65 Inf ITN Influenza Intranasal 8969 single dose... 10.65 Inf ph1n1(adj) Influenza pandemic H1N1 adjuvanted 8893... 10.65 Inf ph1n1 (unadj) Influenza pandemic H1N1 unadjuvanted 8894... 10.65 IPV Inactivated Polio Virus 8931 single dose... 10.65 Men B Multicomponent Meningococcal B 8970 single dose... 10.65 B-30 April 1, 2019
Anesthesia 1424 22.750 1522 20.000 1656 22.750 1785 21.375 1425 22.750 1525 20.000 1657 20.000 1788 21.375 1426 26.875 1531 20.000 1659 20.000 1802 21.375 1430 20.000 1534 20.000 1661 20.000 1803 21.375 1431 20.000 1535 20.000 1670 21.375 1804 21.375 1433 20.000 1536 20.000 1701 25.500 1811 20.000 1435 20.000 1539 20.000 1703 25.500 1815 20.000 1436 20.000 1541 20.000 1705 21.375 1817 20.000 1440 22.750 1552 20.000 1708 20.000 1819 21.375 1442 22.750 1553 20.000 1709 20.000 1820 21.375 1444 22.750 1562 21.375 1710 21.375 1840 21.375 1446 22.750 1570 20.000 1711 21.375 1841 21.375 1448 22.750 1573 20.000 1712 20.000 1842 21.375 1449 22.750 1574 20.000 1718 20.000 1843 22.750 1450 20.000 1580 20.000 1722 20.000 1844 21.375 1452 20.000 1582 20.000 1725 20.000 1845 21.375 1453 20.000 1583 20.000 1739 20.000 1846 21.375 1454 21.375 1585 20.000 1740 20.000 1848 21.375 1456 21.375 1586 20.000 1741 20.000 1849 22.750 1458 20.000 1589 20.000 1742 20.000 1851 20.000 1460 20.000 1593 20.000 1743 20.000 1854 20.000 1461 21.375 1595 20.000 1745 25.500 1856 20.000 1470 22.750 1596 20.000 1748 25.500 1860 20.000 1471 22.750 1612 20.000 1750 21.375 1862 20.000 1500 21.375 1613 20.000 1752 22.750 1867 20.000 1501 21.375 1616 20.000 1760 22.750 1870 20.000 1502 21.375 1632 20.000 1761 20.000 1878 20.000 1503 21.375 1633 20.000 1763 22.750 1882 20.000 1504 25.500 1635 21.375 1767 21.375 1885 20.000 1505 25.500 1636 21.375 1771 21.375 1886 20.000 1511 20.000 1640 20.000 1772 20.000 1889 20.000 1514 20.000 1641 20.000 1774 21.375 1890 20.000 1519 20.000 1654 21.375 1778 21.375 1891 20.000 1521 20.000 1655 21.375 1782 21.375 1892 20.000 April 1, 2019 C-23
Anesthesia 2987 22.750 3070 25.500 3125 25.500 3190 21.375 2989 20.000 3072 25.500 3131 22.750 3191 22.750 2990 20.000 3075 21.375 3133 22.750 3193 22.750 2992 21.375 3076 25.500 3134 21.375 3194 22.750 2993 21.375 3077 22.750 3135 22.750 3195 22.750 2994 25.500 3078 25.500 3136 21.375 3201 22.750 2996 21.375 3079 25.500 3137 22.750 3203 21.375 2998 21.375 3080 21.375 3138 25.500 3204 22.750 3000 21.375 3081 25.500 3139 25.500 3205 22.750 3002 21.375 3083 25.500 3140 25.500 3207 22.750 3004 21.375 3085 22.750 3141 22.750 3208 22.750 3006 25.500 3086 25.500 3142 22.750 3209 22.750 3008 20.000 3089 26.875 3149 25.500 3211 22.750 3010 21.375 3092 21.375 3153 22.750 3215 22.750 3011 22.750 3093 21.375 3160 20.000 3216 22.750 3020 22.750 3094 21.375 3161 22.750 3221 22.750 3021 22.750 3095 21.375 3162 21.375 3223 22.750 3022 22.750 3096 21.375 3166 22.750 3224 22.750 3031 21.375 3097 21.375 3171 22.750 3225 21.375 3033 22.750 3098 21.375 3172 22.750 3226 22.750 3038 22.750 3099 21.375 3174 22.750 3227 22.750 3040 26.875 3100 20.000 3175 22.750 3228 22.750 3041 26.875 3101 22.750 3177 21.375 3231 21.375 3043 25.500 3103 21.375 3179 22.750 3235 22.750 3044 25.500 3104 21.375 3180 25.500 3241 22.750 3046 25.500 3105 22.750 3181 25.500 3251 21.375 3053 21.375 3112 22.750 3182 25.500 3259 22.750 3055 21.375 3114 22.750 3183 25.500 3261 21.375 3057 21.375 3115 22.750 3184 22.750 3262 22.750 3063 21.375 3117 22.750 3185 21.375 3263 22.750 3065 21.375 3118 22.750 3186 21.375 3283 20.000 3066 21.375 3121 21.375 3187 21.375 3285 21.375 3067 25.500 3122 21.375 3188 21.375 3286 25.500 3068 25.500 3123 21.375 3189 21.375 3288 25.500 C-28 April 1, 2019
