list of medical case rates (updated february 2017) icd 10 ... · amoebic appendicitis; amoebic...
TRANSCRIPT
Case Rate Professional
Fee
Health Care
Institution Fee
P91.3 Neonatal cerebral irritability ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.4 Neonatal cerebral depression ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.6 Hypoxic ischaemic encephalopathy of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.8 Other specified disturbances of cerebral status of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
P91.9 Disturbance of cerebral status of newborn, unspecified ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400
J36Peritonsillar abscess; Abscess of tonsil; Peritonsillar
cellulitis; QuinsyABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J38.7
Other diseases of larynx; Abscess of larynx; Cellulitis of
larynx; Disease NOS of larynx; Necrosis of larynx;
Pachyderma of larynx; Perichondritis of larynx; Ulcer of
larynx
ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J39.0Retropharyngeal and parapharyngeal abscess;
Peripharyngeal abscessABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J39.1Other abscess of pharynx; Cellulitis of pharynx;
Nasopharyngeal abscessABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J39.2Other diseases of pharynx; Cyst of pharynx or nasopharynx;
Oedema of pharynx or nasopharynxABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J85.1 Abscess of lung with pneumonia ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J85.2 Abscess of lung without pneumonia; Abscess of lung NOS ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J85.3 Abscess of mediastinum ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J86.0 Pyothorax with fistula ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
J86.9Pyothorax without fistula; Abscess of pleura; Abscess of
thorax; Empyema; PyopneumothoraxABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000
A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae ACUTE GASTROENTERITIS 6,000 1,800 4,200
A00.1 Cholera due to Vibrio cholerae 01, biovar eltor ACUTE GASTROENTERITIS 6,000 1,800 4,200
A00.9 Cholera, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.0Shigellosis due to Shigella dysenteriae; Group A shigellosis
[Shiga-Kruse dysentery]ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.1 Shigellosis due to Shigella flexneri;Group B shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.2 Shigellosis due to Shigella boydii; Group C shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.3 Shigellosis due to Shigella sonnei; Group D shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.8 Other shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A03.9 Shigellosis, unspecified; ; Bacillary dysentery NOS ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.0 Enteropathogenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.1 Enterotoxigenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.2 Enteroinvasive Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.3 Enterohaemorrhagic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.4 Other intestinal Escherichia coli infections ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.5 Campylobacter enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.6 Enteritis due to Yersinia enterocolitica ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.7
Enterocolitis due to Clostridium difficile; Foodborne
intoxication by Clostridium difficile; Pseudomembranous
colitis
ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.8 Other specified bacterial intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200
A04.9Bacterial intestinal infection, unspecified. Bacterial enteritis
NOSACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.0 Foodborne staphylococcal intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.2
Foodborne Clostridium perfringens [Clostridium welchii]
intoxication. Enteritis necroticans.
Pig-bel
ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.3 Foodborne Vibrio parahaemolyticus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.4 Foodborne Bacillus cereus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.8 Other specified bacterial foodborne intoxications ACUTE GASTROENTERITIS 6,000 1,800 4,200
A05.9 Bacterial foodborne intoxication, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.0 Balantidiasis; Balantidial dysentery ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.1 Giardiasis [lambliasis] ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.2 Cryptosporidiosis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.3Isosporiasis; Infection due to Isospora belli and Isospora
hominis; Intestinal coccidiosis; IsosporosisACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.8Other specified protozoal intestinal diseases; Intestinal
trichomoniasis; Sarcocystosis; SarcosporidiosisACUTE GASTROENTERITIS 6,000 1,800 4,200
A07.9
Protozoal intestinal disease, unspecified;Flagellate
diarrhoea; Protozoal colitis; Protozoal diarrhoea; Protozoal
dysentery
ACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.0 Rotaviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.1Acute gastroenteropathy due to Norovirus; Noroviral
enteritis; Small round structured virus enteritisACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.2 Adenoviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.3 Other viral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.4Viral intestinal infection, unspecified; Viral enteritis NOS;
Viral gastroenteritis NOS; Viral gastroenteropathy NOSACUTE GASTROENTERITIS 6,000 1,800 4,200
A08.5 Other specified intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Page 1 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
A09.0
Infectious diarrhea
Infectious diarrhea with no dehydration
Other and unspecified gastroenteritis and colitis of
infectious origin
ACUTE GASTROENTERITIS 6,000 1,800 4,200
A09.9Gastroenteritis and colitis of unspecified origin; Neonatal
diarrhoea NOSACUTE GASTROENTERITIS 6,000 1,800 4,200
K52.0 Gastroenteritis and colitis due to radiation ACUTE GASTROENTERITIS 6,000 1,800 4,200
K52.1 Toxic gastroenteritis and colitis ACUTE GASTROENTERITIS 6,000 1,800 4,200
K52.2Allergic and dietetic gastroenteritis and colitis; Food
hypersensitivity gastroenteritis or colitisACUTE GASTROENTERITIS 6,000 1,800 4,200
K52.8Other specified noninfective gastroenteritis and colitis;
Eosinophilic gastritis or gastroenteritisACUTE GASTROENTERITIS 6,000 1,800 4,200
K52.9
Noninfective gastroenteritis and colitis, unspecified;
Diarrhoea specified as noninfective, or NOS in countries
where the conditions can be presumed to be of
noninfectious origin; Enteritis specified as noninfective, or
NOS in countries where the conditions can be presumed to
be of noninfectious origin; Ileitis specified as noninfective,
or NOS in countries where the conditions can be presumed
to be noninfectious origin; Jejunitis specified as
noninfective, or NOS in countries where the conditions can
be presumed to be noninfectious origin; Sigmoiditis
pecified as noninfective, or NOS in countries where the
conditions can be presumed to be noninfectious origin
ACUTE GASTROENTERITIS 6,000 1,800 4,200
K58.0 Irritable bowel syndrome with diarrhoea ACUTE GASTROENTERITIS 6,000 1,800 4,200
N17.0Acute renal failure with tubular necrosis; Tubular necrosis
NOS; Acute Tubular necrosis ; Renal Tubular necrosisACUTE RENAL FAILURE 19,300 5,790 13,510
N17.1
Acute renal failure with acute cortical necrosis; Cortical
necrosis NOS; Acute Cortical necrosis ; Renal Cortical
necrosis
ACUTE RENAL FAILURE 19,300 5,790 13,510
N17.2
Acute renal failure with medullary necrosis; Medullary
papillary necrosis, NOS; Acute medullary papillary necrosis;
Renal medullary papillary necrosis
ACUTE RENAL FAILURE 19,300 5,790 13,510
N17.8 Other acute renal failure ACUTE RENAL FAILURE 19,300 5,790 13,510
N17.9 Acute renal failure, unspecified; ACUTE RENAL FAILURE 19,300 5,790 13,510
O08.4
Renal failure following abortion and ectopic and molar
pregnancy; Oliguria Acute renal failure; Oliguria renal
shutdown; Oliguria renal tubular necrosis; Oliguria Uraemia
ACUTE RENAL FAILURE 19,300 5,790 13,510
J80Adult respiratory distress syndrome; Adult hyaline
membrane diseaseADULT RESPIRATORY DISTRESS SYNDROME 32,000 9,600 22,400
T78.1 Other adverse food reactions, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340
T78.3 Angioneurotic oedema; Giant urticaria; Quinke's oedema ALLERGIC REACTIONS 6,200 1,860 4,340
T78.4Allergy, unspecified; Allergic reaction NOS; Hypersensitivity
NOS; Idiosyncracy NOSALLERGIC REACTIONS 6,200 1,860 4,340
T78.8 Other adverse effects, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340
T78.9 Adverse effect, unspecified ALLERGIC REACTIONS 6,200 1,860 4,340
T88.7
Unspecified adverse effect of drug or medicament; Adverse
effect of correct drug or medicament properly
administered; Allergic reactiion to correct drug or
medicament properly administered; Hypersensitivity to
correct drug or medicament properly administered;
Idiosyncracy to correct drug or medicament properly
administered; Drug: hypersensitivity NOS; reaction NOS
ALLERGIC REACTIONS 6,200 1,860 4,340
A06.4+ K77.0* Amoebic liver abscess; Hepatic amoebiasis AMOEBIASIS, HEPATIC 10,000 3,000 7,000
A06.0Acute amoebic dysentery; Acute amoebiasis; Intestinal
amoebiasis NOSAMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.1 Chronic intestinal amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.2 Amoebic nondysenteric colitis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.3 Amoeboma of intestine; Amoeboma NOS AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.7 Cutaneous amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
A06.8Amoebic infection of other sites
Amoebic Appendicitis; Amoebic balanitis (N51.2*)AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200
E85.8 Other amyloidosis; Localized amyloidosis AMYLOIDOSIS 11,100 3,330 7,770
T78.0 Anaphylactic shock due to adverse food reaction ANAPHYLACTIC SHOCK 7,600 2,280 5,320
T78.2Anaphylactic shock, unspecified; Allergic shock NOS;
Anaphylactic reaction NOS; Anaphylaxis NOSANAPHYLACTIC SHOCK 7,600 2,280 5,320
T88.6Anaphylactic shock due to adverse effect of correct drug or
medicament properly administeredANAPHYLACTIC SHOCK 7,600 2,280 5,320
D50.0Iron deficiency anaemia secondary to blood loss (chronic);
Posthaemorrhagic anaemia (chronic)ANEMIA 10,000 3,000 7,000
Page 2 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D50.1Sideropenic dysphagia; Kelly-Paterson syndrome; Plummer-
Vinson syndromeANEMIA 10,000 3,000 7,000
D50.8 Other iron deficiency anaemias ANEMIA 10,000 3,000 7,000
D50.9 Iron deficiency anaemia, unspecified ANEMIA 10,000 3,000 7,000
D51.0
Vitamin B12 deficiency anaemia due to intrinsic factor
deficiency; Addison Anaemia; Biermer Anaemia;
Congenital Pernicious Anaemia; Congenital intrinsic factor
deficiency
Pernicious anemia
ANEMIA 10,000 3,000 7,000
D51.8 Other vitamin B12 deficiency anaemias ANEMIA 10,000 3,000 7,000
D51.9 Vitamin B12 deficiency anaemia, unspecified ANEMIA 10,000 3,000 7,000
D52.1
Drug-induced folate deficiency anaemia
Use additional external cause code (Chapter XX), if desired
to identify drug
ANEMIA 10,000 3,000 7,000
D52.9Folate deficiency anaemia, unspecified; Folic acid deficiency
anaemia NOSANEMIA 10,000 3,000 7,000
D53.0Protein deficiency anaemia; Amino-acid deficiency
anaemia; Orotaciduric anaemiaANEMIA 10,000 3,000 7,000
D53.1Other megaloblastic anaemias, not elsewhere classified;
Megaloblastic anaemia NOSANEMIA 10,000 3,000 7,000
D53.2 Scorbutic anaemia ANEMIA 10,000 3,000 7,000
D53.8
Other specified nutritional anaemias; Anaemia associated
with deficiency of copper; Anaemia associated with
deficiency of molybdenum; Anaemia associated with
deficiency of zinc
ANEMIA 10,000 3,000 7,000
D53.9 Nutritional anaemia, unspecified; Simple chronic anaemia ANEMIA 10,000 3,000 7,000
D55.0
Anaemia due to glucose-6-phosphate dehydrogenase
[G6PD] deficiency; Favism;
G6PD deficiency anaemia
ANEMIA 10,000 3,000 7,000
D55.1
Anaemia due to other disorders of glutathione metabolism;
Anaemia due to enzyme deficiencies, except G6PD, related
to the hexose monophosphate [HMP] shunt pathway;
Anaemia due to haemolytic nonspherocytic hereditary,
type I
ANEMIA 10,000 3,000 7,000
D55.2
Anaemia due to disorders of glycolytic enzymes;
Haemolytic nonspherocytic hereditary Anaemia, type II;
Hexokinase deficiency Anaemia; Pyruvate kinase [PK]
deficiency Anaemia; Triose-phosphate isomerase deficiency
Anaemia
ANEMIA 10,000 3,000 7,000
D55.8 Other anaemias due to enzyme disorders ANEMIA 10,000 3,000 7,000
D55.9 Anaemia due to enzyme disorder, unspecified ANEMIA 10,000 3,000 7,000
D56.9
Thalassaemia, unspecified
Mediterranean anaemia; Mediterranean anaemia with
other haemoglobinopathy; Thalassaemia minor with other
haemoglobinopathy; Thalassaemia mixed with other
haemoglobinopathy;
ANEMIA 10,000 3,000 7,000
D57.0 Sickle-cell anaemia with crisis; Hb-SS disease with crisis ANEMIA 10,000 3,000 7,000
D57.1Sickle-cell anaemia without crisis; Sickle-cell anaemia NOS;
Sickle-cell disease NOS ; Sickle-cell disorder NOSANEMIA 10,000 3,000 7,000
D57.3 Sickle-cell trait; Hb-S trait ; Heterozygous Haemoglobin S ANEMIA 10,000 3,000 7,000
D57.8 Other sickle-cell disorders ANEMIA 10,000 3,000 7,000
D58.0
Hereditary spherocytosis; Acholuric (familial) jaundice;
Congenital (spherocytic) haemolytic icterus; Minkowski-
Chauffard syndrome
ANEMIA 10,000 3,000 7,000
D58.1Hereditary elliptocytosis; Congenital Elliptocytosis;
Congenital Ovalocytosis; Hereditary OvalocytosisANEMIA 10,000 3,000 7,000
D58.2
Other haemoglobinopathies; Abnormal haemoglobin NOS;
Congenital Heinz body anaemia; Hb-C Disease; Hb-C
Disease; Hb-D Disease; Hb-E Disease; Haemoglobinopathy
NOS; Unstable haemoglobin haemolytic disease
ANEMIA 10,000 3,000 7,000
D58.8Other specified hereditary haemolytic anaemias;
StomatocytosisANEMIA 10,000 3,000 7,000
D58.9Hereditary haemolytic anaemia, unspecified; Acquired
haemolytic anaemiaANEMIA 10,000 3,000 7,000
D59.0 Drug-induced autoimmune haemolytic anaemia ANEMIA 10,000 3,000 7,000
D59.1
Other autoimmune haemolytic anaemias; Autoimmune
haemolytic disease, cold type; (Autoimmune haemolytic
disease, warm type; Chronic cold haemagglutinin disease;
Cold agglutinin disease; Cold agglutinin haemoglobinuria;
Secondary symptomatic Haemolytic anaemia, cold type;
Secondary symptomatic Haemolytic anaemia, warm type;
ANEMIA 10,000 3,000 7,000
Page 3 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D59.2Drug-induced nonautoimmune haemolytic anaemia; Drug-
induced enzyme deficiency anaemiaANEMIA 10,000 3,000 7,000
D59.4
Other nonautoimmune haemolytic anaemias; Mechanical
Haemolytic anaemia; Microangiopathic Haemolytic
anaemia; Toxic Haemolytic anaemia
ANEMIA 10,000 3,000 7,000
D59.5Paroxysmal nocturnal haemoglobinuria [Marchiafava-
Micheli]ANEMIA 10,000 3,000 7,000
D59.6
Haemoglobinuria due to haemolysis from other external
causes; Haemoglobinuria from exertion; Haemoglobinuria
march; Haemoglobinuria paroxysmal cold
ANEMIA 10,000 3,000 7,000
D59.8 Other acquired haemolytic anaemias ANEMIA 10,000 3,000 7,000
D59.9Acquired haemolytic anaemia, unspecified; Chronic
Idiopathic haemolytic anaemiaANEMIA 10,000 3,000 7,000
D60.1 Transient acquired pure red cell aplasia ANEMIA 10,000 3,000 7,000
D61.0
Constitutional aplastic anaemia; Congenital Pure red cell
Aplasia; Pure red cell Aplasia of infants; Primary Pure red
cell Aplasia; Blackfan-Diamond syndrome; Familial
hypoplastic anaemia; Fanconi's anaemia; Pancytopenia
with malformations
ANEMIA 10,000 3,000 7,000
D61.1 Drug-induced aplastic anaemia ANEMIA 10,000 3,000 7,000
D61.2 Aplastic anaemia due to other external agents ANEMIA 10,000 3,000 7,000
D61.3 Idiopathic aplastic anaemia ANEMIA 10,000 3,000 7,000
D61.8 Other specified aplastic anaemias ANEMIA 10,000 3,000 7,000
D61.9Aplastic anaemia, unspecified; Hypoplastic anaemia NOS;
Medullary hypoplasia; PanmyelophthisisANEMIA 10,000 3,000 7,000
D62 Acute posthaemorrhagic anaemia ANEMIA 10,000 3,000 7,000
D63.0* Anaemia in neoplastic disease ANEMIA 10,000 3,000 7,000
D63.8* Anaemia in other chronic diseases classified elsewhere ANEMIA 10,000 3,000 7,000
D64.0Hereditary sideroblastic anaemia; Sex-linked hypochromic
sideroblastic anaemiaANEMIA 10,000 3,000 7,000
D64.1 Secondary sideroblastic anaemia due to disease ANEMIA 10,000 3,000 7,000
D64.2 Secondary sideroblastic anaemia due to drugs and toxins ANEMIA 10,000 3,000 7,000
D64.3Other sideroblastic anaemias; Sideroblastic anaemia NOS;
pyridoxine-responsive NEC Sideroblastic anaemiaANEMIA 10,000 3,000 7,000
D64.8Other specified anaemias; Infantile pseudoleukaemia;
Leukoerythroblastic anaemiaANEMIA 10,000 3,000 7,000
D64.9Anaemia, unspecified
Severe anemiaANEMIA 10,000 3,000 7,000
M00.16 Pneumococcal arthritis and polyarthritis, Lower leg ARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.19 Pneumococcal arthritis and polyarthritis, Site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.29Other streptococcal arthritis and polyarthritis, Site
unspecifiedARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.82Arthritis and polyarthritis due to other specified bacterial
agents upper armARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.90Pyogenic arthritis, unspecified; Infective arthritis NOS
multiple sitesARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.91Pyogenic arthritis, unspecified; Infective arthritis NOS
shoulder regionARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.93Pyogenic arthritis, unspecified; Infective arthritis NOS
forearmARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.94Pyogenic arthritis, unspecified; Infective arthritis NOS
handARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.95Pyogenic arthritis, unspecified; Infective arthritis NOS
pelvic region and thighARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.96Pyogenic arthritis, unspecified; Infective arthritis NOS
lower legARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.97Pyogenic arthritis, unspecified; Infective arthritis NOS
ankle and footARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.98Pyogenic arthritis, unspecified; Infective arthritis NOS
other sitesARTHRITIS INFECTIOUS 9,700 2,910 6,790
M00.99Pyogenic arthritis, unspecified; Infective arthritis NOS
site unspecifiedARTHRITIS INFECTIOUS 9,700 2,910 6,790
M02.39 Reiter's disease, site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790
M06.19 Adult-onset Still's disease, site unspecified ARTHRITIS INFECTIOUS 9,700 2,910 6,790
M08.29Juvenile arthritis with systemic onset; Still's disease NOS
site unspecifiedARTHRITIS INFECTIOUS 9,700 2,910 6,790
M02.99 Reactive arthropathy, unspecified, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M05.99Seropositive rheumatoid arthritis, unspecified, site
unspecifiedARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.01 Seronegative rheumatoid arthritis, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.09 Seronegative rheumatoid arthritis, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.36 Rheumatoid nodule, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.45 Inflammatory polyarthropathy, pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Page 4 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M06.49 Inflammatory polyarthropathy, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.81 Other specified rheumatoid arthritis, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.86 Other specified rheumatoid arthritis, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.87 Other specified rheumatoid arthritis, ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.89 Other specified rheumatoid arthritis, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.90 Rheumatoid arthritis, unspecified, multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.91 Rheumatoid arthritis, unspecified, shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.93 Rheumatoid arthritis, unspecified, forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.94 Rheumatoid arthritis, unspecified, hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.95 Rheumatoid arthritis, unspecified, pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.96 Rheumatoid arthritis, unspecified, lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.97 Rheumatoid arthritis, unspecified, ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.98 Rheumatoid arthritis, unspecified, other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M06.99 Rheumatoid arthritis, unspecified, site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.06Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis
with or without rheumatoid factor lower legARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.07Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis
with or without rheumatoid factor ankle and footARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.09Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis
with or without rheumatoid factor site unspecifiedARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.19 Juvenile ankylosing spondylitis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.86 Other juvenile arthritis lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.89 Other juvenile arthritis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.91 Juvenile arthritis, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.96 Juvenile arthritis, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M08.99 Juvenile arthritis, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.00 Idiopathic gout; Gouty bursitis; Primary gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.01Idiopathic gout; Gouty bursitis; Primary gout;
Urate tophus of heart shoulder regionARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.02Idiopathic gout; Gouty bursitis; Primary gout;
Urate tophus of heart upper armARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.03 Idiopathic gout; Gouty bursitis; Primary gout forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.04Idiopathic gout; Gouty bursitis; Primary gout;
Urate tophus of heart handARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.05Idiopathic gout; Gouty bursitis; Primary gout;Urate tophus
of heart pelvic region and thighARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.06 Idiopathic gout; Gouty bursitis; Primary gout lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.07Idiopathic gout; Gouty bursitis; Primary gout;
Urate tophus of heart ankle and footARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.08Idiopathic gout; Gouty bursitis; Primary gout;
Urate tophus of heart other sitesARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.09Idiopathic gout; Gouty bursitis; Primary gout;
Urate tophus of heart site unspecifiedARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.10 Lead-induced gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.29 Drug-induced gout site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.30 Gout due to impairment of renal function multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.36 Gout due to impairment of renal function lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.39 Gout due to impairment of renal function site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.40 Other secondary gout multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.49 Other secondary gout site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.90 Gout, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.91 Gout, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.92 Gout, unspecified upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.93 Gout, unspecified forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.94 Gout, unspecified hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.96 Gout, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.97 Gout, unspecified ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.98 Gout, unspecified other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M10.99 Gout, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M11.89 Other specified crystal arthropathies site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M11.90 Crystal arthropathy, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M11.99 Crystal arthropathy, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.26 Villonodular synovitis (pigmented) lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.39 Palindromic rheumatism site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.50 Traumatic arthropathy multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.52 Traumatic arthropathy upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.53 Traumatic arthropathy forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.54 Traumatic arthropathy hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.55 Traumatic arthropathy pelvic region and thigh ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.56 Traumatic arthropathy lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
Page 5 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M12.57 Traumatic arthropathy ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.58 Traumatic arthropathy other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.59 Traumatic arthropathy site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.86Other specific arthropathies, not elsewhere classified;
Transient arthropathy lower legARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M12.89Other specific arthropathies, not elsewhere classified;
Transient arthropathy site unspecifiedARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.00 Polyarthritis, unspecified multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.01 Polyarthritis, unspecified shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.02 Polyarthritis, unspecified upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.06 Polyarthritis, unspecified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.09 Polyarthritis, unspecified site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.13 Monoarthritis, not elsewhere classified forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.16 Monoarthritis, not elsewhere classified lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.17 Monoarthritis, not elsewhere classified ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.18 Monoarthritis, not elsewhere classified other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.80 Other specified arthritis; Allergic arthritis multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.81 Other specified arthritis; Allergic arthritis shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.85Other specified arthritis; Allergic arthritis pelvic region and
thighARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.86 Other specified arthritis; Allergic arthritis lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.87 Other specified arthritis; Allergic arthritis ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.88 Other specified arthritis; Allergic arthritis other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.89 Other specified arthritis; Allergic arthritis site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.90 Arthritis, unspecified; Arthropathy NOS multiple sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.91 Arthritis, unspecified; Arthropathy NOS shoulder region ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.92 Arthritis, unspecified; Arthropathy NOS upper arm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.93 Arthritis, unspecified; Arthropathy NOS forearm ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.94 Arthritis, unspecified; Arthropathy NOS hand ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.95Arthritis, unspecified; Arthropathy NOS pelvic region and
thighARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.96 Arthritis, unspecified; Arthropathy NOS lower leg ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.97 Arthritis, unspecified; Arthropathy NOS ankle and foot ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.98 Arthritis, unspecified; Arthropathy NOS other sites ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
M13.99 Arthritis, unspecified; Arthropathy NOS site unspecified ARTHRITIS NONINFECTIOUS 7,000 2,100 4,900
A92.0Chikungunya virus disease; Chikungunya (haemorrhagic)
feverARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A92.1 O'nyong-nyong fever ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A92.2Venezuelan equine fever; Venezuelan equine encephalitis;
Venezuelan encephalomyelitis virus diseaseARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A92.8 Other specified mosquito-borne viral fevers ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A93.1 Sandfly fever; Pappataci fever; Phlebotomus fever ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A93.8
Other specified arthropod-borne viral fevers; Piry virus
disease; Severe fever with thrombocytopenia syndrome
[SFTS]; Vesicular stomatitis virus disease [Indiana fever]
ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
A94
Unspecified arthropod-borne viral fever; Unspecified
arthropod-borne viral fever; Arboviral fever NOS; Arbovirus
infection NOS
Acute hemorrhagic fever
ARTHROPOD BORNE VIRAL FEVER 8,100 2,430 5,670
M15.0 Primary generalized (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900
M15.2 Bouchard's nodes (with arthropathy) ARTHROSIS 7,000 2,100 4,900
M15.3 Secondary multiple arthrosis; Post-traumatic polyarthrosis ARTHROSIS 7,000 2,100 4,900
M15.4 Erosive (osteo)arthrosis ARTHROSIS 7,000 2,100 4,900
M15.8 Other polyarthrosis ARTHROSIS 7,000 2,100 4,900
M15.9 Polyarthrosis, unspecified; Generalized osteoarthritis NOS ARTHROSIS 7,000 2,100 4,900
M16.0 Primary coxarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900
M16.1Other primary coxarthrosis; Primary coxarthrosis NOS;
Primary coxarthrosis unilateralARTHROSIS 7,000 2,100 4,900
M16.2 Coxarthrosis resulting from dysplasia, bilateral ARTHROSIS 7,000 2,100 4,900
M16.3Other dysplastic coxarthrosis; Dysplastic coxarthrosis NOS;
Dysplastic coxarthrosis unilateralARTHROSIS 7,000 2,100 4,900
M16.9 Coxarthrosis, unspecified ARTHROSIS 7,000 2,100 4,900
M17.0 Primary gonarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900
M17.1Other primary gonarthrosis; Primary gonarthrosis NOS;
Primary gonarthrosis unilateralARTHROSIS 7,000 2,100 4,900
M17.2 Post-traumatic gonarthrosis, bilateral ARTHROSIS 7,000 2,100 4,900
Page 6 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M17.3Other post-traumatic gonarthrosis; Post-traumatic
gonarthrosis NOS; Post-traumatic gonarthrosis unilateralARTHROSIS 7,000 2,100 4,900
M17.5Other secondary gonarthrosis; Secondary gonarthrosis
NOS; Secondary gonarthrosis unilateralARTHROSIS 7,000 2,100 4,900
M17.9 Gonarthrosis, unspecified ARTHROSIS 7,000 2,100 4,900
M18.0 Primary arthrosis of first carpometacarpal joints, bilateral ARTHROSIS 7,000 2,100 4,900
M18.9 Arthrosis of first carpometacarpal joint, unspecified ARTHROSIS 7,000 2,100 4,900
M19.00Primary arthrosis of other joints; Primary arthrosis
NOSmultiple sitesARTHROSIS 7,000 2,100 4,900
M19.02Primary arthrosis of other joints; Primary arthrosis
NOSupper armARTHROSIS 7,000 2,100 4,900
M19.05Primary arthrosis of other joints; Primary arthrosis
NOSpelvic region and thighARTHROSIS 7,000 2,100 4,900
M19.06Primary arthrosis of other joints; Primary arthrosis
NOSlower legARTHROSIS 7,000 2,100 4,900
M19.08Primary arthrosis of other joints; Primary arthrosis
NOSother sitesARTHROSIS 7,000 2,100 4,900
M19.09Primary arthrosis of other joints; Primary arthrosis NOSsite
unspecifiedARTHROSIS 7,000 2,100 4,900
M19.10Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS multiple sitesARTHROSIS 7,000 2,100 4,900
M19.11Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS shoulder regionARTHROSIS 7,000 2,100 4,900
M19.12Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS upper armARTHROSIS 7,000 2,100 4,900
M19.19Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS site unspecifiedARTHROSIS 7,000 2,100 4,900
M19.21Other secondary arthrosis; Secondary arthrosis NOS
shoulder regionARTHROSIS 7,000 2,100 4,900
M19.29Other secondary arthrosis; Secondary arthrosis NOS site
unspecifiedARTHROSIS 7,000 2,100 4,900
M19.81 Other specified arthrosis shoulder region ARTHROSIS 7,000 2,100 4,900
M19.86 Other specified arthrosis lower leg ARTHROSIS 7,000 2,100 4,900
M19.87 Other specified arthrosis ankle and foot ARTHROSIS 7,000 2,100 4,900
M19.88 Other specified arthrosis other sites ARTHROSIS 7,000 2,100 4,900
M19.89 Other specified arthrosis site unspecified ARTHROSIS 7,000 2,100 4,900
M19.90 Arthrosis, unspecified multiple sites ARTHROSIS 7,000 2,100 4,900
M19.91 Arthrosis, unspecified shoulder region ARTHROSIS 7,000 2,100 4,900
M19.92 Arthrosis, unspecified upper arm ARTHROSIS 7,000 2,100 4,900
M19.93 Arthrosis, unspecified forearm ARTHROSIS 7,000 2,100 4,900
M19.94 Arthrosis, unspecified hand ARTHROSIS 7,000 2,100 4,900
M19.95 Arthrosis, unspecified pelvic region and thigh ARTHROSIS 7,000 2,100 4,900
M19.96 Arthrosis, unspecified lower leg ARTHROSIS 7,000 2,100 4,900
M19.97 Arthrosis, unspecified ankle and foot ARTHROSIS 7,000 2,100 4,900
M19.98 Arthrosis, unspecified other sites ARTHROSIS 7,000 2,100 4,900
M19.99Arthrosis, unspecified site unspecified
OsteoarthritisARTHROSIS 7,000 2,100 4,900
J45.00
Predominantly allergic asthma; Allergic bronchitis NOS;
Allergic rhinitis with asthma; Atopic asthma; Extrinsic
allergic asthma; Hay fever with asthma; in Acute
Exacerbation
ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J45.10Nonallergic asthma; Idiosyncratic asthma; Intrinsic
nonallergic asthma, in Acute ExacerbationASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J45.80 Mixed asthma, in Acute Exacerbation ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J45.90 Bronchial Asthma in Acute Exacerbation ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J46 Status asthmaticus; Acute severe asthma ASTHMA IN ACUTE EXACERBATION 9,000 2,700 6,300
J98.1Pulmonary collapse; Atelectasis; Collapse of lung; Brock's
syndromeATELECTASIS 13,800 4,140 9,660
M54.01Panniculitis affecting regions of neck and back occipito-
atlanto-axial regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.06Panniculitis affecting regions of neck and back lumbar
regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.08Panniculitis affecting regions of neck and back sacral and
sacrococcygeal regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.10
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
Multiple sites in spine
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.11
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
occipito-atlanto-axial region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
Page 7 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M54.12
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
cervical region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.14
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
thoracic region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.15
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
thoracolumbar region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.16
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
lumbar region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.17
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
lumbosacral region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.18
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
sacral and sacrococcygeal region
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.19
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral; thoracic
Neuritis or radiculitis NOS ; Radiculitis NOS
site unspecified
BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.2 Cervicalgia BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.20 Cervicalgia Multiple sites in spine BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.22 Cervicalgia cervical region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.26 Cervicalgia lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.3 Sciatica BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.30 Sciatica Multiple sites in spine BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.31 Sciatica occipito-atlanto-axial region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.35 Sciatica thoracolumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.36 Sciatica lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.37 Sciatica lumbosacral region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.38 Sciatica sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.39 Sciatica site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.4 Lumbago with sciatica BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.41 Lumbago with sciatica occipito-atlanto-axial region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.44 Lumbago with sciatica thoracic region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.46 Lumbago with sciatica lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.48 Lumbago with sciatica sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.49 Lumbago with sciatica site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.5 Low back pain; Loin pain; Low back strain; Lumbago NOS BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.50Low back pain; Loin pain; Low back strain; Lumbago NOS
Multiple sites in spineBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.51Low back pain; Loin pain; Low back strain; Lumbago NOS
occipito-atlanto-axial regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.52Low back pain; Loin pain; Low back strain; Lumbago NOS
cervical regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.84 Other dorsalgia thoracic region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.88 Other dorsalgia sacral and sacrococcygeal region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.91Dorsalgia, unspecified; Backache NOS occipito-atlanto-axial
regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.93Dorsalgia, unspecified; Backache NOS cervicothoracic
regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.96 Dorsalgia, unspecified; Backache NOS lumbar region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.97 Dorsalgia, unspecified; Backache NOS lumbosacral region BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.98Dorsalgia, unspecified; Backache NOS sacral and
sacrococcygeal regionBACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
M54.99 Dorsalgia, unspecified; Backache NOS site unspecified BACK PAIN, RADICULOPATHY, SCIATICA 6,400 1,920 4,480
N31.0 Uninhibited neuropathic bladder, not elsewhere classified BLADDER DYSFUNCTION 9,000 2,700 6,300
N31.1 Reflex neuropathic bladder, not elsewhere classified BLADDER DYSFUNCTION 9,000 2,700 6,300
N31.2
Flaccid neuropathic bladder, not elsewhere classified;
Atonic Motor Neuropathic bladder; Sensory Atonic Motor
Neuropathic bladder; Autonomous Neuropathic bladder ;
Nonreflex Neuropathic bladder
BLADDER DYSFUNCTION 9,000 2,700 6,300
N31.8 Other neuromuscular dysfunction of bladder BLADDER DYSFUNCTION 9,000 2,700 6,300
N31.9Neuromuscular dysfunction of bladder, unspecified;
Neurogenic bladder dysfunction NOSBLADDER DYSFUNCTION 9,000 2,700 6,300
Page 8 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N32.9 Bladder disorder, unspecified BLADDER DYSFUNCTION 9,000 2,700 6,300
N39.3 Stress incontinence BLADDER DYSFUNCTION 9,000 2,700 6,300
N39.4Other specified urinary incontinence; Overflow
incontinence, Reflex incontinence, Urge incontinenceBLADDER DYSFUNCTION 9,000 2,700 6,300
R32 Unspecified urinary incontinence; Enuresis NOS BLADDER DYSFUNCTION 9,000 2,700 6,300
A05.1Botulism; Classical foodborne intoxication due to
Clostridium botulinumBOTULISM 4,800 1,440 3,360
G93.5Compression of brain; [compression, Herniation] of brain
(stem)BRAIN HERNIATION 22,400 6,720 15,680
N61
Inflammatory disorders of breast; Acute abscess of non
puerperal areola; Acute abscess nonpuerperal breast;
Chronic abscess of nonpuerperal areola; Chronic abscess of
nonpuerperal breast; Carbuncle of breast; Acute mastitis
nonpuerperal, NOS; Acute mastitis nonpuerperal, infective;
subacute mastitis nonpuerperal, NOS; subacute mastitis
nonpuerpural, infective
BREAST INFECTIONS 7,900 2,370 5,530
O91.0Infection of nipple associated with childbirth; Gestational
abscess of nipple; Puerperal abscess of nippleBREAST INFECTIONS 7,900 2,370 5,530
O91.1
Abscess of breast associated with childbirth; Mammary
abscess gestational or puerperal; Purulent mastitis
gestational or puerperal; Subareolar abscess gestational or
puerperal
BREAST INFECTIONS 7,900 2,370 5,530
O91.2
Nonpurulent mastitis associated with childbirth;
Lymphangitis of breast gestational or puerperal; Mastitis
NOS gestational or puerperal; Interstitial mastitis
gestational or puerperal; Parenchymatous mastitis
gestational or puerperal
BREAST INFECTIONS 7,900 2,370 5,530
O92.0 Retracted nipple associated with childbirth BREAST INFECTIONS 7,900 2,370 5,530
O92.1Cracked nipple associated with childbirth; Fissure of nipple,
gestational or puerperalBREAST INFECTIONS 7,900 2,370 5,530
C50.0 Malignant neoplasm of Nipple and areola, breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.1 Malignant neoplasm of Central portion of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.2 Malignant neoplasm of Upper-inner quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.3 Malignant neoplasm of Lower-inner quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.4 Malignant neoplasm of Upper-outer quadrant of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.6 Malignant neoplasm of Axillary tail of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.8 Malignant neoplasm of Overlapping lesion of breast BREAST MALIGNANCY 11,800 3,540 8,260
C50.9 Malignant neoplasm of Breast, unspecified BREAST MALIGNANCY 11,800 3,540 8,260
L10.0 Pemphigus vulgaris BULLOUS DISORDERS 12,000 3,600 8,400
L10.1 Pemphigus vegetans BULLOUS DISORDERS 12,000 3,600 8,400
L10.2 Pemphigus foliaceus BULLOUS DISORDERS 12,000 3,600 8,400
L10.4 Pemphigus erythematosus; Senear-Usher syndrome BULLOUS DISORDERS 12,000 3,600 8,400
L10.8 Other pemphigus BULLOUS DISORDERS 12,000 3,600 8,400
L10.9 Pemphigus, unspecified BULLOUS DISORDERS 12,000 3,600 8,400
L11.0 Acquired keratosis follicularis BULLOUS DISORDERS 12,000 3,600 8,400
L11.1 Transient acantholytic dermatosis [Grover] BULLOUS DISORDERS 12,000 3,600 8,400
L11.9 Acantholytic disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400
L12.0 Bullous pemphigoid BULLOUS DISORDERS 12,000 3,600 8,400
L12.1Cicatricial pemphigoid; Benign mucous membrane
pemphigoidBULLOUS DISORDERS 12,000 3,600 8,400
L12.2Chronic bullous disease of childhood; Juvenile dermatitis
herpetiformisBULLOUS DISORDERS 12,000 3,600 8,400
L12.3 Acquired epidermolysis bullosa BULLOUS DISORDERS 12,000 3,600 8,400
L12.8 Other pemphigoid BULLOUS DISORDERS 12,000 3,600 8,400
L13.0 Dermatitis herpetiformis; Duhring's disease BULLOUS DISORDERS 12,000 3,600 8,400
L13.1 Subcorneal pustular dermatitis; Sneddon-Wilkinson disease BULLOUS DISORDERS 12,000 3,600 8,400
L13.9 Bullous disorder, unspecified BULLOUS DISORDERS 12,000 3,600 8,400
T20.4 Corrosion of unspecified degree of head and neck BURN A 8,500 2,550 5,950
T21.0 Burn of unspecified degree of trunk BURN A 8,500 2,550 5,950
T21.2 Burn of second degree of trunk BURN A 8,500 2,550 5,950
T21.5 Corrosion of first degree of trunk BURN A 8,500 2,550 5,950
T21.6 Corrosion of second degree of trunk BURN A 8,500 2,550 5,950
T22.2Burn of second degree of shoulder and upper limb, except
wrist and handBURN A 8,500 2,550 5,950
T22.5Corrosion of first degree of shoulder and upper limb,
except wrist and handBURN A 8,500 2,550 5,950
T22.6Corrosion of second degree of shoulder and upper limb,
except wrist and handBURN A 8,500 2,550 5,950
T23.2 Burn of second degree of wrist and hand BURN A 8,500 2,550 5,950
T23.4 Corrosion of unspecified degree of wrist and hand BURN A 8,500 2,550 5,950
T24.2Burn of second degree of hip and lower limb, except ankle
and footBURN A 8,500 2,550 5,950
Page 9 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T24.5Corrosion of first degree of hip and lower limb, except
ankle and footBURN A 8,500 2,550 5,950
T24.6Corrosion of second degree of hip and lower limb, except
ankle and footBURN A 8,500 2,550 5,950
T25.2 Burn of second degree of ankle and foot BURN A 8,500 2,550 5,950
T25.5 Corrosion of first degree of ankle and foot BURN A 8,500 2,550 5,950
T26.0 Burn of eyelid and periocular area BURN A 8,500 2,550 5,950
T26.4 Burn of eye and adnexa, part unspecified BURN A 8,500 2,550 5,950
T26.9 Corrosion of eye and adnexa, part unspecified BURN A 8,500 2,550 5,950
T27.3 Burn of respiratory tract, part unspecified BURN A 8,500 2,550 5,950
T27.7 Corrosion of respiratory tract, part unspecified BURN A 8,500 2,550 5,950
T28.9 Corrosion of other and unspecified internal organs BURN A 8,500 2,550 5,950
T29.1Burns of multiple regions, no more than first-degree burns
mentionedBURN A 8,500 2,550 5,950
T30.0Burn of unspecified body region, unspecified degree; Burn
NOSBURN A 8,500 2,550 5,950
T30.2Burn of second degree, body region unspecified; Secodn-
degree burn NOSBURN A 8,500 2,550 5,950
T30.3Burn of third degree, body region unspecified; Third-degree
burn NOSBURN A 8,500 2,550 5,950
T30.4Corrosion of unspecified body region, unspecified degree;
Corrosion NOSBURN A 8,500 2,550 5,950
T30.5Corrosion of first degree, body region unspecified; First-
degree corrosion NOSBURN A 8,500 2,550 5,950
T30.6Corrosion of second degree, body region unspecified;
Second-degree corrosion NOSBURN A 8,500 2,550 5,950
T30.7Corrosion of third degree, body region unspecified; Thrid-
degree corrosion NOSBURN A 8,500 2,550 5,950
T31.0 Burns involving less than 10% of body surface BURN A 8,500 2,550 5,950
T31.1 Burns involving 10-19% of body surface BURN A 8,500 2,550 5,950
T32.0 Corrosions involving less than 10% of body surface BURN A 8,500 2,550 5,950
T32.1 Corrosions involving 10-19% of body surface BURN A 8,500 2,550 5,950
T34.1 Frostbite with tissue necrosis of neck BURN A 8,500 2,550 5,950
T35.0Superficial frostbite involving multiple body regions;
Multiple superficial frosbite NOSBURN A 8,500 2,550 5,950
T35.1Frostbite with tissue necrosis involving multiple body
regions; Multiple frosbite with tissue necrosis NOSBURN A 8,500 2,550 5,950
T20.2 Burn of second degree of head and neck BURN B 10,600 3,180 7,420
T20.3 Burn of third degree of head and neck BURN B 10,600 3,180 7,420
T20.6 Corrosion of second degree of head and neck BURN B 10,600 3,180 7,420
T22.3Burn of third degree of shoulder and upper limb, except
wrist and handBURN B 10,600 3,180 7,420
T23.3 Burn of third degree of wrist and hand BURN B 10,600 3,180 7,420
T23.6 Corrosion of second degree of wrist and hand BURN B 10,600 3,180 7,420
T23.7 Corrosion of third degree of wrist and hand BURN B 10,600 3,180 7,420
T24.3Burn of third degree of hip and lower limb, except ankle
and footBURN B 10,600 3,180 7,420
T24.7Corrosion of third degree of hip and lower limb, except
ankle and footBURN B 10,600 3,180 7,420
T25.3 Burn of third degree of ankle and foot BURN B 10,600 3,180 7,420
T26.1 Burn of cornea and conjunctival sac BURN B 10,600 3,180 7,420
T26.2 Burn with resulting rupture and destruction of eyeball BURN B 10,600 3,180 7,420
T26.3 Burn of other parts of eye and adnexa BURN B 10,600 3,180 7,420
T26.6 Corrosion of cornea and conjunctival sac BURN B 10,600 3,180 7,420
T27.0 Burn of larynx and trachea BURN B 10,600 3,180 7,420
T27.2 Burn of other parts of respiratory tract; Thoracic cavity BURN B 10,600 3,180 7,420
T28.0 Burn of mouth and pharynx BURN B 10,600 3,180 7,420
T28.1 Burn of oesophagus BURN B 10,600 3,180 7,420
T28.2 Burn of other parts of alimentary tract BURN B 10,600 3,180 7,420
T28.3 Burn of internal genitourinary organs BURN B 10,600 3,180 7,420
T28.5 Corrosion of mouth and pharynx BURN B 10,600 3,180 7,420
T28.6 Corrosion of oesophagus BURN B 10,600 3,180 7,420
T28.7 Corrosion of other parts of alimentary tract BURN B 10,600 3,180 7,420
T28.8 Corrosion of internal genitourinary organs BURN B 10,600 3,180 7,420
T29.2Burns of multiple regions, no more than second-degree
burns mentionedBURN B 10,600 3,180 7,420
T29.3Burns of multiple regions, at least one burn of third degree
mentionedBURN B 10,600 3,180 7,420
T29.6Corrosions of multiple regions, no more than second-
degree corrosions mentionedBURN B 10,600 3,180 7,420
T31.2 Burns involving 20-29% of body surface BURN B 10,600 3,180 7,420
T31.3 Burns involving 30-39% of body surface BURN B 10,600 3,180 7,420
T31.4 Burns involving 40-49% of body surface BURN B 10,600 3,180 7,420
T31.5 Burns involving 50-59% of body surface BURN B 10,600 3,180 7,420
T32.2 Corrosions involving 20-29% of body surface BURN B 10,600 3,180 7,420
T32.3 Corrosions involving 30-39% of body surface BURN B 10,600 3,180 7,420
T32.4 Corrosions involving 40-49% of body surface BURN B 10,600 3,180 7,420
Page 10 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T34.9
Frostbite with tissue necrosis of other and unspecified
sites; Frosbite with tissue necrosis NOS; Frosbite with tissue
of leg NOS; Frosbite with tissue necrosis of trunk NOS
BURN B 10,600 3,180 7,420
T21.3 Burn of third degree of trunk BURN C 16,100 4,830 11,270
T31.6 Burns involving 60-69% of body surface BURN C 16,100 4,830 11,270
T31.7 Burns involving 70-79% of body surface BURN C 16,100 4,830 11,270
T31.8 Burns involving 80-89% of body surface BURN C 16,100 4,830 11,270
T31.9 Burns involving 90% or more of body surface BURN C 16,100 4,830 11,270
T32.9 Corrosions involving 90% or more of body surface BURN C 16,100 4,830 11,270
I47.0 Re-entry ventricular arrhythmia CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I47.1
Supraventricular tachycardia; Atrial Paroxysmal
tachycardia; Atrioventricular [AV] Paroxysmal tachycardia;
Junctional Paroxysmal tachycardia; Nodal Paroxysmal
tachycardia
CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I47.2 Ventricular tachycardia CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I47.9Paroxysmal tachycardia, unspecified; Bouveret (-Hoffmann)
syndromeCARDIAC ARRHYTHMIA 12,200 3,660 8,540
I48 Atrial fibrillation and flutter CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.0 Ventricular fibrillation and flutter CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.1 Atrial premature depolarization; Atrial premature beats CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.2 Junctional premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.3 Ventricular premature depolarization CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.4
Other and unspecified premature depolarization; Ectopic
beats; Extrasystoles; Extrasystolic arrhythmias; Premature
beats NOS; Premature contractions
CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.5 Sick sinus syndrome; Tachycardia-bradycardia syndrome CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.8Other specified cardiac arrhythmias; Brugada syndrome;
Long QT syndrome; coronary sinus rhythm disorder;
ectopic rhythm disorder; nodal rhythm disorder
CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I49.9 Cardiac arrhythmia, unspecified; Cardiac arrhythmia NOS CARDIAC ARRHYTHMIA 12,200 3,660 8,540
I42.0 Dilated cardiomyopathy; Congestive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380
I42.1Obstructive hypertrophic cardiomyopathy; Hypertrophic
subaortic stenosisCARDIOMYOPATHY 13,400 4,020 9,380
I42.2Other hypertrophic cardiomyopathy; Nonobstructive
hypertrophic cardiomyopathyCARDIOMYOPATHY 13,400 4,020 9,380
I42.3Endomyocardial (eosinophilic) disease; Endomyocardial
(tropical) fibrosis; Löffler's endocarditisCARDIOMYOPATHY 13,400 4,020 9,380
I42.4 Endocardial fibroelastosis; Congenital cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380
I42.5 Other restrictive cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380
I42.6 Alcoholic cardiomyopathy CARDIOMYOPATHY 13,400 4,020 9,380
I42.7 Cardio myopathy due to drugs and other external agents CARDIOMYOPATHY 13,400 4,020 9,380
I42.8 Other cardiomyopathies CARDIOMYOPATHY 13,400 4,020 9,380
I42.9Cardio myopathy, unspecified; Primary cardiomyopathy
NOS; Secondary cardiomyopathy NOSCARDIOMYOPATHY 13,400 4,020 9,380
P29.0 Neonatal cardiac failureCARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN22,700 6,810 15,890
P29.1 Neonatal cardiac dysrhythmiaCARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN22,700 6,810 15,890
P29.2 Neonatal hypertensionCARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN22,700 6,810 15,890
P29.4 Transient myocardial ischaemia of newbornCARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN22,700 6,810 15,890
P29.8Other cardiovascular disorders originating in the perinatal
period
CARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN22,700 6,810 15,890
G83.4
Cauda equina syndrome; Neurogenic bladder due to cauda
equina syndrome
Excludes: cord bladder NOS (G95.8)
CAUDA EQUINA SYNDROME 8,800 2,640 6,160
A46 Erysipelas CELLULITIS 9,600 2,880 6,720
A48.0 Gas gangrene; Clostridial cellulitis; Clostridial myonecrosis CELLULITIS 9,600 2,880 6,720
L03.0Cellulitis of finger and toe; Infection of nail; Onychia;
Paronychia; PerionychiaCELLULITIS 9,600 2,880 6,720
L03.1Cellulitis of other parts of limb, Axilla; Cellulitis of
Hip;Cellulitis of ShoulderCELLULITIS 9,600 2,880 6,720
L03.2 Cellulitis of face CELLULITIS 9,600 2,880 6,720
L03.3
Cellulitis of trunk;Cellulitis of Abdominal wall;Cellulitis of
Back [any part]; Cellulitis of Chest wall;Cellulitis of
Groin;Cellulitis of Perineum;Cellulitis of Umbilicus
CELLULITIS 9,600 2,880 6,720
L03.8Cellulitis of other sites; Cellulitis of Head [any part, except
face];Cellulitis of ScalpCELLULITIS 9,600 2,880 6,720
Page 11 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
L03.9 Cellulitis, unspecified CELLULITIS 9,600 2,880 6,720
L98.3 Eosinophilic cellulitis [Wells] CELLULITIS 9,600 2,880 6,720
G80.0Spastic cerebral palsy; Congenital spastic paralysis
(cerebral); Spastic tetraplegic cerebral palsyCEREBRAL PALSY 9,500 2,850 6,650
G80.1 Spastic diplegia; Spastic cerebral palsy NOS CEREBRAL PALSY 9,500 2,850 6,650
G80.2Infantile hemiplegia
Spastic hemiplegic cerebral palsyCEREBRAL PALSY 9,500 2,850 6,650
G80.3Dyskinetic cerebral palsy; Athetoid cerebral palsy; Dystonic
cerebral palsyCEREBRAL PALSY 9,500 2,850 6,650
G80.4 Ataxic cerebral palsy CEREBRAL PALSY 9,500 2,850 6,650
G80.8Other infantile cerebral palsy; Mixed cerebral palsy
syndromesCEREBRAL PALSY 9,500 2,850 6,650
G80.9 Infantile cerebral palsy, unspecified; Cerebral palsy NOS CEREBRAL PALSY 9,500 2,850 6,650
K74.3Primary biliary cirrhosis; Chronic nonsupparative
destructive cholangitisCHOLANGITIS 13,200 3,960 9,240
K80.3Calculus of bile duct with cholangitis; Any condition listed in
K80.5 with cholangitisCHOLANGITIS 13,200 3,960 9,240
K80.0
Calculus of gallbladder with acute cholecystitis; Any
condition listed in K80.2 with acute cholecystitis
Acute cholecystitis with cholelithiasis
CHOLECYSTITIS 11,300 3,390 7,910
K80.1
Calculus of gallbladder with other cholecystitis; Any
condition listed in K80.2 with chronic cholecystitis;
Cholecystitis with cholelithiasis NOS
CHOLECYSTITIS 11,300 3,390 7,910
K80.4Calculus of bile duct with cholecystitis; Any condition listed
in K80.5 with cholecystitis (with cholangitis)CHOLECYSTITIS 11,300 3,390 7,910
K81.0
Acute cholecystitis; Abscess of gallbladder without calculus;
Angiocholecystitis without calculus; Acute emphysematous
cholecystitis without calculus; Gangrenous cholecystitis
without calculus; Supparative cholecystitis without
calculus; Empyema of gallbladder without calculus;
Gangrene of gallbladder without calculus
CHOLECYSTITIS 11,300 3,390 7,910
K81.1 Chronic cholecystitis CHOLECYSTITIS 11,300 3,390 7,910
K81.8 Other cholecystitis CHOLECYSTITIS 11,300 3,390 7,910
Q90.0 Trisomy 21, meiotic nondisjunction CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q90.2 Trisomy 21, translocation CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q90.9 Down's syndrome, unspecified; Trisomy 21 NOS CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.0 Trisomy 18, meiotic nondisjunction CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.2 Trisomy 18, translocation CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.3 Edwards' syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q91.7 Patau's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q92.9 Trisomy and partial trisomy of autosomes, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.1Whole chromosome monosomy, mosaicism (mitotic
nondisjunction)CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.2 Chromosome replaced with ring or dicentric CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.4Deletion of short arm of chromosome 5; Cri-du-chat
syndromeCHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.5Other deletions of part of a chromosome; Angelman
syndromeCHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.7 Deletions with other complex rearrangements CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q93.9 Deletion from autosomes, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q95.9 Balanced rearrangement and structural marker, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q96.9 Turner's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q97.9Sex chromosome abnormality, female phenotype,
unspecifiedCHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q98.4 Klinefelter's syndrome, unspecified CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q99.2 Fragile X chromosome; Fragile X syndrome CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
Q99.8 Other specified chromosome abnormalities CHROMOSOMAL ABNORMALITIES 12,700 3,810 8,890
N18.0 End stage renal disease CHRONIC KIDNEY DISEASE N/A N/A N/A
N18.5
Chronic kidney disease, stage 5
Chronic uraemia
End stage kidney disease:
• in allograft failure
• NOS
• on dialysis
• without dialysis or transplant
Renal retinitis+(H32.8*)
Uraemic:
• apoplexia+(I68.8*)
• dementia+(F02.8*)
• neuropathy+(G63.8*)
• paralysis+(G99.8*)
• pericarditis+(I32.8*)
CHRONIC KIDNEY DISEASE 14,500 4,350 10,150
N18.8 Other chronic renal failure CHRONIC KIDNEY DISEASE N/A N/A N/A
Page 12 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N18.9Chronic renal failure
Chronic kidney disease, unspecifiedCHRONIC KIDNEY DISEASE 14,500 4,350 10,150
N19
Unspecified renal failure
Unspecified kidney failure
Renal insufficiency NOS
CHRONIC KIDNEY DISEASE 14,500 4,350 10,150
J44.0Chronic obstructive/ asthmatic/ emphysematous
pulmonary disease with acute lower respiratory infectionCHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
J44.1Chronic obstructive/ asthmatic/ emphysematous
pulmonary disease with acute exacerbation, unspecifiedCHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
J44.8
Chronic asthmatic (obstructive) bronchitis NOS; Chronic
emphysematous bronchitis NOS; Chronic obstructive
bronchitis NOS
CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
J44.9
Chronic obstructive pulmonary disease, unspecified;
Chronic obstructive airway disease NOS; Chronic
obstructive lung disease NOS
CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12,200 3,660 8,540
Q35.0Cleft hard palate, bilateral; Bilateral fissure of hard palate;
Bilateral palatoschisis of hard palateCLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.1 Cleft hard palate CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.3 Cleft soft palate CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.5 Cleft hard palate with cleft soft palate CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.7 Cleft uvula CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.8 Cleft palate, unspecified, bilateral CLEFT LIP AND PALATE 7,800 2,340 5,460
Q35.9 Cleft palate, unspecified CLEFT LIP AND PALATE 7,800 2,340 5,460
Q36.0 Cleft lip, bilateral CLEFT LIP AND PALATE 7,800 2,340 5,460
Q36.1 Cleft lip, median CLEFT LIP AND PALATE 7,800 2,340 5,460
Q36.9 Cleft lip, unilateral; Cleft lip NOS CLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.0 Cleft hard palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.1Cleft hard palate with unilateral cleft lip; Cleft hard palate
with cleft lip NOSCLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.2 Cleft soft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.3Cleft soft palate with unilateral cleft lip; Cleft soft palate
with cleft lip NOSCLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.4 Cleft hard and soft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.5Cleft hard and soft palate with unilateral cleft lip; Cleft hard
and soft palate with cleft lip NOSCLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.8 Unspecified cleft palate with bilateral cleft lip CLEFT LIP AND PALATE 7,800 2,340 5,460
Q37.9Unspecified cleft palate with unilateral cleft lip; Cleft palate
with cleft lip NOSCLEFT LIP AND PALATE 7,800 2,340 5,460
F01.0 Vascular dementia of acute onset COGNITIVE DYSFUNCTION 8,200 2,460 5,740
R41.0 Disorientation, unspecified; Confusion NOS COGNITIVE DYSFUNCTION 8,200 2,460 5,740
R41.3 Other amnesia; Amnesia NOS COGNITIVE DYSFUNCTION 8,200 2,460 5,740
R54
Senility; Old age without mention of psychosis; Senescence
without mention of psychosis; Senile asthenia; Senile
debility
COGNITIVE DYSFUNCTION 8,200 2,460 5,740
D34 Benign neoplasm of thyroid glandCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D35.0 Benign neoplasm of Adrenal glandCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D35.1 Benign neoplasm of Parathyroid glandCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D35.2 Benign neoplasm of Pituitary glandCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D35.3 Benign neoplasm of Craniopharyngeal ductCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D35.4 Benign neoplasm of Pineal glandCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D35.9 Benign neoplasm of Endocrine gland, unspecifiedCOMPLICATIONS OF BENIGN NEOPLASMS OF
ENDOCRINE GLANDS12,000 3,600 8,400
D16.0 Benign neoplasm of Scapula and long bones of upper limbCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.1 Benign neoplasm of Short bones of upper limbCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.2 Benign neoplasm ofLong bones of lower limbCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.3 Benign neoplasm of Short bones of lower limbCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.4
Benign neoplasm of Bones of skull and face; Benign
neoplasm of Superior Maxilla; Benign neoplasm of Orbital
bone
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.5 Benign neoplasm of Lower jaw boneCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.6 Benign neoplasm of Vertebral columnCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.7 Benign neoplasm of Ribs, sternum and clavicleCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
Page 13 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D16.8 Benign neoplasm of Pelvic bones, sacrum and coccyxCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D16.9Benign neoplasm of Bone and articular cartilage,
unspecified
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
BONES10,500 3,150 7,350
D12.0Benign neoplasm of Caecum;Benign neoplasm of
Ileocaecal valve
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.1 Benign neoplasm of AppendixCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.3Benign neoplasm of Transverse colon; Benign neoplasm of
Hepatic flexure; Benign neoplasm of Splenic flexure
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.4 Benign neoplasm of Descending colonCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.5 Benign neoplasm of Sigmoid colonCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.6
Benign neoplasm of Colon, unspecified; Adenomatosis of
colon; Benign neoplasm of Large intestine NOS; Hereditary
Polyposis of colon
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.7
Benign neoplasm of Rectosigmoid junction; Adenomatosis
of colon; Benign neoplasm of Large intestine NOS;
Hereditary Polyposis of colon
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.8 Benign neoplasm of RectumCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D12.9 Benign neoplasm of Anus and anal canalCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.0 Benign neoplasm of OesophagusCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.1 Benign neoplasm of StomachCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.2 Benign neoplasm of DuodenumCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.3Benign neoplasm of Other and unspecified parts of small
intestine
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.4Benign neoplasm of Liver; Benign neoplasm of Intrahepatic
bile ducts
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.5 Benign neoplasm of Extrahepatic bile ductsCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.6 Benign neoplasm of PancreasCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.7
Benign neoplasm of Endocrine pancreas; Benign neoplasm
of Islet cell tumour; Benign neoplasm of Islets of
Langerhans
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D13.9
Benign neoplasm of Ill-defined sites within the digestive
system; Benign neoplasm of Digestive system NOS; Benign
neoplasm of Intestine NOS; Benign neoplasm of Spleen
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D17.5 Benign lipomatous neoplasm of intra-abdominal organsCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D17.6 Benign lipomatous neoplasm of spermatic cordCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D17.7
Benign lipomatous neoplasm of other sites; Benign
lipomatous neoplasm of Peritoneum; Benign lipomatous
neoplasm of Retroperitoneum
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D20.0 Benign neoplasm of of soft tissue of RetroperitoneumCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D20.1 Benign neoplasm of of soft tissue of PeritoneumCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D21.4Benign neoplasm of Connective and other soft tissue of
abdomen
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM8,700 2,610 6,090
D25.0 Submucous leiomyoma of uterusCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D25.1 Intramural leiomyoma of uterusCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D25.2 Subserosal leiomyoma of uterusCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D25.9 Leiomyoma of uterus, unspecifiedCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D26.0 Other Benign neoplasm of Cervix uteriCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D26.1 Other Benign neoplasm of Corpus uteriCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D26.7 Other Benign neoplasm of Other parts of uterusCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D26.9 Other Benign neoplasm of Uterus, unspecifiedCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D27 Benign neoplasm of ovaryCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
Page 14 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D28.0 Benign neoplasm of VulvaCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D28.1 Benign neoplasm of VaginaCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D28.2
Benign neoplasm of Uterine tubes and ligaments; Benign
neoplasm of Fallopian Tubes; Benign neoplasm of Uterine
Broad Ligament; Benign neoplasm of Uterine round
ligament
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D28.7 Benign neoplasm of Other specified female genital organsCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D28.9 Benign neoplasm of Female genital organ, unspecifiedCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
FEMALE GENITAL TRACT9,600 2,880 6,720
D29.0 Benign neoplasm of PenisCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
MALE GENITAL TRACT7,700 2,310 5,390
D29.1 Benign neoplasm of ProstateCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
MALE GENITAL TRACT7,700 2,310 5,390
D29.2 Benign neoplasm of TestisCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
MALE GENITAL TRACT7,700 2,310 5,390
D29.4Benign neoplasm of Scrotum; Benign neoplasm of Skin of
scrotum
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
MALE GENITAL TRACT7,700 2,310 5,390
D32.0 Benign neoplasm of Cerebral meningesCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D32.1 Benign neoplasm of Spinal meningesCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D32.9Benign neoplasm of Meninges, unspecified; Meningioma
NOS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.0
Benign neoplasm of Brain, supratentorial; Benign neoplasm
of Cerebral ventricle; Benign neoplasm of Cerebrum;
Benign neoplasm of Frontal lobe; Benign neoplasm of
Occipital lobe; Benign neoplasm of Parietal lobe; Benign
neoplasm of Temporal lobe
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.1
Benign neoplasm of Brain, infratentorial; Benign neoplasm
of Brain stem; Benign neoplasm of Cerebellum; Benign
neoplasm of Fourth ventricle
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.2 Benign neoplasm of Brain, unspecifiedCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.3Benign neoplasm of Cranial nerves; Benign neoplasm of
Olfactory bulb
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.4 Benign neoplasm of Spinal cordCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.7Benign neoplasm of Other specified parts of central
nervous system
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D33.9Benign neoplasm of Central nervous system, unspecified;
Central Nervous system NOS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D36.1Benign neoplasm of Peripheral nerves and autonomic
nervous system
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
NERVOUS SYSTEM14,800 4,440 10,360
D10.0
Benign neoplasm of Lip; Benign neoplasm of frenulum of
Lip; Benign neoplasm of Inner aspect of lip; Benign
neoplasm of Mucosa of Lip; Vermilion border of Lip
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D10.1Benign neoplasm of Tongue;Benign neoplasm of Lingual
tonsil
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D10.3Benign neoplasm of Other and unspecified parts of mouth;
Benign neoplasm of Minor salivary gland NOS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D10.6
Benign neoplasm of Nasopharynx; Benign neoplasm of
Pharyngeal tonsil; Benign neoplasm of Posterior margin of
septum and choanae
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D10.7 Benign neoplasm of Hypopharynx
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D10.9 Benign neoplasm of Pharynx, unspecified
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D11.0 Benign neoplasm of Parotid gland
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D11.7Benign neoplasm of Other major salivary glands; sublingual;
submandibular
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D11.9 Benign neoplasm of Major salivary gland, unspecified
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D14.1Benign neoplasm of Larynx; Benign neoplasm of
suprahyoid portion of Epiglottis
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
Page 15 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D14.2 Benign neoplasm of Trachea
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
9,500 2,850 6,650
D30.0 Benign neoplasm of KidneyCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM8,300 2,490 5,810
D30.1 Benign neoplasm of Renal pelvisCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM8,300 2,490 5,810
D30.3
Benign neoplasm of Bladder; Benign neoplasm of Urethral
orifice of bladder; Benign neoplasm of ureteric orifice of
bladder
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM8,300 2,490 5,810
D30.4 Benign neoplasm of UrethraCOMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM8,300 2,490 5,810
D30.9Benign neoplasm of Urinary organ, unspecified; Benign
neoplasm of Urinary system NOS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM8,300 2,490 5,810
I51.0
Cardiac septal defect, acquired; Acquired atrial septal
defect old; Acquired auricular septal defect old ; Acquired
ventricular septal defect old
COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.1 Rupture of chordae tendineae, not elsewhere classified COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.2 Rupture of papillary muscle, not elsewhere classified COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.3
Intra cardiac thrombosis, not elsewhere classified; Old
Apical thrombosis; Old Atrial thrombosis; Old Auricular
thrombosis; Old Venticular thrombosis
COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.4Myocarditis, unspecified; Myocardial fibrosis; Myocarditis
NOS; Chronic interstitial myocarditisCOMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.5
Myocardial degeneration; Fatty Degeneration of heart or
myocardium fatty; Senile Degeneration of heart or
myocardium; Myocardial disease
COMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
I51.8Other ill-defined heart diseases; Acute carditis; Chronic
Carditis; Acute pancarditis; Chronic pancarditisCOMPLICATIONS OF HEART DISEASES 14,400 4,320 10,080
D18.0 Haemangioma, any site; Angioma NOSCOMPLICATIONS OF HEMANGIOMA AND
LYMPHANGIOMA9,000 2,700 6,300
D18.1 Lymphangioma, any siteCOMPLICATIONS OF HEMANGIOMA AND
LYMPHANGIOMA9,000 2,700 6,300
D14.3 Benign neoplasm of Bronchus and lungCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D14.4 Benign neoplasm of Respiratory system, unspecifiedCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D15.0 Benign neoplasm of ThymusCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D15.1 Benign neoplasm of HeartCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D15.2 Benign neoplasm of MediastinumCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D15.9 Benign neoplasm of Intrathoracic organ, unspecifiedCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D17.4 Benign lipomatous neoplasm of intrathoracic organsCOMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
D21.3
Benign neoplasm of Connective and other soft tissue of
thorax; Benign neoplasm of Connective and other soft
tissue of Axilla; Benign neoplasm of Connective and other
soft tissue of Diaphragm; Benign neoplasm of Connective
and other soft tissue of Great vessels
COMPLICATIONS OF INTRATHORACIC BENIGN
NEOPLASMS 10,100 3,030 7,070
A52.1 Late Symptomatic neurosyphilis; Tabes dorsalisCOMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A52.3
Neurosyphilis, unspecified; Syphilitic Gumma of central
nervous system NOS; Late Syphilis of central nervous
system NOS; Syphiloma of central nervous system NOS
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A52.7 Other symptomatic late syphilisCOMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A53.0Latent syphilis, unspecified as early or late; Latent syphilis
NOS; Positive serological reaction for syphilis
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A54.1
Gonococcal infection of lower genitourinary tract with
periurethral and accessory gland abscess; Gonococcal
Bartholin's gland abscess
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A54.2Gonococcal Pelviperitonitis and other gonococcal
genitourinary infections
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A54.8Other gonococcal infections:
Gonococcal septicaemia; Gonococcal skin lesions
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A55
Chlamydial lymphogranuloma (venereum); Climatic or
tropical bubo ; Durand-Nicolas-Favre disease; Esthiomene;
Lymphogranuloma inguinale
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A56.1Chlamydial infection of pelviperitoneum and other
genitourinary organs;
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
A59 TrichomoniasisCOMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES 5,500 1,650 3,850
T79.0 Air embolism (traumatic) COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
Page 16 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T79.1 Fat embolism (traumatic) COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.2 Traumatic secondary and recurrent haemorrhage COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.3 Post-traumatic wound infection, not elsewhere classified COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.4Traumatic shock; immediate shock following injury;
Delayed shock following injuryCOMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.5Traumatic anuria; Crush syndrome; Renal failure following
crushingCOMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.6Traumatic ischaemia of muscle; Compartment syndrome;
Volkmann's ischaemic contractureCOMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.7 Traumatic subcutaneous emphysema COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
T79.8 Other early complications of trauma COMPLICATIONS OF TRAUMA 9,300 2,790 6,510
E25.0
Congenital adrenogenital disorders associated with enzyme
deficiency; Congenital adrenal hyperplasia; 21-Hydroxylase
deficiency; Salt-losing congenital adrenal hyperplasia
CONGENITAL ANDROGENITAL DISORDER 7,800 2,340 5,460
P61.2 Anaemia of prematurity CONGENITAL ANEMIA 15,200 4,560 10,640
P61.3 Congenital anaemia from fetal blood loss CONGENITAL ANEMIA 15,200 4,560 10,640
P61.4Other congenital anaemias, not elsewhere classified;
Congenital anaemia NOSCONGENITAL ANEMIA 15,200 4,560 10,640
D64.4Congenital dyserythropoietic anaemia; Congenital
Dyshaematopoietic anaemiaCONGENITAL BLOOD DISORDERS 4,000 1,200 2,800
D74.0 Congenital methaemoglobinaemia CONGENITAL BLOOD DISORDERS 4,000 1,200 2,800
Q80.2 Lamellar ichthyosis; Collodion baby CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q80.9 Congenital ichthyosis, unspecified CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q81.2 Epidermolysis bullosa dystrophica CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q81.8 Other epidermolysis bullosa CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q81.9 Epidermolysis bullosa, unspecified CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.0 Hereditary lymphoedema CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.2 Mastocytosis; Urticaria pigmentosa CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.3 Incontinentia pigmenti CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.4 Ectodermal dysplasia (anhidrotic) CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q82.8
Other specified congenital malformations of skin; Abnormal
palmar creases; Accessory skin tags; Benign familial
pemphigus [Hailey-Hailey]; Cutis laxa (hyperelastica);
Dermatoglyphic anomalies; Inherited keratosis palmaris et
plantaris; Keratosis follicula
CONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q84.8Other specified congenital malformations of integument;
Aplasia cutis congenitaCONGENITAL DERMATOLOGIC DISEASES 11,800 3,540 8,260
Q50.1 Developmental ovarian cystCONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q50.3Other congenital malformations of ovary; Accessory ovary;
Congenital malformation of ovary NOS; Ovarian streak
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q50.4 Embryonic cyst of fallopian tube; Fimbrial cystCONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q50.5Embryonic cyst of broad ligament; Cyst epoophoron;
Gartner's duct Cyst; Parovarian Cyst
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q50.6
Other congenital malformations of fallopian tube and
broad ligament; Absence of fallopian tube or broad
ligament; Accessory of fallopian tube or broad ligament;
Atresia of fallopian tube or broad ligament; Congenital
malformation of fallopian tube or broad ligament NOS
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q51.0Agenesis and aplasia of uterus; Congenital absence of
uterus
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q51.9 Congenital malformation of uterus and cervix, unspecifiedCONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT9,300 2,790 6,510
Q65.6 Unstable hip; Dislocatable hip; Subluxatable hipCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q67.3 PlagiocephalyCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q67.4
Other congenital deformities of skull, face and jaw;
Depressions in skull; Deviation of nasal septum, congenital;
Hemifacial atrophy or hypertrophy; Squashed or bent nose,
congenital
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q67.6 Pectus excavatum; Congenital funnel chestCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q67.7 Pectus carinatum; Congenital pigeon chestCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q68.0
Congenital deformity of sternocleidomastoid muscle;
Congenital, sternomastoid torticollis; Contracture of
sternocleidomastoid muscle; Sternomastoid tumour,
congenital
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q76.3
Congenital scoliosis due to congenital bony malformation;
Hemivertebra fusion or failure of segmentation with
scoliosis
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Page 17 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q78.0 Osteogenesis imperfecta; Fragilitas ossiumCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q78.2 Osteopetrosis; Albers-Schönberg syndromeCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q78.8 Other specified osteochondrodysplasias; OsteopoikilosisCONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q78.9Osteochondrodysplasia, unspecified; Chondrodystrophy
NOS; Osteodystrophy NOS
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q87.5Other congenital malformation syndromes with other
skeletal changes
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM5,300 1,590 3,710
Q39.0Atresia of oesophagus without fistula; Atresia of
oesophagus NOSCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q39.1Atresia of oesophagus with tracheo-oesophageal fistula;
Atresia of oesophagus with broncho-oesophageal fistulaCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q39.2Congenital tracheo-oesophageal fistula without atresia;
Congenital tracheo-oesophageal fistula NOSCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q39.6 Diverticulum of oesophagus; Oesophageal pouch CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q39.9 Congenital malformation of oesophagus, unspecified CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q40.0
Congenital hypertrophic pyloric stenosis; Congenital or
infantile constriction of pylorus; Congenital or infantile
hypertrophy of pylorus; Congenital or infantile spasm of
pylorus; Congenital or infantile stenosis of pylorus;
Congenital or infantile stricture of pylorus
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q40.1Congenital hiatus hernia; Displacement of cardia through
oesophageal hiatusCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q40.2
Other specified congenital malformations of stomach;
Congenital displacement of stomach; Congenital
diverticulum of stomach; Congenital hourglass stomach;
Duplication of stomach; Megalogastria; Microgastria
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q40.9
Congenital malformation of upper alimentary tract,
unspecified; Congenital anomaly NOS of upper alimentary
tract; Congenital deformity NOS of upper alimentary tract
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q41.0 Congenital absence, atresia and stenosis of duodenum CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q41.1Congenital absence, atresia and stenosis of jejunum; Apple
peel syndrome; Imperforate jejunumCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q41.2 Congenital absence, atresia and stenosis of ileum CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q41.9
Congenital absence, atresia and stenosis of small intestine,
part unspecified; Congenital absence, atresia and stenosis
of intestine NOS
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q42.0Congenital absence, atresia and stenosis of rectum with
fistulaCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q42.1Congenital absence, atresia and stenosis of rectum without
fistula; Imperforate rectumCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q42.2 Congenital absence, atresia and stenosis of anus with fistula CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q42.3Congenital absence, atresia and stenosis of anus without
fistula; Imperforate anusCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q42.9Congenital absence, atresia and stenosis of large intestine,
part unspecifiedCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.0Meckel's diverticulum; Persistent omphalomesenteric duct;
Persistent vitelline ductCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.1Hirschsprung's disease; Aganglionosis; Congenital
(aganglionic) megacolonCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.2Other congenital functional disorders of colon; Congenital
dilatation of colonCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.3
Congenital malformations of intestinal fixation; Congenital
anomalous omental adhesions [bands] ; Congenital
peritoneal adhesions [bands]; Jackson's membrane;
Malrotation of colon; Failure of rotation of caecum and
colon; Incomplete rotation of caecum and colon;
Insufficient rotation of caecum and colon; Universal
mesentery
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.4 Duplication of intestine CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.5 Ectopic anus CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.6 Congenital fistula of rectum and anus CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.7 Persistent cloaca; Cloaca NOS CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.8
Other specified congenital malformations of intestine;
Congenital blind loop syndrome; Congenital diverticulitis,
colon; Congenital diverticulum, intestine; Dolichocolon;
Megaloappendix; Megaloduodenum;
Microcolon; Transposition of appendix; Transposition of
colon; Transposition of intestine
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q43.9 Congenital malformation of intestine, unspecified CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Page 18 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q44.0Agenesis, aplasia and hypoplasia of gallbladder; Congenital
absence of gallbladderCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.1Other congenital malformations of gallbladder; Congenital
malformation of gallbladder NOS; Intrahepatic gallbladderCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.2 Atresia of bile ducts CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.3 Congenital stenosis and stricture of bile ducts CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.4 Choledochal cyst CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.5
Other congenital malformations of bile ducts; Accessory
hepatic duct; Congenital malformation of bile duct NOS;
Biliary duct Duplication; Cystic duct Duplication
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.6 Cystic disease of liver; Fibrocystic disease of liver CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q44.7
Other congenital malformations of liver; Accessory liver;
Alagille's syndrome; Congenital absence of liver; Congenital
hepatomegaly; Congenital malformation of liver NOS
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q45.0Agenesis, aplasia and hypoplasia of pancreas; Congenital
absence of pancreasCONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q45.8
Other specified congenital malformations of digestive
system; Absence of alimentary tract NOS, complete;
Absence of alimentary tract NOS, partial; Duplication of
digestive organs NOS; Malposition, congenital of digestive
organs NOS
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q45.9
Congenital malformation of digestive system, unspecified;
Congenital anomaly NOS of digestive system ; Congenital
deformity NOS of digestive system
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.0 Congenital diaphragmatic hernia CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.1
Other congenital malformations of diaphragm; Absence of
diaphragm; Congenital malformation of diaphragm NOS;
Eventration of diaphragm
CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.2 Exomphalos; Omphalocele CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.3 Gastroschisis CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.4 Prune belly syndrome CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q79.5 Other congenital malformations of abdominal wall CONGENITAL GASTROINTESTINAL DISORDERS 11,300 3,390 7,910
Q20.0 Common arterial trunk; Persistent truncus arteriosus CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.1 Double outlet right ventricle; Taussig-Bing syndrome CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.2 Double outlet left ventricle CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.3
Discordant ventriculoarterial connection;
Dextrotransposition of aorta; Transposition of great vessels
(complete)
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.4Double inlet ventricle; Common ventricle; Cor triloculare
biatriatum; Single ventricleCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.5Discordant atrioventricular connection; Corrected
transposition; Laevotransposition; Ventricular inversionCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q20.9Congenital malformation of cardiac chambers and
connections, unspecifiedCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.0 Ventricular septal defect CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.1
Atrial septal defect; Coronary sinus defect; Patent or
persistent foramen ovale; Patent or persistent ostium
secundum defect (type II); Sinus venosus defect
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.2
Atrioventricular septal defect; Common atrioventricular
canal; Endocardial cushion defect; Ostium primum atrial
septal defect (type I)
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.3
Tetralogy of Fallot; Ventricular septal defect with
pulmonary stenosis or atresia, dextroposition of aorta and
hypertrophy of right ventricle.
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.4Aortopulmonary septal defect; Aortic septal defect;
Aortopulmonary windowCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.8Other congenital malformations of cardiac septa;
Eisenmenger's defect; Pentalogy of FallotCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q21.9Congenital malformation of cardiac septum, unspecified;
Septal (heart) defect NOSCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.0 Pulmonary valve atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.1 Congenital pulmonary valve stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.2Congenital pulmonary valve insufficiency; Congenital
pulmonary valve regurgitationCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.4 Congenital tricuspid stenosis; Tricuspid atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.5 Ebstein's anomaly CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.6 Hypoplastic right heart syndrome CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q22.8 Other congenital malformations of tricuspid valve CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.0Congenital stenosis of aortic valve; Congenital aortic
atresia; Congenital aortic stenosisCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.1Congenital insufficiency of aortic valve; Bicuspid aortic
valve; Congenital aortic insufficiencyCONGENITAL HEART DISEASES 11,600 3,480 8,120
Page 19 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q23.2 Congenital mitral stenosis; Congenital mitral atresia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.3 Congenital mitral insufficiency CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.4
Hypoplastic left heart syndrome; Atresia, or marked
hypoplasia of aortic orifice or valve, with hypoplasia of
ascending aorta and defective development of left ventricle
(with mitral valve stenosis or
atresia).
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.8 Other congenital malformations of aortic and mitral valves CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q23.9Congenital malformation of aortic and mitral valves,
unspecifiedCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.0 Dextrocardia CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.2 Cor triatriatum CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.3 Pulmonary infundibular stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.4 Congenital subaortic stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.5Malformation of coronary vessels; Congenital coronary
(artery) aneurysmCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.6 Congenital heart block CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.8
Other specified congenital malformations of heart;
Congenital diverticulum of left ventricle; Congenital
malformation of myocardium; Congenital malformation of
pericardium; Malposition of heart; Uhl's disease
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q24.9Congenital malformation of heart, unspecified; Congenital
anomaly NOS of heart; Congenital disease NOS of heartCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.0Patent ductus arteriosus; Patent ductus Botallo; Persistent
ductus arteriosusCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.1Coarctation of aorta; Preductal coarctation of aorta;
Postductal coarctation of aortaCONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.2 Atresia of aorta CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.3 Stenosis of aorta; Supravalvular aortic stenosis CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.4
Other congenital malformations of aorta; Absence of aorta;
Aplasia of aorta; Congenital aneurysm of aorta; Congenital
dilatation of aorta; Aneurysm of sinus of valsalva (rupture);
Double aortic arch [vascular ring or aorta]; Hypoplasia of
aorta; Persistent convolutions of aortic arch; Persistent
right aortic arch
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.5 Atresia of pulmonary artery CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.6 Stenosis of pulmonary artery CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.7
Other congenital malformations of pulmonary artery;
aberrant pulmonary artery; agenesis of pulmonary artery;
aneurysm, congenital of pulmonary artery; anomaly of
pulmonary artery; hypoplasia of pulmonary artery;
pulmonary arteriovenous aneurysm
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.8 Other congenital malformations of great arteries CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q25.9 Congenital malformation of great arteries, unspecified CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q26.0
Congenital stenosis of vena cava; Congenital stenosis of
inferior vena cava; Congenital stenosis of superior vena
cava
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q26.2 Total anomalous pulmonary venous connection CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q26.4 Anomalous pulmonary venous connection, unspecified CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q26.8
Other congenital malformations of great veins; Absence of
inferior vena cava ; Absence of superior vena cava ; Azygos
continuation of inferior vena cava; Persistent left posterior
cardinal vein; Scimitar syndrome
CONGENITAL HEART DISEASES 11,600 3,480 8,120
Q26.9
Congenital malformation of great vein, unspecified;
Anomaly of inferior vena cava NOS; Anomaly of superior
vena cava NOS
CONGENITAL HEART DISEASES 11,600 3,480 8,120
E00.0Congenital iodine-deficiency syndrome, neurological type;
Endemic cretinism, neurological typeCONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930
E03.0
Congenital hypothyroidism with diffuse goitre; Nontoxic
congenital Goitre NOS; Nontoxic ongenital
parenchymatous Goitre
CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930
E03.1
Congenital hypothyroidism without goitre; Aplasia of
thyroid (with myxoedema); Congenital atrophy of thyroid;
Congenital hypothyroidism NOS
CONGENITAL HYPOTHYROIDISM 9,900 2,970 6,930
Q00.0Anencephaly; Acephaly; Acrania; Amyelencephaly;
Hemicephaly; Hemicephaly
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q01.0 Frontal encephaloceleCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q01.1 Nasofrontal encephaloceleCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q01.2 Occipital encephaloceleCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Page 20 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q01.8 Encephalocele of other sitesCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q02 Microcephaly; Hydromicrocephaly; MicrencephalonCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q03.0
Malformations of aqueduct of Sylvius; Anomaly of
aqueduct of sylvius; Obstruction, congenital of aqueduct of
sylvius; Stenosis of aqueduct of sylvius
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q03.1Atresia of foramina of Magendie and Luschka; Dandy-
Walker syndrome
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.0Congenital malformations of corpus callosum; Agenesis of
corpus callosum
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.2 HoloprosencephalyCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.3
Other reduction deformities of brain; Absence of part of
brain; Agenesis of part of brain; Aplasia of part of brain;
Hypoplasia of part of brain ; Agyria; Hydranencephaly;
Lissencephaly; Microgyria; Pachygyria
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.4 Septo-optic dysplasiaCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.6 Congenital cerebral cysts; Porencephaly; SchizencephalyCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.8Other specified congenital malformations of brain;
Macrogyria
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q04.9
Congenital malformation of brain, unspecified; Congenital
anomaly NOS of brain; Congenital deformity NOS of brain;
Congenital disease of lesion NOS of brain; Congenital
multiple anomalis NOS of brain
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.1
Thoracic spina bifida with hydrocephalus; Dorsal spina
bifida with hydrocephalus; Thoracolumbar spina bifida with
hydrocephalus
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.2Lumbar spina bifida with hydrocephalus; Lumbosacral spina
bifida with hydrocephalus
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.4 Unspecified spina bifida with hydrocephalusCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.6Thoracic spina bifida without hydrocephalus; Dorsal NOS
spina bifida; Thoracolumbar NOS spina bifida
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.7Lumbar spina bifida without hydrocephalus; Lumbosacral
spina bifida NOS
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.8 Sacral spina bifida without hydrocephalusCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q05.9 Spina bifida, unspecifiedCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q06.0 AmyeliaCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q06.2 DiastematomyeliaCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q06.4 Hydromyelia; HydrorachisCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q06.8 Other specified congenital malformations of spinal cordCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q06.9
Congenital malformation of spinal cord, unspecified;
Congenital anomaly NOS of spinal cord or meninges;
Congenital deformity NOS of spinal cord or meninges;
Congenital disease or lesion NOS of spinal cord or meninges
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q07.0 Arnold-Chiari syndromeCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q07.9
Congenital malformation of nervous system, unspecified;
Congenital anomaly NOS of nervous system; Congenital
deformity NOS of nervous system; Congenital disease or
lesion NOS of nervous system
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q74.3 Arthrogryposis multiplex congenitaCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q75.0Craniosynostosis; Acrocephaly; ]Imperfect fusion of skull;
Oxycephaly; Trigonocephaly
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q75.1 Craniofacial dysostosis; Crouzon's diseaseCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q75.2 HypertelorismCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q75.4Mandibulofacial dysostosis; Franceschetti Syndrome;
Treacher Collins Syndrome
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q75.8
Other specified congenital malformations of skull and face
bones; Absence of skull bone, congenital; Congenital
deformity of forehead; Platybasia
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Page 21 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q75.9
Congenital malformation of skull and face bones,
unspecified; Congenital anomaly of face bones NOS;
Congenital anomaly of skull NOS
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q76.0 Spina bifida occultaCONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q76.4
Other congenital malformations of spine, not associated
with scoliosis; Congenital absence of vertebra unspecified
or not associated with scoliosis; Congenital fusion of spine
unspecified or not associated with scoliosis; Congenital
kyphosis unspecified or not associated with scoliosis;
Congenital lordosis unspecified or not associated with
scoliosis; Congenital malformation of lumbosacral joint
unspecified or not associated with scoliosis; Congenital
malformation of lumbosacral region unspecified or not
associated with scoliosis; Hemivertebra unspecified or not
associated with scoliosis; Malformation of spine
unspecified or not associated with scoliosis;
Platyspondylisis unspecified or not associated with
scoliosis; Supernumerary vertebra unspecified or nor
associated with scoliosis
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM13,000 3,900 9,100
Q32.0 Congenital tracheomalaciaCONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q32.4
Other congenital malformations of bronchus; Absence of
bronchus; Agenesis of bronchus; Atresia of bronchus;
Congenital malformation NOS of bronchus; Diverticulum of
bronchus; Congenital malformations of lung] of bronchus
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q33.0
Congenital cystic lung; Congenital honeycomb lung;
Congenital cystic lung disease; Congenital polycystic lung
disease
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q33.2 Sequestration of lungCONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q33.3 Agenesis of lung; Absence of lung, lobeCONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q33.4 Congenital bronchiectasisCONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q33.6 Hypoplasia and dysplasia of lungCONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q34.1 Congenital cyst of mediastinumCONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q34.8Other specified congenital malformations of respiratory
system; Atresia of nasopharynx
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q34.9
Congenital malformation of respiratory system,
unspecified; Congenital absence of respiratory organ ;
Congenital anomaly NOS of respiratory organ
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT21,700 6,510 15,190
Q30.0
Choanal atresia; Absence of anterior nares; Absence of
posterior nares; congenital stenosis of anterior nares;
Congenital stenosis of posterior nares
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q30.1Agenesis and underdevelopment of nose; Congenital
absence of nose
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q30.2 Fissured, notched and cleft noseCONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q31.3 LaryngoceleCONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q31.5 Congenital laryngomalaciaCONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q31.8
Other congenital malformations of larynx; Absence of
cricoid cartilage, epiglottis, glottis, larynx or thyroid
cartilage; Agenesis of cricoid cartilage, epiglottis, glottis,
larynx or thyroid cartilage; Atresia of cricoid cartilage,
epiglottis, glottis, larynx or thyroid cartilage; Cleft thyroid
cartilage; Congenital stenosis of larynx NEC; Fissure of
epiglottis; Posterior cleft of cricoid cartilage
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q31.9 Congenital malformation of larynx, unspecifiedCONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT11,000 3,300 7,700
Q38.2 MacroglossiaCONGENITAL MALFORMATIONS OF THE ORAL
CAVITY4,000 1,200 2,800
Q38.5
Congenital malformations of palate, not elsewhere
classified; Absence of uvula; Congenital malformation of
palate NOS; High arched palate
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY4,000 1,200 2,800
Q38.6Other congenital malformations of mouth; Congenital
malformation of mouth NOS
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY4,000 1,200 2,800
Q38.8Other congenital malformations of pharynx; Congenital
malformation of pharynx NOS
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY4,000 1,200 2,800
Q12.2 Coloboma of lens CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Page 22 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q12.4 Spherophakia CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q13.4
Other congenital corneal malformations; Congenital
malformation of cornea NOS;
Microcornea; Peter's anomaly
CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q14.0Congenital malformation of vitreous humour; Congenital
vitreous opacityCONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q14.1Congenital malformation of retina; Congenital retinal
aneurysmCONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q14.9Congenital malformation of posterior segment of eye,
unspecifiedCONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q15.0
Congenital glaucoma; Buphthalmos; Glaucoma of newborn;
Hydrophthalmos; Keratoglobus, congenital, with glaucoma;
Macrocornea with glaucoma; Macrophthalmos in
congenital glaucoma; Megalocornea with glaucoma
CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q15.8 Other specified congenital malformations of eye CONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
Q15.9Congenital malformation of eye, unspecified; Congenital
anomaly NOS of eye; Congenital deformity NOS of eyeCONGENITAL OPHTHALMOLOGIC DISORDERS 4,300 1,290 3,010
P96.0 Congenital renal failure; Uraemia of newborn CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.0 Renal agenesis, unilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.1 Renal agenesis, bilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.2 Renal agenesis, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.3 Renal hypoplasia, unilateral CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.5 Renal hypoplasia, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q60.6 Potter's syndrome CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.0Congenital single renal cyst; Congenital cyst of kidney;
Single cyst of kidneyCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.1Polycystic kidney, autosomal recessive; Polycystic kidney,
infantile typeCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.2Polycystic kidney, autosomal dominant; Polycystic kidney,
adult typeCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.3 Polycystic kidney, unspecified CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.4 Renal dysplasia CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.5 Medullary cystic kidney; Sponge kidney NOS CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.8Other cystic kidney diseases; Fibrocystic kidney; Fibrocystic
renal degeneration or diseaseCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q61.9Cystic kidney disease, unspecified; Meckel-Gruber
syndromeCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q62.0 Congenital hydronephrosis CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q62.7 Congenital vesico-uretero-renal reflux CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.0 Accessory kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.1 Lobulated, fused and horseshoe kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.2Ectopic kidney; Congenital displaced kidney; Malrotation of
kidneyCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.3 Hyperplastic and giant kidney CONGENITAL RENAL DISORDERS 9,100 2,730 6,370
Q63.8Other specified congenital malformations of kidney;
Congenital renal calculiCONGENITAL RENAL DISORDERS 9,100 2,730 6,370
A50.0
Early cutaneous congenital syphilis: , Early mucocutaneous
congenital syphilis, Early visceral congenital syphilis; Early
congenital syphilitic laryngitis; Early congenital syphilitic
oculopathy; Early congenital syphilitic
osteochondropathy; Early congenital syphilitic pharyngitis;
Early congenital syphilitic pneumonia; Early congenital
syphilitic rhinitis
CONGENITAL SYPHILIS 12,800 3,840 8,960
A50.2Early congenital syphilis, unspecified; Congenital syphilis
NOS less than two years after birth.CONGENITAL SYPHILIS 12,800 3,840 8,960
A50.4
Late congenital neurosyphilis [juvenile neurosyphilis];
Dementia paralytica juvenilis; Juvenile general paresis ;
Juvenile tabes dorsalis; Juvenile taboparetic neurosyphilis
CONGENITAL SYPHILIS 12,800 3,840 8,960
A50.5Other late congenital syphilis, symptomatic; Syphilitic
saddle noseCONGENITAL SYPHILIS 12,800 3,840 8,960
A50.9 Congenital syphilis, unspecified CONGENITAL SYPHILIS 12,800 3,840 8,960
Q62.1
Atresia and stenosis of ureter; Congenital occlusion of
ureter; Congenital occlusion of ureteropelvic junction;
Congenital occlusion of ureterovesical orifice; Impervious
ureter
CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q62.2 Congenital megaloureter; Congenital dilatation of ureter CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q62.3Other obstructive defects of renal pelvis and ureter;
Congenital ureteroceleCONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q62.5 Duplication of ureter; Accessory of ureter, Double of ureter CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Page 23 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q62.6
Malposition of ureter; Deviation of ureter or ureteric
orifice; Displacement of ureter or ureteric orifice; Ectopic of
ureter or ureteric orifice; Implantation, anomalous of
ureter or ureteric orifice
CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.1Exstrophy of urinary bladder; Ectopia vesicae; Extroversion
of bladderCONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.2 Congenital posterior urethral valves CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.3
Other atresia and stenosis of urethra and bladder neck;
Congenital bladder neck obstruction; Congenital stricture of
urethra; Congenital stricture of urinary meatus; Congenital
stricture of vesicourethral orifice; Impervious urethra
CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.4Malformation of urachus; Cyst of urachus; Patent urachus;
Prolapse of urachusCONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.7
Other congenital malformations of bladder and urethra;
Accessory bladder; Accessory urethra; Congenital hernia of
bladder; Congenital malformation of bladder or urethra
NOS; Congenital prolapse of bladder (mucosa); Congenital
prolapse of urethra; Congenital prolapse of urinary meatus;
Congenital prolapse of urethrorectal fistula; Double
urethra; Double urinary meatus
CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.8 Other specified congenital malformations of urinary system CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q64.9
Congenital malformation of urinary system, unspecified;
Congenital anomaly NOS of urinary system; Congenital
deformity NOS of urinary system
CONGENITAL URINARY TRACT DISORDERS 9,100 2,730 6,370
Q27.1 Congenital renal artery stenosis CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q27.3Peripheral arteriovenous malformation; Arteriovenous
aneurysmCONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q27.8
Other specified congenital malformations of peripheral
vascular system; Aberrant subclavian artery; Absence of
artery or vein NEC; Atresia of artery or vein NEC; Congenital
aneurysm (peripheral); Congenital stricture, artery;
Congenital varix
CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q27.9Congenital malformation of peripheral vascular system,
unspecified; Anomaly of artery or vein NOSCONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q28.0
Arteriovenous malformation of precerebral vessels;
Congenital arteriovenous precerebral aneurysm
(nonruptured)
CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q28.1
Other malformations of precerebral vessels; Congenital
malformation of precerebral vessels NOS; Congenital
precerebral aneurysm (nonruptured)
CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q28.2
Arteriovenous malformation of cerebral vessels;
Arteriovenous malformation of brain NOS;
Congenital arteriovenous cerebral aneurysm (nonruptured)
CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
Q28.3
Other malformations of cerebral vessels; Congenital
cerebral aneurysm, nonruptured; Congenital malformation
of cerebral vessels NOS
CONGENITAL VASCULAR DISEASES 12,000 3,600 8,400
M30.0 Polyarteritis nodosa CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M30.1Polyarteritis with lung involvement [Churg-Strauss]; Allergic
granulomatous angiitisCONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M30.2 Juvenile polyarteritis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M30.3 Mucocutaneous lymph node syndrome [Kawasaki] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M30.8Other conditions related to polyarteritis nodosa;
Polyangiitis overlap syndromeCONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.0 Hypersensitivity angiitis; Goodpasture's syndrome CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.1Thrombotic microangiopathy; Thrombotic
