E809

PDF page 718 / S36

DIGESTIVE SYSTEM SURGICAL PROCEDURES
ABDOMEN, PERITONEUM AND OMENTUM
                                                                                                 Asst         Surg          Anae
    Panniculectomy
# S318 Panniculectomy, including any necessary diastasis repair .....                          6 500.00 6
# E748    - with repair of umbilical hernia, to S318 ...................... add                  122.05
# E809    - excision of panniculus that extends beyond the mid thigh,
            to S318....................................................................... add   250.00
      Note:
      1.Panniculectomy is only insured in those circumstances described in Appendix D of this
        Schedule. Prior authorization of payment from the MOH is required.
      2.S318 is not eligible for payment when performed in conjunction with abdominal or pelvic
        procedures unless the payment requirements for panniculectomy are separately fulfilled.
         [Commentary:
         1.In circumstances where the proposed panniculectomy surgery may include excision of a
           panniculus that extends below the mid thigh, the requesting physician must provide sufficient
           information with the request for prior authorization of payment.
         2.Abdominoplasty is not an insured service.]
# S319 Mesenteric cyst.......................................................................       6         381.65          6

Master, record 1504. Record Layout PDF, page 1.

E80920250401999999990000250000000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.