Musculoskeletal System Knee Arthroplasty Rules: 1) All arthroplasty fees include associated bone and soft tissue procedures, including but not limited to synovectomy, ligament and tendon release and lengthening and repair, and injection of medications. 2) Revision fees include insertion of PROSTALAC type components. UNIT VAULE 1402 Total knee arthroplasty, with patellar resurfacing... 883.25 22.750 1403 Total knee arthroplasty without patellar resurfacing... 883.25 22.750 1404 Unicondylar knee arthroplasty, medial or lateral compartment... 874.85 21.375 1405 Patellar resurfacing only... 707.70 21.375 1407 Total knee arthroplasty with removal of previous partial prosthesis... 1,591.65 25.500 1408 Revision knee arthroplasty with removal and replacement of modular tibial bearing surface (with or without patellar revision)... 1,325.40 25.500 1409 Revision of knee arthroplasty with removal and replacement of one or both femoral or tibial components (with or without patellar component revision)... 1,568.15 25.500 1411 Removal of knee prosthesis with or without spacer insertion... 862.95 25.500 1412 Removal of knee prosthesis with knee arthrodesis, with or without bone graft... 1,720.75 25.500 1440 Structural bone graft and bone graft substitutes, including fixation of graft e.g. Tantalum type, to one or more sites, add... 378.90 22.750 1442 Morsellized bone graft, to one or more sites, add... 229.70 22.750 1444 Impaction bone graft to femur (Exeter/Ling technique), add... 378.90 22.750 1449 Tibial tubercle osteotomy, add... 204.00 22.750 1448 Non-structural bone substitute, to one or more sites, add... 55.70 22.750 Tariffs 1440, 1442, 1444, 1448 and 1449 are add-ons that apply to Knee Arthroplasty only. Foot and Ankle Arthroplasty 1152 Ankle, distraction includes application of frame... 950.60 21.375 ~1500 Total ankle arthroplasty... 957.20 21.375 ~1501 Revision total ankle arthroplasty with exchange of liner... 957.20 21.375 ~1502 Removal of ankle prosthesis with or without spacer insertion... 914.90 21.375 ~1503 Revision of one or both components of ankle arthroplasty... 1,648.00 21.375 ~1504 Removal of ankle prosthesis with ankle arthrodesis, with or without bone graft... 1,872.00 25.500 ~1505 Total ankle arthroplasty with take down of arthrodesis... 1,217.00 25.500 ~1506 Morsellized bone graft, to one or more sites, add... 229.70 F-20 April 1, 2019
Musculoskeletal System ~1507 Impaction bone graft or structural bone graft to one or more sites, add... 378.90 1) All arthroplasty fees include associated bone and soft tissue procedures including but not limited to synovectomy, ligament lengthening and injection of medications. 2) Other procedures, e.g., subtular fusion, deltoid and/or lateral ligament repair, tendon repair and/or release and calcaneous osteotomy performed away from the ankle, at the same sitting, are claimable in accordance with the Surgical Rules of Application. 3) ~1506 and ~1507 are not claimable together. ~1506 and ~1507 may only be claimed as add-ons to tariffs ~1500, ~1503 and ~1505. UNIT VAULE 1153 Toe, one (1) joint (50% for each additional)... 270.90 20.000 1162 First Metatarsophalangeal joint, all methods including hallux valgus correction with bunionectomy and medial placation... 350.00 20.000 1233 Proximal phalanx osteotomy, add... 225.00 1234 Shaft metatarsal osteotomy, add... 225.00 1235 1st TMT fusion, add... 300.00 1163 Reconstruction, all metacarpophalangeal joints, one (1) hand... 865.05 20.000 1164 all metatarsophalangeal joints, one (1) foot... 603.85 20.000 1165 both feet... 845.15 20.000 ARTHROTOMY OR CAPSULOTOMY With exploration, drainage, or removal of loose body, (e.g. for osteochondritis, foreign body or synovial biopsy). 1001 Shoulder... 390.85 21.375 1002 Elbow... 366.65 20.000 1003 Wrist... 377.35 20.000 1017 Finger, one (1)... 281.70 20.000 1006 Other joints of upper extremity... 340.20 20.000 1007 Hip... 465.55 21.375 1008 Knee... 365.75 21.375 1010 Ankle... 355.00 20.000 1026 Toe, great toe... 315.90 20.000 1013 Other joints lower extremity... 315.90 20.000 DISLOCATION 1251* Dislocation, temporomandibular joint, closed reduction...46.80 20.000 1256 Vertebrae, cervical, closed reduction... 574.70 21.375 1258 open reduction... 574.70 22.750 1262 dorsal, simple, closed reduction... 574.70 21.375 April 1, 2019 F-21