thrombocytopenic purpuraCONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.2 Lethal midline granuloma CONNECTIVE TISSUE DISEASES N/A N/A N/A
M31.3Wegener's granulomatosis; Necrotizing respiratory
granulomatosisCONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.4 Aortic arch syndrome [Takayasu] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.6 Other giant cell arteritis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.8Other specified necrotizing vasculopathies;
Hypocomplementaemic vasculitisCONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M31.9 Necrotizing vasculopathy, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.0 Juvenile dermatomyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.1 Other dermatomyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.2 Polymyositis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M33.9 Dermatopolymyositis, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M34.0 Progressive systemic sclerosis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M34.1
CR(E)ST syndrome; Combination of calcinosis, Raynaud's
phenomenon, (o)esophageal dysfunction,
sclerodactyly, telangiectasia
CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M34.2 Systemic sclerosis induced by drugs and chemicals CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
Page 24 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M34.9 Systemic sclerosis, unspecified CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.0 Sicca syndrome [SJÖGREN] CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.1 Other overlap syndromes; Mixed connective tissue disease CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.2 Behçet's disease CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.3 Polymyalgia rheumatica CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.4 Diffuse (eosinophilic) fasciitis CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.8 Other specified systemic involvement of connective tissue CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
M35.9
Systemic involvement of connective tissue, unspecified;
Systemic Autoimmune disease NOS; Collagen (vascular)
disease NOS
CONNECTIVE TISSUE DISEASES 13,800 4,140 9,660
G50.0Trigeminal neuralgia; Syndrome of paroxysmal facial pain;
Tic douloureuxCRANIAL NERVE DISORDER 7,400 2,220 5,180
G50.8 Other disorders of trigeminal nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.0 Bell's palsy; Facial palsy CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.1 Geniculate ganglionitis CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.3 Clonic hemifacial spasm CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.4 Facial myokymia CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.8 Other disorders of facial nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
G51.9 Disorder of facial nerve, unspecified CRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.0 Disorders of olfactory nerve; Disorder of 1st cranial nerve CRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.1Disorders of glossopharyngeal nerve; Disorder of 9th
cranial nerve; Glossopharyngeal neuralgiaCRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.2Disorders of vagus nerve; Disorder of pneumogastric [10th]
nerveCRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.7 Disorders of multiple cranial nerves; Polyneuritis cranialis CRANIAL NERVE DISORDER 7,400 2,220 5,180
G52.8 Disorders of other specified cranial nerves CRANIAL NERVE DISORDER 7,400 2,220 5,180
H46Optic neuritis; Optic neuropathy, except ischaemic; Optic
papillitis; Retrobulbar neuritis NOSCRANIAL NERVE DISORDER 7,400 2,220 5,180
H47.0
Disorders of optic nerve, not elsewhere classified;
Compression of optic nerve; Haemorrhage in optic nerve
sheath; Ischaemic optic neuropathy
CRANIAL NERVE DISORDER 7,400 2,220 5,180
J05.0Acute obstructive laryngitis [croup]; Obstructive laryngitis
NOSCROUP 8,200 2,460 5,740
E24.0Pituitary-dependent Cushing's disease; Overproduction of
pituitary ACTH; Pituitary-dependent hyperadrenocorticismCUSHING'S SYNDROME 9,500 2,850 6,650
E24.1 Nelson's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.2 Drug-induced Cushing's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.3 Ectopic ACTH syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.8 Other Cushing's syndrome CUSHING'S SYNDROME 9,500 2,850 6,650
E24.9 Cushing's syndrome, unspecified CUSHING'S SYNDROME 9,500 2,850 6,650
E84.0 Cystic fibrosis with pulmonary manifestations CYSTIC FIBROSIS 7,300 2,190 5,110
E84.1 Cystic fibrosis with intestinal manifestations CYSTIC FIBROSIS 7,300 2,190 5,110
E84.8Cystic fibrosis with other manifestations; Cystic fibrosis with
combined manifestationsCYSTIC FIBROSIS 7,300 2,190 5,110
E84.9 Cystic fibrosis, unspecified CYSTIC FIBROSIS 7,300 2,190 5,110
G30.0 Alzheimer's disease with early onsetDEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G30.1 Alzheimer's disease with late onsetDEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G30.8 Other Alzheimer's diseaseDEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G30.9+F00.9* Dementia in alzheimer's disease, unspecifiedDEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G31.0Circumscribed brain atrophy; Pick's disease; Progressive
isolated aphasia
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G31.1 Senile degeneration of brain, not elsewhere classifiedDEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G31.2
Degeneration of nervous system due to alcohol; Alcoholic
cerebellar ataxia; Alcoholic cerebellar degeneration;
Alcoholic cerebral degeneration; Alcoholic encephalopathy;
Dysfunction of autonomic nervous system due to alcohol
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G31.8
Other specified degenerative diseases of nervous system;
Grey-matter degeneration [Alpers]; Lewy body (ies)
dementia; Lewy body (ies) disease; Subacute necrotizing
encephalopathy [Leigh]
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G32.8*Other specified degenerative disorders of nervous system
in diseases classified elsewhere
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM10,000 3,000 7,000
G35
Multiple sclerosis; Multiple sclerosis NOS; Multiple
sclerosis of brain stem; Multiple sclerosis of cord; Multiple
sclerosis, disseminated; Multiple sclerosis, generalized
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
Page 25 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
G36.0Neuromyelitis optica [Devic]; Demyelination in optic
neuritis
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G36.1Acute and subacute haemorrhagic leukoencephalitis
[Hurst]
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G36.8 Other specified acute disseminated demyelinationDEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G36.9 Acute disseminated demyelination, unspecifiedDEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.0 Diffuse sclerosis; Periaxial encephalitis; Schilder's diseaseDEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.1 Central demyelination of corpus callosumDEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.2 Central pontine myelinolysisDEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.3Acute transverse myelitis in demyelinating disease of
central nervous system; Acute transverse myelitis NOS
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.4 Subacute necrotizing myelitisDEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.8Other specified demyelinating diseases of central nervous
system
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
G37.9
Demyelinating disease of central nervous system,
unspecified
Brain sclerosis
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM11,600 3,480 8,120
A97.0
Dengue without warning signs: Dengue fever (DF) Dengue
haemorrhagic fever Grades 1 and 2; Dengue haemorrhagic
fever without warning signs
DENGUE FEVER 10,000 3,000 7,000
A97.1Dengue with warning sings; Dengue haemorrhagic fever
with warning signsDENGUE FEVER 10,000 3,000 7,000
A97.2Severe Dengue; Severe Dengue fever; Severe Dengue
haemorrhagic feverDENGUE, SEVERE 16,000 4,800 11,200
E23.2 Diabetes insipidus DIABETES INSIPIDUS 10,100 3,030 7,070
N25.1 Nephrogenic diabetes insipidus DIABETES INSIPIDUS 10,100 3,030 7,070
E10.0
Insulin-dependent diabetes mellitus with coma; Brittle
diabetes (mellitus) with coma; Juvenile-onset diabetes
(mellitus) withcoma ; Ketosis-prone diabetes (mellitus)
with coma; Type I diabetes (mellitus) with coma;
DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E10.1
Insulin-dependent diabetes mellitus with acididosis/
ketoacidosis without mention of coma; Diabetic acididosis
without mention of coma; Diabetic ketoacidosis without
mention of coma;
DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E11.0
Non-insulin-dependent diabetes mellitus with coma;
Nonobese diabetes (mellitus) With coma ; Obese diabetes
mellitus With coma ; Adult-onset diabetes mellitus With
coma ; Maturity-onset diabetes mellitus With coma ;
Nonketotic diabetes mellitus With coma; Stable diabetes
mellitus with coma; Type II diabetes mellitus with coma;
Non-insulin-dependent diabetes of the young
DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E11.1
Non-insulin-dependent diabetes mellitus with ketoacidosis
without mention of coma; ; Nonobese diabetes (mellitus)
With ketoacidosis without mention of coma; Obese
diabetes mellitus With ketoacidosis without mention of
coma; Adult-onset diabetes mellitus without mention of
coma; Maturity-onset diabetes mellitus without mention of
coma; Nonketotic diabetes mellitus without mention of
coma; Stable diabetes mellitus without mention of coma;
Type II diabetes mellitus without mention of coma; Non-
insulin-dependent diabetes of the young
DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E12.0
Malnutrition-related diabetes mellitus with coma; Insulin-
dependent malnutrition-related diabetes mellitus with
coma ; Non-insulin-dependent malnutrition-related
diabetes mellitus with coma
DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E13.0 Other specified diabetes mellitus with coma DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E13.1Other specified diabetes mellitus with acididosis/
ketoacidosis without mention of comaDIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E14.0 Unspecified diabetes mellitus; diabetes NOS with coma DIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E14.1Unspecified diabetes mellitus; diabetes NOS with
acididosis/ ketoacidosis without mention of comaDIABETES MELLITUS WITH COMA OR KETOSIS 15,800 4,740 11,060
E10.5Insulin-dependent diabetes mellitus with Diabetic
gangrene/ ulcer
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E10.6Insulin-dependent diabetes mellitus with other specified
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E10.7Insulin-dependent diabetes mellitus with multiple
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
Page 26 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
E10.8Insulin-dependent diabetes mellitus with unspecified
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E11.5
Non-insulin-dependent diabetes mellitus with Diabetic
gangrene/ ulcer; Nonobese diabetes (mellitus) with
Diabetic gangrene/ ulcer; Obese diabetes mellitus with
Diabetic gangrene/ ulcer; Adult-onset diabetes mellitus
with Diabetic gangrene/ ulcer; Maturity -onset diabetes
mellitus with Diabetic gangrene/ulcer; Nonketotic diabetes
mellitus with Diabetic gangrene/ulcer; Stable diabetes
mellitus with diabetic gangrene/ulcer; Type II diabetes
mellitus with diabetic gangrene/ulcer; Non-insulin-
dependent diabetes of the young
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E11.6Non-insulin-dependent diabetes mellitus with other
specified complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E11.7
Non-insulin-dependent diabetes mellitus with multiple
complications ; Nonobese diabetes (mellitus) With
multiple complications ; Obese diabetes mellitus With
multiple complications ; Adult-onset diabetes mellitus
With multiple complications ; Matur
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E12.5
Malnutrition-related diabetes mellitus with Diabetic
gangrene/ ulcer; Insulin-dependent malnutrition-related
diabetes mellitus with Diabetic gangrene/ ulcer; Non-
insulin-dependent malnutrition-related diabetes mellitus
with Diabetic gangrene/ ulcer
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E12.6Malnutrition-related diabetes mellitus with other specified
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E12.8
Malnutrition-related diabetes mellitus with unspecified
complications; Insulin-dependent malnutrition-related
diabetes mellitus with unspecified complications; Non-
insulin-dependent malnutrition-related diabetes mellitus
with unspecified complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E13.5Other specified diabetes mellitus with Diabetic gangrene/
ulcer
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E13.6Other specified diabetes mellitus with other specified
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E14.5Unspecified diabetes mellitus; diabetes NOS with Diabetic
gangrene/ ulcer
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E14.6Unspecified diabetes mellitus with other specified
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E14.7Unspecified diabetes mellitus; diabetes NOS with multiple
complications
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
A36.0Pharyngeal diphtheria; Diphtheritic membranous angina;
Tonsillar diphtheriaDIPHTHERIA 8,700 2,610 6,090
A36.3 Cutaneous diphtheria DIPHTHERIA 8,700 2,610 6,090
A36.9 Diphtheria, unspecified DIPHTHERIA 8,700 2,610 6,090
D70
Agranulocytosis; Agranulocytic angina; Infantile genetic
agranulocytosis; Kostmann's disease;
Neutropenia NOS; Congenital Neutropenia; Cyclic
Neutropenia; Drug-induced Neutropenia; Periodic
Neutropenia; Primary Splenic Neutropenia; Toxic
Neutropenia; Neutropenic splenomegaly
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D71
Functional disorders of polymorphonuclear neutrophils;
Cell membrane receptor complex [CR3] defect; Chronic
(childhood) granulomatous disease;
Congenital dysphagocytosis; Progressive septic
granulomatosis; Other disorders of white blood cells
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D72.0
Genetic anomalies of leukocytes; Alder Granulation
Anomaly or Syndrome; Alder Granulocyte Anomaly or
Syndrome; May-Hegglin Granulation Anomaly or
Syndrome; May-Hegglin Granulocyte Anomaly or
Syndrome; Pelger-Huët Granulocyte Anomaly or
Syndrome; Hereditary leukocytic: hypersegmentation,;
hyposegmentation ; Hereditary leukomelanopathy
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D72.8
Other specified disorders of white blood cells; Lymphocytic
Leukaemoid reaction; Monocytic Leukaemoid reaction;
Myelocytic Leukaemoid reaction; Leukocytosis;
Symptomatic Lymphocytosis; Lymphopenia; Symptomatic
Monocytosis;Plasmacytosis
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D73.2 Chronic congestive splenomegalyDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D73.3 Abscess of spleenDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
Page 27 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D73.4 Cyst of spleenDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D73.5Infarction of spleen; Nontraumatic Splenic rupture; Torsion
of spleen
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D73.8Other diseases of spleen; Fibrosis of spleen NOS;
Perisplenitis; Splenitis NOS
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D74.9 Methaemoglobinaemia, unspecifiedDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D75.0Familial erythrocytosis; Benign Polycythaemia; Familial
Polycythaemia
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D75.1
Secondary polycythaemia; Acquired Polycythaemia due to
erythropoietin; Acquired Polycythaemia due to fall in
plasma volume; Acquired Polycythaemia due to high
altitude; Acquired Polycythaemia due to stress; Emotional
Polycythaemia; Hypoxaemic Polycythaemia; nephrogenous
Polycythaemia; relative Polycythaemia
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D75.2 Essential thrombocytosisDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D75.8 Other specified diseases of blood and blood-forming organsDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D76.0 Langerhans' cell histiocytosis, not elsewhere classifiedDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D76.1
Haemophagocytic lymphohistiocytosis; Eosinophilic
granuloma; Hand-Schüller-Christian disease; Chronic
Histiocytosis X
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D76.2 Haemophagocytic syndrome, infection-associatedDISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
D76.3
Other histiocytosis syndromes; Reticulohistiocytoma (giant-
cell); Sinus histiocytosis with massive lymphadenopathy;
Xanthogranuloma
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS12,100 3,630 8,470
K20Oesophagitis; Abscess of oesophagus; Oesophagitis NOS;
Chemical oesophagitis; Peptic oesophagitisDISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.0 Achalasia of cardia; Achalasia NOS; Cardiospasm DISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.1
Ulcer of oesophagus; Erosion of oesophagus; Ulcer of
oesophagus NOS; Ulcer of oesophagus due to ingestion of
chemicals; Ulcer of oesophagus due to ingestion of drugs
and medicaments; Fungal ulcer of oesophagus; Peptic ulcer
of oesophagus; Ulcerative oesophagitis
DISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.2
Oesophageal obstruction; Oesophageal web (acquired);
Compression of oesophagus; Constriction of oesophagus;
Stenosis of oesophagus; Stricture of oesophagus
DISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.3 Perforation of oesophagus; Rupture of oesophagus DISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.4Dyskinesia of oesophagus; Corksrew oesophagus; Diffuse
oesophageal spasm; Spasm of oesophagusDISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.6Gastro-oesophageal laceration-haemorrhage syndrome;
Mallory-Weiss syndromeDISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.7 Barrett's esophagus; Barret's disease; Barett's syndrome DISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.8Other specified diseases of oesophagus; Haemorrhage of
oesophagus NOSDISEASES OF ESOPHAGUS 8,300 2,490 5,810
K22.9 Disease of oesophagus, unspecified DISEASES OF ESOPHAGUS 8,300 2,490 5,810
H60.1Cellulitis of external ear; Cellulitis of auricle; Cellulitis of
external auditory canalDISEASES OF EXTERNAL EAR 9,000 2,700 6,300
H60.2 Malignant otitis externa DISEASES OF EXTERNAL EAR 9,000 2,700 6,300
H60.3Other infective otitis externa; diffuse Otitis externa ;
Haemorrhagic Otitis externa ; Swimmer's earDISEASES OF EXTERNAL EAR 9,000 2,700 6,300
H60.4Cholesteatoma of external ear; Keratosis obturans of
external ear (canal)DISEASES OF EXTERNAL EAR 9,000 2,700 6,300
H83.0 Labyrinthitis DISEASES OF INNER EAR 6,200 1,860 4,340
H83.8 Other specified diseases of inner ear DISEASES OF INNER EAR 6,200 1,860 4,340
H68.1
Obstruction of Eustachian tube; Compression of
Eustachian tube; Stenosis of Eustachian tube; Stricture of
Eustachian tube
DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H69.9 Eustachian tube disorder, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H70.0Acute mastoiditis; Abscess of mastoid; Empyema of
mastoidDISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H70.1 Chronic mastoiditis; Caries of mastoid; Fistula of mastoid DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H70.2Petrositis; Acute inflammation of petrous bone; Chronic
inflammation of petrous boneDISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H70.8 Other mastoiditis and related conditions DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H70.9 Mastoiditis, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
Page 28 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
H71
Cholesteatoma of middle ear; Cholesteatoma tympani;
Perforation of tympanic membrane; Persistent post-
traumatic perforation of ear drum; Postinflammatory
perforation of ear drum
DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.0 Acute myringitis; Acute tympanitis; Bullous myringitis DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.1 Chronic myringitis; Chronic tympanitis DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.8 Other specified disorders of tympanic membrane DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H73.9 Disorder of tympanic membrane, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H74.8 Other specified disorders of middle ear and mastoid DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
H74.9 Disorder of middle ear and mastoid, unspecified DISEASES OF MIDDLE EAR AND MASTOID 10,400 3,120 7,280
K09.0
Developmental odontogenic cysts; Dentigerous cyst;
Eruption Cyst; Follicular cyst; Gingival cyst; Lateral
periodontal cyst; Primordial cyst; Keratocyst
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K09.1
Developmental (nonodontogenic) cysts of oral region; Cyst
of globulomaxillary; Cyst of incisive canal; Cyst of median
palatal; Cyst of nasopalatine; Cyst of palatine papilla
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K09.2Other cysts of jaw; Cyst of jaw NOS; Aneurysmal cyst of
jaw; Haemorrhagic cyst of jaw; Traumatic cyst of jaw
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K09.8
Other cysts of oral region, not elsewhere classified;
Dermoid cyst of mouth; Epidermoid cyst of mouth;
Lymphoepithelial cyst of mouth; Epstein's pearl;
Nasoalveolar cyst; Nasolabial cyst
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K09.9 Cyst of oral region, unspecifiedDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K10.0Developmental disorders of jaws; Latent bone cyst of jaw;
Stafne's cyst; Torus mandibularis; Torus palatinus
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K10.1 Giant cell granuloma, central; Giant cell granuloma NOSDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K10.2
Inflammatory conditions of jaws; Acute osteitis of jaw;
Chronic osteitis of jaw; Supparative osteitis of jaw; Acute
neonatal osteomyelitis of jaw; Chronic neonatal
osteomyelitis of jaw; Supparative neonatal osteomyelitis of
jaw; Acute osteoradionecrosis of jaw; chronic
osteoradionecrosis of jaw; Suppurative osteoradionecrosis
of jaw; Acute periostitis of jaw; Chronic periortitis of jaw;
Suppurative periortitis of jaw; Sequestrum, of jaw bone
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K10.3 Alveolitis of jaws; Alveolar osteitis; Dry socketDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K10.8
Other specified diseases of jaws; Cherubism of jaw;
Exostosis of jaw; Fibrous dysplasia of jaw; Unilateral
condylar hyperplasia; Unilateral condylar hypoplasia
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.2 SialoadenitisDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.3 Abscess of salivary glandDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.4 Fistula of salivary glandDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.5Sialolithiasis; Calculus of salivary gland or duct; Stone of
salivary gland or duct
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.6
Mucocele of salivary gland; Mucous extravasation cyst of
salivary gland; Mucous retention cyst of salivary gland;
Ranula
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.8
Other diseases of salivary glands; Benign lymphoepithelial
lesion of salivary gland; Mikulicz' disease; Necrotizing
sialometaplasia; Sialectasia; Stenosis of salivary duct;
Stricture of salivary duct
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K11.9 Disease of salivary gland, unspecified; Sialoadenopathy NOSDISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K12.2Cellulitis and abscess of mouth; Cellulitis of floor of mouth;
Submandibular abscess
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K13.4
Granuloma and granuloma-like lesions of oral mucosa;
Eosinophilic granuloma of oral mucosa; Granuloma
pyogenicum of oral mucosa; Verrucous xanthoma of oral
mucosa
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K13.7Other and unspecified lesions of oral mucosa; Focal oral
mucinosis
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW8,300 2,490 5,810
K31.1 Adult hypertrophic pyloric stenosis; Pyloric stenosis NOS DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.2 Hourglass stricture and stenosis of stomach DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.3 Pylorospasm, not elsewhere classified DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.4 Gastric diverticulum DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.5
Obstruction of duodenum; Constriction of duodenum;
Stenosis of duodenum; Stricture of duodenum; Chronic
duodenal ileus
DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
Page 29 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K31.6Fistula of stomach and duodenum; Gastrocolic fistula;
Gastrojejunocolic fistulaDISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.7 Polyp of stomach and duodenum DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K31.8
Other specified diseases of stomach and duodenum;
Achlorhydria; Gastroptosis; Hourglass contraction of
stomach
DISEASES OF STOMACH AND DUODENUM 6,600 1,980 4,620
K74.4 Secondary biliary cirrhosisDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K74.5 Biliary cirrhosis, unspecifiedDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K80.2
Calculus of gallbladder without cholecystitis;
Cholecystolithiasis unspecified or without cholecystitis;
Cholelithiasis unspecified or without cholecystitis;
Recurrent colic of gallbladder unspecified or without
cholecystitis; Impacted gallstone of cystic duct unspecified
or without cholecystitis; impacted gallstone of gallbladder
unspecified or without cholecystitis
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K80.5
Calculus of bile duct without cholangitis or cholecystitis;
Choledocholithiasis unspecified or without cholangitis or
cholecystitis; Impacted gallstone of bile duct NOS
unspecified or without cholangitis or cholecystitis;
Impacted gallstone of common duct unspecified or without
cholangitis or cholecystitis; Impacted gallstone of hepatic
duct unspecified or without cholangitis or cholecystitis;
Hepatic cholelithiasis unspecified or without cholangitisor
cholecystitis; Hepatic recurrent colic unspecified or without
cholangitis or cholecystitis
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K80.8 Other cholelithiasisDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K82.0
Obstruction of gallbladder; Occlusion of cystic duct of
gallbladder without calculus; Stenosis of cystic duct or
gallbladder without calculus; Stricture of cystic duct or
gallbladder without calculus
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K82.1 Hydrops of gallbladder; Mucocele of gallbladderDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K82.2Perforation of gallbladder; Rupture of cystic duct or
gallbladder
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K82.3Fistula of gallbladder; Cholecystocolic fistula;
Cholecystoduodenal fistula
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K82.4 Cholesterolosis of gallbladder; Strawberry gallbladderDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K82.8
Other specified diseases of gallbladder; Adhesions of cystic
duct or gallbladder; Atrophy of cystic duct or gallbladder;
Cyst of cystic duct or gallbladder; Dyskinesia of cystic duct
or gallbladder; Hypertrophy of cystic duct or gallbladder;
Nonfunctioning of cystic duct or gallbladder; Ulcer of cystic
duct or gallbladder
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K83.0
Cholangitis; Cholangitis NOS; Ascending cholangitis;
Primary cholangitis; Recurrent cholangitis; Sclerosing
cholangitis; Secondary cholangitis; Stenosing cholangitis;
Suppurative cholangitis
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K83.1
Obstruction of bile duct; Occlusion of bile duct without
calculus; Stenosis of bile duct without calculus; Stricture of
bile duct without calculus
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K83.3 Fistula of bile duct; Choledochoduodenal fistulaDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K83.4 Spasm of sphincter of OddiDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K83.5 Biliary cystDISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K83.8
Other specified diseases of biliary tract; Adhesions of bile
duct; Atrophy of bile duct; Hypertrophy of bile duct; Ulcer
of bile duct
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT9,800 2,940 6,860
K85
Acute pancreatitis; Abscess of pancreas; Acute necrosis of
pancreas; Infective necrosis of pancreas; Pancreatitis NOS;
Acute recurrent pancreatitis; Haemorrhagic pancreatitis;
Subacute pancreatitis; Supparative pancreatitis
DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.0 Idiopathic acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.1 Biliary acute pancreatitis; Gallstone pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.2 Alcohol-induced acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.8 Other acute pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
K85.9 Acute pancreatitis, unspecified; Other diseases of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820
K86.0 Alcohol-induced chronic pancreatitis DISEASES OF THE PANCREAS 12,600 3,780 8,820
Page 30 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K86.1
Other chronic pancreatitis; Chronic pancreatitis NOS;
Infectious chronic pancreatitis; Recurrent chronic
pancreatitis; Relapsing chronic pancreatitis
DISEASES OF THE PANCREAS 12,600 3,780 8,820
K86.2 Cyst of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820
K86.3 Pseudocyst of pancreas DISEASES OF THE PANCREAS 12,600 3,780 8,820
K86.8
Other specified diseases of pancreas; Atrophy of pancreas;
Calculus of pancreas; Cirrhosis of pancreas; Fibrosis of
pancreas; Pancreatic infantilism; Pancreatic necrosis NOS;
Aseptic pancreatic necrosis; Fat necrosis of pancreas
DISEASES OF THE PANCREAS 12,600 3,780 8,820
I28.8
Other specified diseases of pulmonary vessels; Rupture of
pulmonary vessel; Stenosis of pulmonary vessel; Stricture
of pulmonary vessel
DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I71.0Dissection of aorta [anypart]; Dissecting aneurysm of aorta
(ruptured) [any part]DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I71.9
Aortic aneurysm of unspecified site without mention of
rupture; Aneurysm of aorta; Dilatation of aorta; Hyaline
necrosis of aorta
DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.0Embolism and thrombosis of abdominal aorta; Aortic
bifurcation syndrome; Leriche's syndromeDISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.1Embolism and thrombosis of other and unspecified parts of
aortaDISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.2 Embolism and thrombosis of arteries of upper extremities DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.3 Embolism and thrombosis of arteries of lower extremities DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.4Embolism and thrombosis of arteries of extremities,
unspecified; Peripheral arterial embolismDISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.5 Embolism and thrombosis of iliac artery DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.8 Embolism and thrombosis of other arteries DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I74.9 Embolism and thrombosis of unspecified artery DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I77.4 Coeliac artery compression syndrome DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I77.6 Arteritis, unspecified; Aortitis NOS; Endarteritis NOS DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I77.8 Other specified disorders of arteries and arterioles DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I85.0 Oesophageal varices with bleeding DISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
I87.1Compression of vein; Stricture of vein; Inferior Vena cava
syndrome; Superior vena cava syndromeDISEASES OF VASCULAR SYSTEM 13,100 3,930 9,170
H30.1
Disseminated chorioretinal inflammation; Disseminated
chorioretinitis; Disseminated choroiditis; Disseminated
retinitis; Disseminated retinochoroiditis
DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220
H30.8 Other chorioretinal inflammations; Harada's disease DISODERS OF CHOROID AND RETINA 4,600 1,380 3,220
H31.3Choroidal haemorrhage and rupture; Choroidal
haemorrhage NOS; Choroidal haemorrhage expulsiveDISODERS OF CHOROID AND RETINA 4,600 1,380 3,220
M80.0 Postmenopausal osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M80.1 Postoophorectomy osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M80.3Postsurgical malabsorption osteoporosis with pathological
fractureDISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.0 Postmenopausal osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.08 Postmenopausal osteoporosis Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.1 Postoophorectomy osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.4 Drug-induced osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.40 Drug-induced osteoporosis Multiple site DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.55 Idiopathic osteoporosis Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.58 Idiopathic osteoporosis Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.6 Localized osteoporosis [Lequesne] DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.8 Other osteoporosis; Senile osteoporosis DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.88Other osteoporosis; Senile osteoporosis Other, head,
neck,ribs,skull,trunk,vertebral columnDISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.89 Other osteoporosis; Senile osteoporosis Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.9 Osteoporosis, unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.95 Osteoporosis, Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M81.98 Osteoporosis, Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.2Adult osteomalacia due to malabsorption; Postsurgical
malabsorption osteomalacia in adultsDISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.4 Aluminium bone disease DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.8 Other adult osteomalacia DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.87 Other adult osteomalacia Ankle and foot DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.89 Other adult osteomalacia Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.9 Adult osteomalacia, unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M83.99 Adult osteomalacia, unspecified Site unspecified DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.0 Fibrous dysplasia (monostotic) DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.1 Skeletal fluorosis Multiple site DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.2 Hyperostosis of skull DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.5 Aneurysmal bone cyst DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
Page 31 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M85.55 Aneurysmal bone cyst Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.6 Other cyst of bone DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.63 Other cyst of bone Forearm DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.65 Other cyst of bone Pelvic region and thigh DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.8Other specified disorders of bone density and structure;
Hyperostosis of bones, except skullDISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M85.88Other specified disorders of bone density and structure;
Hyperostosis of bones, except skull OtherDISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
M89.38 Hypertrophy of bone Other DISORDER OF BONE DENSITY AND STRUCTURE 7,900 2,370 5,530
E75.2
Other sphingolipidosis; Fabry(-Anderson) Disease; Gaucher
Disease; Krabbe Disease; Niemann-Pick Disease; Faber's
syndrome; Metachromatic leukodystrophy; Sulfatase
deficiency
DISORDER OF LIPID STORAGE 8,100 2,430 5,670
E75.4
Neuronal ceroid lipofuscinosis; Batten Disease;
Bielschowsky-Jansky Disease; Kufs Disease; pielmeyer-Vogt
Disease
DISORDER OF LIPID STORAGE 8,100 2,430 5,670
E75.5
Other lipid storage disorders; Cerebrotendinous
cholesterosis [van Bogaert-Scherer-Epstein]; Wolman's
disease
DISORDER OF LIPID STORAGE 8,100 2,430 5,670
E75.6 Lipid storage disorder, unspecified DISORDER OF LIPID STORAGE 8,100 2,430 5,670
N95.0 Postmenopausal bleeding DISORDERS ASSOCIATED WITH MENOPAUSE 6,000 1,800 4,200
E26.0
Primary hyperaldosteronism; Conn's syndrome;
Primary aldosteronism due to adrenal hyperplasia
(bilateral)
DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E26.1 Secondary hyperaldosteronism DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E26.8 Other hyperaldosteronism; Bartter's syndrome DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E26.9Hyperaldosteronism, unspecified; Other disorders of
adrenal glandDISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E27.1Primary adrenocortical insufficiency; Addison's disease;
Autoimmune adrenalitisDISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E27.2 Addisonian crisis; Adrenal crisis; Adrenocortical crisis DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E27.3 Drug-induced adrenocortical insufficiency DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E27.4
Other and unspecified adrenocortical insufficiency; Adrenal
haemorrhage; Adrenal infarction;
Adrenocortical insufficiency NOS; Hypoaldosteronism
DISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E27.8Other specified disorders of adrenal gland; Abnormality of
cortisol-binding globulinDISORDERS OF ADRENAL GLAND 9,900 2,970 6,930
E70.0 Classical phenylketonuria DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E70.1 Other hyperphenylalaninaemias DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E70.2Disorders of tyrosine metabolism; Alkaptonuria;
Hypertyrosinaemia; Ochronosis; Tyrosinaemia; TyrosinosisDISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E70.3
Albinism; OcularAlbinism; Oculocutaneous Albinism
Chediak(-Steinbrinck)-Higashi Syndrome; Cross Syndrome;
Hermansky-Pudlak Syndrome
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E70.8
Other disorders of aromatic amino-acid metabolism;
Disorders of histidine metabolism; Disorders of tryptophan
metabolism
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E71.0 Maple-syrup-urine disease DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E71.1
Other disorders of branched-chain amino-acid metabolism;
Hyperleucine-isoleucinaemia; Hypervalinaemia; Isovaleric
acidaemia;
Methylmalonic acidaemia; Propionic acidaemia
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E71.3
Disorders of fatty-acid metabolism; Adrenoleukodystrophy
[Addison-Schilder]; Muscle carnitine palmityltransferase
deficiency
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E72.0
Disorders of amino-acid transport; Cystinosis; Cystinuria;
Fanconi(-de Toni)(-Debré) syndrome; Hartnup's disease;
Lowe's syndrome
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E72.2
Disorders of urea cycle metabolism; Argininaemia;
Argininosuccinic aciduria; Citrullinaemia;
Hyperammonaemia
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E72.3Disorders of lysine and hydroxylysine metabolism / Glutaric
aciduria; Hydroxylysinaemia; HyperlysinaemiaDISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E72.5
Disorders of glycine metabolism;
Hyperhydroxyprolinaemia; Hyperprolinaemia (type I) ,
Hyperprolinaemia type II; Non-ketotic hyperglycinaemia;
Sarcosinaemia
DISORDERS OF AMINO ACID METABOLISM 10,600 3,180 7,420
E73.0 Congenital lactase deficiency DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
E74.0
Glycogen storage disease; Cardiac glycogenosis; Andersen
Disease; Cori Disease; Forbes Disease; Hers Disease;
McArdle Disease; Pompe Disease; Tauri Disease; von
Gierke Disease; Liver phosphorylase deficiency
DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
E74.1
Disorders of fructose metabolism; Essential fructosuria;
Fructose-1,6-diphosphatase deficiency; Hereditary fructose
intolerance
DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
Page 32 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
E74.2Disorders of galactose metabolism; Galactokinase
deficiency; GalactosaemiaDISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
E74.3Other disorders of intestinal carbohydrate absorption;
Glucose-galactose malabsorption; Sucrase deficiencyDISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
E74.8
Other specified disorders of carbohydrate
metabolism/Essential pentosuria; Oxalosis; Oxaluria; Renal
glycosuria
DISORDERS OF CARBOHYDRATE METABOLISM 5,800 1,740 4,060
E77.8 Other disorders of glycoprotein metabolism DISORDERS OF GLYCOPROTEIN METABOLISM 10,600 3,180 7,420
E76.0Mucopolysaccharidosis, type I; Hurler Syndrome; Hurler-
Scheie Syndrome; Scheie Syndrome
DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM10,900 3,270 7,630
E76.1 Mucopolysaccharidosis, type II; Hunter's syndromeDISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM10,900 3,270 7,630
E76.2
Other mucopolysaccharidoses; ß-Glucuronidase deficiency;
Mucopolysaccharidosis, type III; Mucopolysaccharidosis IV,
Mucopolysaccharidosis VI, Mucopolysaccharidosis VII;
Mild Maroteaux-Lamy Syndrome; Severe Maroteaux-Lamy
Syndrome; Morquio-like Syndrome; Morquio-classic
syndrome; Sanfilippo type B syndrome; Sanfilippo type C
syndrome; Sanfilippo type D syndrome
DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM10,900 3,270 7,630
E76.3 Mucopolysaccharidosis, unspecifiedDISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM10,900 3,270 7,630
E76.8 Other disorders of glucosaminoglycan metabolismDISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM10,900 3,270 7,630
E78.0
Pure hypercholesterolaemia; Familial
hypercholesterolaemia; Fredrickson's
hyperlipoproteinaemia, type Iia;
Hyperbetalipoproteinaemia; Hyperlipidaemia, group A; Low-
density-lipoprotein-type [LDL] hyperlipoproteinaemia
DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E78.1
Pure hyperglyceridaemia; Endogenous hyperglyceridaemia;
Fredrickson's hyperlipoproteinaemia, type IV;
Hyperlipidaemia, group B; Hyperprebetalipoproteinaemia';
Very-low-density-lipoprotein-type [VLDL]
hyperlipoproteinaemia
DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E78.2
Mixed hyperlipidaemia; Broad- or floating-
betalipoproteinaemia; Fredrickson's
hyperlipoproteinaemia, type IIb; Fredrickson's
hyperlipoproteinaemia type III; Hyperbetalipoproteinaemia
with prebetalipoproteinaemia; Hypercholesterolaemia with
endogenous hyperglyceridaemia; Hyperlipidaemia, group C;
Tubero-eruptive xanthoma; Xanthoma tuberosum
DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E78.3
Hyperchylomicronaemia; Fredrickson's
hyperlipoproteinaemia, type I; Fredrickson's
hyperlipoproteinaemia, type V; Hyperlipidaemia, group D;
Mixed hyperglyceridaemia
DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E78.4 Other hyperlipidaemia; Familial combined hyperlipidaemia DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E78.6
Lipoprotein deficiency; Abetalipoproteinaemia;
High-density lipoprotein deficiency;
Hypoalphalipoproteinaemia; Familial
Hypobetalipoproteinaemia; Lecithin cholesterol
acyltransferase deficiency; Tangier disease
DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E78.8 Other disorders of lipoprotein metabolism DISORDERS OF LIPOPROTEIN METABOLISM 6,600 1,980 4,620
E83.0Disorders of copper metabolism; Menkes' kinky hair
disease; Menkes' steely hair disease; Wilson's diseaseDISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.1 Disorders of iron metabolism; Haemochromatosis DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.2 Disorders of zinc metabolism; Acrodermatitis enteropathica DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.3
Disorders of phosphorus metabolism; Acid phosphatase
deficiency; Familial hypophosphataemia;
Hypophosphatasia; Vitamin-D-resistant osteomalacia;
Vitamin-D-resistant rickets
DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.4Disorders of magnesium metabolism; Hypermagnesaemia;
HypomagnesaemiaDISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.5Disorders of calcium metabolism; Familial hypocalciuric
hypercalcaemia; Idiopathic hypercalciuriaDISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
E83.8 Other disorders of mineral metabolism DISORDERS OF MINERAL METABOLISM 7,300 2,190 5,110
H05.0
Acute inflammation of orbit; Abscess of orbit;Cellulitis of
orbit; Osteomyelitis of orbit; Periostitis of orbit, Tenonitis of
orbit
DISORDERS OF ORBIT 9,500 2,850 6,650
H05.2Exophthalmic conditions; Displacement of globe (lateral)
NOS; Haemorrhage of orbit; Oedema of orbitDISORDERS OF ORBIT 9,500 2,850 6,650
Page 33 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
E80.0Hereditary erythropoietic porphyria; Congenital
erythropoietic porphyria; Erythropoietic protoporphyria
DISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM9,800 2,940 6,860
E80.2Other porphyria; Hereditary coproporphyria
Porphyria NOS; Acute intermittent (hepatic) Porphyria
DISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM9,800 2,940 6,860
E80.4 Gilbert's syndromeDISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM9,800 2,940 6,860
E80.5 Crigler-Najjar syndromeDISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM9,800 2,940 6,860
E80.6Other disorders of bilirubin metabolism; Dubin-Johnson
syndrome; Rotor's syndrome
DISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM9,800 2,940 6,860
E79.8Other disorders of purine and pyrimidine metabolism;
Hereditary xanthinuria
DISORDERS OF PURINE AND PYRIMIDINE
METABOLISM7,000 2,100 4,900
E20.0 Idiopathic hypoparathyroidism DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E20.8 Other hypoparathyroidism DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E20.9 Hypoparathyroidism, unspecified; Parathyroid tetany DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E21.0
Primary hyperparathyroidism; Hyperplasia of parathyroid;
Osteitis fibrosa cystica generalisata [von Recklinghausen's
disease of bone]
DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E21.4 Other specified disorders of parathyroid gland DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E21.5 Disorder of parathyroid gland, unspecified DISORDERS OF THE PARATHYROID 9,300 2,790 6,510
E22.2Syndrome of inappropriate secretion of antidiuretic
hormoneDISORDERS OF THE PITUITARY GLAND 11,800 3,540 8,260
E23.0
Hypopituitarism; Fertile eunuch syndrome;
Hypogonadotropic hypogonadism; Idiopathic growth
hormone deficiency; Isolated deficiency of gonadotropin;
Isolated deficiency of growth hormone; Isolated deficiency
of pituitary hormone; Kallmann's syndrome; Loraine-Levi
short stature; Necrosis of pituitary gland(postpartum);
Panhypopituitarism; Pituitary cachexia; Pituitary
insufficiency NOS; Pituitary short stature; Sheehan's
syndrome; Simmond's disease
DISORDERS OF THE PITUITARY GLAND 11,800 3,540 8,260
H43.0 Vitreous prolapse DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
H43.1 Vitreous haemorrhage DISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
H44.0Purulent endophthalmitis; Panophthalmitis; Vitreous
abscessDISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
H44.1Other endophthalmitis; Parasitic endophthalmitis NOS;
Sympathetic uveitisDISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
H44.5Degenerated conditions of globe; Absolute glaucoma;
Atrophy of globe; Phthisis bulbiDISORDERS OF VITREOUS BODY AND GLOBE 10,400 3,120 7,280
D65
Disseminated intravascular coagulation [defibrination
syndrome]; Acquired Afibrinogenaemia; Consumption
coagulopathy; Diffuse or disseminated intravascular
coagulation [DIC] ; Acquired Fibrinolytic haemorrhage;
Fibrinolytic Purpura; Purpura fulminans;
DISSEMINATED INTRAVASCULAR COAGULATION 32,000 9,600 22,400
P60Disseminated intravascular coagulation of fetus and
newborn; Defibrination syndrome of fetus or newbornDISSEMINATED INTRAVASCULAR COAGULATION 32,000 9,600 22,400
M42.1 Adult osteochondrosis of spine DORSOPATHIES 7,600 2,280 5,320
M43.02 Spondylolysis cervical region DORSOPATHIES 7,600 2,280 5,320
M43.03 Spondylolysis cervicothoracic region DORSOPATHIES 7,600 2,280 5,320
M43.04 Spondylolysis thoracic region DORSOPATHIES 7,600 2,280 5,320
M43.06 Spondylolysis lumbar region DORSOPATHIES 7,600 2,280 5,320
M43.07 Spondylolysis lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M43.09 Spondylolysis site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.10 Spondylolisthesis Multiple sites in spine DORSOPATHIES 7,600 2,280 5,320
M43.12 Spondylolisthesis cervical region DORSOPATHIES 7,600 2,280 5,320
M43.15 Spondylolisthesis thoracolumbar region DORSOPATHIES 7,600 2,280 5,320
M43.16 Spondylolisthesis lumbar region DORSOPATHIES 7,600 2,280 5,320
M43.17 Spondylolisthesis lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M43.18 Spondylolisthesis sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M43.19 Spondylolisthesis site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.22Other fusion of spine; Ankylosis of spinal joint cervical
regionDORSOPATHIES 7,600 2,280 5,320
M43.26Other fusion of spine; Ankylosis of spinal joint lumbar
regionDORSOPATHIES 7,600 2,280 5,320
M43.27Other fusion of spine; Ankylosis of spinal joint lumbosacral
regionDORSOPATHIES 7,600 2,280 5,320
M43.29Other fusion of spine; Ankylosis of spinal joint site
unspecifiedDORSOPATHIES 7,600 2,280 5,320
M43.42 Other recurrent atlantoaxial subluxation cervical region DORSOPATHIES 7,600 2,280 5,320
M43.49 Other recurrent atlantoaxial subluxation site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.60 Torticollis Multiple sites in spine DORSOPATHIES 7,600 2,280 5,320
M43.62 Torticollis cervical region DORSOPATHIES 7,600 2,280 5,320
M43.64 Torticollis thoracic region DORSOPATHIES 7,600 2,280 5,320
M43.66 Torticollis lumbar region DORSOPATHIES 7,600 2,280 5,320
Page 34 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M43.68 Torticollis sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M43.69 Torticollis site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.8 Other specified deforming dorsopathies DORSOPATHIES 7,600 2,280 5,320
M43.82 Other specified deforming dorsopathies cervical region DORSOPATHIES 7,600 2,280 5,320
M43.85Other specified deforming dorsopathies thoracolumbar
regionDORSOPATHIES 7,600 2,280 5,320
M43.86 Other specified deforming dorsopathies lumbar region DORSOPATHIES 7,600 2,280 5,320
M43.87 Other specified deforming dorsopathies lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M43.88Other specified deforming dorsopathies sacral and
sacrococcygeal regionDORSOPATHIES 7,600 2,280 5,320
M43.89 Other specified deforming dorsopathies site unspecified DORSOPATHIES 7,600 2,280 5,320
M43.9Deforming dorsopathy, unspecified; Curvature of spine
NOSDORSOPATHIES 7,600 2,280 5,320
M43.94Deforming dorsopathy, unspecified; Curvature of spine
NOS thoracic regionDORSOPATHIES 7,600 2,280 5,320
M43.95Deforming dorsopathy, unspecified; Curvature of spine
NOS thoracolumbar regionDORSOPATHIES 7,600 2,280 5,320
M43.96Deforming dorsopathy, unspecified; Curvature of spine
NOS lumbar regionDORSOPATHIES 7,600 2,280 5,320
M43.97Deforming dorsopathy, unspecified; Curvature of spine
NOS lumbosacral regionDORSOPATHIES 7,600 2,280 5,320
M43.99Deforming dorsopathy, unspecified; Curvature of spine
NOS site unspecifiedDORSOPATHIES 7,600 2,280 5,320
M53.0Cervicocranial syndrome; Posterior cervical sympathetic
syndromeDORSOPATHIES 7,600 2,280 5,320
M53.1 Cervicobrachial syndrome DORSOPATHIES 7,600 2,280 5,320
M53.12 Cervicobrachial syndrome cervical region DORSOPATHIES 7,600 2,280 5,320
M53.19 Cervicobrachial syndrome site unspecified DORSOPATHIES 7,600 2,280 5,320
M53.2 Spinal instabilities DORSOPATHIES 7,600 2,280 5,320
M53.22 Spinal instabilities cervical region DORSOPATHIES 7,600 2,280 5,320
M53.24 Spinal instabilities thoracic region DORSOPATHIES 7,600 2,280 5,320
M53.26 Spinal instabilities lumbar region DORSOPATHIES 7,600 2,280 5,320
M53.27 Spinal instabilities lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M53.28 Spinal instabilities sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M53.29 Spinal instabilities site unspecified DORSOPATHIES 7,600 2,280 5,320
M53.3 Coccygodynia DORSOPATHIES 7,600 2,280 5,320
M53.38 Coccygodynia sacral and sacrococcygeal region DORSOPATHIES 7,600 2,280 5,320
M53.8 Other specified dorsopathies DORSOPATHIES 7,600 2,280 5,320
M53.86 Other specified dorsopathies lumbar region DORSOPATHIES 7,600 2,280 5,320
M53.87 Other specified dorsopathies lumbosacral region DORSOPATHIES 7,600 2,280 5,320
M53.89 Other specified dorsopathies site unspecified DORSOPATHIES 7,600 2,280 5,320
M53.9 Dorsopathy, unspecified DORSOPATHIES 7,600 2,280 5,320
M53.92 Dorsopathy, unspecified cervical region DORSOPATHIES 7,600 2,280 5,320
M53.95 Dorsopathy, unspecified thoracolumbar region DORSOPATHIES 7,600 2,280 5,320
M54 Dorsalgia DORSOPATHIES 7,600 2,280 5,320
T75.1Drowning and nonfatal submersion; Immersion; Swimmer's
crampDROWNING 7,100 2,130 4,970
O00.0 Abdominal pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460
O00.1Tubal pregnancy; Fallopian pregnancy; Rupture of fallopian
tube due to pregnancy; Tubal abortionECTOPIC PREGNANCY 7,800 2,340 5,460
O00.2 Ovarian pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460
O00.8Other ectopic pregnancy; Cervical pregnancy; Cornual
pregnancy; Intraligamentous pregnancy; Mural pregnancyECTOPIC PREGNANCY 7,800 2,340 5,460
O00.9 Ectopic pregnancy, unspecified ECTOPIC PREGNANCY 7,800 2,340 5,460
O36.7 Maternal care for viable fetus in abdominal pregnancy ECTOPIC PREGNANCY 7,800 2,340 5,460
T75.0Effects of lightning; Shock from lightning; Struck by
lightning NOSELECTRICAL SHOCK 5,400 1,620 3,780
T75.4Effects of electric current; Electrocution; Shock from
electric currentELECTRICAL SHOCK 5,400 1,620 3,780
J43.0MacLeod's syndrome; Unilateral emphysema; Unilateral
transparency of lungEMPHYSEMA 11,400 3,420 7,980
J43.1 Panlobular emphysema; Panacinar emphysema EMPHYSEMA 11,400 3,420 7,980
J43.2 Centrilobular emphysema EMPHYSEMA 11,400 3,420 7,980
J43.8 Other emphysema EMPHYSEMA 11,400 3,420 7,980
J43.9
Emphysema, unspecified; Lung emphysema NOS;
Pulmonary emphysema NOS; Bullous lung emphysema;
Bullous pulmonary emphysema; Vesicular lung
emphysema; Vesucular pulmonary emphysema;
Emphysematous bleb
EMPHYSEMA 11,400 3,420 7,980
J98.2 Interstitial emphysema; Mediastinal emphysema EMPHYSEMA 11,400 3,420 7,980
J98.3 Compensatory emphysema EMPHYSEMA 11,400 3,420 7,980
B22.0
Human immunodeficiency virus [HIV] disease resulting in
encephalopathy; Human immunodeficiency virus [HIV]
dementia
ENCEPHALOPATHY 22,200 6,660 15,540
Page 35 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
G92 Toxic encephalopathy ENCEPHALOPATHY 22,200 6,660 15,540
G93.1 Anoxic brain damage, not elsewhere classified ENCEPHALOPATHY 22,200 6,660 15,540
I67.4 Hypertensive encephalopathy ENCEPHALOPATHY 22,200 6,660 15,540
N80.0 Endometriosis of uterus; Adenomyosis ENDOMETRIOSIS 7,700 2,310 5,390
N80.1 Endometriosis of ovary ENDOMETRIOSIS 7,700 2,310 5,390
N80.2 Endometriosis of fallopian tube ENDOMETRIOSIS 7,700 2,310 5,390
N80.3 Endometriosis of pelvic peritoneum ENDOMETRIOSIS 7,700 2,310 5,390
N80.4 Endometriosis of rectovaginal septum and vagina ENDOMETRIOSIS 7,700 2,310 5,390
N80.5 Endometriosis of intestine ENDOMETRIOSIS 7,700 2,310 5,390
N80.8 Other endometriosis; Endometriosis of thorax ENDOMETRIOSIS 7,700 2,310 5,390
N80.9 Endometriosis, unspecified ENDOMETRIOSIS 7,700 2,310 5,390
J05.1 Acute epiglottitis; Epiglottitis NOS EPIGLOTTITIS 9,700 2,910 6,790
G40.0
Localization-related focal idiopathic epilepsy and epileptic
syndromes with seizures of localized onset; Localization-
related partial idiopathic epilepsy and epileptic syndromes
with seizures of localized onset; Benign childhood epilepsy
with centrotemporal EEG spikes;Childhood epilepsy with
occipital EEG paroxysms
EPILEPSY 7,800 2,340 5,460
G40.1
Localization-related focal symptomatic epilepsy and
epileptic syndromes with simple partial seizures;
Localization-related partial symptomatic epilepsy and
epileptic syndromes with simple partial seizures; Attacks
without alteration of consciousness ; Simple partial seizures
developing into secondarily generalized seizures
EPILEPSY 7,800 2,340 5,460
G40.2
Localization-related focal symptomatic epilepsy and
epileptic syndromes with complex partial seizures;
Localization-related partial symptomatic epilepsy and
epileptic syndromes with complex partial seizures; Attacks
with alteration of consciousness, often with automatisms.
Complex partial seizures developing into secondarily
generalized seizures
EPILEPSY 7,800 2,340 5,460
G40.3
Generalized idiopathic epilepsy and epileptic syndromes;
Benign myoclonic epilepsy in infancy; Benign familial
neonatal convulsions; Childhood absence epilepsy
[pyknolepsy]; Epilepsy with grand mal seizures on
awakening; Juvenile absence epilepsy; Juvenile absence
epilepsy; Juvenile myoclonic epilepsy impulsive petit mal);
Nonspecific atonic epileptic seizures; Nonspecific clonic
epileptic seizures; Nonspecific myoclonic epileptic seizures;
nonspecific tonic epileptic seizures; Nonspecific tonic-clonic
epileptic seizures
EPILEPSY 7,800 2,340 5,460
G40.4
Other generalized epilepsy and epileptic syndromes;
Epilepsy with myoclonic absences; Epilepsy with myoclonic-
astatic seizures; Infantile spasms; Lennox-Gastaut
syndrome; Salaam attacks; Symptomatic early myoclonic;
Encephalopathy; West's syndrome
EPILEPSY 7,800 2,340 5,460
G40.5
Special epileptic syndromes; Epilepsia partialis continua
[Kozhevnikof]; Epileptic seizures related to alcohol;
Epileptic seizures related to drugs; Epileptic seizures related
to hormonal changes; Epileptic seizures related to sleep
deprivation; Epileptic seizures related to stress
EPILEPSY 7,800 2,340 5,460
G40.6 Grand mal seizures, unspecified (with or without petit mal) EPILEPSY 7,800 2,340 5,460
G40.7 Petit mal, unspecified, without grand mal seizures EPILEPSY 7,800 2,340 5,460
G40.8Other epilepsy; Epilepsies and epileptic syndromes
undetermined as to whether they are focal or generalizedEPILEPSY 7,800 2,340 5,460
G40.9Epilepsy, unspecified; Epileptic convulsions NOS; Epileptic
fits NOS; Epileptic seizures NOSEPILEPSY 7,800 2,340 5,460
G21.0 Malignant neuroleptic syndrome EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G21.1 Other drug-induced secondary parkinsonism EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G21.8 Other secondary parkinsonism EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G21.9 Secondary parkinsonism, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G23.0Hallervorden-Spatz disease; Pigmentary pallidal
degenerationEXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G23.1Progressive supranuclear ophthalmoplegia [Steele-
Richardson-Olszewski]EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
Page 36 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
G23.8
Other specified degenerative diseases of basal ganglia;
Calcification of basal ganglia; Neurogenic orthostatic
hypotension [Shy-Drager}
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G23.9 Degenerative disease of basal ganglia, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.0 Carcinomatous neuromyopathy in Drug-induced dystonia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.1 Idiopathic familial dystonia; Idiopathic dystonia NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.3 Spasmodic torticollis EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.4 Idiopathic orofacial dystonia; Orofacial dyskinesia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.8 Other dystonia EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G24.9 Dystonia, unspecified; Dyskinesia NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G25.3 Myoclonus; Drug-induced myoclonus EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G25.5 Other chorea; Chorea NOS EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G25.8
Other specified extrapyramidal and movement disorders;
Akathisia (drug-induced) (treatment-induced) Restless legs
syndrome; Stiff-man syndrome
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
G25.9 Extrapyramidal and movement disorder, unspecified EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300 2,490 5,810
R56.0 Febrile convulsions FEBRILE SEIZURES 7,000 2,100 4,900
R56.8Other and unspecified convulsions; Fit NOS; Seizure
(convulsive) NOSFEBRILE SEIZURES 7,000 2,100 4,900
P92.1 Regurgitation and rumination in newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.2 Slow feeding of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.4 Overfeeding of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.8 Other feeding problems of newborn FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
P92.9 Feeding problem of newborn, unspecified FEEDING PROBLEMS NEWBORN 8,700 2,610 6,090
R50.9 Fever, unspecified; Hyperpyrexia NOS; Pyrexia NOS FEVER OF UNKNOWN ORIGIN 7,000 2,100 4,900
E87.0Hyperosmolality and hypernatraemia; Sodium [Na] excess;
Sodium [Na] overload FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.1 Hypo-osmolality and hyponatraemia FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.2Acidosis; Acidosis NOS; Lactic Acidosis; Metabolic Acidosis;
Respiratory AcidosisFLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.3Alkalosis; Alkalosis NOS; Metabolic Alkalosis; Respiratory
AlkalosisFLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.4 Mixed disorder of acid-base balance FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.5Hyperkalaemia; Potassium [K] excess; Potassium [K]
overloadFLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.6 Hypokalaemia; Potassium [K] deficiency FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.7 Fluid overload FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
E87.8
Other disorders of electrolyte and fluid balance, not
elsewhere classified; Electrolyte imbalance NOS;
Hyperchloraemia; Hypochloraemia; Other metabolic
disorders
Electrolyte abnormality
FLUID AND ELECTROLYTE DISTURBANCES 8,500 2,550 5,950
S22.00Fracture of thoracic vertebra; Fracture of thoracic spine
NOS (closed)FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.10 Multiple fractures of thoracic spine (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.2 Fracture of sternum FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.20 Fracture of sternum (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.3 Fracture of rib FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.30 Fracture of rib (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.31 Fracture of rib (open) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.4 Multiple fractures of ribs FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.40 Multiple fractures of ribs (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.41 Multiple fractures of ribs (open) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.80 Fracture of other parts of bony thorax (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
S22.90 Fracture of bony thorax, part unspecified (closed) FRACTURES OF THE BONES OF THE THORAX 8,700 2,610 6,090
J85.0 Gangrene and necrosis of lung GANGRENE 13,200 3,960 9,240
L88Pyoderma gangrenosum; Dermatitis gangrenosa;
Phagedenic pyodermaGANGRENE 13,200 3,960 9,240
R02 Gangrene, not elsewhere classified GANGRENE 13,200 3,960 9,240
K21.0Gastro-oesophageal reflux disease with oesophagitis;
Reflux oesophagitisGASTROESOPHAGEAL REFLUX DISEASE 6,100 1,830 4,270
K21.9Gastro-oesophageal reflux disease without oesophagitis;
Oesophageal reflux NOSGASTROESOPHAGEAL REFLUX DISEASE 6,100 1,830 4,270
P76.0 Meconium plug syndromeGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P76.1 Transitory ileus of newbornGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
Page 37 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
P76.8 Other specified intestinal obstruction of newbornGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P76.9 Intestinal obstruction of newborn, unspecifiedGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P77 Necrotizing enterocolitis of fetus and newbornGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P78.0 Perinatal intestinal perforation; Meconium peritonitisGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P78.2Neonatal haematemesis and melaena due to swallowed
maternal blood
GASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P78.3 Noninfective neonatal diarrhoeaGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P78.8Other specified perinatal digestive system disorders;
Congenital cirrhosis of liver; Peptic ulcer of newborn
GASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
P78.9 Perinatal digestive system disorder, unspecifiedGASTROINTESTINAL DISORDERS OF THE
NEWBORN11,700 3,510 8,190
H40.0 Glaucoma suspect; Ocular hypertension GLAUCOMA 6,500 1,950 4,550
H40.1
Primary open-angle glaucoma; primary capsular with
pseudoexfoliation of lens glaucoma; Residual stage capsular
with pseudoexfoliation of lens; Primary chronic simple
glaucoma; Residual stage chronic simple glaucoma; Primary
low-tension glaucoma; Residual low tension glaucoma;
Primary pigmentary glaucoma; Residual pigmentary
glaucoma
GLAUCOMA 6,500 1,950 4,550
H40.2
Primary angle-closure glaucoma; Primary acute angle-
closure glaucoma ; Acute residual stage angle-closure
glaucoma ; Primary chronic angle-closure glaucoma ;
Residual stage chronic angle-closure glaucoma; Primary
intermittent angle-cloure glaucoma; Residual intermittent
angle-closure glaucoma
GLAUCOMA 6,500 1,950 4,550
H40.3 Glaucoma secondary to eye trauma GLAUCOMA 6,500 1,950 4,550
H40.4 Glaucoma secondary to eye inflammation GLAUCOMA 6,500 1,950 4,550
H40.5 Glaucoma secondary to other eye disorders GLAUCOMA 6,500 1,950 4,550
H40.8 Other glaucoma GLAUCOMA 6,500 1,950 4,550
H40.9 Glaucoma, unspecified GLAUCOMA 6,500 1,950 4,550
N00.0
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS, with Minor glomerular abnormality
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.1
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS, with Focal and segmental glomerular
lesions (with focal and segmental hyalinosis; focal and
segmental sclerosis) & Focal glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.2
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS with Diffuse membranous
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.3
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS with Diffuse mesangial proliferative
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.4
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS with Diffuse endocapillary proliferative
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.5
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS with Diffuse mesangiocapillary
glomerulonephritis (Membranoproliferative
glomerulonephritis, types 1 and 3, or NOS)
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.7
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS with Diffuse crescentic
glomerulonephritis (Extracpillary glomerulonephritis)
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.8
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS with Other (Proliferative
glomerulonephritis NOS)
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N00.9
Acute nephritic syndrome including Acute glomerular
disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS, Unspecified renal biopsy
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Page 38 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N01.0
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Minor glomerular abnormality
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N01.1
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Focal and segmental
glomerular lesions
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N01.3
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Diffuse mesangial
proliferative glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N01.5
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Diffuse mesangiocapillary
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N01.8
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, other
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N01.9
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Unspecified
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N02.0
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Minor glomerular abnormality
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N02.1
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Focal and segmental glomerular lesions
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N02.2
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Diffuse membranous glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N02.5
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Diffuse mesangiocapillary glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N02.8
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with other (Proliferative glomerulonephritis NOS)
IgA Nephropathy
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N02.9
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Unspecified renal biopsy
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.0
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Minor glomerular
abnormality
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.1
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Focal and segmental
glomerular lesions
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.2
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, withDiffuse membranous
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.3
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse mesangial
proliferative glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.4
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse endocapillary
proliferative glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.5
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse mesangiocapillary
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Page 39 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N03.7
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse crescentic
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.8
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Other (Proliferative
glomerulonephritis NOS)
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N03.9
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Unspecified renal biopsy
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.0Nephrotic syndrome: Minor glomerular abnormality;
Minimal change lesionGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.1
Nephrotic syndrome: Focal and segmental glomerular
lesions; Focal and segmental hyalinosis; Focal and
segmental sclerosis; Focal glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.2Nephrotic syndrome: Diffuse membranous
glomerulonephritisGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.3Nephrotic syndrome: Diffuse mesangial proliferative
glomerulonephritisGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.4Nephrotic syndrome: Diffuse endocapillary proliferative
glomerulonephritisGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.5
Nephrotic syndrome: Diffuse mesangiocapillary
glomerulonephritis; Membranoproliferative
glomerulonephritis, types 1 and 3, or NOS
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.7Nephrotic syndrome: Diffuse crescentic glomerulonephritis;
Extracapillary glomerulonephritisGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.8 Nephrotic syndrome: Other GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N04.9 Nephrotic syndrome:Unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.0
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Minor
glomerular abnormality, minimal change lesion
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.1
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Focal and
segmental glomerular lesions (with focal and segmental
hyalinosis; focal and segmental sclerosis) & Focal
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.2
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Diffuse
membranous glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.3
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Diffuse
mesangial proliferative glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.4
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Diffuse
endocapillary proliferative glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.5
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Diffuse
mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1 and 3,
or NOS
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.6
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Dense
deposit disease
Membranoproliferative glomerulonephritis, type 2
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.7
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Diffuse
crescentic glomerulonephritis, Extracapillary
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.8
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with Other
(Proliferative glomerulonephritis NOS)
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N05.9
Unspecified nephritic syndrome including Glomerular
disease, Glomerulonephritis, Nephritis NOS with
Unspecified renal biopsy
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N06.0
Isolated proteinuria with specified morphological lesion
with morphological lesion specified with Minor glomerular
abnormality
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N06.8
Isolated proteinuria with specified morphological lesion
with Other
(Proliferative glomerulonephritis NOS)
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N06.9Isolated proteinuria with specified morphological lesion
with Unspecified renal biopsyGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
Page 40 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N07.0Hereditary nephropathy, not elsewhere classified with
Minor glomerular abnormalityGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N07.1
Hereditary nephropathy, not elsewhere classified with
Focal and segmental glomerular lesions (with focal and
segmental hyalinosis; focal and segmental sclerosis) & Focal
glomerulonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N07.2Hereditary nephropathy, not elsewhere classified with
Diffuse membranous glomerulonephritisGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N07.3Hereditary nephropathy, not elsewhere classified with
Diffuse mesangial proliferative glomerulonephritisGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N07.5
Hereditary nephropathy, not elsewhere classified with
Diffuse mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1 and 3,
or NOS
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N07.9Hereditary nephropathy, not elsewhere classified with
Unspecified renal biopsyGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N10
Acute tubulo-interstitial nephritis; pyelonephritis; Acute
infectious interstitial nephritis; Acute pyelitis; Acute
pyelonephritis
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N11.9
Chronic tubulo-interstitial nephritis, unspecified; Chronic
interstitial nephritis NOS; Chronic pyelitis NOS; Chronic
pyelonephritis NOS
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N12
Tubulo-interstitial nephritis, not specified as acute or
chronic; Interstitial nephritis NOS; Pyelitis NOS;
Pyelonephritis NOS
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N14.0 Analgesic nephropathy GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N14.1Nephropathy induced by other drugs, medicaments and
biological substancesGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N14.2Nephropathy induced by unspecified drug, medicament or
biological substanceGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N14.4 Toxic nephropathy, not elsewhere classified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N15.0 Balkan nephropathy; Balkan endemic nephropathy GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N15.8 Other specified renal tubulo-interstitial diseases GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N15.9Renal tubulo-interstitial disease, unspecified; Infection of
kidney NOSGLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N39.1 Persistent proteinuria, unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
N39.2 Orthostatic proteinuria, unspecified GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 10,000 3,000 7,000
M23.20Derangement of meniscus due to old tear or injury; Old
bucket-handle tear multiple sitesHAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.21
Derangement of meniscus due to old tear or injury; Old
bucket-handle tear Anterior cruciate ligament or Anterior
horn of medial meniscus
HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.22
Derangement of meniscus due to old tear or injury; Old
bucket-handle tear Posterior cruciate ligament or Posterior
horn of medial meniscus
HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.25Derangement of meniscus due to old tear or injury; Old
bucket-handle tear Posterior horn of lateral meniscusHAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.46 Loose body in knee Other and unspecified lateral meniscus HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.5 Chronic instability of knee HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.80Other internal derangements of knee; Laxity of ligament of
knee; Snapping knee multiple sitesHAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.9 Internal derangement of knee, unspecified HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M23.91Internal derangement of knee, unspecified Anterior
cruciate ligament or Anterior horn of medial meniscusHAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.08 Loose body in joint other sites HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.1 Other articular cartilage disorders HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.2Disorder of ligament; Instability secondary to old ligament
injury; Ligamentous laxity NOS HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.4 Recurrent dislocation and subluxation of joint HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.41Recurrent dislocation and subluxation of joint shoulder
regionHAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.50 Contracture of joint multiple sites HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.54 Contracture of joint hand HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.56 Contracture of joint lower leg HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.6 Ankylosis of joint HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.65 Ankylosis of joint pelvic region and thigh HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.66 Ankylosis of joint lower leg HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.69 Ankylosis of joint site unspecified HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
M24.7 Protrusio acetabuli HAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
Page 41 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M24.88Other specific joint derangements, not elsewhere classified;
Irritable hip other sitesHAND, FEET AND JOINT DEFORMITIES 9,200 2,760 6,440
G43.0 Migraine without aura [common migraine] HEADACHE SYNDROMES 5,500 1,650 3,850
G43.1
Migraine with aura [classical migraine]; Migraine aura
without headache; Migraine, basilar; Migraine equivalents;
Familial hemiplegic Migraine; Migraine with acute-onset
aura; Migraine with prolonged aura; Migraine with typical
aura
HEADACHE SYNDROMES 5,500 1,650 3,850
G43.2 Status migrainosus HEADACHE SYNDROMES 5,500 1,650 3,850
G43.3 Complicated migraine HEADACHE SYNDROMES 5,500 1,650 3,850
G43.8Other migraine; Ophthalmoplegic migraine; Retinal
migraineHEADACHE SYNDROMES 5,500 1,650 3,850
G43.9 Migraine, unspecified HEADACHE SYNDROMES 5,500 1,650 3,850
G44.0
Cluster headache syndrome; Chronic paroxysmal
hemicrania; Chronic cluster headache; Episodic Cluster
headache
HEADACHE SYNDROMES 5,500 1,650 3,850
G44.1Vascular headache, not elsewhere classified; Vascular
headache NOSHEADACHE SYNDROMES 5,500 1,650 3,850
G44.2Tension-type headache; Chronic tension-type headache;
Episodic tension headache; Tension headache NOSHEADACHE SYNDROMES 5,500 1,650 3,850
G44.3 Chronic post-traumatic headache HEADACHE SYNDROMES 5,500 1,650 3,850
G44.4 Drug-induced headache, not elsewhere classified HEADACHE SYNDROMES 5,500 1,650 3,850
G44.8 Other specified headache syndromes HEADACHE SYNDROMES 5,500 1,650 3,850
R51 Headache; Facial pain NOS HEADACHE SYNDROMES 5,500 1,650 3,850
I44.2Atrioventricular block, complete; Complete heart block
NOS; Third-degree blockHEART CONDUCTION DISORDERS 12,300 3,690 8,610
I44.3Other and unspecified atrioventricular block;
Atrioventricular block NOSHEART CONDUCTION DISORDERS 12,300 3,690 8,610
I44.4 Left anterior fascicular block HEART CONDUCTION DISORDERS 12,300 3,690 8,610
I45.5Other specified heart blockl; Sinoatrial NOS; Sinoauricular
blockHEART CONDUCTION DISORDERS 12,300 3,690 8,610
I45.6
Pre-excitation syndrome; Anomalous atrioventicular
excitation; Atrioventricular conduction, accelerated;
Atrioventicular conduction, accesory; Atrioventicular
conduction pre-excitation; Lown-Ganong-Levine syndrome;
Wolff-Parkinson-White syndrome
HEART CONDUCTION DISORDERS 12,300 3,690 8,610
I45.8Other specified conduction disorder; Atrioventricular [AV]
dissociation; Interference dissociationHEART CONDUCTION DISORDERS 12,300 3,690 8,610
I45.9Heart conduction disorders, unspecified; Heart block NOS;
Stokes-Adams syndromeHEART CONDUCTION DISORDERS 12,300 3,690 8,610
I09.9Rheumatic heart disease, unspecified; Rheumatic carditis;
Rheumatic heart failureHEART FAILURE 15,700 4,710 10,990
I50.0Congestive heart failure; Congestive heart disease; Right
venticular failure (secondary to left heart failure)HEART FAILURE 15,700 4,710 10,990
I50.1
Left ventricular failure; Acute oedema of lung with mention
of heart disease NOS or heart failure; Acute pulmonary
oedema with mention of heart disease NOS or heart failure;
Cardiac asthma with mention of heart disease NOS or heart
failure; Left heart failure with mention of heart disease NOS
or heart failure
HEART FAILURE 15,700 4,710 10,990
I50.9Heart failure, unspecified; Cardiac, heart or myocardial
failure NOSHEART FAILURE 15,700 4,710 10,990
I34.0
Mitral (valve) insufficiency; Incompetence mitral valve NOS
or of specified cause, except rheumatic; Regurgitation
mitral valve NOS or of specified cause, except rheumatic
HEART VALVE DISORDERS 8,400 2,520 5,880
I34.1 Mitral (valve) prolapse; Floppy mitral valve syndrome HEART VALVE DISORDERS 8,400 2,520 5,880
I34.2 Nonrheumatic mitral (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
I34.8 Other nonrheumatic mitral heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I34.9 Nonrheumatic mitral valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
I35.0 Aortic (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
I35.1
Aortic (valve) insufficiency; Incompetence Aortic valve NOS
or of specified cause, except rheumatic; Aortic valve
regurgitation NOS or of specified cause, except rheumatic
HEART VALVE DISORDERS 8,400 2,520 5,880
I35.2 Aortic (valve) stenosis with insufficiency HEART VALVE DISORDERS 8,400 2,520 5,880
I35.8 Other aortic heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I35.9 Aortic valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
I36.0 Nonrheumatic tricuspid (valve) stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
I36.1
Nonrheumatic tricuspid (valve) insufficiency; Incompetence
tricuspid valve of specified cause, except rheumatic;
Tricuspid valve regurgitation of specified cause, except
rheumatic
HEART VALVE DISORDERS 8,400 2,520 5,880
I36.8 Other nonrheumatic tricuspid valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I36.9 Nonrheumatic tricuspid valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
I37.0 Pulmonary valve stenosis HEART VALVE DISORDERS 8,400 2,520 5,880
Page 42 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I37.1
Pulmonary valve insufficiency; Incompetence pulmonary
valve NOS or specified cause, except rheumatic; Pulmonary
valve regurgitation NOS or of specified cause, except
rheumatic
HEART VALVE DISORDERS 8,400 2,520 5,880
I37.8 Other pulmonary heart valve disorders HEART VALVE DISORDERS 8,400 2,520 5,880
I37.9 Pulmonary valve disorder, unspecified HEART VALVE DISORDERS 8,400 2,520 5,880
T67.0Heat stroke and sunstroke; Heat apoplexy; Heat pyrexia;
Siriasis; ThermoplegiaHEAT EXHAUSTION 6,500 1,950 4,550
T67.1 Heat syncope; Heat collapse HEAT EXHAUSTION 6,500 1,950 4,550
T67.2 Heat cramp HEAT EXHAUSTION 6,500 1,950 4,550
T67.3Heat exhaustion, anhydrotic; Heat prostration due to water
depletionHEAT EXHAUSTION 6,500 1,950 4,550
T67.4Heat exhaustion due to salt depletion; Heat prostation due
to salt (and water) depletionHEAT EXHAUSTION 6,500 1,950 4,550
T67.5 Heat exhaustion, unspecified; Heat prostration NOS HEAT EXHAUSTION 6,500 1,950 4,550
T67.9 Effect of heat and light, unspecified HEAT EXHAUSTION 6,500 1,950 4,550
M25.00 Haemarthrosis multiple sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.01 Haemarthrosis shoulder region HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.05 Haemarthrosis pelvic region and thigh HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.06 Haemarthrosis lower leg HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.07 Haemarthrosis ankle and foot HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.08 Haemarthrosis other sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.09 Haemarthrosis site unspecified HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.38 Other instability of joint other sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.40 Effusion of joint multiple sites HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.41 Effusion of joint shoulder region HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.46 Effusion of joint lower leg HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
M25.47 Effusion of joint ankle and foot HEMARTHROSIS/JOINT EFFUSION 7,800 2,340 5,460
D59.3 Haemolytic-uraemic syndrome HEMOLYTIC UREMIC SYNDROME 20,200 6,060 14,140
O08.1
Delayed or excessive haemorrhage following abortion and
ectopic and molar pregnancy; Afibrinogenaemia;
Defibrination syndrome; Intravascular coagulation
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
O72.0
Third-stage haemorrhage; Haemorrhage associated with
retained, trapped or adherent placenta; Retained placenta
NOS
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
O72.1
Other immediate postpartum haemorrhage; Haemorrhage
following delivery of placenta; Postpartum atomic
haemorrhage NOS
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
O72.2
Delayed and secondary postpartum haemorrhage;
Haemorrhage associated with retained portions of placenta
or membranes; Retained products of concepcion NOS,
following delivery
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
O72.3Postpartum coagulation defects; Afibrinogenaemia
postpartum; Fibrinolysis postpartum
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
O73.0Retained placenta without haemorrhage; Placenta accreta
without haemorrhage
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
O73.1
Retained portions of placenta and membranes without
haemorrhage; Retained products of conception following
delivery, without haemorrhage
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD7,000 2,100 4,900
P50.0 Fetal blood loss from vasa praeviaHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P50.1 Fetal blood loss from ruptured cordHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P50.2 Fetal blood loss from placentaHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P50.9 Fetal blood loss, unspecified; Fetal haemorrhage NOSHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P51.9 Umbilical haemorrhage of newborn, unspecifiedHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P53Haemorrhagic disease of fetus and newborn; Vitamin K
deficiency of newborn
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.0 Neonatal haematemesisHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.2 Neonatal rectal haemorrhageHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.3 Other neonatal gastrointestinal haemorrhageHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.4 Neonatal adrenal haemorrhageHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.5
Neonatal cutaneous haemorrhage; Bruising in fetus or
newborn; Ecchymoses in fetus or newborn; Petechiae in
fetus or newborn; Superficial haematomata in fetus or
newborn
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.6 Neonatal vaginal haemorrhage; PseudomensesHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P54.8 Other specified neonatal haemorrhagesHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
Page 43 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
P54.9 Neonatal haemorrhage, unspecifiedHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P55.0 Rh isoimmunization of fetus and newbornHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P55.1 ABO isoimmunization of fetus and newbornHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P55.8 Other haemolytic diseases of fetus and newbornHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P55.9 Haemolytic disease of fetus and newborn, unspecifiedHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P61.0
Transient neonatal thrombocytopenia; neonatal
thrombocytopenia due to exchange transfusion; Neonatal
thrombocytopenia due to idiophatic maternal
thrombocytopenia; Neonatal thrombocytopenia due to
isoimmunization
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P61.1 Polycythaemia neonatorumHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P61.5 Transient neonatal neutropeniaHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P61.6 Other transient neonatal disorders of coagulationHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P61.8 Other specified perinatal haematological disordersHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
P61.9 Perinatal haematological disorder, unspecifiedHEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN7,800 2,340 5,460
D66
Hereditary factor VIII deficiency; Deficiency factor VIII (with
functional defect); Haemophilia NOS; Haemophilia A;
Classical Haemophilia
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D67
Hereditary factor IX deficiency; Christmas disease; Factor IX
Deficiency (with functional defect); Plasma thromboplastin
component [PTC] Deficiency; Haemophilia B
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.0Von Willebrand's disease; Angiohaemophilia; Factor VIII
deficiency with vascular defect; Vascular haemophiliaHEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.1Hereditary factor XI deficiency; Haemophilia C Plasma
thromoplastin antecedent [PTA] deficiencyHEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.2
Hereditary deficiency of other clotting factors; Congenital
afibrinogenaemia; AC globulin Deficiency; Proaccelerin
Deficiency; Deficiency of factor I [fibrinogen]; Deficiency of
factor II [prothrombin]; Deficiency of factor V [labile];
Deficiency of factor VII [stable]; Deficiency of factor X
[Stuart-Prower]; Deficiency of XII [hageman]; XIII [fibrin-
stabilizing]; Congenital dysfibrinogenaemia;
Hypoproconvertinaemia; Owren's disease
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.3
Haemorrhagic disorder due to circulating anticoagulants;
Haemorrhage during long term use of anticoagulants;
Hyperheparinaemia; Increase in antithrombin; Increase in
anti-VIIIa; Increase in anti-Ixa; Increase in anti-Xa; Increase
in anti-Xia
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.4
Acquired coagulation factor deficiency; Deficiency of
coagulation factor due to liver disease; Deficiency of
coagulation factor due to vitamin K deficiency
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.8Other specified coagulation defects; Presence of systemic
lupus erythematosus [SLE] inhibitorHEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D68.9 Coagulation defect, unspecified HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D69.0
Allergic purpura; Anaphylactoid Purpura; Henoch(-
Schönlein) Purpura; Nonthrombocytopenic Purpura;
Haemorrhagic Purpura; Idiopathic Purpura; Vascular
Purpura; AllergicVasculitis
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D69.1
Qualitative platelet defects; Bernard-Soulier [giant platelet]
syndrome; Glanzmann's disease; Grey platelet syndrome;
Haemorrhagic Thromboasthenia; Hereditary
Thromboasthenia; Thrombocytopathy ;
HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D69.2Other nonthrombocytopenic purpura; Purpura NOS; Senile
Purpura; Simplex PurpuraHEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D69.3 Idiopathic thrombocytopenic purpura; Evans' syndrome HEMORRHAGIC CONDITIONS 12,800 3,840 8,960
D69.8Other specified haemorrhagic conditions; Hereditary
Capillary fragility; Vascular pseudohaemophiliaHEMORRHAGIC CONDITIONS 12,800 3,840 8,960
K70.4
Alcoholic hepatic failure; Alcoholic hepatic failure NOS;
Acute alcoholic hepatic failure; Chronic alcoholic hepatic
failure; Subacute alcoholic hepatic failure; Alcoholic hepatic
failure with or without hepatic coma
HEPATIC FAILURE 20,600 6,180 14,420
K72.0Acute and subacute hepatic failure
Acute hepatitisHEPATIC FAILURE 20,600 6,180 14,420
Page 44 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K72.1 Chronic hepatic failure HEPATIC FAILURE 20,600 6,180 14,420
K72.9Hepatic failure, unspecified
Liver necrosisHEPATIC FAILURE 20,600 6,180 14,420
O01.0 Classical hydatidiform mole; Complete hydatidiform mole HYDATIDIFORM MOLE 6,600 1,980 4,620
O01.1 Incomplete and partial hydatidiform mole HYDATIDIFORM MOLE 6,600 1,980 4,620
O01.9Hydatidiform mole, unspecified; Trophoblastic disease
NOS; Vesicular mole NOSHYDATIDIFORM MOLE 6,600 1,980 4,620
G91.0 Communicating hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.1 Obstructive hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.2 Normal-pressure hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.3 Post-traumatic hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110
G91.8 Other hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
G91.9 Hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110
Q03.8 Other congenital hydrocephalus HYDROCEPHALUS 17,300 5,190 12,110
Q03.9 Congenital hydrocephalus, unspecified HYDROCEPHALUS 17,300 5,190 12,110
P56.0 Hydrops fetalis due to isoimmunization HYDROPS FETALIS 7,400 2,220 5,180
P56.9Hydrops fetalis due to other and unspecified haemolytic
diseaseHYDROPS FETALIS 7,400 2,220 5,180
P83.2Hydrops fetalis not due to haemolytic disease; Hydrops
fetalis NOSHYDROPS FETALIS 7,400 2,220 5,180
I10.1 Hypertension, stage 2 HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I10.9
Hypertension
Essential hypertension
Malignant hypertension
HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I11.0Hypertensive heart disease with (congestive) heart failure;
Hypertensive heart failureHYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I11.9Hypertensive heart disease without (congestive) heart
failure; Hypertensive heart disease NOSHYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I12.0Hypertensive renal disease with renal failure; Hypertensive
renal failureHYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I12.9Hypertensive renal disease without renal failure;
Hypertensive renal disease NOSHYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I13.0Hypertensive heart and renal disease with (congestive)
heart failureHYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I13.1 Hypertensive heart and renal disease with renal failure HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I13.2Hypertensive heart and renal disease with both
(congestive) heart failure and renal failureHYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I13.9 Hypertensive heart and renal disease, unspecified HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.0 Renovascular hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.1 Hypertension secondary to other renal disorders HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.2 Hypertension secondary to endocrine disorders HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.8 Other secondary hypertension HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
I15.9 Secondary hypertension, unspecified HYPERTENSIVE EMERGENCY/URGENCY 9,000 2,700 6,300
E05.0Thyrotoxicosis with diffuse goitre; Exophthalmic or toxic
goitre NOS; Graves' disease; Toxic diffuse goitreHYPERTHYROIDISM 8,500 2,550 5,950
E05.1Thyrotoxicosis with toxic single thyroid nodule;
Thyrotoxicosis with toxic uninodular goitreHYPERTHYROIDISM 8,500 2,550 5,950
E05.2
Thyrotoxicosis with toxic multinodular goitre; Toxic nodular
goitre NOS
Thyroid nodules with hyperthyroidism
Toxic thyroid nodules
HYPERTHYROIDISM 8,500 2,550 5,950
E05.3 Thyrotoxicosis from ectopic thyroid tissue HYPERTHYROIDISM 8,500 2,550 5,950
E05.4 Thyrotoxicosis factitia HYPERTHYROIDISM 8,500 2,550 5,950
E05.5 Thyroid crisis or storm HYPERTHYROIDISM 8,500 2,550 5,950
E05.8Other thyrotoxicosis; Overproduction of thyroid-stimulating
hormoneHYPERTHYROIDISM 8,500 2,550 5,950
E05.9Thyrotoxicosis, unspecified; Hyperthyroidism NOS;
ThyroiditisHYPERTHYROIDISM 8,500 2,550 5,950
E01.0 Iodine-deficiency-related diffuse (endemic) goitre HYPOTHYROIDISM 8,100 2,430 5,670
E01.1Iodine-deficiency-related multinodular (endemic) goitre;
Iodine-deficiency-related nodular goitreHYPOTHYROIDISM 8,100 2,430 5,670
E01.2 Iodine-deficiency-related (endemic) goitre, unspecified HYPOTHYROIDISM 8,100 2,430 5,670
E01.8Other iodine-deficiency-related thyroid disorders and allied
conditions; Acquired iodine-deficiency hypothyroidism NOSHYPOTHYROIDISM 8,100 2,430 5,670
E02 Subclinical iodine-deficiency hypothyroidism HYPOTHYROIDISM 8,100 2,430 5,670
E03.2Hypothyroidism due to medicaments and other exogenous
substancesHYPOTHYROIDISM 8,100 2,430 5,670
E03.5 Myxoedema coma HYPOTHYROIDISM 8,100 2,430 5,670
E03.8 Other specified hypothyroidism HYPOTHYROIDISM 8,100 2,430 5,670
E03.9 Hypothyroidism, unspecified; HYPOTHYROIDISM 8,100 2,430 5,670
D80.0
Hereditary hypogammaglobulinaemia; Autosomal recessive
agammaglobulinaemia (Swiss type); X-linked
agammaglobulinaemia [Bruton] (with growth hormone
deficiency)
IMMUNODEFICIENCY 11,600 3,480 8,120
D80.2 Selective deficiency of immunoglobulin A [IgA] IMMUNODEFICIENCY 11,600 3,480 8,120
Page 45 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D80.7 Transient hypogammaglobulinaemia of infancy IMMUNODEFICIENCY 11,600 3,480 8,120
D80.8Other immunodeficiencies with predominantly antibody
defects; Kappa light chain deficiencyIMMUNODEFICIENCY 11,600 3,480 8,120
D80.9Immunodeficiency with predominantly antibody defects,
unspecifiedIMMUNODEFICIENCY 11,600 3,480 8,120
D81.1Severe combined immunodeficiency [SCID] with low T- and
B-cell numbersIMMUNODEFICIENCY 11,600 3,480 8,120
D81.6Major histocompatibility complex class I deficiency; Bare
lymphocyte syndromeIMMUNODEFICIENCY 11,600 3,480 8,120
D81.9Combined immunodeficiency, unspecified; Severe
combined immunodeficiency disorder [SCID] NOSIMMUNODEFICIENCY 11,600 3,480 8,120
D82.0Wiskott-Aldrich syndrome; Immunodeficiency with
thrombocytopenia and eczemaIMMUNODEFICIENCY 11,600 3,480 8,120
D82.1
Di George's syndrome; Pharyngeal pouch syndrome;
Thymic alymphoplasia; Thymic aplasia or hypoplasia with
immunodeficiency
IMMUNODEFICIENCY 11,600 3,480 8,120
D82.3Immunodeficiency following hereditary defective response
to Epstein-Barr virus; X-linked lymphoproliferative diseaseIMMUNODEFICIENCY 11,600 3,480 8,120
D82.4 Hyperimmunoglobulin E [IgE] syndrome IMMUNODEFICIENCY 11,600 3,480 8,120
D82.9Immunodeficiency associated with major defect,
unspecifiedIMMUNODEFICIENCY 11,600 3,480 8,120
D83.0Common variable immunodeficiency with predominant
abnormalities of B-cell numbers and functionIMMUNODEFICIENCY 11,600 3,480 8,120
D83.1Common variable immunodeficiency with predominant
immunoregulatory T-cell disordersIMMUNODEFICIENCY 11,600 3,480 8,120
D83.9 Common variable immunodeficiency, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
D84.8 Other specified immunodeficiencies IMMUNODEFICIENCY 11,600 3,480 8,120
D84.9 Immunodeficiency, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
D86.1 Sarcoidosis of lymph nodes IMMUNODEFICIENCY 11,600 3,480 8,120
D86.8Sarcoidosis of other and combined sites; Uveoparotid fever
[Heerfordt]IMMUNODEFICIENCY 11,600 3,480 8,120
D86.9 Sarcoidosis, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
D89.0
Polyclonal hypergammaglobulinaemia; Benign
hypergammaglobulinaemic purpura; Polyclonal
gammopathy NOS
IMMUNODEFICIENCY 11,600 3,480 8,120
D89.1
Cryoglobulinaemia; Essential Cryoglobulinaemia; Idiopathic
Cryoglobulinaemia; Mixed Cryoglobulinaemia; Primary
Cryoglobulinaemia; Secondary Cryoglobulinaemia;
Cryoglobulinaemic purpura; Cryoglobulinaemic vasculitis
IMMUNODEFICIENCY 11,600 3,480 8,120
D89.2 Hypergammaglobulinaemia, unspecified IMMUNODEFICIENCY 11,600 3,480 8,120
D89.8Other specified disorders involving the immune
mechanism, not elsewhere classifiedIMMUNODEFICIENCY 11,600 3,480 8,120
D89.9Disorder involving the immune mechanism, unspecified;
Immune disease NOSIMMUNODEFICIENCY 11,600 3,480 8,120
N48.0Leukoplakia of penis; Balanitis xerotica obliterans; Kraurosis
of penis
INFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N48.1 Balanoposthitis; BalanitisINFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N48.2
Other inflammatory disorders of penis; Abscess of corpus
cavernosum and penis; Boil of corpus cavernosum and
penis; Carbuncle of corpus cavernosum and penis; Cellulitis
of corpus cavernosum and penis; Cavernitis (penis) of
corpus cavernosum and penis
INFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N48.5 Ulcer of penisINFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N48.6Induratio penis plastica; Peyronie's disease; Plastic
induration of penis
INFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N49.0 Inflammatory disorders of seminal vesicle; Vesiculitis NOSINFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N49.1Inflammatory disorders of spermatic cord, tunica vaginalis
and vas deferens; Vasitis
INFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N49.2 Inflammatory disorders of scrotumINFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N49.8
Inflammatory disorders of other specified male genital
organs; Inflammation of multiple sites in male genital
organs
INFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
N49.9
Inflammatory disorder of unspecified male genital organ;
Abscess of unspecified male genital organ; Boil of
unspecified male genital organ; Carbuncle of unspecified
male genital organ; Cellulitis of unspecified male genital
organ
INFLAMMATION/INFECTION OF THE MALE
GENITAL TRACT9,000 2,700 6,300
Page 46 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K50.0
Crohn's disease of small intestine; Crohn's disease [regional
enteritis] of duodenum; Crohn's disease [regional enteritis]
of ileum; Crohn's disease [regional enteritis] of jejunum;
Regional ileitis; Terminal ileitis
INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K50.1
Crohn's disease of large intestine; Granulomatous colitis;
Regional colitis; Crohn's disease [regional enteritis] of
colon; Crohn's disease [regional enteritis] of large bowel;
Crohn's disease [regional enteritis] of rectum
INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K50.8Other Crohn's disease; Crohn's disease of both small and
large intestineINFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K50.9
Crohn's disease [regional enteritis], unspecified; Crohn's
disease NOS; Regional enteritis NOS; Granulomatous
enteritis NOS
INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.0 Ulcerative (chronic) enterocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.1 Ulcerative (chronic) ileocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.2 Ulcerative (chronic) proctitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.3 Ulcerative (chronic) rectosigmoiditis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.5 Mucosal proctocolitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.8 Other ulcerative colitis INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
K51.9 Ulcerative colitis, unspecified; Ulcerative enteritis NOS INFLAMMATORY BOWEL DISEASE 9,100 2,730 6,370
G04.0Acute disseminated encephalitis; Postimmunization
[Encephalitis; Postimmunization Encephalomyelitis
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G04.1 Tropical spastic paraplegiaINFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G04.2Bacterial meningoencephalitis and meningomyelitis, not
elsewhere classified
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G04.8Other encephalitis, myelitis and encephalomyelitis;
Postinfectious encephalitis and encephalomyelitis NOS
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G04.9Encephalitis, myelitis and encephalomyelitis, unspecified;
Ventriculitis (cerebral) NOS
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G05.8*Encephalitis, myelitis and encephalomyelitis in other
diseases classified elsewhere
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G07*Intracranial and intraspinal abscess and grauloma in
diseases classified elsewhere
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
G08
Intracranial and intraspinal phlebitis and thrombophlebitis;
Septic [embolism, endophlebitis, phlebitis,
thrombophlebitis, thrombosis] of intracranial or intraspinal
venous sinuses and veins
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
B05.0+ G05.1*Measles complicated by encephalitis; Encephalitis, myelitis
and encephalomyelitis in viral diseases classified elsewhere
INFLAMMATORY DISEASE OF THE CENTRAL
NERVOUS SYSTEM21,600 6,480 15,120
I30.0 Acute nonspecific idiopathic pericarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I30.1
Infective pericarditis; Pneumococcal pericarditis; Purulent
pericarditis; Staphylococcal pericarditis; Streptococcal
pericarditis; Viral pericarditis; Pyopericarditis
INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I30.8 Other forms of acute pericarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I30.9 Acute pericarditis, unspecified INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I31.0Chronic adhesive pericarditis; Accretio cordis; Adherent
pericardium; Adhesive mediastinopericarditisINFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I31.1Chronic constrictive pericarditis; Concretio cordis;
Pericardial calcificationINFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I33.0
Acute and subacute infective endocarditis; Acute bacterial
endocarditis; Subacute bacterial endocarditis; Acute
infective endocarditis NOS; Subacute infective endocarditis
NOS; Acute lenta endocarditis; Subacute lenta endocarditis;
Acute malignant endocarditis; Subacute malignant
endocarditis; Acute septic endocarditis; Subacute septic
endocarditis; Acute ulcerative endocarditis; Subacute
ulcerative endocarditis
INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I33.9
Acute endocarditis, unspecified; Endocarditis, acute or
subacute; Myoendocarditis, acute or subacute;
Periendocarditis, acute or subacute
INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I38
Endocarditis, valve unspecified; Chronic Endocarditis NOS;
Valvular incompetence of unspecified valve NOS or of
specified cause, except rheumatic or congenital; Valvular
insufficiency of unspecified valve NOS or of specified cause,
except rheumatic or congenital; Valvular regurgitation of
unspecified valve NOS or of specified cause, except
rheumatic or congenital; Valvular stenosis of unspecified
valve NOS or of specified cause, except rheumatic or
congenital; Chronic valvulitis of unspecified valve NOS or of
specified cause, except rheumatic or congenital
INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
Page 47 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I40.0 Infective myocarditis; Septic myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I40.1 Isolated myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I40.8 Other acute myocarditis INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
I40.9 Acute myocarditis, unspecified INFLAMMATORY DISEASES OF THE HEART 14,400 4,320 10,080
J09
Influenza due to identified zoonotic or pandemic influenza
virus; Influenza caused by influenza virus strains of special
epidemiological importance with an animal-human or inter-
human transimission
INFLUENZA 6,600 1,980 4,620
J10.0
Influenza with pneumonia, seasonal influenza virus
identified; Influenzal (broncho)pneumonia, other influenza
virus identified
INFLUENZA 6,600 1,980 4,620
J10.1
Influenza with other respiratory manifestations, seasonal
influenza virus identified; Influenza; Influenzal acute upper
respiratory infection, seasonal influenza virus identified;
Influenzal laryngitis, seasonal influenza virus identified;
Influenzal pharyngitis, seasonal influenza virus identified;
Influenzal pleural effusion, seasonal influenza virus
identified
INFLUENZA 6,600 1,980 4,620
J10.8
Influenza with other manifestations, seasonal influenza
virus identified; Encephalopathy due to influenza, seasonal
influenza virus identified; Influenzal gastroenteritis,
seasonal influenza virus identified; Influenzal myocarditis
(acute), seasonal influenza virus identified
INFLUENZA 6,600 1,980 4,620
J11.0
Influenza with pneumonia, virus not identified; Influenzal
(broncho) pneumonia, unspecified or specific virus not
identified
INFLUENZA 6,600 1,980 4,620
J11.1
Influenza with other respiratory manifestations, virus not
identified; Influenza NOS; Influenzal Acute upper
respiratory infection, unspecified or specific virus not
identified; Influenzal laryngitis, unspecified or specific virus
not identified; Influenzal pharyngitis, unspecified or specific
virus not identified; Influenzal pleural effusion, unspecified
or specific virus not identified
INFLUENZA 6,600 1,980 4,620
J11.8
Influenza with other manifestations, virus not identified;
Encephalopathy due to influenza, unspecified or specific
virus not identified; Influenzal gastroentiritis, unspecified or
specific virus not identified; Acute influenzal myocarditis,
unspecified or specific virus not identified
INFLUENZA 6,600 1,980 4,620
J11.8+ I41.1* Influenzal myocarditis (acute), virus not identified INFLUENZA 6,600 1,980 4,620
T66 Unspecified effects of radiationINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T67.6 Heat fatigue, transientINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T67.8 Other effects of heat and lightINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T68 HypothermiaINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T69.0 Immersion hand and foot; Trench footINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T69.9 Effect of reduced temperature, unspecifiedINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T70.0
Otitic barotrauma; Aero-otitis media; Effects of change in
ambient atmospheric pressure or water pressure on ears/
on sinuses
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T70.2
Other and unspecified effects of high altitude; Alpine
sickness; Anoxia due to high altitude; Barotrauma NOS;
Hypobaropathy; Mountain sickness
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T70.3Caisson disease [decompression sickness]; Compressed-air
disease; Diver's palsy or paralysis
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T70.4Effects of high-pressure fluids; Traumatic jet injection
(industrial)
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T70.8Other effects of air pressure and water pressure; Blast
injury syndrome
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T70.9 Effect of air pressure and water pressure, unspecifiedINJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T75.2Effects of vibration; Pneumatic hammer syndrome;
Traumatic vasospastic syndrome; Vertigo from infrasound
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
T75.8
Other specified injuries due to environmental and other
external factors causes; Effects of abnormal gravitation [G]
forces; Effects of weightlessness
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES9,300 2,790 6,510
S14.0 Concussion and oedema of cervical spinal cord INJURIES TO NEURAL STRUCTURES AND NERVES 18,400 5,520 12,880
S34.0 Concussion and oedema of lumbar spinal cord INJURIES TO NEURAL STRUCTURES AND NERVES 18,400 5,520 12,880
Page 48 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
S16 Injury of muscle and tendon at neck levelINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S39.0Injury of muscle and tendon of abdomen, lower back and
pelvis
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S43.0Dislocation of shoulder joint; Dislocation of Glenohumeral
joint
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S43.4
Sprain and strain of shoulder joint; sprain and strain of
Coracohumeral (ligament); Sprain and strain of Rotator cuff
capsule
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S43.5Sprain and strain of acromioclavicular joint; sprain and
strain of Acromioclavicular ligament
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S43.7Sprain and strain of other and unspecified parts of shoulder
girdle; Sprain and strain of shoulder girdle NOS
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S46.0 Injury of tendon of the rotator cuff of shoulderINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S46.1 Injury of muscle and tendon of long head of bicepsINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S46.2 Injury of muscle and tendon of other parts of bicepsINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S46.7Injury of multiple muscles and tendons at shoulder and
upper arm level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S46.8Injury of other muscles and tendons at shoulder and upper
arm level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S46.9Injury of unspecified muscle and tendon at shoulder and
upper arm level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S53.4 Sprain and strain of elbowINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S56.0Injury of flexor muscle and tendon of thumb at forearm
level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S56.1Injury of long flexor muscle and tendon of other finger(s) at
forearm level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S56.2 Injury of other flexor muscle and tendon at forearm levelINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S56.3Injury of extensor or abductor muscles and tendons of
thumb at forearm level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S63.5
Sprain and strain of wrist; Sprain and strain of Carpal joint;
Sprain and strain of Radiocarpal joint; Sprain and strain of
Radiocarpal ligament
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S63.6
Sprain and strain of finger(s); Sprain and strain of
Interphalangeal joint, hand; Sprain and strain
Metacarpophalangeal joint; Sprain and strain of Phalanx,
hand; Sprain and strain of Thumb
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S63.7 Sprain and strain of other and unspecified parts of handINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S66.1Injury of flexor muscle and tendon of other finger at wrist
and hand level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S66.3Injury of extensor muscle and tendon of other finger at
wrist and hand level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S66.5Injury of intrinsic muscle and tendon of other finger at wrist
and hand level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S66.6Injury of multiple flexor muscles and tendons at wrist and
hand level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S66.8 Injury of other muscles and tendons at wrist and hand levelINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S66.9Injury of unspecified muscle and tendon at wrist and hand
level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S73.1 Sprain and strain of hipINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S76.1Injury of quadriceps muscle and tendon; injury of Patellar
ligament (tendon)
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S76.2 Injury of adductor muscle and tendon of thighINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S76.3Injury of muscle and tendon of the posterior muscle group
at thigh level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S76.4Injury of other and unspecified muscles and tendons at
thigh level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S83.4
Sprain and strain involving fibular collateral ligament of
knee; Sprain and strain involving tibial collateral ligament of
knee
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S83.5
Sprain and strain involving anterior cruciate ligament of
knee; Sprain and strain involving posterior cruciate
ligament of knee
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S83.6Sprain and strain of other and unspecified parts of knee;
Tibiofibular joint and ligament, superior
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S86.8 Injury of other muscles and tendons at lower leg levelINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
Page 49 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
S86.9 Injury of unspecified muscle and tendon at lower leg levelINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S93.4
Sprain and strain of ankle including Calcaneofibular
(ligament), Deltoid (ligament), Internal collateral (ligament),
Talofibular (ligament), Tibiofibular , distal (ligament)
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S93.5Sprain and strain of toe(s) including Interphalangeal
(joint(s), metatarsophalangeal (joint(s)
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S93.6Sprain and strain of other and unspecified parts of foot
including Tarsal (ligament), Tarsometatarsal (ligament)
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S96.0Injury of muscle and tendon of long flexor muscle of toe at
ankle and foot level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
S96.9Injury of unspecified muscle and tendon at ankle and foot
level
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
T03.9 Multiple dislocations, sprains and strains, unspecifiedINJURIES TO THE MUSCLES AND TENDONS AND
JOINTS7,200 2,160 5,040
J81Pulmonary oedema; Acute oedema of lung; Passive
pulmonary congestion; Lung dropsyINTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
J82
Pulmonary eosinophilia, not elsewhere classified;
Eosinophilic asthma; Loffler's pneumonia; Tropical
pulmonary eosinophilia NOS
INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
J84.0Alveolar and parietoalveolar conditions; Alveolar
proteinosis; Pulmonary alveolar microlithiasisINTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
J84.1
Other interstitial pulmonary diseases with fibrosis; Diffuse
pulmonary fibrosis; Cryptogenic fibrosing alveolitis;
Hamman-Rich syndrome; Idiopathic pulmonary fibrosis
INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
J84.8 Other specified interstitial pulmonary diseases INTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
J84.9Interstitial pulmonary disease, unspecified; Interstitial
pneumonia NOSINTERSTITIAL PULMONARY DISEASE 14,000 4,200 9,800
K55.0
Acute vascular disorders of intestine; Acute fulminant
ischaemic colitis; Acute intestinal infarction; Acute small
intestine ischaemia; Mesentric artery embolism; Mesentric
vein embolism; Mesentric artery infarction; Mesentric vein
infarction; Mesentric artery thrombosis; Mesenteric vein
thrombosis; Subacute ischaemic colitis
INTESTINAL DISORDERS 9,500 2,850 6,650
K55.1
Chronic vascular disorders of intestine; Chronic ischaemic
colitis; Chronic ischaemic enteritis; Chronic ischaemic
enterocolitis; Ischaemic stricture of intestine; Mesentric
atherosclerosis; Mesentric vascular insufficiency
INTESTINAL DISORDERS 9,500 2,850 6,650
K55.2 Angiodysplasia of colon; Angiodysplasia of intestine NOS INTESTINAL DISORDERS 9,500 2,850 6,650
K55.9Vascular disorder of intestine, unspecified; Ischaemic colitis
NOS; Ischaemic enteritis NOS; Ischaemic enterocolitis NOSINTESTINAL DISORDERS 9,500 2,850 6,650
K57.0
Diverticular disease of small intestine with perforation and
abscess; Diverticular disease of small intestine with
peritonitis
INTESTINAL DISORDERS 9,500 2,850 6,650
K57.1Diverticular disease of small intestine without perforation
or abscess; Diverticular disease of small intestine NOSINTESTINAL DISORDERS 9,500 2,850 6,650
K57.2
Diverticular disease of large intestine with perforation and
abscess; Diverticular disease/ Diverticulitis/ Diverticulosis/
Diverticulum of colon with peritonitis
INTESTINAL DISORDERS 9,500 2,850 6,650
K57.3Diverticular disease of large intestine without perforation
or abscess; Diverticular disease of colon NOSINTESTINAL DISORDERS 9,500 2,850 6,650
K57.4
Diverticular disease of both small and large intestine with
perforation and abscess; Diverticular disease of both small
and large intestine with peritonitis
INTESTINAL DISORDERS 9,500 2,850 6,650
K57.5
Diverticular disease of both small and large intestine
without perforation or abscess; Diverticular disease of both
small and large intestine NOS
INTESTINAL DISORDERS 9,500 2,850 6,650
K57.8
Diverticular disease of intestine, part unspecified, with
perforation and abscess; Diverticular disease of intestine
NOS with peritonitis
INTESTINAL DISORDERS 9,500 2,850 6,650
K57.9Diverticular disease of intestine, part unspecified, without
perforation or abscess; Diverticular disease of intestine NOSINTESTINAL DISORDERS 9,500 2,850 6,650
K59.3Megacolon, not elsewhere classified; Dilatation of colon;
Toxic megacolonINTESTINAL DISORDERS 9,500 2,850 6,650
K59.8Other specified functional intestinal disorders; Atony of
colonINTESTINAL DISORDERS 9,500 2,850 6,650
K59.9 Functional intestinal disorder, unspecified INTESTINAL DISORDERS 9,500 2,850 6,650
K63.0 Abscess of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
Page 50 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K63.1 Nontraumatic perforation of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.2 Fistula of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.3 Ulcer of intestine; Primary ulcer of small intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.4 Enteroptosis INTESTINAL DISORDERS 9,500 2,850 6,650
K63.5 Polyp of colon INTESTINAL DISORDERS 9,500 2,850 6,650
K63.8 Other specified diseases of intestine INTESTINAL DISORDERS 9,500 2,850 6,650
K63.9 Disease of intestine, unspecified INTESTINAL DISORDERS 9,500 2,850 6,650
B05.4 Measles with intestinal complications INTESTINAL DISORDERS 9,500 2,850 6,650
K90.0Coeliac disease; Gluten-sensitive enteropathy; Idiopathic
steatorrhoea; Nontropical sprueINTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.1 Tropical sprue; Sprue NOS; Tropical steatorrhoea INTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.2Blind loop syndrome, not elsewhere classified; Blind loop
syndrome NOSINTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.3 Pancreatic steatorrhoea INTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.4
Malabsorption due to intolerance, not elsewhere classified;
Malabsorption due to intolerance to carbohydrate;
Malabsorption due to intolerance to fat; Malabsorption
due to intolerance to protein; Malabsorption due to
intolerance to starch
INTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.8 Other intestinal malabsorption INTESTINAL MALABSORPTION 4,100 1,230 2,870
K90.9 Intestinal malabsorption, unspecified INTESTINAL MALABSORPTION 4,100 1,230 2,870
K56.0Paralytic ileus; Paralysis of bowel; Paralysis of colon;
Paralysis of intestineINTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.1
Intussusception; Intussusception or invagination of bowel;
Intussusception or invagination of colon; Intussusception or
invagination of intestine; Intussusception or invagination of
rectum
INTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.2Volvulus; Strangulation of colon or intestine; Torsion of
colon or intestine; Twist of colon or intestineINTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.3 Gallstone ileus; Obstruction of intestine by gallstone INTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.4Other impaction of intestine; Enterolith; Impaction of
colon; Impaction of faecalINTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.5Intestinal adhesions [bands] with obstruction; Peritoneal
adhesions [bands] with intestinal obstructionINTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.6
Other and unspecified intestinal obstruction; Enterotenosis;
Obstructive ileus NOS; Occlusion of colon or intestine;
Stenosis of colon or intestine; Stricture of colon or intestine
INTESTINAL OBSTRUCTION 10,100 3,030 7,070
K56.7 Ileus, unspecified INTESTINAL OBSTRUCTION 10,100 3,030 7,070
G06.0
Intracranial abscess and granuloma; Abscess (embolic)(of)