Digestive System ESOPHAGUS 3055* Esophagoscopy, diagnostic, with or without biopsy... 108.25 21.375 3063* subsequent, same hospital admission... 98.95 21.375 3057 with foreign body removal... 186.70 21.375 3065* with injection of varices or band ligation... 211.10 21.375 STOMACH 3121* Gastroscopy, diagnostic with or without biopsy... 122.05 21.375 3122* with polypectomy... 206.00 21.375 3123* Esophagogastroduodenoscopy (EGD) with or without biopsy... 129.40 21.375 SMALL INTESTINE ~3215 Balloon assisted enteroscopy, oral route... 325.00 22.750 ~3216 Balloon assisted enteroscopy, rectal route... 350.00 22.750 1) Patients will have previously undergone some or all of the following: a capsule endoscopy, CT scan, or present exceptional clinical circumstances as per by report, such as small bowel bleeding. 2) Payable only for services performed at a facility to be designated by Manitoba Health (Health Sciences Centre) by a gastroenterologist who has been approved by the Gastroenterology Section Head at the Winnipeg Regional Health Authority. 3) Tariffs 3055, 3057, 3063, 3065, 3121, 3122, 3123, 3185, 3186, 3187, 3188, 3189, 3190, 3196 cannot be claimed concurrently with tariff ~3215 or ~3216. 3190* Small bowel enteroscopy by mouth using designated enteroscope or colonoscope... 230.00 21.375 Pathology report may be required. 3192 Capsule Endoscopy Includes the review of imaging of the small bowel and report to the referring physician... 437.35 1) A visit cannot be claimed at the same sitting as the initiation of capsule endoscopy. 2) Minimum time for the service is one (1) hour including the assessment of referrals to determine indication for procedure. 3) Patients will have previously undergone some or all of the following: Esophagogastroduodenoscopy (EGD), colonoscopy, small bowel enteroscopy and/or small bowel series radiography & fluoroscopy. 4) Payable only for services provided by a Gastroenterologist or by a qualified physician with training in capsule endoscopy, at a facility to be designated by Manitoba Health (Health Science Centre and Brandon Regional Health Centre). J-8 April 1, 2019
Renal Transplants P RENAL TRANSPLANTS These benefits cannot be correctly interpreted without reference to the Rules of Application. 5883 Renal transplant... 1,948.35 25.500 5884 Cadaver nephrectomy single for local implant or export... 1,006.95 22.750 5885 Cadaver nephrectomy double for local implants or export... 1,006.95 22.750 ~5900 Donor nephrectomy after cardiac death... 2,500.00 Tariff ~5900 is for all procedures performed including but not limited to: unilateral or bilateral nephrectomy, aortic and venous cannulation, supra renal clamping and incisional or excisional biopsy of the spleen. 5886 Live donor nephrectomy... 1,294.45 22.750 5881 Laparoscopic live donor nephrectomy... 1,566.05 22.750 5887 Rejection transplant nephrectomy... 1,000.50 22.750 5888 Pre-transplant nephrectomy (recipient) unilateral... 490.00 22.750 5889 bilateral... 859.00 22.750 5882 Marsupialization of post transplant lymphocele... 536.85 22.750 The above fees represent the total fees of those surgeons in actual attendance and will be divided among the team in accordance with their involvement. They do not include Nephrologists fees which are listed below. NEPHROLOGISTS BENEFITS Recipient related services; including nephrological management of transplantation including examination, supervision of allocation, tissue typing and interpretation of cross-match and immunological risk, determining induction and maintenance immunosuppression and complete patient care for the first three (3) day of postoperative care. 1) One of each service may be billed per patient. 2) 5871, 5872 and 5873 are payable to the attending physician of record for the day. 5871 Day 1... 605.30 5872 Day 2... 302.65 5873 Day 3... 302.65 5898 Donor related services; including the nephrological management of organ procurement, management of the neurologically dead donor on life support systems, the assessment of renal functions pre-nephrectomy, immunotherapy prenephrectomy, and assessment of potential recipients, etc.... 446.15 5894 Subsequent postoperative routine care at daily care rates, per day...78.85 5895 Management of rejection crises, care ordinarily equivalent to that of the first three (3) postoperative days, per day... 138.05 5896 Management of rejection crises requiring dialysis; as for acute renal failure (includes daily care by a Nephrologist); equivalent to repeat hemodialysis in acute renal failure, per dialysis See existing schedule... 190.70 April 1, 2019 P-1