brain [any part]; Abscess (embolic)(of) cerebellar; Abscess
(embolic)(of) cerebral; Abscess (embolic)(of) otogenic;
IIntracranial abscess or granuloma, epidural; Intracranial
abscess or granuloma, extradural; Intracranial abscess or
granuloma, subdural
INTRACRANIAL AND INTRASPINAL ABSCESS AND
GRANULOMA27,900 8,370 19,530
G06.1
Intraspinal abscess and granuloma; Abscess (embolic) of
spinal cord [any part]; Intraspinal abscess or granuloma
epidural; Intraspinal abscess or granuloma extradural;
Intraspinal abscess or granuloma subdural
INTRACRANIAL AND INTRASPINAL ABSCESS AND
GRANULOMA27,900 8,370 19,530
G06.2Encephalitis, myelitis and encephalomyelitis in Extradural
and subdural abscess, unspecified
INTRACRANIAL AND INTRASPINAL ABSCESS AND
GRANULOMA27,900 8,370 19,530
S04.0Injury of optic nerve and pathways; Injury of Optic chiasm;
Injury of 2nd cranial nerve; Injury of Visual cortexINTRACRANIAL INJURIES 8,800 2,640 6,160
S04.1 Injury of oculomotor nerve; injury of 3rd cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
S04.4 Injury of abducent nerve; injury of 6th cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
S04.5 Injury of facial nerve; injury of 7th cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
S04.6Injury of acoustic nerve; injury of Auditory nerve; injury of
8th cranial nerveINTRACRANIAL INJURIES 8,800 2,640 6,160
S04.8
Injury of other cranial nerves; injury of Glossopharyngeal
[9th] nerve; injury of Hypoglossal [12th] nerve; injury of;
injury of Olfactory [1st] nerve; injury of Vagus [10th] nerve
INTRACRANIAL INJURIES 8,800 2,640 6,160
S04.9 Injury of unspecified cranial nerve INTRACRANIAL INJURIES 8,800 2,640 6,160
S05.0Injury of conjunctiva and corneal abrasion without mention
of foreign bodyINTRACRANIAL INJURIES 8,800 2,640 6,160
S06.00Concussion; Commotio cerebri (without open intracranial
wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.01Concussion; Commotio cerebri (with open intracranial
wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.10Traumatic cerebral oedema (without open intracranial
wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
Page 51 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
S06.20
Diffuse brain injury; Cerebral contusion NOS; Cerebral
laceration NOS; Traumatic compression of brain NOS (with
open intracranial wound)
INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.21
Diffuse brain injury; Cerebral contusion NOS; Cerebral
laceration NOS; Traumatic compression of brain NOS
(without open intracranial wound)
INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.30
Focal brain injury; Focal cerebral; Focal cerebral contusion;
Focal cerebral laceration; Focal traumatic intracerebral
haemorrhage (without open intracranial wound)
INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.31
Focal brain injury; Focal cerebral; Focal cerebral contusion;
Focal cerebral laceration; Focal traumatic intracerebral
haemorrhage (with open intracranial wound)
INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.40Epidural haemorrhage; Extradural haemorrhage, traumatic
(without open intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.41Epidural haemorrhage; Extradural haemorrhage, traumatic
(with open intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.50Traumatic subdural haemorrhage (without open
intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.51Traumatic subdural haemorrhage (with open intracranial
wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.60Traumatic subarachnoid haemorrhage (without open
intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.61Traumatic subarachnoid haemorrhage (with open
intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.70Intracranial injury with prolonged coma (without open
intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.80
Other intracranial injuries; traumatic haemorrhage
cerebellar; traumatic haemorrhage intracranial NOS
(without open intracranial wound)
INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.81
Other intracranial injuries; traumatic haemorrhage
cerebellar; traumatic haemorrhage intracranial NOS (with
open intracranial wound)
INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.90Intracranial injury, unspecified; brain injury NOS (without
open intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S06.91Intracranial injury, unspecified; brain injury NOS (with open
intracranial wound)INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.0 Injury of blood vessels of head, not elsewhere classified INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.1 Injury of muscle and tendon of head INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.2 Traumatic rupture of ear drum INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.7 Multiple injuries of head INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.8 Other specified injuries of head INTRACRANIAL INJURIES 8,800 2,640 6,160
S09.9Unspecified injury of head; Injury of face NOS; Injury of ear
NOS; Injury of nose NOSINTRACRANIAL INJURIES 8,800 2,640 6,160
P52.0
Intraventricular (nontraumatic) haemorrhage, grade 1, of
fetus and newborn; Subependymal haemorrhage (without
intraventricular extension)
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.1
Intraventricular (nontraumatic) haemorrhage, grade 2, of
fetus and newborn; Subependymal haemorrhage with
intraventricular extension
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.3Unspecified intraventricular (nontraumatic) haemorrhage
of fetus and newborn
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.4Intracerebral (nontraumatic) haemorrhage of fetus and
newborn
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.5Subarachnoid (nontraumatic) haemorrhage of fetus and
newborn
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.6Cerebellar (nontraumatic) and posterior fossa haemorrhage
of fetus and newborn
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.8Other intracranial (nontraumatic) haemorrhages of fetus
and newborn
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
P52.9Intracranial (nontraumatic) haemorrhage of fetus and
newborn, unspecified
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
25,600 7,680 17,920
I21.0
Acute transmural myocardial infarction of anterior wall [or
duration of <4 weeks] KILLIPS stage unspecified; Acute
transmural infarction of anterior wall NOS [or duration of
<4 weeks] KILLIPS stage unspecified; Acute anteroapical;
anterolateral; anteroseptal transmural infarction [or
duration of <4 weeks] KILLIPS stage unspecified;
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
Page 52 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I21.1
Acute transmural myocardial infarction of inferior wall [or
duration of <4 weeks] KILLIPS I; Acute transmural infarction
of diaphragmatic wall [or duration of <4 weeks] KILLIPS I;
Acute transmural infarction of inferior wall NOS;
inferolateral; inferoposterior [or duration of <4
weeks]KILLIPS I;
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I21.2
Acute transmural myocardial infarction of other sites [or
duration of <4 weeks] KILLIPS II; Acute apical-lateral
transmural infarction [or duration of <4 weeks] KILLIPS II;
Acute basal-lateral transmural infarction [or duration of <4
weeks] KILLIPS II; high lateral; lateral wall NOS; posterior
(true); posterobasal; posterolateral; posteroseptal; septal
NOS
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I21.3Acute transmural myocardial infarction of unspecified site;
Transmural myocardial infarction NOS
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I21.4Acute subendocardial myocardial infarction;
Nontransmural myocardial infarction NOS
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I21.9
Acute myocardial infarction, unspecified [or duration of <4
weeks] KILLIPS I; Acute myocardial infarction NOS [or
duration of <4 weeks] KILLIPS I
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I22.0
Subsequent myocardial infarction of anterior wall; Acute
Subsequent infarction of anterior wall NOS; Acute
subsequent infarction of anteroapical wall; Acute
subsequent infarction of anterolateral wall; Acute
subsequent infarction of anteroseptal wall
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I22.1
Subsequent myocardial infarction of inferior wall; Acute
subsequent infarction of diaphragmatic wall; Acute
subsequent infarction of inferior wall NOS; Acute
subsequent infarction of inferolateral wall; Acute
subsequent infarction of inferoposterior wall
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I22.8
Subsequent myocardial infarction of other sites; Acute
myocardial infarction of apical-lateral wall; Acute
myocardial infarction of basal-lateral wall; Acute myocardial
infarction of high lateral wall; Acute myocardial infarction
of lateral wall NOS; posterior (true); posterobasal;
posterolateral; posteroseptal; septal NOS
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I22.9 Subsequent myocardial infarction of unspecified siteISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.0Haemopericardium as current complication following acute
myocardial infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.1Atrial septal defect as current complication following acute
myocardial infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.2Ventricular septal defect as current complication following
acute myocardial infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.3Rupture of cardiac wall without haemopericardium as
current complication following acute myocardial infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.4Rupture of chordae tendineae as current complication
following acute myocardial infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.5Rupture of papillary muscle as current complication
following acute myocardial infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I23.8Other current complications following acute myocardial
infarction
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I24.1 Dressler's syndrome; Postmyocardial infarction syndromeISCHEMIC HEART DISEASE WITH MYOCARDIAL
INFARCTION18,900 5,670 13,230
I20.0
Unstable angina; Angina crescendo; Angina de novo effort;
Angina worsening effort; Intermediate coronary syndrome;
Preinfarction syndrome
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I20.1
Angina pectoris with documented spasm; Angiospastic
Angina ; Prinzmetal Angina ; spasm-induced Angina ;
Variant Angina
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I20.8Other forms of angina pectoris; Angina of effort;
Stenocardia
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I20.9Angina pectoris, unspecified; Angina NOS; Cardiac Angina ;
Anginal syndrome; Ischaemic chest pain
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I24.0
Coronary thrombosis not resulting in myocardial infarction;
Coronary artery embolism not resulting in myocardial
infaction; Coronary vein embolism not resulting in
myocardial infarction; Coronary artery occlusion not
resulting in myocardial infarction; Coronary artery
thromboembolism not resulting in myocardial infarction;
Coronary vein thromboembolism not resulting in
myocardial infarction;
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I24.8Other forms of acute ischaemic heart disease; Coronary
failure; Coronary insufficiency
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
Page 53 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I25.5 Ischaemic cardiomyopathyISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I25.6 Silent myocardial ischaemiaISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I25.8 Other forms of chronic ischaemic heart diseaseISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
I25.9Chronic ischaemic heart disease, unspecified; Chronic
Ischaemic heart disease NOS
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL
INFARCTION12,000 3,600 8,400
P57.0 Kernicterus due to isoimmunization JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P57.8 Other specified kernicterus JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P57.9 Kernicterus, unspecified JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.1 Neonatal jaundice due to bleeding JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.2 Neonatal jaundice due to infection JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.3 Neonatal jaundice due to polycythaemia JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.4Neonatal jaundice due to drugs or toxins transmitted from
mother or given to newbornJAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.8Neonatal jaundice due to other specified excessive
haemolysisJAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P58.9 Neonatal jaundice due to excessive haemolysis, unspecified JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.0
Neonatal jaundice associated with preterm delivery;
Hyperbilirubinaemia of prematurity; Jaundice due to
delayed conjucation associated with preterm delivery
JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.1 Inspissated bile syndrome JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.2Neonatal jaundice from other and unspecified
hepatocellular damageJAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.3 Neonatal jaundice from breast milk inhibitor JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.8 Neonatal jaundice from other specified causes JAUNDICE IN THE NEWBORN 7,400 2,220 5,180
P59.9Neonatal jaundice, unspecified; Intense physiological
jaundice, NOS; Prolonged physiological jaundice, NOSJAUNDICE IN THE NEWBORN 7,400 2,220 5,180
A30.0 Hansen's disease: Indeterminate leprosy; I leprosy LEPROSY 8,800 2,640 6,160
A30.1 Hansen's disease : Tuberculoid leprosy; TT leprosy LEPROSY 8,800 2,640 6,160
A30.2Hansen's disease: Borderline tuberculoid leprosy; BT
leprosyLEPROSY 8,800 2,640 6,160
A30.4Hansen's disease: Borderline lepromatous leprosy; BL
leprosyLEPROSY 8,800 2,640 6,160
A30.5 Hansen's disease: Lepromatous leprosy; LL leprosy LEPROSY 8,800 2,640 6,160
A30.8 Other forms of leprosy LEPROSY 8,800 2,640 6,160
A30.9Leprosy, unspecified
Hansen DiseaseLEPROSY 8,800 2,640 6,160
A27.0Leptospirosis icterohaemorrhagica; Leptospirosis due to
Leptospira interrogans serovar icterohaemorrhagiaeLEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700
A27.8 Other forms of leptospirosis LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700
A27.9 Leptospirosis, unspecified LEPTOSPIROSIS MODERATE TO SEVERE 11,000 3,300 7,700
K70.0 Alcoholic fatty liver LIVER DISEASES I 11,800 3,540 8,260
K70.1 Alcoholic hepatitis LIVER DISEASES I 11,800 3,540 8,260
K70.2 Alcoholic fibrosis and sclerosis of liver LIVER DISEASES I 11,800 3,540 8,260
K70.3Alcoholic cirrhosis of liver; Alcoholic cirrhosis NOS;
Laennec's cirrhosisLIVER DISEASES I 11,800 3,540 8,260
K70.9 Alcoholic liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260
K71.0Toxic liver disease with cholestasis; Cholestatis with
hepatocyte injury; Pure cholestasisLIVER DISEASES I 11,800 3,540 8,260
K71.1Toxic liver disease with hepatic necrosis; Acute hepatic
failure due to drugs; Chronic hepatic failure due to drugsLIVER DISEASES I 11,800 3,540 8,260
K71.2 Toxic liver disease with acute hepatitis LIVER DISEASES I 11,800 3,540 8,260
K71.3 Toxic liver disease with chronic persistent hepatitis LIVER DISEASES I 11,800 3,540 8,260
K71.5Toxic liver disease with chronic active hepatitis; Toxic liver
disease with lupoid hepatitisLIVER DISEASES I 11,800 3,540 8,260
K71.6 Toxic liver disease with hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K71.8
Toxic liver disease with other disorders of liver; Toxic liver
disease with focal nodular hyperplasia; Toxic liver disease
with hepatic granulomas; Toxic liver disease with peliosis
hepatis; Toxic liver disease with veno-occlusive disease of
liver
LIVER DISEASES I 11,800 3,540 8,260
K71.9 Toxic liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260
K73.0 Chronic persistent hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K73.2Chronic active hepatitis, not elsewhere classified; Lupoid
hepatitis NECLIVER DISEASES I 11,800 3,540 8,260
K73.8 Other chronic hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K73.9 Chronic hepatitis, unspecified LIVER DISEASES I 11,800 3,540 8,260
K74.1 Hepatic sclerosis LIVER DISEASES I 11,800 3,540 8,260
K74.6+I98.2*Oesophageal varices in other and unspecified cirrhosis of
liverLIVER DISEASES I 11,800 3,540 8,260
Page 54 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K75.0
Abscess of liver; Hepatic abscess NOS; Cholangitic hepatic
abscess; Haematogenic hepatic abscess; Lymphogenic
hepatic abscess; Pylephlebitic hepatic abscess
LIVER DISEASES I 11,800 3,540 8,260
K75.1 Phlebitis of portal vein; Pylephlebitis LIVER DISEASES I 11,800 3,540 8,260
K75.2 Nonspecific reactive hepatitis LIVER DISEASES I 11,800 3,540 8,260
K75.3 Granulomatous hepatitis, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K75.4 Autoimmune hepatitis LIVER DISEASES I 11,800 3,540 8,260
K75.8Other specified inflammatory liver diseases
Non alcoholic Steatohepatitis (NASH)LIVER DISEASES I 11,800 3,540 8,260
K75.9 Inflammatory liver disease, unspecified; Hepatitis NOS LIVER DISEASES I 11,800 3,540 8,260
K76.0 Fatty (change of) liver, not elsewhere classified LIVER DISEASES I 11,800 3,540 8,260
K76.8Other specified diseases of liver; Focal nodular hyperplasia
of liver; HepatoptosisLIVER DISEASES I 11,800 3,540 8,260
K76.9 Liver disease, unspecified LIVER DISEASES I 11,800 3,540 8,260
K71.4 Toxic liver disease with chronic lobular hepatitis LIVER DISEASES II 15,100 4,530 10,570
K71.7 Toxic liver disease with fibrosis and cirrhosis of liver LIVER DISEASES II 15,100 4,530 10,570
K74.0 Hepatic fibrosis LIVER DISEASES II 15,100 4,530 10,570
K74.2 Hepatic fibrosis with hepatic sclerosis LIVER DISEASES II 15,100 4,530 10,570
K74.6
Other and unspecified cirrhosis of liver; Cirrhosis of liver
NOS; Cryptogenic cirrhosis of liver; Macronodular cirrhosis
of liver; Micronodular cirrhosis of liver; Mixed type cirrhosis
of liver; Portal cirrhosis of liver; Postnecrotic cirrhosis of
liver;
LIVER DISEASES II 15,100 4,530 10,570
K76.1Chronic passive congestion of liver; Cardiac cirrhosis (so-
called) of liver; Cardiac sclerosis of liverLIVER DISEASES II 15,100 4,530 10,570
K76.2 Central haemorrhagic necrosis of liver LIVER DISEASES II 15,100 4,530 10,570
K76.3 Infarction of liver LIVER DISEASES II 15,100 4,530 10,570
K76.4 Peliosis hepatis; Hepatic angiomatosis LIVER DISEASES II 15,100 4,530 10,570
K76.6 Portal hypertension LIVER DISEASES II 15,100 4,530 10,570
K76.7 Hepatorenal syndrome LIVER DISEASES II 15,100 4,530 10,570
I88.0Nonspecific mesenteric lymphadenitis; Acute Mesenteric
lymphadenitis; Chronic Mesenteric lymphadenitisLYMPHADENITIS 6,800 2,040 4,760
I89.1Lymphangitis; Lymphangitis NOS; Chronic Lymphangitis;
Subacute LymphangitisLYMPHATIC VESSELS DISORDER 8,900 2,670 6,230
I89.8
Other specified noninfective disorders of lymphatic vessels
and lymph nodes; Chylocele (nonfilarial); Lipomelanotic
reticulosis
LYMPHATIC VESSELS DISORDER 8,900 2,670 6,230
I89.9Noninfective disorder of lymphatic vessels and lymph
nodes, unspecified; Disease of lymphatic vessels NOSLYMPHATIC VESSELS DISORDER 8,900 2,670 6,230
C64Malignant neoplasm of kidney, except renal pelvis & renal
calycesMALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C65Malignant neoplasm of renal pelvis; Malignant neoplasm of
Pelviureteric junction; Malignant neoplasm of Renal calycesMALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C66 Malignant neoplasm of ureter MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.0 Malignant neoplasm of Trigone of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.1 Malignant neoplasm of Dome of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.2 Malignant neoplasm of Lateral wall of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.3 Malignant neoplasm of Anterior wall of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.5Malignant neoplasm of Bladder neck; Malignant neoplasm
of Internal urethral orificeMALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.6 Malignant neoplasm of Ureteric orifice MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.7 Malignant neoplasm of Urachus MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.8 Malignant neoplasm of Overlapping lesion of bladder MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C67.9 Malignant neoplasm of Bladder, unspecified MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C68.0 Malignant neoplasm of Urethra MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C68.9Malignant neoplasm of Urinary organ, unspecified;
Malignant neoplasm of Urinary system NOSMALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C79.0 Secondary malignant neoplasm of kidney and renal pelvis MALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C79.1Secondary malignant neoplasm of bladder and other and
unspecified urinary organsMALIGNANT NEOPLASM OF URINARY TRACT 14,100 4,230 9,870
C40.0Malignant neoplasm of Scapula and long bones of upper
limb
MALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C40.1 Malignant neoplasm of Short bones of upper limbMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C40.2 Malignant neoplasm of Long bones of lower limbMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C40.3 Malignant neoplasm of Short bones of lower limbMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C40.9Malignant neoplasm of Bone and articular cartilage of limb,
unspecified
MALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C41.0
Malignant neoplasm of Bones of skull and face; Malignant
neoplasm o f Superior maxilla; Malignant neoplasm of
Orbital bone
MALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
Page 55 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C41.1Malignant neoplasm of Mandible; Malignant neoplasm of
Lower jaw bone
MALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C41.2 Malignant neoplasm of Vertebral columnMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C41.3 Malignant neoplasm of Ribs, sternum and clavicleMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C41.4 Malignant neoplasm of Pelvic bones, sacrum and coccyxMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C41.8Malignant neoplasm of Overlapping lesion of bone and
articular cartilage
MALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C41.9Malignant neoplasm of Bone and articular cartilage,
unspecified
MALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C79.5 Secondary malignant neoplasm of bone and bone marrowMALIGNANT NEOPLASMS OF BONE AND
ARTICULAR CARTILAGE16,500 4,950 11,550
C70.0 Malignant neoplasm of Cerebral meningesMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C70.1 Malignant neoplasm of Spinal meningesMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C70.9 Malignant neoplasm of Meninges, unspecifiedMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.0Malignant neoplasm of Cerebrum, except lobes and
ventricles; Malignant neoplasm of Supratentorial NOS
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.1 Malignant neoplasm of Frontal lobeMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.2 Malignant neoplasm of Temporal lobeMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.3 Malignant neoplasm of Parietal lobeMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.4 Malignant neoplasm of Occipital lobeMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.5 Malignant neoplasm of Cerebral ventricleMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.6 Malignant neoplasm of CerebellumMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.7Malignant neoplasm of Brain stem; Malignant neoplasm of
Fourth Ventricle; Malignant neoplasm of Infratentorial NOS
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.8 Malignant neoplasm of Overlapping lesion of brainMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C71.9 Malignant neoplasm of Brain, unspecifiedMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.0 Malignant neoplasm of Spinal cordMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.1 Malignant neoplasm of Cauda equinaMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.2Malignant neoplasm of Olfactory nerve; Malignant
neoplasm of Olfactory bulb
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.3 Malignant neoplasm of Optic nerveMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.4 Malignant neoplasm of Acoustic nerveMALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.5Malignant neoplasm of Other and unspecified cranial
nerves; Malignant neoplasm of Cranial nerve NOS
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.8Malignant neoplasm of Overlapping lesion of brain and
other parts of central nervous system
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C72.9Malignant neoplasm of Central nervous system,
unspecified; Malignant neoplasm of Nervous system NOS
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C79.3Secondary malignant neoplasm of brain and cerebral
meninges
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C79.4Secondary malignant neoplasm of other and unspecified
parts of nervous system
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM16,900 5,070 11,830
C15.0 Malignant neoplasm of Cervical part of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.2 Malignant neoplasm of Abdominal part of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.3 Malignant neoplasm of Upper third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.4 Malignant neoplasm of Middle third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.5 Malignant neoplasm of Lower third of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.8 Malignant neoplasm of Overlapping lesion of oesophagus MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C15.9 Malignant neoplasm of Oesophagus, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Page 56 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C16 Dermato(poly)myositis in Malignant neoplasm of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.0
Malignant neoplasm of Cardia; Malignant neoplasm of
Cardiac orifice; Malignant neoplasm of Cardio-oesophageal
junction; Malignant neoplasm of
Gastro-oesophageal junction; Malignant neoplasm of
Oesophagus and stomach
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.1 Malignant neoplasm of Fundus of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.2 Malignant neoplasm of Body of stomach MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.3Malignant neoplasm of Pyloric antrum; Malignant
neoplasm of Gastric antrumMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.4Malignant neoplasm of Pylorus; Malignant neoplasm of
Prepylorus; Malignant neoplasm of pyloric canalMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.5Malignant neoplasm of Lesser curvature of stomach,
unspecifiedMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.6Malignant neoplasm of Greater curvature of stomach,
unspecifiedMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C16.9Malignant neoplasm of Stomach, unspecified; Gastric
cancer NOSMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.0 Malignant neoplasm of Duodenum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.1 Malignant neoplasm of Jejunum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.2 Malignant neoplasm of Ileum MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C17.9 Malignant neoplasm of Small intestine, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.0Malignant neoplasm of Caecum; Malignant neoplasm of
Ileocaecal valveMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.1 Malignant neoplasm of Appendix MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.2 Malignant neoplasm of Ascending colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.3 Malignant neoplasm of Hepatic flexure MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.4 Malignant neoplasm of Transverse colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.5 Malignant neoplasm of Splenic flexure MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.6 Malignant neoplasm of Descending colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.7Malignant neoplasm of Sigmoid colon; Malignant neoplasm
of Sigmoid flexureMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.8 Malignant neoplasm of Overlapping lesion of colon MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C18.9Malignant neoplasm of Colon, unspecified; Malignant
neoplasm of Large intestine NOSMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C19
Malignant neoplasm of rectosigmoid junction; Malignant
neoplasm of Colon with rectum; Malignant neoplasm of
Rectosigmoid colon
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C20Malignant neoplasm of rectum; Malignant neoplasm of
Rectal ampullaMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C21.0 Malignant neoplasm of Anus, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C21.1Malignant neoplasm of Anal canal; Malignant neoplasm of
Anal sphincterMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C21.8
Malignant neoplasm of Overlapping lesion of rectum, anus
and anal canal; Malignant neoplasm of Anorectal junction;
Malignant neoplasm of Anorectum
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.0Liver cell carcinoma; Hepatocellular carcinoma
HepatomaMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.1 Intrahepatic bile duct carcinoma; Cholangiocarcinoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.2 Hepatoblastoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.3 Angiosarcoma of liver; Kupffer cell sarcoma MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.4 Other sarcomas of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.7 Other specified carcinomas of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C22.9 Liver, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C23 Malignant neoplasm of gallbladder MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
Page 57 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C24.0
Malignant neoplasm of Extrahepatic bile duct; Malignant
neoplasm of Biliary duct or passage NOS; Malignant
neoplasm of Common bile duct; Malignant neoplasm of
Cystic duct; Malignant neoplasm of Hepatic duct
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C24.1 Malignant neoplasm of Ampulla of Vater MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C24.8 Malignant neoplasm of Overlapping lesion of biliary tract MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C24.9 Malignant neoplasm of Biliary tract, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.0 Malignant neoplasm of Head of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.1 Malignant neoplasm of Body of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.2 Malignant neoplasm of Tail of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.3 Malignant neoplasm of Pancreatic duct MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.4Malignant neoplasm of Endocrine pancreas; Malignant
neoplasm of Islets of LangerhansMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.7Malignant neoplasm of Other parts of pancreas; Malignant
neoplasm of Neck of pancreasMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.8 Malignant neoplasm of Overlapping lesion of pancreas MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C25.9 Malignant neoplasm of Pancreas, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C26.0Malignant neoplasm of Intestinal tract, part unspecified;
Malignant neoplasm of Intestine NOSMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C26.1 Malignant neoplasm of Spleen MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C26.8Malignant neoplasm of Overlapping lesion of digestive
systemMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C26.9
Malignant neoplasm of Ill-defined sites within the digestive
system; Malignant neoplasm of Alimentary canal or tract
NOS; Malignant neoplasm of Gastrointestinal tract NOS
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C45.1
Mesothelioma of peritoneum; Mesothelioma of Mesentery;
Mesothelioma of Mesocolon; Mesothelioma of Omentum;
Mesothelioma of Parietal
Peritoneum; Mesothelioma of Pelvic Peritoneum
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C48.1
Malignant neoplasm of Specified parts of peritoneum;
Malignant neoplasm of Mesentery; Malignant neoplasm of
Mesocolon; Malignant neoplasm of Omentum; Malignant
neoplasm of Parietal Peritoneum; Malignant neoplasm of
Pelvic peritoneum
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C48.2 Malignant neoplasm of Peritoneum, unspecified MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C76.2 Malignant neoplasm of Abdomen MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C77.2Secondary and unspecified malignant neoplasm of Intra-
abdominal lymph nodesMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C78.4 Secondary malignant neoplasm of small intestine MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C78.5Secondary malignant neoplasm of large intestine and
rectumMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C78.6Secondary malignant neoplasm of retroperitoneum and
peritoneum; Malignant ascites NOSMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C78.7 Secondary malignant neoplasm of liver MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C78.8Secondary malignant neoplasm of other and unspecified
digestive organsMALIGNANT NEOPLASMS OF DIGESTIVE ORGANS 14,200 4,260 9,940
C30.0
Malignant neoplasm of Nasal cavity; Malignant neoplasm of
Cartilage of nose; Malignant neoplasm of nasal Concha;
Malignant neoplasm of Internal nose; Malignant neoplasm
of Septum of nose; Malignant neoplasm of Vestibule of
nose
MALIGNANT NEOPLASMS OF EARS AND NOSE 10,300 3,090 7,210
C30.1
Malignant neoplasm of Middle ear; Malignant neoplasm of
Eustachian tube; Malignant neoplasm of Inner ear;
Malignant neoplasm of
Mastoid air cells
MALIGNANT NEOPLASMS OF EARS AND NOSE 10,300 3,090 7,210
C69.1 Malignant neoplasm of Cornea MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.2 Malignant neoplasm of Retina MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.3 Malignant neoplasm of Choroid MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.4Malignant neoplasm of Ciliary body; Malignant neoplasm
of EyeballMALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
Page 58 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C69.5
Malignant neoplasm of Lacrimal gland and duct; Malignant
neoplasm of Lacrimal sac; Malignant neoplasm of
Nasolacrimal duct
MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.6
Malignant neoplasm of Orbit; Malignant neoplasm of
Connective tissue of orbit; Malignant neoplasm of
Extraocular muscle; Malignant neoplasm of Peripheral
nerves of orbit; Malignant neoplasm of Retrobulbar tissue;
Malignant neoplasm of Retro-ocular tissue
MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C69.9 Malignant neoplasm of Eye, unspecified MALIGNANT NEOPLASMS OF EYE 16,900 5,070 11,830
C51.0Malignant neoplasm of Labium majus; Malignant neoplasm
of Bartholin's [greater vestibular] gland
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C51.1 Malignant neoplasm of Labium minusMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C51.2 Malignant neoplasm of ClitorisMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C51.9
Malignant neoplasm of Vulva, unspecified; Malignant
neoplasm of External female genitalia NOS; Malignant
neoplasm of Pudendum
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C52 Malignant neoplasm of vaginaMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C53.0 Malignant neoplasm of EndocervixMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C53.1 Malignant neoplasm of ExocervixMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C53.8 Malignant neoplasm of Overlapping lesion of cervix uteriMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C53.9 Malignant neoplasm of Cervix uteri, unspecifiedMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C54.0Malignant neoplasm of Isthmus uteri; Malignant neoplasm
of Lower uterine segment
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C54.1 Malignant neoplasm of EndometriumMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C54.2 Malignant neoplasm of MyometriumMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C54.3 Malignant neoplasm of Fundus uteriMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C54.8 Malignant neoplasm of Overlapping lesion of corpus uteriMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C54.9 Corpus uteri, unspecifiedMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C55 Malignant neoplasm of uterus, part unspecifiedMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C56 Malignant neoplasm of ovaryMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C57.0Malignant neoplasm of Fallopian tube; Malignant
neoplasm of Oviduct; Malignant neoplasm of Uterine tube
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C57.3Malignant neoplasm of Parametrium; Malignant neoplasm
of Uterine ligament NOS
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C57.4 Malignant neoplasm of Uterine adnexa, unspecifiedMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C57.7Malignant neoplasm of Other specified female genital
organs; Malignant neoplasm of Wolffian body or duct
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C57.8
Malignant neoplasm of Overlapping lesion of female genital
organs; Malignant neoplasm of Tubo-ovarian; Malignant
neoplasm of Utero-ovarian
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C57.9Malignant neoplasm of Female genital organ, unspecified;
Malignant neoplasm of Female genitourinary tract NOS
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C58Malignant neoplasm of placenta; Choriocarcinoma NOS;
Chorionepithelioma NOS
MALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C79.6 Secondary malignant neoplasm of ovaryMALIGNANT NEOPLASMS OF FEMALE GENITAL
TRACT11,400 3,420 7,980
C00.0
Malignant neoplasm of External upper lip; Malignant
neoplasm of Upper lip NOS; Malignant neoplasm of Upper
lip; Malignant neoplasm of lipstick area; Malignant
neoplasm of Upper lip, vermilion border
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C00.9 Malignant neoplasm of Lip, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C01
Malignant neoplasm of base of Dorsal surface of tongue ;
Malignant neoplasm of Fixed part of tongue NOS;
Malignant neoplasm of Posterior third of tongue
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C02.0
Malignant neoplasm of Dorsal surface of base of tongue;
Malignant neoplasm of Anterior two-thirds of dorsal
surface of tongue
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C02.1Malignant neoplasm of Border of tongue; Malignant
neoplasm of Tip of tongue
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
Page 59 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C02.2
Malignant neoplasm of Ventral surface of tongue;
Malignant neoplasm of Anterior two-thirds of ventral
surface of tongue; Malignant neoplasm of Frenulum
linguae
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C02.3
Malignant neoplasm of Anterior two-thirds of tongue, part
unspecified; Malignant neoplasm of Middle third of tongue
NOS; Malignant neoplasm of Mobile part of tongue NOS
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C02.4 Malignant neoplasm of Lingual tonsilMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C02.8 Malignant neoplasm of Overlapping lesion of tongueMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C02.9 Malignant neoplasm of Tongue, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C03.0 Malignant neoplasm of Upper gumMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C03.1 Malignant neoplasm of Lower gumMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C03.9 Malignant neoplasm of Gum, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C04.9 Malignant neoplasm of Floor of mouth, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C05.0 Malignant neoplasm of Hard palateMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C05.1 Malignant neoplasm of Soft palateMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C05.9 Malignant neoplasm of Palate, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C06.0
Malignant neoplasm of Cheek mucosa; Malignant neoplasm
of Buccal mucosa NOS; Malignant neoplasm of Internal
cheek
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C06.1
Malignant neoplasm of Vestibule of mouth; Malignant
neoplasm of Upper buccal sulcus; Malignant neoplasm of
Lower buccal sulcus; Malignant neoplasm of Upper Labial
sulcus; Malignant neoplasm of Lower Labial sulcus
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C06.2 Malignant neoplasm of Retromolar areaMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C06.9
Malignant neoplasm of Mouth, unspecified; Minor
Malignant neoplasm of minor salivary gland, unspecified
site; Malignant neoplasm of Oral cavity NOS
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C07 Malignant neoplasm of parotid glandMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C08.0Malignant neoplasm of Submandibular gland; Malignant
neoplasm of Submaxillary gland
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C08.1 Malignant neoplasm of Sublingual glandMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C08.9Malignant neoplasm of Major salivary gland, unspecified;
Malignant neoplasm of Major Salivary gland NOS
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C09.0 Malignant neoplasm of Tonsillar fossaMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C09.9
Malignant neoplasm of Tonsil, unspecified; Malignant
neoplasm of Tonsil NOS; Malignant neoplasm of Faucial
Tonsil; Malignant neoplasm of Palatine Tonsil
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C10.0 Malignant neoplasm of ValleculaMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C10.3 Malignant neoplasm of Posterior wall of oropharynxMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C10.4Malignant neoplasm of Branchial cleft; Malignant neoplasm
of Branchial cyst
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C10.9 Malignant neoplasm of Oropharynx, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C11.0Malignant neoplasm of Superior wall of nasopharynx;
Malignant neoplasm of Roof of nasopharynx
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C11.1
Malignant neoplasm of Posterior wall of nasopharynx;
Malignant neoplasm of Adenoid; Malignant neoplasm of
Pharyngeal tonsil
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C11.2
Malignant neoplasm of Lateral wall of nasopharynx;
Malignant neoplasm of Fossa of Rosenmüller; Malignant
neoplasm of Opening of auditory tube; Malignant
neoplasm of Pharyngeal recess
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
Page 60 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C11.3
Malignant neoplasm of Anterior wall of nasopharynx;
Malignant neoplasm of A nterior Nasopharyngeal surface
of soft palate; Malignant neoplasm of Posterior
Nasopharyngeal surface of soft palate; Malignant
neoplasm of Posterior margin of nasal choana; Malignant
of Posterior margin of nasal septum;
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C11.9 Malignant neoplasm of Nasopharynx, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C13.1
Malignant neoplasm of Aryepiglottic fold, hypopharyngeal
aspect hypopharynx ; Malignant neoplasm of Aryepiglottic
fold, hypopharynx NOS; Malignant neoplasm of
Aryepiglottic fold, marginal zone, hypopharynx
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C13.9Malignant neoplasm of Hypopharynx, unspecified;
Malignant neoplasm of Hypopharyngeal wall NOS
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C14.0 Malignant neoplasm of Pharynx, unspecifiedMALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C14.8Malignant neoplasm of Overlapping lesion of lip, oral cavity
and pharynx
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C76.0Malignant neoplasm of Head, face and neck; Malignant
neoplasm of Cheek NOS; Malignant neoplasm of Nose NOS
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
C77.0
Secondary and unspecified malignant neoplasm of Lymph
nodes of head, face and neck; Malignant neoplasm of
Supraclavicular lymph nodes
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX11,500 3,450 8,050
B21.1Human immunodeficiency virus [HIV] disease resulting in
Burkitt's lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
B21.2Human immunodeficiency virus [HIV] disease resulting in
other types of non-Hodgkin's lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
B21.3
Human immunodeficiency virus [HIV] disease resulting in
other malignant neoplasms of lymphoid, haematopoietic
and related tissue
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C81.0
Hodgkin's disease (Lymphocytic predominance); Hodgkin's
disease (Lymphocytic-histiocytic predominance)
Nodular lymphocyte predominant Hodgkin lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C81.1 Hodgkin's disease( Nodular sclerosis)MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C81.9 Hodgkin's disease, unspecifiedMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C82.0Small cleaved cell, follicular non-Hodgkin's lymphoma
Follicular lymphoma grade I
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C82.1
Mixed small cleaved non-Hodgkin's lymphoma and large
cell, follicular non-Hodgkin's lymphoma
Follicular lymphoma grade II
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C82.2Large cell, follicular non-Hodgkin's lymphoma
Follicular lymphoma grade III, unspecified
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C82.7 Other types of follicular non-Hodgkin's lymphomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C82.9Follicular non-Hodgkin's lymphoma, unspecified; Nodular
non-Hodgkin's lymphoma NOS
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C83.0Small cell diffuse non-Hodgkin's lymphoma
Small cell B-cell lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C83.2 Mixed small and large cell diffuse non-Hodgkin's lymphomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUEN/A N/A N/A
C83.3Large cell diffuse non-Hodgkin's lymphoma
Diffuse large B-cell lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C83.4 Immunoblastic diffuse non-Hodgkin's lymphomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUEN/A N/A N/A
C83.5 Lymphoblastic diffuse non-Hodgkin's lymphomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C83.7Burkitt's tumour
Burkitt"s lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C83.8Other types of diffuse non-Hodgkin's lymphoma
Other non-follicular lymphoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C83.9Diffuse non-Hodgkin's lymphoma, unspecified
Non-follicular lymphoma, unspecified
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C84.0 Mycosis fungoidesMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C84.1 Sézary's diseaseMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C84.3 Lymphoepithelioid lymphoma; Lennert's lymphomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUEN/A N/A N/A
C84.4 Peripheral T-cell lymphomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
Page 61 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C84.5 Other and unspecified T-cell lymphomasMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C85.0 LymphosarcomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUEN/A N/A N/A
C85.1 B-cell lymphoma, unspecifiedMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C85.7
Other specified types of non-Hodgkin's lymphoma;
Malignant reticuloendotheliosis; Malignant reticulosis;
Microglioma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C85.9Non-Hodgkin's lymphoma, unspecified type; Lymphoma
NOS
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C90.0 Multiple myeloma; Kahler's disease; MyelomatosisMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C90.1 Plasma cell leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C90.2Extramedullary Plasmacytoma; Malignant plasma cell
tumour NOS; Plasmacytoma NOS ; Solitary myeloma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.0 Acute lymphoblastic leukemia; Acute lymphocytic leukemia MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.1 Chronic lymphocytic leukaemia of B-cell typeMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.2 Subacute lymphocytic leukaemia of B-cell typeMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.3 Prolymphocytic leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.4 Hairy-cell leukaemia; Leukaemic reticuloendotheliosisMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.5 Adult T-cell leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.7 Other lymphoid leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C91.9 Lymphoid leukaemia, unspecifiedMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.0Acute myeloid leukaemia
Acute myeloblastic leukaemia
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.1 Chronic myeloid leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.2 Subacute myeloid leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.3 Myeloid sarcoma; Chloroma; Granulocytic sarcomaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.4 Acute promyelocytic leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.5 Acute myelomonocytic leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.7 Other myeloid leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C92.9 Myeloid leukaemia, unspecifiedMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C93.0 Acute monocytic leukaemiaMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C93.1Chronic monocytic leukaemia
Chronic myelomonocytic leukaemia
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C93.9 Monocytic leukaemia, unspecifiedMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C94.0
Acute erythraemia and erythroleukaemia; Acute
erythraemic myelosis; Di Guglielmo's disease
Acute erythroid leukaemia
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C94.2Acute megakaryoblastic leukaemia; Acute megakaryocytic
Leukaemia
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C94.4 Acute panmyelosisMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C94.5 Acute myelofibrosisMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C95.0Acute leukaemia of unspecified cell type; Blast cell
leukaemia; Stem cell leukaemia
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C95.1 Chronic leukaemia of unspecified cell typeMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C95.2 Subacute leukaemia of unspecified cell typeMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUEN/A N/A N/A
C95.7 Other leukaemia of unspecified cell typeMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C95.9 Leukaemia, unspecifiedMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C96.0Letterer-Siwe disease; Nonlipid reticuloendotheliosis;
Nonlipid reticulosis
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
Page 62 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C96.1 Malignant histiocytosis; Histiocytic medullary reticulosisMALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUEN/A N/A N/A
C96.2Malignant mast cell tumour; Malignant mastocytoma;
Malignant mastocytosis; Mast cell sarcoma
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C96.7Other specified malignant neoplasms of lymphoid,
haematopoietic and related tissue
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C96.9Malignant neoplasm of lymphoid, haematopoietic and
related tissue, unspecified
MALIGNANT NEOPLASMS OF LYMPHOID,
HEMATOPOIETIC AND RELATED TISSUE13,900 4,170 9,730
C60.9Malignant neoplasm of Penis, unspecified; Malignant
neoplasm of Skin of penis NOS
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C61 Malignant neoplasm of prostateMALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C62.0Malignant neoplasm of Undescended testis; Ectopic testis
; Malignant neoplasm of Retained testis
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C62.1Malignant neoplasm of Descended testis; Malignant
neoplasm of Scrotal Testis
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C62.9 Malignant neoplasm of Testis, unspecifiedMALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C63.0 Malignant neoplasm of EpididymisMALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C63.1 Malignant neoplasm of Spermatic cordMALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C63.2Malignant neoplasm of Scrotum; Malignant neoplasm of
Skin of scrotum
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C63.7Malignant neoplasm of Seminal vesicle; Malignant
neoplasm of Tunica vaginalis
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C63.9Malignant neoplasm of Male genital organ, unspecified;
Male genitourinary tract NOS
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT13,400 4,020 9,380
C45.2 Mesothelioma of pericardium MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C45.7 Mesothelioma of other sites MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C45.9 Mesothelioma, unspecified MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C48.0 Malignant neoplasm of Retroperitoneum MALIGNANT NEOPLASMS OF MESOTHELIUM 10,600 3,180 7,420
C76.3
Malignant neoplasm of Pelvis; Malignant neoplasm of
Groin NOS; Malignant neoplasm of
Sites overlapping systems within the pelvis, such as
rectovaginal (septum) & rectovesical (septum)
MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C76.4 Malignant neoplasm of Upper limb MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C76.5 Malignant neoplasm of Lower limb MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C76.7 Malignant neoplasm of Other ill-defined sites MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C76.8Malignant neoplasm of Overlapping lesion of other and ill-
defined sitesMALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C77.3
Secondary and unspecified malignant neoplasm of Axillary
and upper limb lymph nodes; Secondary and unspecified
malignant neoplasm of Pectoral lymph nodes
MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C77.9Secondary and unspecified malignant neoplasm of Lymph
node, unspecifiedMALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C79.7 Secondary malignant neoplasm of adrenal gland MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C79.8 Secondary malignant neoplasm of other specified sites MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C80
Malignant neoplasm without specification of site;
Unspecified site whether primary or secondary [Cancer,
Carcinoma, Carcinomatosis, Generalized cancer,
Generalized malignancy, Malignancy, Multiple cancer];
Malignant cachexia; Malignant neoplasm of Primary site
unknown
MALIGNANT NEOPLASMS OF OTHER SITES 16,100 4,830 11,270
C47.0Malignant neoplasm of Peripheral nerves of head, face and
neckMALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.1Malignant neoplasm of Peripheral nerves of upper limb,
including shoulderMALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.2Malignant neoplasm of Peripheral nerves of lower limb,
including hipMALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.3 Malignant neoplasm of Peripheral nerves of thorax MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.4 Malignant neoplasm of Peripheral nerves of abdomen MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.5 Malignant neoplasm of Peripheral nerves of pelvis MALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.6Malignant neoplasm of Peripheral nerves of trunk,
unspecifiedMALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C47.9Malignant neoplasm of Peripheral nerves and autonomic
nervous system, unspecifiedMALIGNANT NEOPLASMS OF PERIPHERAL NERVES 13,300 3,990 9,310
C32.0Malignant neoplasm of Glottis; Malignant neoplasm of
Intrinsic larynx; Malignant neoplasm of true Vocal cord NOS
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
Page 63 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C32.1
Malignant neoplasm of Supraglottis: Malignant neoplasm
of Aryepiglottic fold, laryngeal aspect; Malignant neoplasm
of Epiglottis (suprahyoid portion) NOS; Malignant neoplasm
of Extrinsic larynx; Malignant neoplasm of False vocal cord;
Malignant neoplasm of posterior laryngeal surface of
epiglottis; Malignant neoplasm of ventricular bands
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C32.2 Malignant neoplasm of SubglottisMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C32.3 Malignant neoplasm of Laryngeal cartilageMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C32.9 Malignant neoplasm of Larynx, unspecifiedMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C33 Malignant neoplasm of tracheaMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C34.0Malignant neoplasm of Main bronchus; Malignant
neoplasm of Carina; Malignant neoplasm of Hilus of lung
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C34.1 Malignant neoplasm of Upper lobe, bronchus or lungMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C34.2 Malignant neoplasm of Middle lobe, bronchus or lungMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C34.3 Malignant neoplasm of Lower lobe, bronchus or lungMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C34.8Malignant neoplasm of Overlapping lesion of bronchus and
lung
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C34.9 Malignant neoplasm of Bronchus or lung, unspecifiedMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C37 Malignant neoplasm of thymusMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C38.0Malignant neoplasm of Heart; Malignant neoplasm of
Pericardium
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C38.1 Malignant neoplasm of Anterior mediastinumMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C38.3 Malignant neoplasm of Mediastinum, part unspecifiedMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C38.4 Malignant neoplasm of PleuraMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C38.8Malignant neoplasm of Overlapping lesion of heart,
mediastinum and pleura
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C39.0Malignant neoplasm of Upper respiratory tract, part
unspecified
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C39.8Malignant neoplasm of Overlapping lesion of respiratory
and intrathoracic organs
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C39.9Malignant neoplasm of Ill-defined sites within the
respiratory system; Respiratory tract NOS
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C45.0 Mesothelioma of pleuraMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS10,600 3,180 7,420
C76.1
Malignant neoplasm of Thorax; Malignant neoplasm of
Axilla NOS; Malignant neoplasm of Intrathoracic NOS;
Malignant neoplasm of Thoracic NOS
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C77.1Secondary and unspecified malignant neoplasm of
Intrathoracic lymph nodes
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C78.0 Secondary malignant neoplasm of lungMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C78.1 Secondary malignant neoplasm of mediastinumMALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C78.2Secondary malignant neoplasm of pleura; Malignant pleural
effusion NOS
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C78.3Secondary malignant neoplasm of other and unspecified
respiratory organs
MALIGNANT NEOPLASMS OF RESPIRATORY AND
INTRATHORACIC ORGANS14,600 4,380 10,220
C31.0
Malignant neoplasm of Maxillary sinus; Malignant
neoplasm of Antrum (Highmore); Malignant neoplasm of
Antrum (maxillary)
MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.1 Malignant neoplasm of Ethmoidal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.2 Malignant neoplasm of Frontal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.3 Malignant neoplasm of Sphenoidal sinus MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.8Malignant neoplasm of Overlapping lesion of accessory
sinusesMALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
C31.9 Malignant neoplasm of Accessory sinus, unspecified MALIGNANT NEOPLASMS OF SINUSES 11,500 3,450 8,050
B21.0Human Immunodeficiency Virus [HIV] Disease resulting in
Kaposi's SarcomaMALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C46.9 Kaposi's sarcoma, unspecified MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.0
Malignant neoplasm of Connective and soft tissue of head,
face and neck; Malignant neoplasm of Connective tissue of
ear; Malignant neoplasm of Connective tissue of eyelid
MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
Page 64 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
C49.1Malignant neoplasm of Connective and soft tissue of upper
limb, including shoulderMALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.2Malignant neoplasm of Connective and soft tissue of lower
limb, including hipMALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.3
Malignant neoplasm of Connective and soft tissue of
thorax; Malignant neoplasm of Connective and soft tissue
of Axilla; Malignant neoplasm of Connective and soft tissue
of Diaphragm; Malignant neoplasm of Connective and soft
tissue of Great vessels
MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.4
Malignant neoplasm of Connective and soft tissue of
abdomen; Malignant neoplasm of Connective and soft
tissue of Abdominal wall; Malignant neoplasm of
Connective and soft tissue of Hypochondrium
MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.5
Malignant neoplasm of Connective and soft tissue of pelvis;
Malignant neoplasm of Connective and soft tissue of
Buttock; Malignant neoplasm of Connective and soft tissue
of Groin; Malignant neoplasm of Connective and soft
tissue of Perineum
MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.6
Malignant neoplasm of Connective and soft tissue of trunk,
unspecified; Malignant neoplasm of Connective and soft
tissue of Back NOS
MALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.8Malignant neoplasm of Overlapping lesion of connective
and soft tissueMALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C49.9Malignant neoplasm of Connective and soft tissue,
unspecifiedMALIGNANT NEOPLASMS OF SOFT TISSUES 12,000 3,600 8,400
C73 Malignant neoplasm of thyroid glandMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C74.0 Malignant neoplasm of Cortex of adrenal glandMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C74.1 Malignant neoplasm of Medulla of adrenal glandMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C74.9 Malignant neoplasm of Adrenal gland, unspecifiedMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C75.0 Malignant neoplasm of Parathyroid glandMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C75.1 Malignant neoplasm of Pituitary glandMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C75.3 Malignant neoplasm of Pineal glandMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C75.5 Malignant neoplasm of Aortic body and other paragangliaMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
C75.9 Malignant neoplasm of Endocrine gland, unspecifiedMALIGNANT NEOPLASMS OF THYROID AND
OTHER ENDOCRINE GLANDS11,400 3,420 7,980
E40 Kwashiorkor MALNUTRITION 11,700 3,510 8,190
E41 Nutritional marasmus; Severe malnutrition with marasmus MALNUTRITION 11,700 3,510 8,190
E42
Marasmic kwashiorkor; Severe protein-energy malnutrition,
intermediate form; Severe protein-energy malnutrition
with signs of both kwashiorkor and marasmus
MALNUTRITION 11,700 3,510 8,190
E43 Unspecified severe protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190
E44.0 Moderate protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190
E44.1 Mild protein-energy malnutrition MALNUTRITION 11,700 3,510 8,190
E45
Retarded development following protein-energy
malnutrition; Nutritional short stature; Nutritional
stunting; Physical retardation due to malnutrition
MALNUTRITION 11,700 3,510 8,190
E46Unspecified protein-energy malnutrition; Malnutrition NOS;
Protein-energy imbalance NOSMALNUTRITION 11,700 3,510 8,190
O10.0Pre-existing essential hypertension complicating pregnancy
child birth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O10.1Pre-existing hypertensive heart disease complicating
pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O10.2Pre-existing hypertensive renal disease complicating
pregnancy childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O10.3Pre-existing hypertensive heart and renal disease
complicating pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O10.4Pre-existing secondary hypertension complicating
pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O10.9Unspecified pre-existing hypertension complicating
pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O11Pre-existing hypertensive disorder with superimposed
proteinuriaMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O12.1 Gestational proteinuria MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O12.2 Gestational oedema with proteinuria MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O13
Gestational [pregnancy-induced] hypertension wihtout
significant proteinuria; Gestational hypertension NOS; Mild
pre-eclampsia
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Page 65 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O14.0 Moderate pre-eclampsia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O14.1 Severe pre-eclampsia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O14.9 Pre-eclampsia, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O15.0 Eclampsia in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O15.1 Eclampsia in labour MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O15.9 Eclampsia, unspecified as to time period; Eclampsia NOS MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O16 Unspecified maternal hypertension MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O20.0Threatened abortion; Haemorrhage specified as due to
threatened abortionMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O20.8 Other haemorrhage in early pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O20.9 Haemorrhage in early pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O21.0
Mild hyperemesis gravidarum; Hyperemesis gravidarum,
mild or unspecified, starting before the end of the 22nd
week of gestation
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O21.1
Hyperemesis gravidarum with metabolic disturbance;
Hyperemesis gravidarum, starting before the end of the
22nd week of gestation, with metabolic disturbance such as
carbohydrate depletion, dehydration, elctrolyte imbalance
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O21.2Late vomiting of pregnancy; Excessive vomiting starting
after 22 completed weeks of gestationMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O21.8Other vomiting complicating pregnancy; Vomiting due to
disease classified elsewhere, complicating pregnancyMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O21.9 Vomiting of pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O22.3Deep phlebothrombosis in pregnancy; Deep-vein
thrombosis, antepartumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O22.5Cerebral venous thrombosis in pregnancy; Cerebrovenous
sinus thrombosis in pregnancyMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O22.9
Venous complication in pregnancy, unspecified; Gestational
phlebitis NOS; Gestational phlebopathy NOS; Gestational
thrombosis NOS
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O23.0 Infections of kidney in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O23.3 Infections of other parts of urinary tract in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.0 Pre-existing diabetes mellitus, insulin-dependent MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.1 Pre-existing diabetes mellitus, non-insulin-dependent MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.2 Pre-existing malnutrition-related diabetes mellitus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.3 Pre-existing diabetes mellitus, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.4Diabetes mellitus arising in pregnancy; Gestational diabetes
mellitus NOSMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O24.9 Diabetes mellitus in pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.2 Pregnancy care of habitual aborter MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.3 Retained in trauterine contraceptive device in pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.4 Herpes gestationis MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.5Maternal hypotension syndrome; Supine hypotensive
syndromeMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.6 Liver disorders in pregnancy, childbirth and the puerperium MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.7Subluxation of symphysis (pubis) in pregnancy childbirth
and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.8
Other specified pregnancy-related conditions; Exhaustion
and fatigue pregnancy-related; Peripheral neuritis
pregnancy-related; Renal disease pregnancy-related
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O26.9 Pregnancy-relatedcondition, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O28.0Abnormal haematological finding on antenatal screening of
motherMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O28.3Abnormal ultrasonic finding on antenatal screening of
motherMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O28.5Abnormal chromosomal and genetic finding on antenatal
screening of motherMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O28.8 Other abnormal findings on antenatal screening of mother MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O28.9Abnormal finding on antenatal screening of mother,
unspecifiedMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O29.8 Other complications of anaesthesia during pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.0 Twin pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.1 Triplet pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.8 Other multiple gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O30.9 Multiple gestation, unspecified; Multiple pregnancy NOS MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O31.0 Papyraceous fetus; Fetus compressus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O31.1 Continuing pregnancy after abortion of one fetus or more MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Page 66 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O31.2Continuing pregnancy after intrauterine death of one fetus
or moreMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O31.8 Other complications specific to multiple gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.0 Maternal care for unstable lie MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.1 Maternal care for breech presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.2Maternal care for transverse and oblique lie; Oblique
presentation; Transverse presentationMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.3 Maternal care for face, brow and chin presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.4Maternal care for high head at term; Failure of head to
enter pelvic brimMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.5Maternal care for multiple gestation with malpresentation
of one fetus or moreMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.6 Maternal care for compound presentation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.8 Maternal care for other malpresentation of fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O32.9 Maternal care for malpresentation of fetus, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.0
Maternal care for disproportion due to deformity of
maternal pelvic bones; Pelvic deformity causing
disproportion NOS
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.1
Maternal care for disproportion due to generally
contracted pelvis; Contracted pelvis NOS causing
disproportion
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.2Maternal care for disproportion due to inlet contraction of
pelvis; Inlet contraction (pelvis) causing disproportionMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.3
Maternal care for disproportion due to outlet contraction
of pelvis; Mid-cavity contraction pelvis causing
disproportion; Outlet contraction pelvis causing
disproportion
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.4Maternal care for disproportion of mixed maternal and
fetal originMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.5
Maternal care for disproportion due to unusually large
fetus; Disproportion of fetal origin with normally formed
fetus; Fetal disproportion NOS
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.6 Maternal care for disproportion due to hydrocephalic fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.7
Maternal care for disproportion due to other fetal
deformities; Conjoined twins; Fetal ascites causing
disproportion; Fetal hydrops causing disproportion; Fetal
meaningomyelocele causing disproportion; Fetal tumour
causing disproportion; Sacral teratoma causing
disproportion
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O33.9Maternal care for disproportion, unspecified; Cephalopelvic
disproportion NOS; Fetopelvic disproportion NOSMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.0
Maternal care for congenital malformation of uterus;
Maternal care for double uterus; Maternal care for Uterus
bicornis
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.1Maternal care for tumour of corpus uteri; Maternal for
polyp of corpus uteri; Maternal care for uterine fibroidMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.2Maternal care due to uterine scar from previous surgery;
Maternal care for scar from previousMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.3
Maternal care for cervical incompetence; Maternal care for
cerclage with or without mention of cervical incompetence;
Maternal care for Shirodkar suture with or without mention
of cervical incompetence
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.4
Maternal care for other abnormalities of cervix; Maternal
care for polyp of cervix; Maternal care for previous surgery
to cervix; Maternal care for stricture or stenosis of cervix;
Maternal care for tumour of cervix
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.5
Maternal care for other abnormalities of gravid uterus;
Maternal care for incarceratiion of gravid uterus; Maternal
care for prolapse of gravid uterus; Maternal care for
retroversion of gravid uterus
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.6
Maternal care for abnormality of vagina; Maternal care for
previous surgery to vagina; Maternal care for septate
vagina; Maternal care for acquired stenosis of vagina;
Maternal care for congenital stenosis of vagina; Maternal
care for tumour of vagina
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.7
Maternal care for abnormality of vulva and perineum;
Maternal care for fibrosis of perineum; Maternal care for
previous surgery to perineum or vulva; Maternal care for
rigid perineum; Maternal care for tumour of vulva
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Page 67 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O34.8
Maternal care for other abnormalities of pelvic organs;
Maternal care for cystocele; Maternal care for previous
pelvic floor repair; Maternal care for pendulous abdomen;
Maternal care for rectocele; Maternal care for rigid pelvic
floor
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O34.9 Maternal care for abnormality of pelvic organ, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O35.0
Maternal care for (suspected) central nervous system
malformation in fetus; Maternal care for suspected fetal
anencephaly; Maternal care for suspected fetal spina bifida
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O35.2 Maternal care for (suspected) hereditary disease in fetus MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O35.3
Maternal care for (suspected) damage to fetus from viral
disease in mother; Maternal care for suspected damage to
fetus from maternal cytomegalovirus infection; Maternal
care for suspected damage to fetus from maternal rubella
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O35.5
Maternal care for (suspected) damage to fetus by drugs;
Maternal care for suspected damage to fetus from drug
addiction
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O35.8
Maternal care for other (suspected) fetal abnormality and
damage; Maternal care for suspected damage to fetus from
maternal listeriosis; Maternal care for suspected damage to
fetus from maternal toxoplasmosis
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O35.9Maternal care for (suspected) fetal abnormality and
damage, unspecifiedMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.0Maternal care for rhesus isoimmunization; Anti-D [Rh]
antibodies; Rh incompatibility (with hydrops fetalis)MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.1
Maternal care for other isoimmunization; ABO
isoimmunization; Isoimmunization NOS (with hydrops
fetalis)
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.2Maternal care for hydrops fetalis; Hydrops fetalis NOS;
Hydrops fetalis not associated with isoimmunizationMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.3 Maternal care for signs of fetal hypoxia MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.4 Maternal care for intrauterine death MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.5
Maternal care for poor fetal growth; Maternal care for
known or suspected light-for-dates; Maternal care for
known or suspected placental insufficiency; Maternal care
for known or suspected small-for-dates
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.6Maternal care for excessive fetal growth; Maternal care for
known or suspected large-for-datesMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.8 Maternal care for other specified fetal problems MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O36.9 Maternal care for fetal problem, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O40 Polyhydramnios; Hydramnios MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O41.0Oligohydramnios; Oligohydramnios without mention of
rupture of membraneMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O41.1Infection of amniotic sac and membranes; Amnionitis;
Chorioamnionitis; Membranitis; PlacentitisMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O41.8 Other specified disorders of amniotic fluid and membranes MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O41.9Disorder of amniotic fluid and membranes, unspecified;
Premature rupture of membranesMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O42.0Premature rupture of membranes on set of labour within
24 hoursMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O42.1Premature rupture of membranes on set of labour after 24
hoursMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O42.2Premature rupture of membranes, labour delayed by
therapyMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O42.9 Premature rupture of membranes, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O43.0Placental transfusion syndromes; Fetomaternal transfusion;
Maternofetal transfusion; Twin-to-twin transfusionMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O43.1Malformation of placenta; Abnormal placenta NOS;
Circumvallate placentaMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O43.8Other placental disorders; Placental dysfunction; Placental
infarctionMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O43.9 Placental disorder, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O44.0Placenta praevia specified as without haemorrhage; Low
implantation of placenta, NOS or with haemorrhageMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O44.1
Placenta praevia with haemorrhage; Low implantation of
placenta, NOS or with haemorrhage; Placenta praevia,
marginal NOS or with haemorrhage; Placenta praevia,
partial NOS or with haemorrhage; Placenta praevia, total
NOS or with haemorrhage
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Page 68 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O45.0
Premature separation of placenta with coagulation defect;
Abruptio placentae with (excessive) haemorrhage
associated with afibrinogenaemia; Abruptio placentae with
(excessive) haemorrhage associated with disseminated
intravascular coagulation; Abruptio placentae with
(excessive) hemorrhage associated with
hyperfibrinogenaemia; Abruptio placentae with (excessive)
haemorrhage associated with hypofibrinogenaemia
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O45.8 Other premature separation of placenta MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O45.9Premature separation of placenta, unspecified; Abruptio
placenta NOSMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O46.0
Antepartum haemorrhage with coagulation defect;
Antepartum haemorrhage (excessive) associated with
afibrinogenaemia; Antepartum haemorrhage (excessive)
associated with disseminated intravascular coagulation;
Antepartum haemorrhage (excessive) associated with
hyperfibrinolysis; Antepartum haemorrahge (excessive)
associated with hypofibrinogenaemia
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O46.8 Other antepartum haemorrhage MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O46.9 Antepartum haemorrhage, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O47.0 False labour before 37 completed weeks of gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O47.1 False labour at or after 37 completed weeks of gestation MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O47.9 False labour, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O48 Prolonged pregnancy; Post-dates; Post-term MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.0Tuberculosis complicating pregnancy, childbirth and the
puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.1Syphilis complicating pregnancy, childbirth and the
puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.2Gonorrhoea complicating pregnancy, childbirth and the
puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.3
Other infections with apredominantly sexual mode of
transmission complicating pregnancy, childbirth and the
puerperium
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.4Viral hepatitis complicating pregnancy, childbirth and the
puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.5Other viral diseases complicating pregnancy, childbirth and
the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.6Protozoal diseases complicating pregnancy, childbirth and
the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.8Other maternal infectious and parasitic diseases
complicating pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O98.9Unspecified maternal infectious or parasitic disease
complicating pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.0Anaemia complicating pregnancy, childbirth and the
puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.1
Other diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
complicating pregnancy, childbirth and the puerperium
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.2Endocrine, nutritional and metabolic diseases complicating
pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.3Mental disorders and diseases of the nervous system
complicating pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.4Diseases of the circulatory system complicating pregnancy,
childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.5Diseases of the respiratory system complicating pregnancy,
childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.6Diseases of the digestive system complicating pregnancy,
childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.7Diseases of the skin and subcutaneous tissue complicating
pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O99.8Other specified diseases and conditions complicating
pregnancy, childbirth and the puerperiumMATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
O60.0 Preterm labor, not resulting to delivery MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z34.0 Supervision of normal first pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z34.8 Supervision of other normal pregnancy MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z34.9 Supervision of normal pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.0 Supervision of pregnancy with history of infertility MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.1
Supervision of pregnancy with history of abortive outcome;
Supervision of pregnancy with history of hydatidiform
mole; Supervision of pregnancy with history of vesicular
mole
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Page 69 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Z35.2
Supervision of pregnancy with other poor reproductive or
obstetric history; Supervision of pregnancy with history of
neonatal death; Supervision of pregnancy with history of
stillbirth
MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.4 Supervision of pregnancy with grand multiparity MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.5 Supervision of elderly primigravida MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.6 Supervision of very young primigravida MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.7 Supervision of high-risk pregnancy due to social problems MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.8 Supervision of other high-risk pregnancies MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
Z35.9 Supervision of high-risk pregnancy, unspecified MATERNAL COMORBIDITIES CONDITIONS 6,800 2,040 4,760
A87.8 Other viral meningitis MENINGITIS 25,700 7,710 17,990
A87.9 Viral meningitis, unspecified MENINGITIS 25,700 7,710 17,990
G00.0Haemophilus meningitis; Meningitis due to Haemophilus
influenzaeMENINGITIS 25,700 7,710 17,990
G00.1 Pneumococcal meningitis MENINGITIS 25,700 7,710 17,990
G00.2 Streptococcal meningitis MENINGITIS 25,700 7,710 17,990
G00.3 Staphylococcal meningitis MENINGITIS 25,700 7,710 17,990
G00.8
Other bacterial meningitis; Meningitis due to Escherichia
coli; Meningitis due to Friedländer bacillus; Meningitis due
to Klebsiella
MENINGITIS 25,700 7,710 17,990
G00.9Bacterial meningitis, unspecified; Meningitis purulent NOS;
Meningitis pyogenic NOS; Meningitis suppurative NOSMENINGITIS 25,700 7,710 17,990
G03.0 Nonpyogenic meningitis; Nonbacterial meningitis MENINGITIS 25,700 7,710 17,990
G03.1 Chronic meningitis MENINGITIS 25,700 7,710 17,990
G03.8 Meningitis due to other specified causes MENINGITIS 25,700 7,710 17,990
G03.9 Meningitis, unspecified; Arachnoiditis (spinal) NOS MENINGITIS 25,700 7,710 17,990
B05.1+ G02.0*Measles complicated by meningitis; Meningitis in viral
diseases classified elsewhereMENINGITIS 25,700 7,710 17,990
A39.2 Acute meningococcaemia MENINGOCOCCAL INFECTION 19,800 5,940 13,860
A39.3 Chronic meningococcaemia MENINGOCOCCAL INFECTION 19,800 5,940 13,860
A39.4Meningococcaemia, unspecified; Meningococcal
bacteraemia NOSMENINGOCOCCAL INFECTION 19,800 5,940 13,860
A39.9Meningococcal infection, unspecified; Meningococcal
disease NOSMENINGOCOCCAL INFECTION 19,800 5,940 13,860
N91.0Primary amenorrhoea; Failure to start menstruation at
puberty.MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N91.1Secondary amenorrhoea; Absence of menstruation in a
woman who had previously menstruated.MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N91.2 Amenorrhoea, unspecified; Absence of menstruation NOS MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N91.5 Oligomenorrhoea, unspecified; Hypomenorrhoea NOS MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.0Excessive and frequent menstruation with regular cycle;
Heavy periods NOS; Menorrhagia NOS; PolymenorrhoeaMENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.1
Excessive and frequent menstruation with irregular cycle;
Irregular intermenstrual bleeding; Irregular, shortened
intervals between menstrual bleeding; Menometrorrhagia;
Metrorrhagia
MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.2
Excessive menstruation at puberty; Excessive bleeding
associated with onset of menstrual periods; Pubertal
menorrhagia; Puberty bleeding
MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.3 Ovulation bleeding; Regular intermenstrual bleeding MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.4
Excessive bleeding in the premenopausal period; Climateric
menorrhagia or metrorrhagia; Menopausal menorrhagia or
metrorrhagia; Preclimateric menorrhagia or metrorrhagia;
Premenopausal menorrhagia or metrorrhagia
MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.5 Other specified irregular menstruation MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N92.6Irregular menstruation, unspecified; Irregular bleeding
NOS; Irregular periods NOSMENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N93.0 Postcoital and contact bleeding MENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N93.8Other specified abnormal uterine and vaginal bleeding;
Dysfunctional or functional uterine or vaginal bleeding NOSMENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N93.9Abnormal uterine and vaginal bleeding, unspecified
Uterine hemorrhage not due to menstrautionMENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N94.8Other specified conditions associated with female genital
organs and menstrual cycleMENSTRUAL IRREGULARITIES 6,600 1,980 4,620
N94.9Unspecified condition associated with female genital
organs and menstrual cycleMENSTRUAL IRREGULARITIES 6,600 1,980 4,620
F01.1 Multi-infarct dementia; Predominantly cortical dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F01.8 Other vascular dementia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F01.9 Vascular dementia, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 70 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
F03
Unspecified dementia; Presenile dementia NOS; Presenile
psychosis NOS; Senile dementia NOS; Senile dementia
depressed or paranoid type; Senile psychosis NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F04
Organic amnesic syndrome, not induced by alcohol and
other psychoactive substances; Korsakov's psychosis or
syndrome, nonalcoholic
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F05.0 Delirium not superimposed on dementia, so described MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F05.8 Other delirium MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F05.9 Other delirium/Delirium, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.0Organic hallucinosis; Organic hallucinatory state
(nonalcoholic)MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.2
Organic delusional [schizophrenia-like] disorder; Paranoid
and paranoid-hallucinatory organic states; Schizophrenia-
like psychosis in epilepsy
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.3 Organic mood [affective] disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.4 Organic anxiety disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.7 Mild cognitive disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.8
Other specified mental disorders due to brain damage and
dysfunction and to physical disease; Epileptic psychosis
NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F06.9
Unspecified mental disorder due to brain damage and
dysfunction and to physical disease; Organic brain
syndrome NOS; Organic mental disorder NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F07.0
Organic personality disorder; Organic pseudopsychopathic
personality;
Organic pseudoretarded personality; Frontal lobe
Syndrome; Limbic epilepsy personality Syndrome ;
Lobotomy Syndrome; Postleucotomy Syndrome
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F07.1 Postencephalitic syndrome MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F07.2
Postconcussional syndrome; Postcontusional syndrome
(encephalopathy); Post-traumatic brain syndrome,
nonpsychotic
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F07.9
Unspecified organic personality and behavioural disorder
due to brain disease, damage and dysfunction; Organic
psychosyndrome
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F09Unspecified organic or symptomatic mental disorder;
Organic Psychosis NOS; Symptomatic Psychosis NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.0Mental and behavioural disorders due to use of alcohol in
acute intoxicationMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.1Mental and behavioural disorders due to use of
alcohol:harmful useMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.2Mental and behavioural disorders due to use of alcohol:
dependency syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.3Mental and behavioural disorders due to use of
alcohol:withdrawal stateMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.4Mental and behavioural disorders due to use of alcohol:
withdrawal state with deliriumMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.5Mental and behavioural disorders due to use of alcohol:
psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.6Mental and behavioural disorders due to use of alcohol:
amnesic syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.7Mental and behavioural disorders due to use of alcohol:
residual and late-onset psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.8Mental and behavioural disorders due to use of alcohol:
other mental and behavioural disordersMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F10.9Mental and behavioural disorders due to use of alcohol:
unspecified mental and behavioural disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F11.1Mental and behavioural disorders due to use of opioids:
harmful useMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F11.2Mental and behavioural disorders due to use of opioids:
dependence syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F11.5Mental and behavioural disorders due to use of opioids:
psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F11.9Mental and behavioural disorders due to use of opioids:
unspecified mental and behavioural disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F12.0Mental and behavioural disorders due to use of
cannabinoids: acute intoxicationMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F12.5Mental and behavioural disorders due to use of
cannabinoids: psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F13.1Mental and behavioural disorders due to use of sedatives
or hypnotics: harmful useMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F13.2Mental and behavioural disorders due to use of sedatives
or hypnotics: dependence syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F13.3Mental and behavioural disorders due to use of sedatives
or hypnotics: withdrawal stateMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 71 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
F13.4Mental and behavioural disorders due to use of sedatives
or hypnotics: withdrawal state with deliriumMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F13.5Mental and behavioural disorders due to use of sedatives
or hypnotics: psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F13.7Mental and behavioural disorders due to use of sedatives
or hypnotics: residual and late-onset psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F14.0Mental and behavioural disorders due to use of cocaine:
acute intoxicationMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F14.2Mental and behavioural disorders due to use of cocaine:
dependence syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F14.5Mental and behavioural disorders due to use of cocaine:
psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F14.6Mental and behavioural disorders due to use of cocaine:
amnesic syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F14.9Mental and behavioural disorders due to use of cocaine:
unspecified mental and behavioural disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.0Mental and behavioural disorders due to use of other
stimulants, including caffeine: acute intoxicationMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.1Mental and behavioural disorders due to use of other
stimulants, including caffeine: harmful useMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.2Mental and behavioural disorders due to use of other
stimulants, including caffeine: dependence syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.3Mental and behavioural disorders due to use of other
stimulants, including caffeine: withdrawal stateMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.5Mental and behavioural disorders due to use of other
stimulants, including caffeine: psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.8
Mental and behavioural disorders due to use of other
stimulants, including caffeine: other mental and
behavioural disorders
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F15.9
Mental and behavioural disorders due to use of other
stimulants, including caffeine: unspecified mental and
behavioural disorder
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F16.0Mental and behavioural disorders due to use of
hallucinogens: acute intoxicationMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F16.1Mental and behavioural disorders due to use of
hallucinogens: harmful useMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F16.2Mental and behavioural disorders due to use of
hallucinogens: dependence syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F16.5Mental and behavioural disorders due to use of
hallucinogens: psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F17.2Mental and behavioural disorders due to use of tobacco:
dependence syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F17.3Mental and behavioural disorders due to use of tobacco:
withdrawal stateMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F18.0Mental and behavioural disorders due to use of volatile
solvents: acute intoxicationMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F18.4Mental and behavioural disorders due to use of volatile
solvents: withdrawal state with deliriumMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F18.6Mental and behavioural disorders due to use of volatile
solvents: amnesic syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.1
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: harmful use
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.2
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: dependence syndrome
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.3
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: withdrawal state
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.5
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: psychotic disorder
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.7
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: residual and late-onset psychotic disorder
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.8
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: other mental and behavioural disorders
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F19.9
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: unspecified mental and behavioural disorder
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.0 Paranoid schizophrenia; Paraphrenic schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.1Hebephrenic schizophrenia; Disorganized schizophrenia;
HebephreniaMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 72 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
F20.2
Catatonic schizophrenia; Catatonic stupor; Schizophrenic
catalepsy; Schizophrenic catatonia; Schizophrenic
flexibilitas cerea
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.3 Undifferentiated schizophrenia; Atypical schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.5
Residual schizophrenia; Chronic undifferentiated
schizophrenia; Restzustand (schizophrenic); Schizophrenic
residual state
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.6 Simple schizophrenia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.8
Other schizophrenia; Cenesthopathic schizophrenia;
Schizophreniform disorder NOS; Schizophreniform
psychosis NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F20.9 Schizophrenia, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F21
Schizotypal disorder; Latent schizophrenic reaction;
Schizophrenia borderline; Schizophrenia latent;
Schizophrenia prepsychotic; Schizophrenia prodromal;
Schizophrenia pseudoneurotic;
Schizophrenia pseudopsychopathic; Schizotypal personality
disorder
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F22.0Delusional disorder; Paranoia; Paranoid psychosis; Paranoid
state; Paraphrenia (late); Sensitiver BeziehungswahnMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F22.8
Other persistent delusional disorders; Delusional
dysmorphophobia; Involutional paranoid state; Paranoia
querulans
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F23.0
Acute polymorphic psychotic disorder without symptoms
of schizophrenia; Bouffée délirante without symptoms of
schizophrenia or unspecified; Cycloid psychosis without
symptoms of schizophrenia or unspecified
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F23.1
Acute polymorphic psychotic disorder with symptoms of
schizophrenia; Bouffée délirante with symptoms of
schizophrenia; Cycloid psychosis with symptoms of
schizophrenia
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F23.2
Acute schizophrenia-like psychotic disorder;Acute
(undifferentiated) schizophrenia;Brief schizophreniform
disorder; Brief schizophreniform psychosis; Oneirophrenia;
Schizophrenic reaction
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F23.3Other acute predominantly delusional psychotic disorders;
Paranoid reaction; Psychogenic paranoid psychosisMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F23.8 Other acute and transient psychotic disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F23.9Acute and transient psychotic disorder, unspecified; Brief
reactive psychosis NOS; Reactive psychosisMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F24Induced delusional disorder; Folie à deux; Induced paranoid
disorder; Induced psychotic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F25.0
Schizoaffective disorder, manic type; Schizoaffective
psychosis, manic type; Schizophreniform psychosis, manic
type
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F25.1
Schizoaffective disorder, depressive type; Schizoaffective
psychosis, depressive type; Schizophreniform psychosis,
depressive type
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F25.2Schizoaffective disorder, mixed type; Cyclic schizophrenia;
Mixed schizophrenic and affective psychosisMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F25.8 Other schizoaffective disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F25.9Schizoaffective disorder, unspecified; Schizoaffective
psychosis NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F28Other nonorganic psychotic disorders; Chronic
hallucinatory psychosisMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F29 Unspecified nonorganic psychosis; Psychosis NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F30.0 Hypomania MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F30.1 Mania without psychotic symptoms MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F30.2
Mania with psychotic symptoms; Mania with mood-
congruent psychotic symptoms; Mania with mood-
incongruent psychotic symptoms; Manic stupor
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F30.9 Manic episode, unspecified; Mania NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.0 Bipolar affective disorder, current episode hypomanic MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.1Bipolar affective disorder, current episode manic without
psychotic symptomsMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.2Bipolar affective disorder, current episode manic with
psychotic symptomsMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.3Bipolar affective disorder, current episode mild or
moderate depressionMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.5Bipolar affective disorder, current episode severe
depression with psychotic symptomsMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.6 Bipolar affective disorder, current episode mixed MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.7 Bipolar affective disorder, currently in remission MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 73 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
F31.8Other bipolar affective disorders; Bipolar II disorder;
Recurrent manic episodes NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F31.9 Bipolar affective disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.0 Mild depressive episode MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.1 Moderate depressive episode MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.2
Severe depressive episode without psychotic symptoms;
[Agitated depression, Major depression, Vital depression]
single episode without psychotic symptoms
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.3
Severe depressive episode with psychotic symptoms; Single
episodes of major depression with psychotic symptoms;
Single episodes of psychogenic depressive psychosis; Single
episodes of psychotic depression; Single episodes of
reactive depressive psychosis
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.8Other depressive episodes; Atypical depression; Single
episodes of "masked" depression NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F32.9Depressive episode, unspecified; Depression NOS;
Depressive disorder NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F33.2
Recurrent depressive disorder, current episode severe
without psychotic symptoms; Endogenous depression
without psychotic symptoms; Major depression, recurrent
without psychotic symptoms; Manic-depressive psychosis,
depressed type without psychotic symptoms; Vital
depression, recurrent without psychotic symptoms
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F33.3
Recurrent depressive disorder, current episode severe with
psychotic symptoms including Endogenous depression with
psychotic symptoms; Manic-depressive psychosis,
depressed type with psychotic symptoms; Recurrent severe
episodes of major depression with psychotic symptoms;
Recurrent severe episodes of psychogenic depressive
psychosis; Recurrent severe episodes of psychotic
depression; Recurrent severe episodes of reactive
depressive psychosis
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F33.8 Other recurrent depressive disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F33.9Recurrent depressive disorder, unspecified; Monopolar
depression NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F34.0Cyclothymia; Affective personality disorder; Cycloid
personality; Cyclothymic personalityMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F34.1
Dysthymia; Depressive neurosis; Depressive personality
disorder; Neurotic depression; Persistent anxiety
depression
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.1 Predominantly compulsive acts [obsessional rituals] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.2 Mixed obsessional thoughts and acts MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.8 Other obsessive-compulsive disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F42.9 Obsessive-compulsive disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F43.0
Acute stress reaction including Acute crisis reaction; Acute
reaction to stress; Combat fatigue; Crisis state; Psychic
shock
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F43.1 Post-traumatic stress disorder; Traumatic neurosis MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F43.2Adjustment disorders; Culture shock; Grief reaction;
Hospitalism in childrenMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F43.8 Other reactions to severe stress MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F44.0 Dissociative amnesia MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F44.4Dissociative motor disorders; Psychogenic aphonia;
Psychogenic dysphoniaMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F44.8
Other dissociative [conversion] disorders; Ganser's
syndrome; Multiple personality; Psychogenic confusion;
Psychogenic twilight state
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F44.9 Dissociative [conversion] disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F45.0Somatization disorder; Briquet’s disorder; Multiple
psychosomatic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F45.1Undifferentiated somatoform disorder; Undifferentiated
psychosomatic disorderMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F45.2
Hypochondriacal disorder; Body dysmorphic disorder;
Dysmorphophobia (nondelusional); Hypochondriacal
neurosis; Hypochondriasis; Nosophobia
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 74 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
F45.3
Somatoform autonomic dysfunction; Cardiac neurosis; Da
Costa's syndrome; Gastric neurosis ; Neurocirculatory
asthenia
Psychogenic forms of aerophagy; Psychogenic forms of
cough, Psychogenic forms of diarrhea; Psychogenic forms
of dyspepsia; Psychogenic forms of dysuria; psychogenic
forms of flatulence; Psychogenic forms of hiccough;
Psychogenic forms of hyperventilation; Psychogenic forms
of increased frequency of micturition; Psychogenic forms of
irritable bowel syndrome; Psychogenic forms of
pylorospasm
Psychogenic urine retention
Psychogenic polyuria
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F45.4
Persistent somatoform pain disorder; Psychalgia;
Psychogenic backache; Psychogenic headache; Somatoform
pain disorder
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F45.8
Other somatoform disorders; Psychogenic dysmenorrhoea;
Psychogenic dysphagia, including "globus hystericus";
Psychogenic pruritus; Psychogenic torticollis; Teeth-
grinding
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F45.9Somatoform disorder, unspecified; Psychosomatic disorder
NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F48.8
Other specified neurotic disorders; Dhat syndrome;
Occupational neurosis, including writer's cramp;
Psychasthenia; Psychasthenic neurosis; Psychogenic
syncope
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F48.9 Neurotic disorder, unspecified; Neurosis NOS MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F50.2 Bulimia nervosa; Bulimia NOS; Hyperorexia nervosa MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F53.0
Mild mental and behavioural disorders associated with the
puerperium, not elsewhere classified; Depression postnatal
NOS; Depression postpartum NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F53.1
Severe mental and behavioural disorders associated with
the puerperium, not elsewhere classified; Puerperal
psychosis NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F53.9 Puerperal mental disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F55
Abuse of non-dependence-producing substances; Abuse of
antacids; Abuse of herbal or folk remedies; Abuse of
steroids or hormones; Abuse of vitamins; Laxative habit
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F59
Unspecified behavioural syndromes associated with
physiological disturbances and physical factors;
Psychogenic physiological dysfunction NOS
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F70.0
Mild mental retardation; feeble-mindedness; mild mental
subnormality with the statement of no, or minimal,
impairment of behaviour
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F72.9Severe mental retardation; severe mental subnormality
without mention of impairment of behaviourMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F78.1Other mental retardation with significant impairment of
behaviour requiring attention or treatmentMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F78.8Other mental retardation with other impairments of
behaviourMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F78.9Other mental retardation without mention of impairment
of behaviourMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F79.8
Unspecified mental retardation; mental deficiency NOS;
mental subnormality NOS with other impairments of
behaviour
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F80.3 Acquired aphasia with epilepsy [Landau-Kleffner] MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F82
Specific developmental disorder of motor function; Clumsy
child syndrome; Developmental coordination disorder;
Developmental dyspraxia
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F84.0Childhood autism; Autistic disorder; Infantile autism;
Infantile psychosis; Kanner's syndromeMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F84.2 Rett's syndrome MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F84.3
Other childhood disintegrative disorder; Dementia
infantilis; Disintegrative psychosis; Heller's syndrome;
Symbiotic psychosis
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F84.5Asperger's syndrome; Autistic psychopathy; Schizoid
disorder of childhoodMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F84.9 Pervasive developmental disorder, unspecified MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F89Unspecified disorder of psychological development;
Developmental disorder NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F90.8 Other hyperkinetic disorders MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F92.0 Depressive conduct disorder MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
F98.1
Nonorganic encopresis; Functional encopresis;
Incontinence of faeces of nonorganic origin; Psychogenic
encopresis
MENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
Page 75 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
F99Mental disorder, not otherwise specified; Mental illness
NOSMENTAL AND BEHAVIORAL DISORDERS 7,800 2,340 5,460
E88.0Disorders of plasma-protein metabolism, not elsewhere
classified; a-1-Antitrypsin deficiency; BisalbuminaemiaMETABOLIC DISORDERS 10,700 3,210 7,490
E88.1 Lipodystrophy, not elsewhere classified; Lipodystrophy NOS METABOLIC DISORDERS 10,700 3,210 7,490
E88.8Other specified metabolic disorders; Launois-Bensaude
adenolipomatosis; TrimethylaminuriaMETABOLIC DISORDERS 10,700 3,210 7,490
E88.9 Metabolic disorder, unspecified METABOLIC DISORDERS 10,700 3,210 7,490
P70.0 Syndrome of infant of mother with gestational diabetes METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P70.1
Syndrome of infant of a diabetic mother; Maternal diabetes
mellitus (pre-existing) affecting fetus or newborn with
hypoglycaemia
METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P70.2 Neonatal diabetes mellitus METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P70.3 Iatrogenic neonatal hypoglycaemia METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P70.4Other neonatal hypoglycaemia; Transitory neonatal
hypoglycaemiaMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P70.9Transitory disorder of carbohydrate metabolism of fetus
and newborn, unspecifiedMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P71.0 Cow's milk hypocalcaemia in newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P71.1 Other neonatal hypocalcaemia METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P71.3Neonatal tetany without calcium or magnesium deficiency;
Neonatal tetany NOSMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P71.4 Transitory neonatal hypoparathyroidism METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P71.9Transitory neonatal disorder of calcium and magnesium
metabolism, unspecifiedMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P72.0Neonatal goitre, not elsewhere classified; Transitory
congenital goitre with normal functionMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P72.1Transitory neonatal hyperthyroidism; neonatal
thyrotoxicosisMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P72.2Other transitory neonatal disorders of thyroid function, not
elsewhere classified; Transitory neonatal hypothyroidismMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P72.8 Other specified transitory neonatal endocrine disorders METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P72.9 Transitory neonatal endocrine disorder, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.0 Late metabolic acidosis of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.1 Dehydration of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.2 Disturbances of sodium balance of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.4 Other transitory electrolyte disturbances of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.8 Other transitory metabolic disturbances of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P74.9 Transitory metabolic disturbance of newborn, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P80.9 Hypothermia of newborn, unspecified METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P81.0 Environmental hyperthermia of newborn METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P81.8Other specified disturbances of temperature regulation of
newbornMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P81.9Disturbance of temperature regulation of newborn,
unspecified; Fever of newborn NOSMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P83.1 Neonatal erythema toxicum METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P83.4Breast engorgement of newborn; Noninfective mastitis of
newbornMETABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
P83.8
Other specified conditions of integument specific to fetus
and newborn; Bronze baby syndrome; Neonatal
scleroderma; Urticaria neonatorum
METABOLIC DISORDERS OF THE NEWBORN 9,300 2,790 6,510
O02.0Blighted ovum and nonhydatidiform mole; Carneous mole;
Fleshy mole; Intrauterine mole NOS; Pathological ovumMISCARRIAGE 5,000 1,500 3,500
O02.1Missed abortion; Early fetal death with retention of dead
fetusMISCARRIAGE 5,000 1,500 3,500
O02.8 Other specified abnormal products of conception MISCARRIAGE 5,000 1,500 3,500
O02.9 Abnormal product of conception, unspecified MISCARRIAGE 5,000 1,500 3,500
O03.4 Spontaneous abortion, incomplete, without complication MISCARRIAGE 5,000 1,500 3,500
O03.9Spontaneous abortion, complete or unspecified, without
complicationMISCARRIAGE 5,000 1,500 3,500
O05.4 Other abortion, incomplete, without complication MISCARRIAGE 5,000 1,500 3,500
O05.9Other abortion, complete or unspecified, without
complicationMISCARRIAGE 5,000 1,500 3,500
O06.4Unspecified abortion or induced abortion NOS, incomplete,
without complicationMISCARRIAGE 5,000 1,500 3,500
O06.9Unspecified abortion or induced abortion NOS, complete or
unspecified, without complicationMISCARRIAGE 5,000 1,500 3,500
Page 76 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O07.0
Failed medical abortion, complicated by genital tract and
pelvic infection with Endometritis; Oophoritis; Parametritis;
Parametritis; Pelvic peritonitis; Salpingitis; Salpingo-
oophoritis; Sepsis; Septic shock; Septicaemia
MISCARRIAGE 5,000 1,500 3,500
O07.3
Failed medical abortion with other and unspecified
complications with Shock following abortion and ectopic
and molar pregnancy; Circulatory collapase; Postoperative
Shock; Renal failure following abortion and ectopic and
molar pregnancy; Oliguria; Acute Renal failure; Renal
shutdown; Renal tubular necrosis; Uraemia
MISCARRIAGE 5,000 1,500 3,500
O07.4Failed medical abortion without complication; Failed
medical abortion NOSMISCARRIAGE 5,000 1,500 3,500
O07.8
Other and unspecified failed attempted abortion with other
and unspecified complications with with Shock following
abortion and ectopic and molar pregnancy; Circulatory
collapase; Postoperative Shock; Renal failure following
abortion and ectopic and molar pregnancy;
Afibrinogenaemia; Defibrination syndrome; Intravascular
coagulation
MISCARRIAGE 5,000 1,500 3,500
O07.9Other and unspecified failed attempted abortion without
complication; Failed attempted abortion NOSMISCARRIAGE 5,000 1,500 3,500
O03.0
Spontaneous abortion, incomplete, complicated by Genital
tract and pelvic infection with Genital tract and pelvic
infection following abortion and ectopic and molar
pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic
peritonitis; Salpingitis; Salpingo-oophoritis and/or Sepsis
and/or Septic shock and/or Septicaemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.1
Spontaneous abortion, incomplete, complicated Delayed or
excessive haemorrhage with Delayed or excessive
haemorrhage following abortion and ectopic and molar
pregnancy; Afibrinogenaemia; Defibrination syndrome;
Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.2
Spontaneous abortion, incomplete, complicated by
Embolism with Embolism NOS or Air embolism or Amniotic
fluid embolism or Blood-clot embolism or Pulmonary
embolism or Pyaemic embolism or Septic or
septicopyaemic embolism or Soap embolism
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.3
Spontaneous abortion, incomplete, with other and
unspecified complications with Shock following abortion
and ectopic and molar pregnancy; Circulatory collapase;
Postoperative Shock; Renal failure following abortion and
ectopic and molar pregnancy; Oliguria; Acute Renal failure;
Renal shutdown; Renal tubular necrosis; Uraemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.5
Spontaneous abortion, complete, complicated by Genital
tract and pelvic infection with Genital tract and pelvic
infection following abortion and ectopic and molar
pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic
peritonitis; Salpingitis; Salpingo-oophoritis and/or Sepsis
and/or Septic shock and/or Septicaemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.6
Spontaneous abortion, complete or unspecified,
complicated Delayed or excessive haemorrhage with
Delayed or excessive haemorrhage following abortion and
ectopic and molar pregnancy; Afibrinogenaemia;
Defibrination syndrome; Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.7
Spontaneous abortion, complete or unspecified, with other
complicated by Embolism with Embolism following
abortion and ectopic and molar pregnancy; Embolism NOS;
Air embolism; Amniotic fluid embolism; Blood-clot
embolism; Pulmonary embolism; Pyaemic embolism
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O03.8
Spontaneous abortion, complete or unspecified, with
other and unspecified complications with Shock following
abortion and ectopic and molar pregnancy; Circulatory
collapase; Postoperative Shock; Renal failure following
abortion and ectopic and molar pregnancy
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O05.0
Other abortion, incomplete, complicated by Genital tract
and pelvic infection with Endometritis and/or Oophoritis
and/or Parametritis and/or Pelvic peritonitis and/or
Salpingitis and/or Salpingo-oophoritis and/or Sepsis and/or
Septic shock and/or Septicaemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
Page 77 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O05.1
Other abortion, incomplete, complicated Delayed or
excessive haemorrhage with Delayed or excessive
haemorrhage following abortion and ectopic and molar
pregnancy; Afibrinogenaemia; Defibrination syndrome;
Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O05.8
Other abortion, complete, with other and unspecified
complications with Shock following abortion and ectopic
and molar pregnancy; Circulatory collapase; Postoperative
Shock; Renal failure following abortion and ectopic and
molar pregnancy; Oliguria Acute
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.0
Unspecified abortion or induced abortion NOS, incomplete,
complicated by Genital tract and pelvic infection with
Endometritis and/or Oophoritis and/or Parametritis and/or
Pelvic peritonitis and/or Salpingitis and/or Salpingo-
oophoritis and/or Sepsis and/or Septic shock and/or
Septicaemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.1
Unspecified abortion or induced abortion NOS, incomplete,
complicated Delayed or excessive haemorrhage with
Afibrinogenaemia or Defibrination syndrome or
Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.2
Unspecified abortion or induced abortion NOS, incomplete,
complicated by Embolism or Embolism NOS with Air
embolism or Amniotic fluid embolism or Blood-clot
embolism or Pulmonary embolism or Pyaemic embolism or
Septic or septicopyaemic embolism or Soap embolism
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.3
Unspecified abortion or induced abortion NOS, incomplete,
with other and unspecified complications with Shock
following abortion and ectopic and molar pregnancy;
Circulatory collapase; Postoperative Shock; Renal failure
following abortion and ectopic and molar pregnancy;
Oliguria; Acute Renal failure; Renal shutdown; Renal
tubular necrosis; Uraemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.5
Unspecified abortion or induced abortion NOS, complete,
or unspecified, complicated by Genital tract and pelvic
infection or Endometritis and/or Oophoritis and/or
Parametritis and/or Pelvic peritonitis and/or Salpingitis
and/or Salpingo-oophoritis and/or Sepsis and/or Septic
shock and/or Septicaemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.6
Unspecified abortion or induced abortion NOS, complete,
complicated by Delayed or excessive haemorrhage or
Afibrinogenaemia or Defibrination syndrome or
Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.7
Unspecified abortion or induced abortion NOS, complete,
complicated by Embolism or Embolism NOS or Air
embolism or Amniotic fluid embolism or Blood-clot
embolism or Pulmonary embolism or Pyaemic embolism or
Septic or septicopyaemic embolism or Soap embolism
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O06.8
Unspecified abortion or induced abortion NOS, complete,
with other and unspecified complications with Shock
following abortion and ectopic and molar pregnancy;
Circulatory collapase; Postoperative Shock; Renal failure
following abortion and ectopic and molar pregnancy;
Oliguria; Acute Renal failure; Renal shutdown; Renal
tubular necrosis; Uraemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O07.1
Failed medical abortion complicated by delayed or
excessive haemorrhage; Afibrinogenaemia with Delayed or
excessive haemorrhage following abortion and ectopic and
molar pregnancy; Afibrinogenaemia; Defibrination
syndrome; Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O07.5
Other and unspecified failed attempted abortion
complicated by genital tract and pelvic infection with
Endometritis; Oophoritis; Parametritis; Pelvic peritonitis;
Salpingitis; Salpingo-oophoritis; Sepsi; Septic shock;
Septicaemia
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O07.6
Other and unspecified failed attempted abortion
complicated by delayed or excessive haemorrhage with
Delayed or excessive haemorrhage following abortion and
ectopic and molar pregnancy; Afibrinogenaemia;
Defibrination syndrome; Intravascular coagulation
MISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O08.3Shock following abortion and ectopic and molar pregnancy;
Circulatory collapase; Postoperative ShockMISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
O08.8Other complications following abortion and ectopic and
molar pregnancy; Cardiac arrest; Urinary tract infectionMISCARRIAGE WITH COMPLICATIONS 6,900 2,070 4,830
M60.0 Infective myositis; Tropical pyomyositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Page 78 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M60.00 Infective myositis; Tropical pyomyositis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.01 Infective myositis; Tropical pyomyositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.02 Infective myositis; Tropical pyomyositis Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.05Infective myositis; Tropical pyomyositis Pelvic region and
thighMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.06 Infective myositis; Tropical pyomyositis Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.07 Infective myositis; Tropical pyomyositis Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.08 Infective myositis; Tropical pyomyositis Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.09 Infective myositis; Tropical pyomyositis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.1 Interstitial myositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.11 Interstitial myositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.2Foreign body granuloma of soft tissue, not elsewhere
classifiedMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.21Foreign body granuloma of soft tissue, not elsewhere
classified Shoulder regionMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.23Foreign body granuloma of soft tissue, not elsewhere
classified ForearmMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.27Foreign body granuloma of soft tissue, not elsewhere
classified Ankle and footMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.8 Other myositis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.80 Other myositis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.81 Other myositis Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.88 Other myositis Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.89 Other myositis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.9 Myositis, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.90 Myositis, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.91 Myositis, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.92 Myositis, unspecified Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.95 Myositis, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.96 Myositis, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.98 Myositis, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M60.99 Myositis, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M61.3Calcification and ossification of muscles associated with
burns; Myositis ossificans associated with burnsMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M61.55 Other ossification of muscle Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M61.59 Other ossification of muscle Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M61.9 Calcification and ossification of muscle, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.0 Diastasis of muscle MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.05 Diastasis of muscle Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.08 Diastasis of muscle Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.1 Other rupture of muscle (nontraumatic) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.48 Contracture of muscle Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.49 Contracture of muscle Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.56Muscle wasting and atrophy, not elsewhere classified;
Disuse atrophy NEC Lower legMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.59Muscle wasting and atrophy, not elsewhere classified;
Disuse atrophy NEC Site unspecifiedMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.60 Muscle strain Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.61 Muscle strain Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.62 Muscle strain Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.63 Muscle strain Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.65 Muscle strain Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.66 Muscle strain Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.67 Muscle strain Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.68 Muscle strain Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.69 Muscle strain Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.8 Muscle (sheath) hernia MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.80 Muscle (sheath) hernia Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.85 Muscle (sheath) hernia Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.86 Muscle (sheath) hernia Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.88 Muscle (sheath) hernia Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.89 Muscle (sheath) hernia Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.9 Disorder of muscle, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.90 Disorder of muscle, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.91 Disorder of muscle, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.95 Disorder of muscle, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.96 Disorder of muscle, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.97 Disorder of muscle, unspecified Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.98 Disorder of muscle, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M62.99 Disorder of muscle, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.0 Abscess of tendon sheath MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.1 Other infective tenosynovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.13 Other infective (teno)synovitis Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.2 Calcific tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.20 Calcific tendinitis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Page 79 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M65.22 Calcific tendinitis Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.25 Calcific tendinitis Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.29 Calcific tendinitis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.3 Trigger finger;Nodular tendinous disease MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.4 Radial styloid tenosynovitis [de Quervain] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.8 Other synovitis and tenosynovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.80 Other synovitis and tenosynovitis Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.84 Other synovitis and tenosynovitis Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.86 Other synovitis and tenosynovitis Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.87 Other synovitis and tenosynovitis Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.89 Other synovitis and tenosynovitis Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.9 Synovitis and tenosynovitis, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.90 Synovitis and tenosynovitis, unspecified Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.91 Synovitis and tenosynovitis, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.92 Synovitis and tenosynovitis, unspecified Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.93 Synovitis and tenosynovitis, unspecified Forearm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.94 Synovitis and tenosynovitis, unspecified Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.95Synovitis and tenosynovitis, unspecified Pelvic region and
thighMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.96 Synovitis and tenosynovitis, unspecified Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.97 Synovitis and tenosynovitis, unspecified Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M65.99 Synovitis and tenosynovitis, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M66.0 Rupture of popliteal cyst MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M66.4 Spontaneous rupture of other tendons MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M66.5Spontaneous rupture of unspecified tendon; Rupture at
musculotendinous junction, nontraumatic MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.0 Short Achilles tendon (acquired) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.1 Other contracture of tendon (sheath) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.2 Synovial hypertrophy, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.3 Transient synovitis; Toxic synovitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.4 Ganglion; Ganglion of joint or tendon (sheath) MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.8 Other specified disorders of synovium and tendon MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M67.9 Disorder of synovium and tendon, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.0 Chronic crepitant synovitis of hand and wrist MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.1 Bursitis of hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.2 Olecranon bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.3 Other bursitis of elbow MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.4 Prepatellar bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.5 Other bursitis of knee MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.6 Trochanteric bursitis; Trochanteric tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.7 Other bursitis of hip; Ischial bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.8Other soft tissue disorders related to use, overuse and
pressure MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M70.9Unspecified soft tissue disorder related to use, overuse and
pressure MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.1 Other infective bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.2 Synovial cyst of popliteal space [Baker] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.3 Other bursal cyst; Synovial cyst NOS MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.31 Other bursal cyst; Synovial cyst NOS Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.5 Other bursitis, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.51 Other bursitis, not elsewhere classified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.8 Other specified bursopathies MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.9 Bursopathy, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.91 Bursopathy, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M71.99 Bursopathy, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.0 Palmar fascial fibromatosis [Dupuytren] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.2 Plantar fascial fibromatosis; Plantar fasciitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.5 Fasciitis, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.88 Other fibroblastic disorders; Abscess of fascia Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.9Fibroblastic disorder, unspecified; Fasciitis NOS;
Fibromatosis NOSMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.98Fibroblastic disorder, unspecified; Fasciitis NOS;
Fibromatosis NOS OtherMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M72.99Fibroblastic disorder, unspecified; Fasciitis NOS;
Fibromatosis NOS Site unspecifiedMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.0Adhesive capsulitis of shoulder; Frozen shoulder;
Periarthritis of shoulderMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.1
Rotator cuff syndrome; Rotator cuff or supraspinatus tear
or rupture complete)(incomplete), not specified
as traumatic; Supraspinatus syndrome
MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.2 Bicipital tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.3 Calcific tendinitis of shoulder; Calcified bursa of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.4 Impingement syndrome of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
Page 80 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M75.5 Bursitis of shoulder MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.8 Other shoulder lesions MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M75.9 Shoulder lesion, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76 Enthesopathies of lower limb, excluding foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.0 Gluteal tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.1 Psoas tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.3 Iliotibial band syndrome MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.4 Tibial collateral bursitis [Pellegrini-Stieda] MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.5 Patellar tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.6 Achilles tendinitis; Achilles bursitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.7 Peroneal tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.8Other enthesopathies of lower limb, excluding foot;
Anterior tibial syndrome; Posterior tibial tendinitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M76.9 Enthesopathy of lower limb, unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.0 Medial epicondylitis MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.1 Lateral epicondylitis; Tennis elbow MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.3 Calcaneal spur MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.5 Other enthesopathy of foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.8 Other enthesopathies, not elsewhere classified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M77.9Enthesopathy, unspecified; Bone spur NOS; Capsulitis NOS;
Periarthritis NOS; Tendinitis NOSMUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.80 Other specified soft tissue disorders Multiple site MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.81 Other specified soft tissue disorders Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.82 Other specified soft tissue disorders Upper arm MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.84 Other specified soft tissue disorders Hand MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.85 Other specified soft tissue disorders Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.86 Other specified soft tissue disorders Lower leg MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.87 Other specified soft tissue disorders Ankle and foot MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.88 Other specified soft tissue disorders Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.89 Other specified soft tissue disorders Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.91 Soft tissue disorder, unspecified Shoulder region MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.95 Soft tissue disorder, unspecified Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.98 Soft tissue disorder, unspecified Other MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.99 Soft tissue disorder, unspecified Site unspecified MUSCLE, TENDON, SOFT TISSUE DISORDERS 6,500 1,950 4,550
M79.00 Rheumatism, unspecified Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.01 Rheumatism, unspecified Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.02 Rheumatism, unspecified Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.05 Rheumatism, unspecified Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.07 Rheumatism, unspecified Ankle and foot MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.08 Rheumatism, unspecified Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.09 Rheumatism, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.10 Myalgia Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.11 Myalgia Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.12 Myalgia Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.15 Myalgia Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.16 Myalgia Lower leg MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.18 Myalgia Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.19 Myalgia Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.20 Neuralgia and neuritis, unspecified Multiple site MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.21 Neuralgia and neuritis, unspecified Shoulder region MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.22 Neuralgia and neuritis, unspecified Upper arm MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.25 Neuralgia and neuritis, unspecified Pelvic region and thigh MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.28 Neuralgia and neuritis, unspecified Other MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.29 Neuralgia and neuritis, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M79.39 Panniculitis, unspecified Site unspecified MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
M96.8 Other postprocedural musculoskeletal disorders MYALGIA, NEURALGIA, RHEUMATISM 5,900 1,770 4,130
P94.0 Transient neonatal myasthenia gravis MYASTHENIA GRAVIS NEWBORN 11,600 3,480 8,120
G70.0 Myasthenia gravis MYOPATHIES 7,900 2,370 5,530
G70.2 Congenital and developmental myasthenia MYOPATHIES 7,900 2,370 5,530
G70.8 Other specified myoneural disorders MYOPATHIES 7,900 2,370 5,530
G70.9 Myoneural disorder, unspecified MYOPATHIES 7,900 2,370 5,530
G71.0
Muscular dystrophy; Muscular dystrophy autosomal
recessive, childhood type, resembling Duchenne or Becker;
Muscular dystrophy benign [Becker]; Muscular dystrophy
benign; capuloperoneal with early contractures [Emery-
Dreifuss]; Muscular dystrophy distal; Muscular dystrophy
facioscapulohumeral; Muscular dystrophy limb-girdle;
Muscular dystrophy ocular; Muscular dystrophy
oculopharyngeal; Muscular dystrophy scapuloperoneal;
Muscular dystrophy severe [Duchenne]
MYOPATHIES 7,900 2,370 5,530
Page 81 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
G71.1
Myotonic disorders; Dystrophia myotonica [Steinert];
Myotonia, chondrodystrophic; Myotonia, drug-induced;
Myotonia, symptomatic; Myotonia, congenita NOS;
Myotonia, congenita dominant [Thomsen]; Myotonia,
congenital recessive [Becker]; Neuromyotonia [Isaac];
Paramyotonia congenita; Pseudomyotonia
MYOPATHIES 7,900 2,370 5,530
G71.2
Congenital myopathies; Congenital muscular dystrophy
NOS; Congenital muscular dystrophy with specific
morphological abnormalities of the muscle fibre; Central
coreDisease ; Minicore Disease ; MulticoreDisease ; Fibre-
type disproportion; Myopathy myotubular (centronuclear);
Myopathy nemaline
MYOPATHIES 7,900 2,370 5,530
G71.9Primary disorder of muscle, unspecified; Hereditary
myopathy NOSMYOPATHIES 7,900 2,370 5,530
G72.0 Drug-induced myopathy MYOPATHIES 7,900 2,370 5,530
G72.1 Alcoholic myopathy MYOPATHIES 7,900 2,370 5,530
G72.2 Myopathy due to other toxic agents MYOPATHIES 7,900 2,370 5,530
G72.3
Periodic paralysis; Periodic paralysis (familial)
hyperkalaemic; Periodic paralysis (familial) hypokalaemic;
Periodic paralysis (familial) myotonic; Periodic paralysis
(familial) normokalaemic
MYOPATHIES 7,900 2,370 5,530
G72.4 Inflammatory myopathy, not elsewhere classified MYOPATHIES 7,900 2,370 5,530
G72.8 Other specified myopathies MYOPATHIES 7,900 2,370 5,530
G72.9 Myopathy, unspecified MYOPATHIES 7,900 2,370 5,530
P91.0 Neonatal cerebral ischaemia NEONATAL CEREBRAL ISCHEMIA 25,800 7,740 18,060
P00.0Fetus and newborn affected by maternal hypertensive
disordersNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.1Fetus and newborn affected by maternal renal and urinary
tract diseasesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.2Fetus and newborn affected by maternal infectious and
parasitic diseasesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.3Fetus and newborn affected by other maternal circulatory
and respiratory diseasesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.4Fetus and newborn affected by maternal nutritional
disorders; Maternal nutriotion NOSNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.5 Fetus and newborn affected by maternal injury NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.6Fetus and newborn affected by surgical procedure on
motherNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.7Fetus and newborn affected by other medical procedures
on mother, not elsewhere classifiedNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.8
Fetus and newborn affected by other maternal conditions;
Fetus or newborn affected by maternal genital tract and
other localized infections; Fetus or newborn affected by
maternal systemic lupus erythematosus
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P00.9Fetus and newborn affected by unspecified maternal
conditionNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.0 Fetus and newborn affected by incompetent cervix NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.1Fetus and newborn affected by premature rupture of
membranesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.2 Fetus and newborn affected by oligohydramnios NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.3Fetus and newborn affected by polyhydramnios;
HydramniosNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.4Fetus and newborn affected by ectopic pregnancy;
Abdominal pregnancyNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.5Fetus and newborn affected by multiple pregnancy; Triplet
pregnance; Twin pregnancyNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.6 Fetus and newborn affected by maternal death NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.7
Fetus and newborn affected by malpresentation before
labour; Breech presentation before labor; External version
before labour; Face presentation before labour; Transverse
lie before labour; Unstable lie before labour
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.8Fetus and newborn affected by other maternal
complications of pregnancy; Spontaneous abortion, fetusNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P01.9Fetus and newborn affected by maternal complication of
pregnancy, unspecifiedNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.0 Fetus and newborn affected by placenta praevia NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.1
Fetus and newborn affected by other forms of placental
separation and haemorrhage; Abruptio placentae;
Accidental haemorrhage; Antepartum haemorrhage;
Damage to placenta from amniocentesis, caesarian section
or surgical induction; Maternal blood loss; Premature
separation of placenta
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
Page 82 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
P02.2
Fetus and newborn affected by other and unspecified
morphological and functional abnormalities of placenta;
Placental dysfunction; Placental infarction; Placental
insufficiency
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.3
Fetus and newborn affected by placental transfusion
syndromes; Placental and cord abnormalities resulting in
twin-to-twin or other transplacental transfusion
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.4 Fetus and newborn affected by prolapsed cord NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.5
Fetus and newborn affected by other compression of
umbilical cord; Cord (tightly) around neck; Entanglement of
cord; Knot in cord
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.6Fetus and newborn affected by other and unspecified
conditions of umbilical cord; Short cord; Vasa praeviaNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.7Fetus and newborn affected by chorioamnionitis;
Amnionitis; Membranitis; PlacentitisNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.8Fetus and newborn affected by other abnormalities of
membranesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P02.9Fetus and newborn affected by abnormality of membranes,
unspecifiedNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.0Fetus and newborn affected by breech delivery and
extractionNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.1
Fetus and newborn affected by other malpresentation,
malposition and disproportion during labour and delivery;
Contracted pelvis; Persistent occipitoposterior; Transverse
lie
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.2 Fetus and newborn affected by forceps delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.3Fetus and newborn affected by delivery by vacuum
extractor [ventouse]NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.4 Fetus and newborn affected by caesarean delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.5 Fetus and newborn affected by precipitate delivery NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.6
Fetus and newborn affected by abnormal uterine
contractions; Fetus and newborn affected by abnormal
Hypertonic lahour; Fetus and newborn affected by
abnormal Uterine inertia
NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.8Fetus and newborn affected by other specified
complications of labour and deliveryNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P03.9Fetus and newborn affected by complication of labour and
delivery, unspecifiedNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.0Fetus and newborn affected by maternal anaesthesia and
analgesia in pregnancy, labour and deliveryNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.1Fetus and newborn affected by other maternal medication;
Cancer chemotherapy; Cytotoxic drugsNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.2 Fetus and newborn affected by maternal use of tobacco NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.3 Fetus and newborn affected by maternal use of alcohol NEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.5Fetus and newborn affected by maternal use of nutritional
chemical substancesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
P04.8Fetus and newborn affected by other maternal noxious
influencesNEONATE AFFECTED BY MATERNAL FACTORS 7,700 2,310 5,390
D37.0
Neoplasm of uncertain or unknown behaviour of Lip, oral
cavity and pharynx; Neoplasm of uncertain or unknown
behaviour of Aryepiglottic fold NOS; Neoplasm of
uncertain or unknown behaviour of hypopharyngeal aspect
of Aryepiglottic fold; Neoplasm of uncertain or unknown
behaviour of marginal zone of Aryepiglottic fold; Neoplasm
of uncertain or unknown behaviour of Major and minor
salivary glands; Neoplasm of uncertain or unknown
behaviour of Vermilion border of lip
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.1 Neoplasm of uncertain or unknown behaviour of Stomach NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.2Neoplasm of uncertain or unknown behaviour of Small
intestineNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.3 Neoplasm of uncertain or unknown behaviour of Appendix NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.4 Neoplasm of uncertain or unknown behaviour of Colon NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.5
Neoplasm of uncertain or unknown behaviour of Rectum;
Neoplasm of uncertain or unknown behaviour of
Rectosigmoid junction
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.6
Neoplasm of uncertain or unknown behaviour of Liver,
gallbladder and bile ducts; Neoplasm of uncertain or
unknown behaviour of Ampulla of Vater
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Page 83 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D37.7
Neoplasm of uncertain or unknown behaviour of Other
digestive organs; Neoplasm of uncertain or unknown
behaviour of Anal canal; Neoplasm of uncertain or
unknown behaviour of Anal sphincter; Neoplasm of
uncertain or unknown behaviour of Anus NOS; Neoplasm
of uncertain or unknown behaviour of Intestine NOS;
Neoplasm of uncertain or unknown behaviour of
Oesophagus; Neoplasm of uncertain or unknown behaviour
of Pancreas
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D37.9Neoplasm of uncertain or unknown behaviour of Digestive
organ, unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.0
Neoplasm of uncertain or unknown behaviour of Larynx;
Neoplasm of uncertain or unknown behaviour of laryngeal
aspect of Aryepiglottic fold; Neoplasm of uncertain or
unknown behaviour of Suprahyoid portion of Epiglottis
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.1Neoplasm of uncertain or unknown behaviour of Trachea,
bronchus and lungNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.2 Neoplasm of uncertain or unknown behaviour of Pleura NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.3Neoplasm of uncertain or unknown behaviour of
MediastinumNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.4 Neoplasm of uncertain or unknown behaviour of Thymus NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.5
Neoplasm of uncertain or unknown behaviour of Other
respiratory organs; Neoplasm of uncertain or unknown
behaviour of Accessory sinuses; Neoplasm of uncertain or
unknown behaviour of Cartilage of nose; Neoplasm of
uncertain or unknown behaviour of Middle ear; Neoplasm
of uncertain or unknown behaviour of Nasal cavities
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D38.6Neoplasm of uncertain or unknown behaviour of
Respiratory organ, unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D39.0 Neoplasm of uncertain or unknown behaviour of Uterus NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D39.1 Neoplasm of uncertain or unknown behaviour of Ovary NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D39.2
Neoplasm of uncertain or unknown behaviour of Placenta;
Chorioadenoma destruens; Invasive Hydatidiform mole;
Malignant Hydatidiform mole
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D39.7
Neoplasm of uncertain or unknown behaviour of Other
female genital organs; Neoplasm of uncertain or unknown
behaviour of Skin of female genital organs
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D39.9Neoplasm of uncertain or unknown behaviour of Female
genital organ, unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D40.0 Neoplasm of uncertain or unknown behaviour of Prostate NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D40.1 Neoplasm of uncertain or unknown behaviour of Testis NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D40.7
Neoplasm of uncertain or unknown behaviour of Other
male genital organs; Neoplasm of uncertain or unknown
behaviour of Skin of male genital organs
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D40.9Neoplasm of uncertain or unknown behaviour of Male
genital organ, unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.0 Neoplasm of uncertain or unknown behaviour of Kidney NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.1Neoplasm of uncertain or unknown behaviour of Renal
pelvisNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.2 Neoplasm of uncertain or unknown behaviour of Ureter NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.3 Neoplasm of uncertain or unknown behaviour of Urethra NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.4 Neoplasm of uncertain or unknown behaviour of Bladder NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D41.9Neoplasm of uncertain or unknown behaviour of Urinary
organ, unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D42.0Neoplasm of uncertain or unknown behaviour of Cerebral
meningesNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D42.1Neoplasm of uncertain or unknown behaviour of Spinal
meningesNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D42.9Neoplasm of uncertain or unknown behaviour of Meninges,
unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Page 84 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D43.0
Neoplasm of uncertain or unknown behaviour of Brain,
supratentorial; Neoplasm of uncertain or unknown
behaviour of Cerebral ventricle; Neoplasm of uncertain or
unknown behaviour of Cerebrum; Neoplasm of uncertain
or unknown behaviour of Frontal lobe; Neoplasm of
uncertain or unknown behaviour of Occipital lobe;
Neoplasm of uncertain or unknown behaviour of Parietal
lobe; Neoplasm of uncertain or unknown behaviour of
Temporal lobe
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D43.1
Neoplasm of uncertain or unknown behaviour of Brain,
infratentorial; Neoplasm of uncertain or unknown
behaviour of Brain stem; Neoplasm of uncertain or
unknown behaviour of Cerebellum; Neoplasm of
uncertain or unknown behaviour of Fourth ventricle
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D43.2Neoplasm of uncertain or unknown behaviour of Brain,
unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D43.3Neoplasm of uncertain or unknown behaviour of Cranial
nervesNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D43.4Neoplasm of uncertain or unknown behaviour of Spinal
cordNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D43.7Neoplasm of uncertain or unknown behaviour of Other
parts of central nervous systemNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D43.9
Neoplasm of uncertain or unknown behaviour of Central
nervous system, unspecified; Neoplasm of uncertain or
unknown behaviour of Central Nervous system NOS
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.0Neoplasm of uncertain or unknown behaviour of Thyroid
glandNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.1Neoplasm of uncertain or unknown behaviour of Adrenal
glandNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.2Neoplasm of uncertain or unknown behaviour of
Parathyroid glandNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.3Neoplasm of uncertain or unknown behaviour of Pituitary
glandNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.4Neoplasm of uncertain or unknown behaviour of
Craniopharyngeal ductNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.5Neoplasm of uncertain or unknown behaviour of Pineal
glandNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.6Neoplasm of uncertain or unknown behaviour of Carotid
bodyNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.7Neoplasm of uncertain or unknown behaviour of Aortic
body and other paragangliaNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.8
Neoplasm of uncertain or unknown behaviour of
Pluriglandular involvement; Multiple endocrine
adenomatosis
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D44.9Neoplasm of uncertain or unknown behaviour of Endocrine
gland, unspecifiedNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D45 Polycythaemia vera NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D46 Myelodysplastic syndromes NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D46.7 Other myelodysplastic syndromes NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D46.9
Myelodysplastic syndrome, unspecified; Myelodysplastic
syndrome NOS; Myelodysplasia NOS; Preleukaemia
syndrome NOS
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D47.0
Histiocytic and mast cell tumours of uncertain and
unknown behaviour; Mast cell tumour NOS; Mastocytoma
NOS
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D47.1
Chronic myeloproliferative disease; Myelofibrosis with
myeloid metaplasia; Myeloproliferative disease,
unspecified; Megakaryocytic Myelosclerosis with myeloid
metaplasia
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D47.2 Monoclonal gammopathy NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D47.3
Essential thrombocythaemia; Haemorrhagic
thrombocythaemia; Idiopathic haemorrhagic
thrombocythaemia
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D47.7Other specified neoplasms of uncertain or unknown
behaviour of lymphoid, haematopoietic and related tissueNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D47.9
Neoplasm of uncertain or unknown behaviour of lymphoid,
haematopoietic and related tissue, unspecified;
Lymphoproliferative disease NOS
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.0Neoplasm of uncertain or unknown behaviour of Bone and
articular cartilageNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.1
Neoplasm of uncertain or unknown behaviour of
Connective and other soft tissue; Neoplasm of uncertain or
unknown behaviour of Connective tissue of ear; Neoplasm
of uncertain or unknown behaviour of eyelid
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
Page 85 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
D48.2Neoplasm of uncertain or unknown behaviour of Peripheral
nerves and autonomic nervous systemNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.3Neoplasm of uncertain or unknown behaviour of
RetroperitoneumNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.4Neoplasm of uncertain or unknown behaviour of
PeritoneumNEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.6
Neoplasm of uncertain or unknown behaviour of Breast;
Neoplasm of uncertain or unknown behaviour of
Connective tissue of breast; Cystosarcoma phyllodes
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.7
Neoplasm of uncertain or unknown behaviour of Other
specified sites; Neoplasm of uncertain or unknown
behaviour of Eye; Neoplasm of uncertain or unknown
behaviour of Heart; Neoplasm of uncertain or unknown
behaviour of Peripheral nerves of orbit
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
D48.9
Neoplasm of uncertain or unknown behaviour, unspecified;
"Growth" NOS ; Neoplasm NOS;
New growth NOS; Tumour NOS
NEOPLASMS OF UNKNOWN BEHAVIOR 12,200 3,660 8,540
G54.0 Brachial plexus disorders; Thoracic outlet syndrome NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.1 Lumbosacral plexus disorders NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.2 Cervical root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.3 Thoracic root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.4 Lumbosacral root disorders, not elsewhere classified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.5Neuralgic amyotrophy; Parsonage-Aldren-Turner
syndrome; Shoulder-girdle neuritisNERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.8 Other nerve root and plexus disorders NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G54.9 Nerve root and plexus disorder, unspecified NERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
G55.8*Nerve root and plexus compressions in other diseases
classified elsewhereNERVE ROOT AND PLEXUS DISORDERS 7,900 2,370 5,530
P05.0 Light for gestational ageNEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P05.1 Small for gestational ageNEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P05.2Fetal malnutrition without mention of light or small for
gestational age
NEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P05.9Slow fetal growth, unspecified; Fetal growth retardation
NOS
NEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P07.0 Extremely low birth weight; Birth weight 999 g or less.NEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P07.1 Other low birth weight; Birth weight 1000-2499 g.NEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P07.2Extreme immaturity; Less than 28 completed weeks (less
than 196 completed days) of gestation.
NEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P07.3
Other preterm infants; 28 completed weeks or more but
less than 37 completed weeks (196 completed days but less
than 259 completed days) of gestation; Prematurity NOS
NEWBORN COMPLICATED- LOW BIRTH
WEIGHT/PRETERM16,900 5,070 11,830
P08.0Exceptionally large baby; Usually implies a birth weight of
4500 g or more.NEWBORN COMPLICATED-LARGE BABY 7,000 2,100 4,900
P08.1
Other heavy for gestational age infants; Other fetus or
infant heavy- or large-for-dates regardless of period of
gestation.
NEWBORN COMPLICATED-LARGE BABY 7,000 2,100 4,900
P08.2
Post-term infant, not heavy for gestational age; Fetus or
infant with gestation period of 42 completed weeks or
more (294 days or
more), not heavy- or large-for-dates; Postmaturity NOS
NEWBORN COMPLICATED-POSTTERM 7,500 2,250 5,250
P36.0 Sepsis of newborn due to streptococcus, group B NEWBORN SEPSIS 11,700 3,510 8,190
P36.1Sepsis of newborn due to other and unspecified
streptococciNEWBORN SEPSIS 11,700 3,510 8,190
P36.2 Sepsis of newborn due to Staphylococcus aureus NEWBORN SEPSIS 11,700 3,510 8,190
P36.3Sepsis of newborn due to other and unspecified
staphylococciNEWBORN SEPSIS 11,700 3,510 8,190
P36.4 Sepsis of newborn due to Escherichia coli NEWBORN SEPSIS 11,700 3,510 8,190
P36.5 Sepsis of newborn due to anaerobes NEWBORN SEPSIS 11,700 3,510 8,190
P36.8 Other bacterial sepsis of newborn NEWBORN SEPSIS 11,700 3,510 8,190
P36.9
Bacterial sepsis of newborn, unspecified
Sepsis neonatorum
Septicemia, newborn
NEWBORN SEPSIS 11,700 3,510 8,190
N83.8
Other noninflammatory disorders of ovary, fallopian tube
and broad ligament; Broad ligament laceration syndrome
[Allen-Masters]
NONINFLAMMATORY DISORDERS OF THE FEMALE
GENITAL TRACT8,500 2,550 5,950
N83.9Noninflammatory disorder of ovary, fallopian tube and
broad ligament, unspecified
NONINFLAMMATORY DISORDERS OF THE FEMALE
GENITAL TRACT8,500 2,550 5,950
N85.8Other specified noninflammatory disorders of uterus;
Atrophy of uterus, acquired; Fibrosis of uterus NOS
NONINFLAMMATORY DISORDERS OF THE FEMALE
GENITAL TRACT8,500 2,550 5,950
Page 86 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N85.9Noninflammatory disorder of uterus, unspecified; Disorder
of uterus NOS
NONINFLAMMATORY DISORDERS OF THE FEMALE
GENITAL TRACT8,500 2,550 5,950
E50.0 Vitamin A deficiency with conjunctival xerosis NUTRITIONAL DISORDER 9,200 2,760 6,440
E50.1Vitamin A deficiency with Bitot's spot and conjunctival
xerosis; Bitot's spot in the young childNUTRITIONAL DISORDER 9,200 2,760 6,440
E50.8
Other manifestations of vitamin A deficiency; Follicular
keratosis due to vitamin A deficiency; Xeroderma due to
vitamin A deficiency
NUTRITIONAL DISORDER 9,200 2,760 6,440
E50.9 Vitamin A deficiency, unspecified; Hypovitaminosis A NOS NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.1 Dry Beriberi NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.2 Wernicke's encephalopathy NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.8 Other manifestations of thiamine deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E51.9 Thiamine deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E53.1 Pyridoxine deficiency; Vitamin B6 deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E53.8
Deficiency of other specified B group vitamins; Biotin
Deficiency; Cyanocobalamin Deficiency; Folate Deficiency;
Folic acid Deficiency; Pantothenic acid Deficiency; Vitamin
B12 Deficiency
NUTRITIONAL DISORDER 9,200 2,760 6,440
E53.9 Vitamin B deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E54 Ascorbic acid deficiency; Deficiency of vitamin C; Scurvy NUTRITIONAL DISORDER 9,200 2,760 6,440
E55.0Rickets, active; Infantile Osteomalacia; Juvenile
OsteomalaciaNUTRITIONAL DISORDER 9,200 2,760 6,440
E55.9 Vitamin D deficiency, unspecified; Avitaminosis D NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.0 Deficiency of vitamin E NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.1 Deficiency of vitamin K NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.8 Deficiency of other vitamins NUTRITIONAL DISORDER 9,200 2,760 6,440
E56.9 Vitamin deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E58 Dietary calcium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E60 Dietary zinc deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.1 Iron deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.2 Magnesium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.6 Vanadium deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E61.9 Deficiency of nutrient element, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E63.1 Imbalance of constituents of food intake NUTRITIONAL DISORDER 9,200 2,760 6,440
E63.8 Other specified nutritional deficiencies NUTRITIONAL DISORDER 9,200 2,760 6,440
E63.9 Nutritional deficiency, unspecified NUTRITIONAL DISORDER 9,200 2,760 6,440
E64.9 Sequelae of unspecified nutritional deficiency NUTRITIONAL DISORDER 9,200 2,760 6,440
E67.0 Hypervitaminosis A NUTRITIONAL DISORDER 9,200 2,760 6,440
E67.1 Hypercarotenaemia NUTRITIONAL DISORDER 9,200 2,760 6,440
E67.3 Hypervitaminosis D NUTRITIONAL DISORDER 9,200 2,760 6,440
E66.2Extreme obesity with alveolar hypoventilation; Obesity
hypoventilation syndrome (OHS); Pickwickian syndromeOBESITY HYPOVENTILATION 13,600 4,080 9,520
N13.0 Hydronephrosis with ureteropelvic junction obstruction OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.1Hydronephrosis with ureteral stricture, not elsewhere
classifiedOBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.2Hydronephrosis with renal and ureteral calculous
obstructionOBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.3 Other and unspecified hydronephrosis OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.4 Hydroureter OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.5 Kinking and stricture of ureter without hydronephrosis OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.6Pyonephrosis; Conditions in N13.0-N13.5 with infection;
Obstructive uropathy with infectionOBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.7Vesicoureteral-reflux-associated uropathy; Vesicoureteral
reflux NOS; Vesicoureteral reflux with scarringOBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.8 Other obstructive and reflux uropathy OBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N13.9Obstructive and reflux uropathy, unspecified; Urinary tract
obstruction NOSOBSTRUCTIVE UROPATHIES 9,700 2,910 6,790
N45.0Orchitis, epididymitis and epididymo-orchitis with abscess;
Abscess of epididymis or testisORCHITIS 7,900 2,370 5,530
N45.9Orchitis, epididymitis and epididymo-orchitis without
abscess; Epididymitis NOS; Orchitis NOSORCHITIS 7,900 2,370 5,530
M86.0 Acute haematogenous osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.1 Other acute osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.15 Other acute osteomyelitis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.17 Other acute osteomyelitis Ankle and foot OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.19 Other acute osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.2 Subacute osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.29 Subacute osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.4 Chronic osteomyelitis with draining sinus OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.5 Other chronic haematogenous osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.50 Other chronic haematogenous osteomyelitis Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
Page 87 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M86.6 Other chronic osteomyelitis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.60 Other chronic osteomyelitis Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.61 Other chronic osteomyelitis Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.62 Other chronic osteomyelitis Upper arm OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.63 Other chronic osteomyelitis Forearm OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.65 Other chronic osteomyelitis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.66 Other chronic osteomyelitis Lower leg OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.67 Other chronic osteomyelitis Ankle and foot OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.68 Other chronic osteomyelitis Other OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.69 Other chronic osteomyelitis Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.8 Other osteomyelitis; Brodie's abscess OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.80 Other osteomyelitis; Brodie's abscess Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.81 Other osteomyelitis; Brodie's abscess Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.88 Other osteomyelitis; Brodie's abscess Other OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.9Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis NOSOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.90Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Multiple siteOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.91
Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Shoulder
region
OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.92Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Upper armOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.94Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis HandOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.95
Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Pelvic region
and thigh
OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.96Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Lower legOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.97Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Ankle and footOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.98Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis OtherOSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M86.99
Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis Site
unspecified
OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.05 Idiopathic aseptic necrosis of bone Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.2 Osteonecrosis due to previous trauma OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.8 Other osteonecrosis OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.85 Other osteonecrosis Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.86 Other osteonecrosis Lower leg OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.9 Osteonecrosis, unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.90 Osteonecrosis, unspecified Multiple site OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.91 Osteonecrosis, unspecified Shoulder region OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.95 Osteonecrosis, unspecified Pelvic region and thigh OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M87.99 Osteonecrosis, unspecified Site unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M88.0 Paget's disease of skull OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
M88.9 Paget's disease of bone, unspecified OSTEOMYELITIS AND OSTEONECROSIS 13,000 3,900 9,100
A31.8 Other mycobacterial infections OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A31.9
Mycobacterial infection, unspecified ; Atypical
mycobacterium infection Not Otherwise Specified;
Mycobacteriosis NOS; Listeriosis (listerial foodborne
infection)
OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.0 Pulmonary actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.1 Abdominal actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.2 Cervicofacial actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.7 Actinomycotic septicaemia OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.8 Other forms of actinomycosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A42.9 Actinomycosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A43.1 Cutaneous nocardiosis OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A43.9 Nocardiosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A44.1Cutaneous and mucocutaneous bartonellosis; Verruga
peruanaOTHER BACTERIAL DISEASES 8,900 2,670 6,230
A44.9 Bartonellosis, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A48.8 Other specified bacterial diseases OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.0 Staphylococcal infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.2 Haemophilus influenzae infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.3 Mycoplasma infection, unspecified OTHER BACTERIAL DISEASES 8,900 2,670 6,230
A49.8
Other specified cardia arrhythmias; Brugada syndrome; ont
QT syndrome; Long QT syndrome; coronary sinus rhythm
disorder; ectopic shythm disorder; nodal rhythm disorder
OTHER BACTERIAL DISEASES 8,900 2,670 6,230
Page 88 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
A49.9 Bacterial infection, unspecified; Bacteraemia NOS OTHER BACTERIAL DISEASES 8,900 2,670 6,230
B20.1 HIV disease resulting in other bacterial infections OTHER BACTERIAL DISEASES 8,900 2,670 6,230
M89.0Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's
atrophy; Sympathetic reflex dystrophyOTHER BONE DISORDERS 8,800 2,640 6,160
M89.01Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's
atrophy; Sympathetic reflex dystrophy Shoulder regionOTHER BONE DISORDERS 8,800 2,640 6,160
M89.2 Other disorders of bone development and growth OTHER BONE DISORDERS 8,800 2,640 6,160
M89.4Other hypertrophic osteoarthropathy; Marie-Bamberger
disease; PachydermoperiostosisOTHER BONE DISORDERS 8,800 2,640 6,160
M89.48Other hypertrophic osteoarthropathy; Marie-Bamberger
disease; Pachydermoperiostosis OtherOTHER BONE DISORDERS 8,800 2,640 6,160
M89.5 Osteolysis OTHER BONE DISORDERS 8,800 2,640 6,160
M89.54 Osteolysis Hand OTHER BONE DISORDERS 8,800 2,640 6,160
M89.6 Osteopathy after poliomyelitis OTHER BONE DISORDERS 8,800 2,640 6,160
M89.8Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossificationOTHER BONE DISORDERS 8,800 2,640 6,160
M89.85
Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossification
Pelvic region and thigh
OTHER BONE DISORDERS 8,800 2,640 6,160
M89.86
Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossification
Lower leg
OTHER BONE DISORDERS 8,800 2,640 6,160
M89.87
Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossification
Ankle and foot
OTHER BONE DISORDERS 8,800 2,640 6,160
M89.88
Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossification
Other
OTHER BONE DISORDERS 8,800 2,640 6,160
M89.89
Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossification
Site unspecified
OTHER BONE DISORDERS 8,800 2,640 6,160
M89.95 Disorder of bone, unspecified Pelvic region and thigh OTHER BONE DISORDERS 8,800 2,640 6,160
M89.98 Disorder of bone, unspecified Other OTHER BONE DISORDERS 8,800 2,640 6,160
M89.99 Disorder of bone, unspecified Site unspecified OTHER BONE DISORDERS 8,800 2,640 6,160
M91.1Juvenile osteochondrosis of head of femur [LEGG-CALVÉ-
PERTHES]OTHER BONE DISORDERS 8,800 2,640 6,160
M91.8Other juvenile osteochondrosis after reduction of
congenital dislocation of hipOTHER BONE DISORDERS 8,800 2,640 6,160
M94.0 Chondrocostal junction syndrome [Tietze] OTHER BONE DISORDERS 8,800 2,640 6,160
M94.8 Other specified disorders of cartilage OTHER BONE DISORDERS 8,800 2,640 6,160
M99.8 Other biomechanical lesions OTHER BONE DISORDERS 8,800 2,640 6,160
M99.9 Biomechanical lesion, unspecified OTHER BONE DISORDERS 8,800 2,640 6,160
I65.2 Occlusion and stenosis of carotid artery OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.0 Dissection of cerebral arteries, nonruptured OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.1Cerebral aneurysm, nonruptured; Cerebral aneurysm NOS;
Cerebral arteriovenous fistula, acquiredOTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.2 Cerebral atherosclerosis; Atheroma of cerebral arteries OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.3Progressive vascular leukoencephalopathy; Binswanger's
diseaseOTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.5 Moyamoya disease OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.6
Nonpyogenic thrombosis of intracranial venous system;
Nonpyogenic thrombosis of cerebral vein; Nonpyogenic
thrombosis of intracrannial venous sinus
OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.7 Cerebral arteritis, not elsewhere classified OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.8
Other specified cerebrovascular diseases; Acute
cerebrovascular insufficiency NOS; Chronic Cerebral
ischaemia
OTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.9+G46.7*Other lacunar syndrome in unspecified cerebrovascular
diseaseOTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
I67.9+G46.8*Other vascular syndrome in unspecified cerebrovascular
diseaseOTHER CEREBROVASCULAR DISEASES 15,200 4,560 10,640
A56.4 Chlamydial infection of pharynx OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
A71.1
Active stage of trachoma; Trachomatous Granular
conjunctivitis; Trachomatous follicular conjunctivitis;
Trachomatous pannus
OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
A71.9 Trachoma, unspecified OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
A74.9 Chlamydial infection, unspecified; Chlamydiosis NOS OTHER CHLAMYDIAL DISEASES 8,500 2,550 5,950
Q85.1 Tuberous sclerosis; Bourneville's disease; Epiloia OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q87.0
Congenital malformation syndromes predominantly
affecting facial appearance; Acrocephalopolysyndactyly;
Acrocephalosyndactyly [Apert]; Cryptophthalmos
syndrome; Cyclopia; Goldenhar Syndrome; Moebius
Syndrome; oro-facial-digital Syndrome; Robin Syndrome;
Whistling face
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Page 89 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q87.1
Congenital malformation syndromes predominantly
associated with short stature; Aarskog Syndrome;
Cockayne Syndrome; De Lange Syndrome ; Dubowitz
Syndrome; Noonan Syndrome; Prader-Willi Syndrome;
Robinow-Silverman-Smith Syndrome ;
Russell-Silver Syndrome; Seckel syndrome; Smith-Lemli-
Opitz syndrome
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q87.2
Congenital malformation syndromes predominantly
involving limbs; Holt-Oram Syndrome; Klippel-Trénaunay-
Weber Syndrome; nail patella Syndrome;
Rubinstein-Taybi Syndrome; sirenomelia Syndrome;
thrombocytopenia Syndrome with absent radius [TAR];
VATER
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q87.3
Congenital malformation syndromes involving early
overgrowth; Beckwith-Wiedemann Syndrome; Sotos;
Syndrome Weaver Syndrome
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q87.4 Marfan's syndrome OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q87.8
Other specified congenital malformation syndromes, not
elsewhere classified; Alport Syndrome; Laurence-Moon(-
Bardet)-Biedl Syndrome; Zellweger Syndrome
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.0Congenital malformations of spleen; Asplenia (congenital);
Congenital splenomegalyOTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.1 Congenital malformations of adrenal gland OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.2
Congenital malformations of other endocrine glands;
Congenital malformation of parathyroid or thyroid gland;
Persistent thyroglossal duct; Thyroglossal cyst
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.4Conjoined twins; Craniopagus; Dicephaly; Double monster;
Pygopagus; ThoracopagusOTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.7
Multiple congenital malformations, not elsewhere
classified; Monster NOS; Multiple congenital anomalies
NOS; Multiple congenital deformities NOS
OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.8 Other specified congenital malformations OTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
Q89.9Congenital malformation, unspecified; Congenital anomaly
NOS; Congenital deformity NOSOTHER CONGENITAL MALFORMATIONS 11,600 3,480 8,120
I80.0Phlebitis and thrombophlebitis of superficial vessels of
lower extremitiesOTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I80.1 Phlebitis and thrombophlebitis of femoral vein OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I80.2Phlebitis and thrombophlebitis of other deep vessels of
lower extremities; Deep vein thrombosis NOSOTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I80.3
Phlebitis and thrombophlebitis of lower extremities,
unspecified; Embolism or thrombosis of lower extermity
NOS
OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I80.8 Phlebitis and thrombophlebitis of other sites OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I80.9 Phlebitis and thrombophlebitis of unspecified site OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I81 Portal vein thrombosis; Portal (vein) obstruction OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.0 Budd-Chiari syndrome OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.1 Thrombophlebitis migrans OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.2 Embolism and thrombosis of vena cava OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.3 Embolism and thrombosis of renal vein OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.8 Embolism and thrombosis of other specified veins OTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
I82.9Embolism and thrombosis of unspecified vein; Embolism of
vein NOS; Thrombosis (vein) NOSOTHER DISORDERS OF CIRCULATORY SYSTEM 12,400 3,720 8,680
E15
Nondiabetic hypoglycaemic coma; Nondiabetic
hypoglycaemic coma; Drug-induced insulin coma in
nondiabetic; Hyperinsulinism with hypoglycaemic coma;
Hypoglycaemic coma NOS
OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
E16.0 Drug-induced hypoglycaemia without coma OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
E16.1
Other hypoglycaemia; Functional nonhyperinsulinaemic
hypoglycaemia; Hyperinsulinism NOS; Functional
Hyperinsulinism; Hyperplasia of pancreatic islet beta cells
NOS; Posthypoglycaemic coma encephalopathy
OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
E16.3
Increased secretion of glucagon; Hyperplasia of pancreatic
endocrine cells with glucagon excess; Hyperplasia of
pancreatic endocrine cells with glucagon excess
OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
E16.4Abnormal secretion of gastrin; Hypergastrinaemia; Zollinger-
Ellison syndromeOTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
E16.8
Other specified disorders of pancreatic internal secretion;
Increased secretion from endocrine pancreas of growth
hormone-releasing hormone; Increased secretion from
endocrine pancreas of pancreatic polypeptide; Increased
secretion from endocrine pancreas of somatostatin;
Increased secretion from endocrine pancreas of vasoactive-
intestinal polypeptide
OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
Page 90 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
E16.9
Disorder of pancreatic internal secretion, unspecified; Islet-
cell hyperplasia NOS; Pancreatic endocrine cell hyperplasia
NOS
OTHER DISORDERS OF GLUCOSE REGULATION 8,100 2,430 5,670
N82.0 Vesicovaginal fistulaOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N83.0Follicular cyst of ovary; Cyst of graafian follicle;
Haemorrhagic follicular cyst of ovary
OTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N83.3 Acquired atrophy of ovary and fallopian tubeOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N83.6 HaematosalpinxOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N83.7 Haematoma of broad ligamentOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N85.7 Haematometra; Haematosalpinx with haematometraOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N89.7Haematocolpos; Haematocolpos with haematometra or
haematosalpinx
OTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q51.2 Other doubling of uterus' Doubling of uterus NOSOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q51.3 Bicornate uterusOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q51.8Other congenital malformations of uterus and cervix;
Hypoplasia of uterus and cervix
OTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q52.1 Doubling of vagina; Septate vaginaOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q52.2 Congenital rectovaginal fistulaOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q52.3 Imperforate hymenOTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
Q52.8Other specified congenital malformations of female
genitalia
OTHER DISORDERS OF THE FEMALE GENITAL
TRACT7,800 2,340 5,460
N47Redundant prepuce, phimosis and paraphimosis; Adherent
prepuce; Tight foreskinOTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
N48.8
Other specified disorders of penis; Atrophyof corpus
cavernosum and penis ; Hypertrophy of corpus cavernosum
and penis ; Thrombosis of corpus cavernosum and penis
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
N50.0 Atrophy of testis OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
N50.1
Vascular disorders of male genital organs; Haematocele of
male genital organs NOS; Haemorrhage of male genital
organs;, Thrombosis of male genital organs
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
N50.8
Other specified disorders of male genital organs; Atrophy of
scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vaginalis and vas deferens; Hypertrophy of
scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vaginalis and vas deferens; Oedema of
scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vaginalis and vas deferens; Ulcer of
scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vaginalis and vas deferens; Chylocele,
tunica vaginalis (nonfilarial) NOS; Fistula, urethroscrotal;
Stricture of spermatic cord; Stricture of tunica vaginalis;
Stricture of vas deferens
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.0 Absence and aplasia of testis; Monorchism OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.1 Hypoplasia of testis and scrotum; Fusion of testes OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.2
Other congenital malformations of testis and scrotum;
Congenital malformation of testis or scrotum NOS;
Polyorchism; Retractile testis; Testis migrans
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.4
Other congenital malformations of vas deferens,
epididymis, seminal vesicles and prostate; Absence or
aplasia of prostate; Absence or aplasia of spermatic cord;
Congenital malformation of vas deferens, epididymis,
seminal vesicles or prostate
NOS
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.6
Other congenital malformations of penis; Congenital
malformation of penis NOS; Curvature of penis (lateral);
Hypoplasia of penis
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q55.9
Congenital malformation of male genital organ,
unspecified; Congenital anomalyNOS of male genital organ
; Congenital deformity NOS of male genital organ
OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Page 91 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Q56.1Male pseudohermaphroditism, not elsewhere classified;
Male pseudohermaphroditism NOSOTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
Q56.3 Pseudohermaphroditism, unspecified OTHER DISORDERS OF THE MALE GENITAL TRACT 6,400 1,920 4,480
G90.0Idiopathic peripheral autonomic neuropathy; Carotid sinus
syncopeOTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G90.1 Familial dysautonomia [Riley-Day] OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G90.2 Horner's syndrome; Bernard(-Horner) syndrome OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G90.3Multi-system degeneration; Neurogenic orthostatic
hypotension [Shy-Drager]OTHER DISORDERS OF THE NERVOUS SYSTEM N/A N/A N/A
G90.4 Autonomic dysreflexia OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G90.9
Disorder of autonomic nervous system, unspecified;
acquired hydrocephalus
Autonomic neuropathy
OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.0 Cerebral cysts; Arachnoid cyst; Porencephalic cyst, acquired OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.2 Benign intracranial hypertension OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.3Postviral fatigue syndrome; Benign myalgic
encephalomyelitisOTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.4 Encephalopathy, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.7 Reye's syndrome OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.8 Other specified disorders of brain OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G93.9 Disorder of brain, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G94.8*Other specified disorders of brain in diseases classified
elswhereOTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G95.0 Syringomyelia and syringobulbia OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G95.1
Vascular myelopathies; Acute infarction of spinal cord
(embolic)(nonembolic); Arterial thrombosis of spinal cord;
Haematomyelia; Nonpyogenic intraspinal phlebitis and
thrombophlebitis; Oedema of spinal cord; Subacute
necrotic myelopathy
OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G95.2 Cord compression, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G95.8
Other specified diseases of spinal cord; Cord bladder NOS;
elopathy drug-induced; Myelopathy radiation-induced
Spinal sclerosis
OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G95.9 Disease of spinal cord, unspecified; Myelopathy NOS OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G96.0 Cerebrospinal fluid leak OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G96.1Disorders of meninges, not elsewhere classified; Cerebral
Meningeal adhesions; Spinal Meningeal adhesionsOTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G96.8 Other specified disorders of central nervous system OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G96.9 Disorder of central nervous system, unspecified OTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
G98 Other disorders of nervous system, not elsewhere
classified; Nervous system disorder NOSOTHER DISORDERS OF THE NERVOUS SYSTEM 15,800 4,740 11,060
P90Convulsions of newborn
Seizures, newbornOTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P91.1 Acquired periventricular cysts of newborn OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P91.2 Neonatal cerebral leukomalacia OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P94.1 Congenital hypertonia OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P94.2 Congenital hypotonia; Nonspecific floppy baby syndrome OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P94.9 Disorder of muscle tone of newborn, unspecified OTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P96.5Complications of intrauterine procedures, not elsewhere
classifiedOTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P96.8Other specified conditions originating in the perinatal
periodOTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
P96.9Condition originating in the perinatal period, unspecified;
Congenital debility NOSOTHER DISORDERS OF THE NEWBORN 12,000 3,600 8,400
E06.0Acute thyroiditis; Abscess of thyroid; Pyogenic Thyroiditis;
Suppurative ThyroiditisOTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E06.1
Subacute thyroiditis; de Quervain Thyroiditis; Giant-Cell
Thyroiditis; Granulomatous Thyroiditis; Nonsuppurative
Thyroiditis
OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E06.2 Chronic thyroiditis with transient thyrotoxicosis OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E06.3
Autoimmune thyroiditis; Hashimoto's thyroiditis ; Transient
hashitoxicosis; Lymphadenoid goitre; lymphocytic
thyroiditis; Struma lymphomatosa
OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E06.5Other chronic thyroiditis; Chronic Thyroiditis NOS; Chronic
Fibrous Thyroiditis; Ligneous Thyroiditis; Riedel ThyroiditisOTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E06.9 Thyroiditis, unspecified OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E07.0Hypersecretion of calcitonin; C-cell hyperplasia of thyroid;
Hypersecretion of thyrocalcitoninOTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E07.1Dyshormogenetic goitre; Familial dyshormogenetic goitre;
Pendred's syndromeOTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
Page 92 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
E07.8
Other specified disorders of thyroid; Abnormality of thyroid-
binding globulin; Haemorrhage of thyroid; Infarction of
thyroid; Sick-euthyroid syndrome
OTHER DISORDERS OF THE THYROID 8,500 2,550 5,950
E25.9Adrenogenital disorder, unspecified; Adrenogenital
syndrome NOSOTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E28.8 Other ovarian dysfunction; Ovarian hyperfunction NOS OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E29.1
Testicular hypofunction; Defective biosynthesis of testicular
androgen NOS; 5-a-Reductase deficiency (with male
pseudohermaphroditism); Testicular hypogonadism NOS
OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E29.9 Testicular dysfunction, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E31.0 Autoimmune polyglandular failure OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E31.1 Polyglandular hyperfunction OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E31.9 Polyglandular dysfunction, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E32.0 Persistent hyperplasia of thymus; Hypertrophy of thymus OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E32.8 Other diseases of thymus OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E32.9 Disease of thymus, unspecified OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E34.0 Carcinoid syndrome OTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E34.8Other specified endocrine disorders; Pineal gland
dysfunction; ProgeriaOTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
E34.9Endocrine disorder, unspecified; Endocrine Disturbance
NOS; Hormone Disturbance NOSOTHER ENDOCRINE DISORDERS 10,900 3,270 7,630
N25.0
Renal osteodystrophy; Azotaemic osteodystrophy;
Phosphate-losing tubular disorders; Renal rickets; Renal
short stature
OTHER NEPHROPATHY 9,500 2,850 6,650
N25.8
Other disorders resulting from impaired renal tubular
function; Lightwood-Albright syndrome; Renal tubular
acidosis NOS; Secondary hyperparathyroidism of renal
origin
OTHER NEPHROPATHY 9,500 2,850 6,650
N25.9Disorder resulting from impaired renal tubular function,
unspecifiedOTHER NEPHROPATHY 9,500 2,850 6,650
N28.1Cyst of kidney, acquired; Multiple cyst of kidney, acquired;
Solitary cyst of kidney, acquiredOTHER NEPHROPATHY 9,500 2,850 6,650
J92.9Pleural plaque without asbestos; Pleural plaque NOS;
Pleural thickeningOTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.0 Chylous effusion; Chyliform effusion OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.1 Fibrothorax OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.8 Other specified pleural conditions; Hydrothorax OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J94.9 Pleural condition, unspecified OTHER PLEURAL CONDITIONS 13,500 4,050 9,450
J98.0
Diseases of bronchus, not elsewhere classified;
Broncholithiasis; Calcification of bronchus; Stenosis of
bronchus; Ulcer of bronchus; Tracheobronchial collapse;
Tracheobronchial dyskinesia
OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
J98.4Other disorders of lung; Calcification of lung; Acquired
cystic lung disease; Lung disease NOS; PulmolithiasisOTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
J98.5
Diseases of mediastinum, not elsewhere classified; Fibrosis
of mediastinum; Hernia of mediastinum; Retraction of
mediastinum; Mediastinitis of mediastinum
OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
J98.6Disorders of diaphragm; Diaphragmatitis; Paralysis of
diaphragm; Relaxation of diaphragmOTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
J98.8 Other specified respiratory disorders OTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
J98.9Respiratory disorder, unspecified; Chronic respiratory
disease NOSOTHER RESPIRATORY DISORDERS 10,200 3,060 7,140
A66.9 Yaws, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
A67.1
Intermediate lesions of pinta; Erythematous plaques of
carate pinta; Hyperchromic lesions of carate pinta;
Hyperkeratosis of carate pinta; Pintids of carate pinta
OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
A68.9 Relapsing fever, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
A69.0Necrotizing ulcerative stomatitis; Cancrum oris;
Fusospirochaetal gangrene; Noma; Stomatitis gangrenosaOTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
A69.1
Other Vincent's infections; Fusospirochaetal pharyngitis ;
Acute Necrotizing Ulcerative gingivitis; Acute Necrotizing
Ulcerative Gingivostomatitis; Spirochaetal stomatitis,
Trench mouth; Vincent's angina; Vincent’s gingivitis
OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
A69.2Lyme disease; Erythema chronicum migrans due to Borrelia
burgdorferiOTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
A69.9 Spirochaetal infection, unspecified OTHER SPIROCHAETAL DISEASES 8,800 2,640 6,160
H65.0Acute serous otitis media; Acute and subacute secretory
otitis mediaOTITIS MEDIA 7,800 2,340 5,460
Page 93 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
H65.1
Other acute nonsuppurative otitis media; Acute otitis
media; Subacute otitis media; Acute Mucoid allergic otitis
media; Subacute mucoid allergic otitis media; Acute
allergic Sanguinous otitis media; Subacute Sanguinous
allergic otitis media; Acute allergic serous otitis media;
Subacute allergic serous otitis media; Acute nonsuppurative
NOS otitis media; Subcute nonsuppurative NOS otitis
media; Acute sanguinous otitis media; Subacute
sanguinous otitis media; Acute seromucinous otitis media;
Subacute seromucinous otitis media
OTITIS MEDIA 7,800 2,340 5,460
H65.2 Chronic serous otitis media; Chronic tubotympanal catarrh OTITIS MEDIA 7,800 2,340 5,460
H65.3
Chronic mucoid otitis media; Glue ear; Otitis media, chronic
mucinous; Otitis media, chronic secretory; Otitis media,
chronic transudative
OTITIS MEDIA 7,800 2,340 5,460
H65.4
Other chronic nonsuppurative otitis media; Otitis media,
chronic allergic; Otitis media, chronic exudative; Otitis
media, chronic nonsuppurative NOS; Otitis media, chronic
seromucinous; Otitis media, chronic with effusion
(nonpurulent)
OTITIS MEDIA 7,800 2,340 5,460
H65.9
Nonsuppurative otitis media, unspecified; Allergic Otitis
media ; Catarrhal Otitis media; Exudative Otitis media ;
Mucoid Otitis media ; Secretory Otitis media ;
Seromucinous otitis media; Serous Otitis media;
Transudative Otitis media; Otitis media with (nonpurulent)
effusion
OTITIS MEDIA 7,800 2,340 5,460
H66.0 Acute suppurative otitis media OTITIS MEDIA 7,800 2,340 5,460
H66.1
Chronic tubotympanic suppurative otitis media; Benign
chronic suppurative otitis media; Chronic tubotympanic
disease
OTITIS MEDIA 7,800 2,340 5,460
H66.2Chronic atticoantral suppurative otitis media; Chronic
atticoantral diseaseOTITIS MEDIA 7,800 2,340 5,460
H66.3Other chronic suppurative otitis media; Chronic
suppurative otitis media NOSOTITIS MEDIA 7,800 2,340 5,460
H66.4Suppurative otitis media, unspecified; Purulent otitis media
NOSOTITIS MEDIA 7,800 2,340 5,460
H66.9Otitis media, unspecified; Otitis media NOS; Acute Otitis
media NOS; Chronic Otitis media NOSOTITIS MEDIA 7,800 2,340 5,460
B05.3+ H67.1* Otitis media in measles OTITIS MEDIA 7,800 2,340 5,460
N83.1 Corpus luteum cyst; Haemorrhagic corpus luteum cyst OVARIAN CYSTS 7,800 2,340 5,460
N83.2Other and unspecified ovarian cysts; Retention cyst of
ovary; Simple cyst of ovaryOVARIAN CYSTS 7,900 2,370 5,530
N70.0 Acute salpingitis and oophoritis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N70.1 Chronic salpingitis and oophoritis; Hydrosalpinx PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N70.9 Salpingitis and oophoritis, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N71.0 Acute inflammatory disease of uterus PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N71.1 Chronic inflammatory disease of uterus PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N71.9 Inflammatory disease of uterus, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N72
Inflammatory disease of cervix uteri; Cervicitis with or
without erosion or ectropion; Endocervicitis with or
without erosion or ectropion; Exocervicitis with or without
erosion or ectropion
PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.0
Acute parametritis and pelvic cellulitis; Acute abcess of
broad ligament; Acute abscess of parametrium; Acute
pelvic cellulitis, female
PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.1 Chronic parametritis and pelvic cellulitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.2 Unspecified parametritis and pelvic cellulitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.3 Female acute pelvic peritonitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.4 Female chronic pelvic peritonitis PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.5 Female pelvic peritonitis, unspecified PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.6 Female pelvic peritoneal adhesions PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.8 Other specified female pelvic inflammatory diseases PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N73.9Female pelvic inflammatory disease, unspecified; Female
pelvic infection or inflammation NOSPELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N74.8*Female pelvic inflammatory disorders in other diseases
classified elsewherePELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
O08.0
Genital tract and pelvic infection following abortion and
ectopic and molar pregnancy; Endometritis; Oophoritis;
Parametritis; Pelvic peritonitis; Salpingitis; Salpingo-
oophoritis; Sepsis; Septic shock; Septicaemia
PELVIC INFLAMMATORY DISEASES 9,000 2,700 6,300
N94.0 Mittelschmerz PELVIC PAIN 4,800 1,440 3,360
N94.1 Dyspareunia PELVIC PAIN 4,800 1,440 3,360
N94.2 Vaginismus PELVIC PAIN 4,800 1,440 3,360
N94.3 Premenstrual tension syndrome PELVIC PAIN 4,800 1,440 3,360
N94.4 Primary dysmenorrhoea PELVIC PAIN 4,800 1,440 3,360
N94.5 Secondary dysmenorrhoea PELVIC PAIN 4,800 1,440 3,360
Page 94 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
N94.6 Dysmenorrhoea, unspecified PELVIC PAIN 4,800 1,440 3,360
K25.0Gastric ulcer, acute / Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer with hemorrhagePEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K25.1Gastric ulcer, acute/ Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer with perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K25.2
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer with both haemorrhage
and perforation
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K25.4
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer, chronic or unspecified
with haemorrhage
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K25.5
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer, chronic or unspecified
with perforation
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K25.6
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer, chronic or unspecified
with both haemorrhage and perforation
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K26.0
Duodenal ulcer, acute / Acute erosion of duodenum/
Duodenal peptic ulcer/ Postpyloric peptic ulcer with
haemorrhage
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K26.1
Duodenal ulcer, acute / Acute erosion of duodenum/
Duodenal peptic ulcer/ Postpyloric peptic ulcer with
perforation
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K26.4Chronic Duodenal/ Postpyloric ulcer/ erosion, or
unspecified with haemorrhagePEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K26.5Chronic Duodenal/ Postpyloric ulcer/ erosion, or
unspecified with perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K26.6Chronic Duodenal/ Postpyloric ulcer/ erosion, or
unspecified with both haemorrhage and perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K27.0Acute Peptic ulcer/ Gastroduodenal ulcer NOS, site
unspecified, with haemorrhagePEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K27.1Acute Peptic ulcer / Gastroduodenal ulcer, site unspecified,
with perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K27.2Acute Peptic/ Gastroduodenal ulcer, site unspecified, with
both haemorrhage and perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K27.4Chronic or unspecified Peptic/ Gastroduodenal ulcer, site
unspecified, with haemorrhagePEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K27.5Chronic or unspecified Peptic/ Gastroduodenal ulcer, site
unspecified with perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K27.6Chronic or unspecified Peptic/ Gastroduodenal ulcer, site
unspecified, with both haemorrhage and perforationPEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K28.0
Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or
erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K28.1
Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or
erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K28.2
Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or
erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K28.3
Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or
erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K28.4
Chronic or unspecified Gastrojejunal ulcer/ Anastomotic
peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
Page 95 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K28.5
Chronic or unspecified Gastrojejunal ulcer/ Anastomotic
peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K28.6
Chronic or unspecified Gastrojejunal ulcer/ Anastomotic
peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K29.0Acute haemorrhagic gastritis; Acute erosive gastritis with
haemorrhagePEPTIC ULCER DISEASE WITH HEMORRHAGE 12,800 3,840 8,960
K25.3
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus
peptic ulcer / Stomach peptic ulcer without haemorrhage
or perforation
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K25.7Gastric/ Peptic/ Pyloric ulcer/ erosion, chronic without
haemorrhage or perforationPEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K25.9Gastric/ Peptic/ Pyloric ulcer/ erosion, unspecified as acute
or chronic, without haemorrhage or perforationPEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K26.3
Duodenal ulcer, acute / Acute erosion of duodenum/
Duodenal peptic ulcer/ Postpyloric peptic ulcer without
haemorrhage or perforation
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K26.7Chronic Duodenal/ Postpyloric ulcer/ erosion, without
haemorrhage or perforationPEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K26.9Duodenal/ Postpyloric ulcer/ erosion, unspecified as acute
or chronic, without haemorrhage or perforationPEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K27.3
Acute Peptic/ Gastroduodenal ulcer, site unspecified,
without haemorrhage or perforation; gastroduodenal ulcer
NOS; Peptic ulcer NOS
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K27.7
Chronic Peptic/ Gastroduodenal ulcer, site unspecified,
without haemorrhage or perforation; gastroduodenal ulcer
NOS; Peptic ulcer NOS
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K27.9
Peptic/ Gastroduodenal ulcer, unspecified as acute or
chronic, without haemorrhage or perforation;
gastroduodenal ulcer NOS; Peptic ulcer NOS
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K28.7
Chronic Gastrojejunal ulcer/ Anastomotic peptic ulcer or
erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal peptic ulcer or
erosion
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K28.9
Unspecified as acute or chronic Gastrojejunal ulcer/
Anastomotic peptic ulcer or erosion/ Gastrocolic peptic
ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/
Gastrojejunal peptic ulcer or erosion/ Jejunal peptic ulcer
or erosion/ Marginal peptic ulcer or erosion; Stomal peptic
ulcer or erosion
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.1 Other acute gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.2 Alcoholic gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.3 Chronic superficial gastritis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.4 Chronic atrophic gastritis; Gastric atrophy PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.5Chronic gastritis, unspecified; Chronic Antral gastritis;
Chronic Fundal gastritisPEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.6Other gastritis; Giant hypertrophic gastritis; Granulomatous
gastritis; Menetrier's diseasePEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.7 Gastritis, unspecified PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.8 Duodenitis PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
K29.9 Gastroduodenitis, unspecified PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 6,100 1,830 4,270
P23.0 Congenital pneumonia due to viral agent PERINATAL INFECTIONS 12,700 3,810 8,890
P23.1 Congenital pneumonia due to Chlamydia PERINATAL INFECTIONS 12,700 3,810 8,890
P23.2 Congenital pneumonia due to staphylococcus PERINATAL INFECTIONS 12,700 3,810 8,890
P23.3 Congenital pneumonia due to streptococcus, group B PERINATAL INFECTIONS 12,700 3,810 8,890
P23.4 Congenital pneumonia due to Escherichia coli PERINATAL INFECTIONS 12,700 3,810 8,890
P23.5 Congenital pneumonia due to Pseudomonas PERINATAL INFECTIONS 12,700 3,810 8,890
P23.6
Congenital pneumonia due to other bacterial agents;
Haemophilus influenzae; Klebsiella pneumonia;
Mycoplasma; Streptococcus, except group B
PERINATAL INFECTIONS 12,700 3,810 8,890
P23.9 Congenital pneumonia, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
Page 96 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
P35.0Congenital rubella syndrome; Congenital rubella
pneumonitisPERINATAL INFECTIONS 12,700 3,810 8,890
P35.1 Congenital cytomegalovirus infection PERINATAL INFECTIONS 12,700 3,810 8,890
P35.2 Congenital herpesviral [herpes simplex] infection PERINATAL INFECTIONS 12,700 3,810 8,890
P35.3 Congenital viral hepatitis PERINATAL INFECTIONS 12,700 3,810 8,890
P35.8Other congenital viral diseases; Congenital varicella
[chickenpox]PERINATAL INFECTIONS 12,700 3,810 8,890
P35.9 Congenital viral disease, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
P37.0 Congenital tuberculosis PERINATAL INFECTIONS 12,700 3,810 8,890
P37.1Congenital toxoplasmosis; Hydrocephalus due to congenital
toxoplasmosisPERINATAL INFECTIONS 12,700 3,810 8,890
P37.3 Congenital falciparum malaria PERINATAL INFECTIONS 12,700 3,810 8,890
P37.5 Neonatal candidiasis PERINATAL INFECTIONS 12,700 3,810 8,890
P37.8 Other specified congenital infectious and parasitic diseases PERINATAL INFECTIONS 12,700 3,810 8,890
P37.9 Congenital infectious and parasitic disease, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
P38 Omphalitis of newborn with or without mild haemorrhage PERINATAL INFECTIONS 12,700 3,810 8,890
P39.0 Neonatal infective mastitis PERINATAL INFECTIONS 12,700 3,810 8,890
P39.1Neonatal conjunctivitis and dacryocystitis; Neonatal
chlaydial conjunctivitis; Ophthalmia neonatorum NOSPERINATAL INFECTIONS 12,700 3,810 8,890
P39.2 Intra-amniotic infection of fetus, not elsewhere classified PERINATAL INFECTIONS 12,700 3,810 8,890
P39.3 Neonatal urinary tract infection PERINATAL INFECTIONS 12,700 3,810 8,890
P39.4 Neonatal skin infection; Neonatal pyoderma PERINATAL INFECTIONS 12,700 3,810 8,890
P39.8 Other specified infections specific to the perinatal period PERINATAL INFECTIONS 12,700 3,810 8,890
P39.9 Infection specific to the perinatal period, unspecified PERINATAL INFECTIONS 12,700 3,810 8,890
K66.0
Peritoneal adhesions; Adhesions of abdominal wall;
Adhesions of diaphragm; Adhesions of intestine; Adhesions
of male pelvis; Mesenteric Adhesions; Adhesions of
omentum; Adhesions of stomach; Adhesive bands
PERITONEAL DISORDERS 10,800 3,240 7,560
K66.8 Other specified disorders of peritoneum PERITONEAL DISORDERS 10,800 3,240 7,560
K66.9 Disorder of peritoneum, unspecified PERITONEAL DISORDERS 10,800 3,240 7,560
K65.0
Acute peritonitis; Abdominopelvic abscess; Mesenteric
abscess; Abscess of omentum; Abscess of peritoneum;
Retrocaecal abscess; Retroperitoneal abscess;
Subdiaphragmatic abscess; Subhepatic abscess; Subphrenic
abscess; Acute Generalized peritonitis; Acute male pelvic
peritonitis; Acute subphrenic peritonitis; Acute suppurative
peritonitis
PERITONITIS 14,700 4,410 10,290
K65.8
Other peritonitis; Chronic proliferative peritonitis;
Mesentric fat necrosis; Mesentric saponification; Peritonitis
due to bile; Peritonitis due to urine
PERITONITIS 14,700 4,410 10,290
K65.9 Peritonitis, unspecified PERITONITIS 14,700 4,410 10,290
Q85.8
Other phakomatoses, not elsewhere classified; Peutz-
Jeghers Syndrome; Sturge-Weber(-Dimitri)Syndrome; von
Hippel-Lindau Syndrome
PHAKOMATOSES 10,800 3,240 7,560
Q85.9 Phakomatosis, unspecified; Hamartosis NOS PHAKOMATOSES 10,800 3,240 7,560
J90Pleural effusion, not elsewhere classified; Pleurisy with
effusionPLEURAL EFFUSION 14,200 4,260 9,940
J91* Pleural effusion in conditions classified elsewhere PLEURAL EFFUSION 14,200 4,260 9,940
B20.6 HIV disease resulting in pneumocystis carinii pneumonia PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.03 Adenoviral pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.13 Respiratory syncytial virus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.23 Parainfluenza virus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.33 Human metapneumovirus pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J12.93 Viral pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J13.3Pneumonia [bronchopneumonia]due to Streptococcus
pneumoniae, high riskPNEUMONIA HIGH RISK 32,000 9,600 22,400
J14.3Pneumonia [bronchopneumonia] due to Haemophilus
influenzae, high riskPNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.03 Pneumonia due to Klebsiella pneumoniae, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.13 Pneumonia due to Pseudomonas, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.23 Pneumonia due to staphylococcus, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.33 Pneumonia due to streptococcus, group B, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.43 Pneumonia due to other streptococci, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.53 Pneumonia due to Escherichia coli, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.63Pneumonia due to other aerobic Gram-negative bacteria;
Pneumonia due to Serratia marcescens, high riskPNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.73 Pneumonia due to Mycoplasma pneumoniae, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J15.93 Bacterial pneumonia [bronchopneumonia], high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J16.03 Chlamydial pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J18.03 Bronchopneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
Page 97 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
J18.13 Lobar pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J18.23 Hypostatic pneumonia, high risk PNEUMONIA HIGH RISK 32,000 9,600 22,400
J18.93
Community-acquired pneumonia IV
(This classification utilized the American Thoracic Society
recommendation. This is equivalent to CAP, high risk in the
Philippine Clinical Practice Guidelines on the Diagnosis,
Empiric Management, and Prevention of Community-
acquired Pneumonia in Immunocompetent Adults, 2010
update)
Adult high risk Community Acquired Pneumonia (CAP),
organism is not specified
Pedia Community Acquired Pneumonia D (PCAP-D) high
risk, organism is not specified
PNEUMONIA HIGH RISK 32,000 9,600 22,400
J18.99, Y95Nosocomial pneumonia
Health care associated pneumoniaPNEUMONIA HIGH RISK 32,000 9,600 22,400
A01.0+ J17.0* Pneumonia in typhoid fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A02.2+ J17.0* Pneumonia in salmonella infection PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A21.2+ J17.0* Pneumonia in tularemia PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A22.1+ J17.0* Pneumonia in anthrax PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A31.0
Pulmonary mycobacterial infection; Infection due to
Mycobacterium avium, Mycobacterium intracellulare
[Battey bacillus]; Mycobacterium kansasii
PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A37.0+ J17.0* Pneumonia in whooping cough due to Bordatella pertusis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A37.1+ J17.0*Pneumonia in whooping cough due to Bordatella
parapertusisPNEUMONIA MODERATE RISK 15,000 4,500 10,500
A37.8+ J17.0*Pneumonia in whooping cough due to Bordatella species
other than pertusis or parapertusisPNEUMONIA MODERATE RISK 15,000 4,500 10,500
A37.9+ J17.0* Pneumonia in whooping cough PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A42.0+ J17.0* Pneumonia in actinomycoses PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A48.1 Legionnaires' disease PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A43.0+ J17.0* Pneumonia in nocardiosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A54.8+ J17.0* Pneumonia in gonorrhea PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A69.8+ J17.8* Pneumonia in spirochaetal PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A70+ J17.8* Pneumonia in ornithosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
A78+ J17.8* Pneumonia in Q fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B01.2+ J17.1* Pneumonia in varicella PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B05.2+ J17.1* Pneumonia in measles PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B06.8+ J17.1* Pneumonia in rubella PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B25.0+ J17.1* Pneumonia in cytomegalovirus disease PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B37.1+ J17.2* Pneumonia in candidiasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B38.0+ J17.2* Pneumonia in acute pulmonary coccidiomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B38.1+ J17.2* Pneumonia in chronic pulmonary coccidiomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B38.2+ J17.2* Pneumonia in pulmonary coccidioidomycosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.0+ J17.2* Pneumonia in acute pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.1+ J17.2* Pneumonia in chronic pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.2+ J17.2* Pneumonia in pulmonary histoplasmosis capsulati PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B39.9+ J17.2* Pneumonia in histoplasmosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B44.0+ J17.2* Pneumonia in invasive pulmonary aspergillosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B44.1+ J17.2* Pneumonia in other pulmonary aspergillosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B58.3+ J17.3* Pneumonia in taxoplasmosis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B65.0+ J17.3*Pneumonia in schistosomiasis due to Schistosoma
hematobiumPNEUMONIA MODERATE RISK 15,000 4,500 10,500
B65.1+ J17.3* Pneumonia in schistosomiasis due to Schistosoma mansoni PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B65.2+ J17.3*Pneumonia in schistosomiasis due to Schistosoma
japonicumPNEUMONIA MODERATE RISK 15,000 4,500 10,500
B65.8+ J17.3*Pneumonia in schistosomiasis due to Schistosoma
intercalatum; mattheei; mekongiPNEUMONIA MODERATE RISK 15,000 4,500 10,500
B65.9+ J17.3* Pneumonia in schistosomiasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
B77.8+ J17.3* Pneumonia in ascariasis PNEUMONIA MODERATE RISK 15,000 4,500 10,500
I00+ J17.8* Pneumonia in rheumatic fever PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.02 Adenoviral pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.12 Respiratory syncytial virus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.22 Parainfluenza virus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.32 Human metapneumovirus pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J12.92 Viral pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J13.2Pneumonia [bronchopneumonia] due to Streptococcus
pneumoniae, moderate riskPNEUMONIA MODERATE RISK 15,000 4,500 10,500
J14.2Pneumonia [bronchopneumonia]due to Haemophilus
influenzae, moderate riskPNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.02 Pneumonia due to Klebsiella pneumoniae, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.12 Pneumonia due to Pseudomonas, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.22 Pneumonia due to staphylococcus, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
Page 98 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
J15.32 Pneumonia due to streptococcus, group B, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.42 Pneumonia due to other streptococci, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.52 Pneumonia due to Escherichia coli, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.62Pneumonia due to other aerobic Gram-negative bacteria;
Pneumonia due to Serratia marcescens, moderate riskPNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.72Pneumonia due to Mycoplasma pneumoniae, moderate
riskPNEUMONIA MODERATE RISK 15,000 4,500 10,500
J15.92 Bacterial pneumonia [bronchopneumonia], moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J16.02 Chlamydial pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.02 Bronchopneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.12 Lobar pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.22 Hypostatic pneumonia, moderate risk PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J18.92
Community-acquired pneumonia III
(This classification utilized the American Thoracic Society
recommendation. This is equivalent to CAP, moderate risk
in the Philippine Clinical Practice Guidelines on the
Diagnosis, Empiric Management, and Prevention of
Community- acquired Pneumonia in Immunocompetent
Adults, 2010 update)
Adult moderate risk Community Acquired Pneumonia
(CAP), organism is not specified
Pedia Community Acquired Pneumonia C (PCAP-C)
moderate risk, organism is not specified
PNEUMONIA MODERATE RISK 15,000 4,500 10,500
J93.0 Spontaneous tension pneumothorax PNEUMOTHORAX 15,300 4,590 10,710
J93.1Other spontaneous pneumothorax
Spontaneous pneumothoraxPNEUMOTHORAX 15,300 4,590 10,710
J93.8 Other pneumothorax PNEUMOTHORAX 15,300 4,590 10,710
J93.9 Pneumothorax, unspecified PNEUMOTHORAX 15,300 4,590 10,710
T40.2Poisoning by Otheropioids; Poisoning by Codeine;
Poisoning by Morphine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T40.4Poisoning by Other synthetic narcotics; Poisoning by
Pethidine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T40.6 Poisoning by Other and unspecified narcoticsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T40.7 Poisoning by Cannabis (derivatives)POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T40.9
Poisoning by Other and unspecified psychodysleptics
[hallucinogens]; Poisoning by Mescaline; Poisoning by
Psilocin; Poisoning by Psilocybine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T41.0 Poisoning by Inhaled anaestheticsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T41.1 Poisoning by Intravenous anaesthetics; ThiobarbituratesPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T41.3 Poisoning by Local anaestheticsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T41.5 Poisoning by Therapeutic gases; Carbon dioxide; OxygenPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.0 Poisoning by Hydantoin derivativesPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.1 Poisoning by Iminostilbenes; CarbamazepinePOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.2 Poisoning by Succinimides and oxazolidinedionesPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.3 Poisoning by BarbituratesPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.4 Poisoning by BenzodiazepinesPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.6
Poisoning by Other antiepileptic and sedative-
hypnoticdrugs; Poisoning by Methaqualone;Poisoning by
Valproic acid
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.7
Poisoning by Antiepileptic and sedative-hypnotic drugs,
unspecified; Poisoning by Draught sleeping NOS; Poisoning
by Sleeping drug NOS;Poisoning by Sleeping tablet NOS
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T42.8Poisoning by Antiparkinsonism drugs and other central
muscle-tone depressants; Poisoning by Amantadine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T43.2 Poisoning by Other and unspecified antidepressantsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T43.3 Poisoning by Phenothiazine antipsychotics and neurolepticsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T43.4Poisoning by Butyrophenone and thioxanthene
neuroleptics
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T43.5Poisoning by Other and unspecified antipsychotics and
neuroleptics
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Page 99 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T43.6 Poisoning by Psychostimulants with abuse potentialPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T43.9 Poisoning by Psychotropic drug, unspecifiedPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.1 Poisoning by Other parasympathomimetics [cholinergics]POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.2Poisoning by Ganglionic blocking drugs, not elsewhere
classified
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.3
Poisoning by Other parasympatholytics [anticholinergics
and antimuscarinics] and spasmolytics, not elsewhere
classified; Poisoning byPapaverine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.4Poisoning by Predominantly α-adrenoreceptor agonists, not
elsewhere classified; Poisoning by Metaraminol
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.5Poisoning by Predominantly ß-adrenoreceptor agonists, not
elsewhere classified
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.6Poisoning by α-Adrenoreceptor antagonists, not elsewhere
classified
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.7Poisoning by ß-Adrenoreceptor antagonists, not elsewhere
classified
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T44.9
Poisoning by Other and unspecified drugs primarily
affecting the autonomic nervous system; Drug stimulating
both α-and ß-adrenoreceptors
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T45.0 Poisoning by Antiallergic and antiemetic drugsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T45.1
Poisoning by Antineoplastic and immunosuppressive drugs;
Poisoning by Antineoplastic antibiotics; Poisoning by
Cytarabine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T45.2 Poisoning by Vitamins, not elsewhere classifiedPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T45.3 Poisoning by Enzymes, not elsewhere classifiedPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T50.7 Poisoning by Analeptics and opioid receptor antagonistsPOISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y46.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Hydantoin derivatives
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y46.6
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other and unspecified antiepileptics
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y47.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Barbiturates, not elsewhere classified
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y47.1
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Benzodiazepines
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y47.9
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Sedative, hypnotic and antianxiety drug,
unspecified;sleeping draught NOS;sleeping drug
NOS;sleeping tablet NOS
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y49.5
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other antipsychotics and neuroleptics
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y49.6
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Psychodysleptics [hallucinogens]
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y51.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other parasympatholytics [anticholinergics and
antimuscarinics] and spasmolytics, not elsewhere
classified;papaverine
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
Y51.7
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Beta-adrenoreceptor antagonists, not elsewhere
classified
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM6,700 2,010 4,690
T36.0 Poisoning by Penicillins POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.1 Poisoning by Cefalosporins and other ß-lactam antibiotics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.2 Poisoning by Chloramphenicol group POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.3 Poisoning by Macrolides POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.4 Poisoning by Tetracyclines POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.5 Poisoning by Aminoglycosides; Streptomycin POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.6 Poisoning by Rifamycins POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.8 Poisoning by Other systemic antibiotics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T36.9 Poisoning by Systemic antibiotic, unspecified POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Page 100 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T37.0 Poisoning by Sulfonamides POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.1 Poisoning by Antimycobacterial drugs POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.2Poisoning by Antimalarials and drugs acting on other blood
protozoaPOISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.4 Poisoning by Anthelminthics POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.5 Poisoning by Antiviral drugs POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.8Poisoning by Other specified systemic anti-infectives and
antiparasitics; Poisoning by Hydroxyquinoline derivativesPOISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T37.9Poisoning by Systemic anti-infective and antiparasitic,
unspecifiedPOISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Penicillins
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.1
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Cefalosporins and other beta-
lactam antibiotics
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Chloramphenicol group
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.4
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Tetracyclines
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.6
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Rifamycins
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.8
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Other systemic antibiotics
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y40.9
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Systemic antibiotics: Systemic antibiotic, unspecified
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y41.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic use: Other systemic anti-
infectives and antiparasitics; Sulfonamides
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y41.1
Drugs, medicaments and biological substances causing
adverse effects in therapeutic use: Other systemic anti-
infectives and antiparasitics; Antimycobacterial drugs
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y41.5
Drugs, medicaments and biological substances causing
adverse effects in therapeutic use: Other systemic anti-
infectives and antiparasitics; Antiviral drugs
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y41.8
Drugs, medicaments and biological substances causing
adverse effects in therapeutic use: Other specified
systemic anti-infectives and antiparasitics;
hydroxyquinoline derivatives
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y41.9
Drugs, medicaments and biological substances causing
adverse effects in therapeutic use: Systemic anti-infective
and antiparasitic, unspecified
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
Y56.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic use: Topical agents primarily
affecting skin and mucous membrane and
ophthalmological, otorhinolaryngological and dental drugs:
Local antifungal, anti-infective and anti-inflammatory drugs,
not elsewhere classified
POISONING CAUSED BY ANTIBIOTICS 7,300 2,190 5,110
T39.0 Poisoning by SalicylatesPOISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
T39.1 Poisoning by 4-Aminophenol derivativesPOISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
T39.3Poisoning by Other nonsteroidal anti-inflammatory drugs
[NSAID]
POISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
T39.8Poisoning by Other nonopioid analgesics and antipyretics,
not elsewhere classified
POISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
T39.9Poisoning by Nonopioid analgesic, antipyretic and
antirheumatic, unspecified
POISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
Y45.8 Other analgesics and antipyreticsPOISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
Y45.9
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Analgesic, antipyretic and anti-inflammatory drug,
unspecified
POISONING CAUSED BY ANTI-INFLAMMATORY
AGENTS7,400 2,220 5,180
T46.0Poisoning by Cardiac-stimulant glycosides and drugs of
similar actionPOISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T46.1 Poisoning by Calcium-channel blockers POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
Page 101 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T46.2Poisoning by Other antidysrhythmic drugs, not elsewhere
classifiedPOISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T46.3Poisoning by Coronary vasodilators, not elsewhere
classified; Poisoning by DipyridamolePOISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T46.5
Poisoning by Other antihypertensive drugs, not elsewhere
classified; Poisoning by Clonidine;Poisoning by
Guanethidine; Poisoning by Rauwolfia
POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T46.6Poisoning by Antihyperlipidaemic and antiarteriosclerotic
drugsPOISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T46.7Poisoning by Peripheral vasodilators;Poisoning by Nicotimic
acid (derivatives)POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T46.9Poisoning by Other and unspecified agents primarily
affecting the cardiovascular systemPOISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
Y52.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Cardiac-stimulant glycosides and drugs of similar
action
POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
Y52.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other antidysrhythmic drugs, not elsewhere classified
POISONING CAUSED BY CARDIOVASCULAR DRUGS 12,500 3,750 8,750
T48.3 Poisoning by AntitussivesPOISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
T48.4 Poisoning by ExpectorantsPOISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
T48.5 Poisoning by Anti-common-cold drugsPOISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
T48.6
Poisoning by Antiasthmatics, not elsewhere classified; β-
adrenoreceptor agonists used in asthma theraphy;
Poisoning by Salbutamol
POISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
Y55.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Antitussives
POISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
Y55.4
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Expectorants
POISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
Y55.6
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Antiasthmatics, not elsewhere classified:
aminophylline, salbutamol, theobromine;theophylline
POISONING CAUSED BY DRUGS AFFECTING THE
PULMONARY SYSTEM6,200 1,860 4,340
T50.0 Poisoning by Mineralocorticoids and their antagonistsPOISONING CAUSED BY DRUGS AFFECTING THE
RENAL SYSTEM6,300 1,890 4,410
T50.1 Poisoning by Loop [high-ceiling] diureticsPOISONING CAUSED BY DRUGS AFFECTING THE
RENAL SYSTEM6,300 1,890 4,410
T50.2
Poisoning by Carbonic-anhydrase inhibitors,
benzothiadiazides and other diuretics;Poisoning by
Acetazolamide
POISONING CAUSED BY DRUGS AFFECTING THE
RENAL SYSTEM6,300 1,890 4,410
T50.4 Poisoning by Drugs affecting uric acid metabolismPOISONING CAUSED BY DRUGS AFFECTING THE
RENAL SYSTEM6,300 1,890 4,410
T50.9
Poisoning by Other and unspecified drugs, medicaments
and biological substances; Poisoning by Acidifying agents;
Poisoning by Alkalizing agents; Poisoning by
Immunoglobulin; Poisoning by Immunologicals; Poisoning
by Lipotropic drugs; Poisoning by Parathyroid hormones
and derivatives
POISONING CAUSED BY DRUGS AFFECTING THE
RENAL SYSTEM6,300 1,890 4,410
T47.0 Poisoning by HistamineH2-receptor antagonistsPOISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.1Poisoning by Other antacids and anti-gastric-secretion
drugs
POISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.2 Poisoning by Stimulant laxativesPOISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.3 Poisoning by Saline and osmotic laxativesPOISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.4Poisoning by Other laxatives; Poisoning by Intestinal atonia
drugs
POISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.5 Poisoning by DigestantsPOISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.6 Poisoning by Antidiarrhoeal drugsPOISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.8Poisoning by Other agents primarily affecting the
gastrointestinal system
POISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T47.9Poisoning by Agent primarily affecting the gastrointestinal
system, unspecified
POISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T48.1Poisoning by Skeletal muscle relaxants [neuromuscular
blocking agents]
POISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
Page 102 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Y53.8
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other agents primarily affecting the gastrointestinal
system
POISONING CAUSED BY GASTROINTESTINAL
DRUGS8,300 2,490 5,810
T45.4 Poisoning by Iron and its compounds POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.5 Poisoning by Anticoagulants POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.6 Poisoning by Fibrinolysis-affecting drugs POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.7Poisoning by Anticoagulant antagonists, vitamin K and
other coagulantsPOISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.8
Poisoning by Other primarily systemic and haematological
agents; Poisoning by Liver preparations and other
antianaemic agents; Poisoning by Natural blood and blood
products; Poisoning by Plasma substitute
POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T45.9 Primarily systemic and haematological agent, unspecified POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
Y44.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Anticoagulants
POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
Y44.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Anticoagulant antagonists, vitamin K and other
coagulants
POISONING CAUSED BY HEMATOLOGIC AGENTS 7,300 2,190 5,110
T38.0 Poisoning by Glucocorticoids and synthetic analogues POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.1 Poisoning by Thyroid hormones and substitutes POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.2 Poisoning by Antithyroid drugs POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.3Poisoning by Insulin and oral hypoglycaemic [antidiabetic]
drugsPOISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.4Poisoning by Oral contraceptives; Poisoning by Multiple-
and-single-ingredient preparationsPOISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.5Poisoning by Other estrogens and progestogens; Mixtures
and substitutesPOISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.6
Poisoning by Antigonadotrophins, antiestrogens,
antiandrogens, not elsewhere classified; Poisoning by
Tamoxifen
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T38.7 Poisoning by Androgens and anabolic congeners POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y42.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Glucocorticoids and synthetic analogues
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y42.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Antithyroid drugs
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y42.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Insulin and oral hypoglycaemic [antidiabetic] drugs
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y42.4
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Oral contraceptives;multiple-and single-ingredient
preparations
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y42.5
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other estrogens and progestogens;mixtures and
substitutes
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y45.1
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Salicylates
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y45.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Propionic acid derivatives;propanoic acid derivatives
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y45.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Other nonsteroidal anti-inflammatory drugs [NSAID]
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
Y45.5
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: 4-Aminophenol derivatives
POISONING CAUSED BY HORMONES 8,500 2,550 5,950
T51.0 Toxic effect of Ethanol;Toxic effect of Ethyl alcoholPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T51.2Toxic effect of 2-Propanol; Toxic effect of Isoprophyl
aclohol
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
Page 103 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T51.3
Toxic effect of Fusel oil; Toxic effect of Amyl alcohol; Toxic
effect of Butyl alcohol [1-butanol]; Toxic effect of Propyl
alcohol [1-proponol]
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T51.8 Toxic effect of Other alcoholsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T51.9 Toxic effect of Alcohol, unspecifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T52.0
Toxic effect of Petroleum products; Toxic effect of
Gasoline [petrol]; Toxic effect of Kerosine [paraffin oil];
Toxic effect of Paraffin wax; Toxic effect of Petroleum
ether; Toxic effect of Petroleum naphtha; Toxic effect of
Petroleum spirits
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T52.2
Toxic effect of Homologues of benzene; Toxic effect of
Toluene [methylbenzene]; Toxic effect of Xylene
[dimethylbenzene]
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T52.4 Toxic effect of KetonesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T52.8 Toxic effect of Other organic solventsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T52.9 Toxic effect of Organic solvent, unspecifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T53.0Toxic effect of Carbon tetrachloride;Toxic effect of
Tetrachloromethane
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T53.1Toxic effect of Chloroform; Toxic effect of
Trichloromethane
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T53.4Toxic effect of Dichloromethane;Toxic effect of Methylene
chloride
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T53.6Toxic effect of Other halogen derivatives of aliphatic
hydrocarbons
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T53.9Toxic effect of Halogen derivative of aliphatic and aromatic
hydrocarbons, unspecified
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T54.1 Toxic effect of Other corrosive organic compoundsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T54.2
Toxic effect of Corrosive acids and acid-like substances;
Toxic effect of Acid hydrochlorie;Toxic effect of Acid
sulfurie
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T54.3
Toxic effect of Corrosive alkalis and alkali-like substances;
Toxic effect of Potassium hydroxide;Toxic effect of Sodium
hydroxide
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T54.9 Toxic effect of Corrosive substance, unspecifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T55 Toxic effect of soaps and detergentsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T56.0 Toxic effect of Lead and its compoundsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T56.1 Toxic effect of Mercury and its compoundsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T56.5 Toxic effect of Zinc and its compoundsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T56.8 Toxic effect of Other metalsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T57.0 Toxic effect of Arsenic and its compoundsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T57.1 Toxic effect of Phosphorus and its compoundsPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T57.3 Toxic effect of Hydrogen cyanidePOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T57.8 Toxic effect of Other specified in organic substancesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T57.9 Toxic effect of Inorganic substance, unspecifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T58 Toxic effect of carbon monoxide from all sourcesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.0 Toxic effect of Nitrogen oxidesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.2 Toxic effect of Formal dehydePOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.3 Toxic effect of Lacrimogenic gas; Toxic effect of Tear gasPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.4 Toxic effect of Chlorine gasPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.7 Toxic effect of Carbon dioxidePOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.8 Toxic effect of Other specified gases, fumes and vapoursPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T59.9 Toxic effect of Gases, fumes and vapours, unspecifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
Page 104 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T60.0Toxic effect of Organophosphate and carbamate
insecticides
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T60.1 Toxic effect of Halogenated insecticidesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T60.2 Other and unspecified insecticidesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T60.3 Toxic effect of Herbicides and fungicidesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T60.4 Toxic effect of Rodenticides; Toxic effect of ThalliumPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T60.8 Toxic effect of Other pesticidesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T60.9 Toxic effect of Pesticide, unspecifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T65.0 Toxic effect of CyanidesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T65.3
Toxic effect of Nitro derivatives and aminoderivatives of
benzene and its homologues; Toxic effect of Aniline
[benzenamine]; Toxic effect of Nitrobenzene; Toxic effect
of Trinitrotoluene
POISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T65.4 Toxic effect of CarbondisulfidePOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T65.6 Toxic effect of Paints and dyes, not elsewhere classifiedPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T65.8 Toxic effect of other specified substancesPOISONING CAUSED BY ORGANIC SUBSTANCES
AND HEAVY METALS6,400 1,920 4,480
T49.2 Poisoning by Local astringents and local detergents POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.3 Poisoning by Emollients, demulcents and protectants POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.4Poisoning by Keratolytics, keratoplastics and other hair
treatment drugs and preparationsPOISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.5Poisoning by Ophthalmological drugs and preparations;
Poisoning by Eye, nose and throat anti-infectivesPOISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.7 Poisoning by Dental drugs, topically applied POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.8 Othertopical agents; Spermicides POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T49.9 Poisoning by Topical agent, unspecified POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
Y56.2
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Local astringents and local detergents
POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
Y56.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Emollients, demulcents and protectants
POISONING CAUSED BY TOPICAL AGENTS 5,300 1,590 3,710
T61.0 Toxic effect of Ciguatera fish poisoning POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T61.1Toxic effect of Scombroid fish poisoning;Toxic effect of
Histamine-like syndromePOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T61.2Toxic effect of Other fish and shellfish poisoning
Fish poisoningPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T61.8 Toxic effect of other seafoods POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T61.9Toxic effect of unspecified seafood
Seafood poisoningPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.0 Toxic effect of Ingested mushrooms POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.1 Toxic effect of Ingested berries POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.2 Toxic effect of Other ingested (parts of) plant(s) POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.8Toxic effect of Other specified noxious substances eaten as
foodPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T62.9
Toxic effect of Noxious substance eaten as food,
unspecified
Food poisoning
POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.0Toxic effect of Snake venom;Toxic effect of Sea-snake
venomPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.1Toxic effect of Venom of other reptiles; Toxic effect of
Lizard venomPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.2 Toxic effect of Venom of scorpion POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.3 Toxic effect of Venom of spider POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.4Toxic effect of Venom of other arthropods;Toxic effect of
Insect bite or sting, venomousPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.5 Toxic effect of contact with fish POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.6Toxic effect of contact with other marine animals; Jellyfish;
Sea anemone; Shellfish; StarfishPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.8Toxic effect of contact with other venomous animals;
Venom of amphibianPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T63.9 Toxic effect of contact with unspecified venomous animal POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T64Toxic effect of aflation and other mycotoxin food
contaminantsPOISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
T65.2 Toxic effect of Tobacco and nicotine POISONING FROM ANIMALS, INSECTS, PLANTS 5,700 1,710 3,990
Page 105 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
Y43.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Antiallergic and antiemetic drugs
POISONING OTHERS 8,300 2,490 5,810
Y54.3
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Benzothiadiazine derivatives
POISONING OTHERS 8,300 2,490 5,810
Y54.8
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Agents affecting uric acid metabolism
POISONING OTHERS 8,300 2,490 5,810
Y55.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Oxytocic drugs;ergot alkaloids
POISONING OTHERS 8,300 2,490 5,810
Y56.6
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Otorhinolaryngological drugs and preparations
POISONING OTHERS 8,300 2,490 5,810
Y58.0
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: BCG vaccine
POISONING OTHERS 8,300 2,490 5,810
Y58.4
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Tetanus vaccine
POISONING OTHERS 8,300 2,490 5,810
Y59.9
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Vaccine or biological substance, unspecified
POISONING OTHERS 8,300 2,490 5,810
G60.0
Hereditary motor and sensory neuropathy; Disease Charcot-
Marie-Tooth; Disease Déjerine-Sottas; Hereditary motor
and sensory neuropathy, types I-IV; Hypertrophic
neuropathy of infancy; Peroneal muscular atrophy axonal
type; Peroneal muscular atrophy hypertrophic type; Roussy-
Levy syndrome
POLYNEUROPATHIES 10,600 3,180 7,420
G60.1 Refsum's disease POLYNEUROPATHIES 10,600 3,180 7,420
G60.2 Neuropathy in association with hereditary ataxia POLYNEUROPATHIES 10,600 3,180 7,420
G60.3 Idiopathic progressive neuropathy POLYNEUROPATHIES 10,600 3,180 7,420
G60.8
Other hereditary and idiopathic neuropathies; Morvan's
disease; Nelaton's syndrome; Sensory neuropathy
dominantly inherited; Sensory neuropathy recessively
inherited
POLYNEUROPATHIES 10,600 3,180 7,420
G60.9 Hereditary and idiopathic neuropathy, unspecified POLYNEUROPATHIES 10,600 3,180 7,420
G61.0Guillain-Barré syndrome; Acute post- infective polyneuritis;
Acute infective polyneuritisPOLYNEUROPATHIES 10,600 3,180 7,420
G61.8 Other inflammatory polyneuropathies POLYNEUROPATHIES 10,600 3,180 7,420
G61.9 Inflammatory polyneuropathy, unspecified POLYNEUROPATHIES 10,600 3,180 7,420
G62.0 Drug-induced polyneuropathy POLYNEUROPATHIES 10,600 3,180 7,420
G62.1 Alcoholic polyneuropathy POLYNEUROPATHIES 10,600 3,180 7,420
G62.2 Polyneuropathy due to other toxic agents POLYNEUROPATHIES 10,600 3,180 7,420
G62.8Other specified polyneuropathies; Radiation-induced
polyneuropathyPOLYNEUROPATHIES 10,600 3,180 7,420
G62.9Polyneuropathy, unspecified; Neuropathy NOS
Peripheral neuropathyPOLYNEUROPATHIES 10,600 3,180 7,420
G63.8*Polyneuropathy in other diseases classified elsewhere;
Uraemic neuropathyPOLYNEUROPATHIES 10,600 3,180 7,420
G64Other disorders of peripheral nervous system; Disorder of
peripheral nervous system NOSPOLYNEUROPATHIES 10,600 3,180 7,420
N84.0Polyp of corpus uteri; Polyp of endometrium; Polyp of
uterus NOSPOLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.1 Polyp of cervix uteri; Mucous polyp of cervix POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.2 Polyp of vagina POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.3 Polyp of vulva; Polyp of labia POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.8 Polyp of other parts of female genital tract POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
N84.9 Polyp of female genital tract, unspecified POLYPS, FEMALE GENITAL TRACT 5,200 1,560 3,640
O08.2
Embolism following abortion and ectopic and molar
pregnancy; Embolism NOS; Air embolism; Amniotic fluid
embolism; Blood-clot embolism; Pulmonary embolism;
Pyaemic embolism; Septic or septicopyaemic embolism;
Soap embolism
POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O08.5Metabolic disorders following abortion and ectopic and
molar pregnancyPOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O08.9Complication following abortion and ectopic and molar
pregnancy, unspecifiedPOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O67.8Other intrapartum haemorrhage; Excessive intrapartum
haemorrhagePOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.0 Rupture of uterus before on set of labour POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.1Rupture of uterus during labour; Rupture of uterus not
stated as occuring before onset of labourPOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.2 Post partum inversion of uterus POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.3 Obstetric laceration of cervix; Annular detachment of cervix POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Page 106 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O71.5Other obstetric injury to pelvic organs; Obstetric injury to
bladder; Obstetric injury to urethraPOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.7
Obstetric haematoma of pelvis; Obstetric haematoma of
perineum; Obstetric haematoma of vagina; Obstetric
haematoma of vulva
POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.8 Other specified obstetric trauma POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O71.9 Obstetric trauma, unspecified POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O74.0
Aspiration pneumonitis due to anaesthesia during labour
and delivery; Inhalation of stomach contents or secretions
NOS due to anaesthesia during labour and delivery;
Mendelson's syndrome due to anaesthesia during labour
and delivery
POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O74.2
Cardiac complications of anaesthesia during labour and
delivery; Cardiac arrest due to anaesthesia during labour
and delivery; Cardiac failure due to anaesthesia during
labour and delivery
POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O74.8Other complications of anaesthesia during labour and
deliveryPOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O75.1Shock during or following labour and delivery; Obstetic
shockPOST PARTUM COMPLICATIONS 9,300 2,790 6,510
O75.8 Other specified complications of labour and delivery POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O75.9 Complication of labour and delivery, unspecified POST PARTUM COMPLICATIONS 9,300 2,790 6,510
O87.9
Venous complication in the puerperium, unspecified;
Puerperal phlebitis NOS; Puerperal phlebopathy NOS;
Puerperal thrombosis NOS
POST PARTUM COMPLICATIONS 9,300 2,790 6,510
Z39.0Care and examination immediately after delivery; Care and
observation in uncomplicated casesPOSTPARTUM CARE FOR DELIVERIES IN TRANSIT 2,000 600 1,400
E89.0Postprocedural hypothyroidism; Postirradiation
hypothyroidism; Postsurgical hypothyroidismPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.2 Postprocedural hypoparathyroidism; Parathyroprival tetany POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.3Postprocedural hypopituitarism; Postirradiation
hypopituitarismPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.4 Postprocedural ovarian failure POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.5 Postprocedural testicular hypofunction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.6Postprocedural adrenocortical hypofunction;
Postprocedural adreno-medullary hypofunctionPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
E89.8 Other postprocedural endocrine and metabolic disorders POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
G97.1 Other reaction to spinal and lumbar puncture POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
G97.8 Other postprocedural disorders of nervous system POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
H59.0Vitreous syndrome following cataract surgery
Keratopathy (bullous aphakic) following cataract surgeryPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
H59.8Other postprocedural disorders of eye and adnexa;
Chorioretinal scars after surgery for detachmentPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
H59.9 Postprocedural disorder of eye and adnexa, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
H95.8 Other postprocedural disorders of ear and mastoid process POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
I97.0 Postcardiotomy syndrome POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
I97.2
Postmastectomy lymphoedema syndrome; Elephantiasis
due to mastectomy; Obliteration of lymphatic vessels due
to mastectomy
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.0
Tracheostomy malfunction; Haemorrhage from
tracheostomy stoma; Obstruction of tracheostomy airway;
Sepsis of tracheostomy stoma; Tracheo-oesophageal fistula
following tracheostomy
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.1 Acute pulmonary insufficiency following thoracic surgery POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.2Acute pulmonary insufficiency following nonthoracic
surgeryPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.4Mendelson syndrome; Chemical pneumonitis due to
aspiration during anaesthesiaPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.5 Postprocedural subglottic stenosis POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.8 Other postprocedural respiratory disorders POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
J95.9 Postprocedural respiratory disorder, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.0 Vomiting following gastrointestinal surgery POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.1Postgastric surgery syndromes; Dumping syndrome;
Postgastrectomy syndrome; Postvagotomy syndromePOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.2Postsurgical malabsorption, not elsewhere classified;
Postsurgical blind loop syndromePOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.3 Postoperative intestinal obstruction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.4 Colostomy and enterostomy malfunction POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.5 Postcholecystectomy syndrome POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
K91.8Other postprocedural disorders of digestive system, not
elsewhere classifiedPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Page 107 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K91.9 Postprocedural disorder of digestive system, unspecified POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N99.0 Postprocedural renal failure POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N99.1Postprocedural urethral stricture; Postcatheterization
urethral stricturePOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N99.4 Postprocedural pelvic peritoneal adhesions POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N99.8Other postprocedural disorders of genitourinary system;
Residual ovary syndromePOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N99.9Postprocedural disorder of genitourinary system,
unspecifiedPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T81.0
Haemorrhage and haematoma complicating a procedure,
not elsewhere classified; Haemorrhage at any site resulting
from a procedure
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T81.1
Shock during or resulting from a procedure not elsewhere
classified; Collapse NOS during or following a procedure;
Endotoxic shock during or following a procedure;
Hypovolaemic during or following a procedure; Septic
shock during or following a procedure;
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T81.2
Accidental puncture and laceration during a procedure not
elsewhere classified; Accidental perforation of blood vessel
by catheter, endoscope, instrument, probe during a
procedure; Accidental perforation of nerve by catheter,
endoscope, instrument, probe
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T81.3
Disruption of operation wound, not elsewhere classified;
Dehiscene of operation wound; Rupture of operation
wound
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T81.4
Infection following a procedure, not elsewhere classified;
Intra-abdominal abscess postprocedural abcess; Intra-
abdominal stitch postprocedural abscess; Intra-abdominal
subphrenic postprocedural abcess; Intra-abdominal wound
postprocedural abcess; Septicemia
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T81.8
Other complications of procedures, not elsewhere
classified; Complication of inhalation therapy; Emphysema
(subcutaneous) resulting from a procedure; Persistent
postoperative fistula
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.0
Mechanical complication of heart valve prosthesis;
Mechanical breakdown due to heart valve prosthesis;
Displacement due to heart valve prosthesis; Failure due to
heart valve prosthesis; Leakage due to heart valve
prosthesis; Malposition due to heart valve prosthesis;
Mechanical obstruction due to heart valve prosthesis;
Perforation due to heart valve prosthesis; Protrusion due to
heart valve prosthesis;
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.1
Mechanical complication of cardiac electronic device;
Conditions listed in T82.0 due to electrodes; Conditions
listed in T82.0 due to pulse generator (battery)
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.2Mechanical complication of coronary artery bypass and
valve graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.3
Mechanical complication of other vascular grafts; Condition
listed in T82.0 due to aortic (bifurcation) graft
(replacement); Condition listed in T82.0 due to arterial
(carotid) (femoral) graft (bypass)
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.4 Mechanical complication of vascular dialysis catheter POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.5
Mechanical complication of other cardiac and vascular
devices and implants; Conditions listed in T82.0 due to
arteriovenous fistula surgically created; arterivenous
Shunt surgically created; Artificial heart; Balloon
counterpulsation device; Infusion catheter; umbrella device
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.7Infection and inflammatory reaction due to other cardiac
and vascular devices, implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T82.8
Other complications of cardiac and vascular prosthetic
devices, implants and grafts; Complication due to cardiac
and vascular prosthetic devices, implants and grafts;
Embolism due to cardiac and vascular prosthetic devices,
implants and grafts; Fibrosis due to cardiac and vascular
prosthetic devices, implants and grafts; Haemorrhage due
to cardiac and vascular prosthetic devices, implants and
grafts; Pain due to cardiac and vascular prosthetic devices,
implants and grafts; Stenosis due to cardiac and vascular
prosthetic devices, implants and grafts; Thrombosis due to
cardiac and vascular prosthetic devices, implants and
grafts;
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
Page 108 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
T83.1
Mechanical complication of other urinary devices and
implants; Concditions listed in T82.0 due to Urinary
electronic stimultor device; Urinary sphincter implant;
Urinary stent
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T83.2 Mechanical complication of graft of urinary organ POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T83.3Mechanical complication of intrauterine contraceptive
devicePOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T83.5Infection and inflammatory reaction due to prosthetic
device, implant and graft in urinary systemPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T83.8Other complications of genitourinary prosthetic devices,
implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T83.9Unspecified complication of genitourinary prosthetic
device, implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.0 Mechanical complication of internal joint prosthesis POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.1Mechanical complication of internal fixation device of
bones of limbPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.2Mechanical complication of internal fixation device of other
bonesPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.4Mechanical complication of other internal orthopaedic
devices, implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.5Infection and inflammatory reaction due to internal joint
prosthesisPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.6Infection and inflammatory reaction due to internal fixation
device [any site]POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.7Infection and inflammatory reaction due to other internal
orthopaedic prosthetic devices, implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.8Other complications of internal orthopaedic prosthetic
devices, implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T84.9Unspecified complication of internal orthopaedic prosthetic
device, implant and graftPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.0Mechanical complication of ventricular intracranial
(communicating) shuntPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.3
Mechanical complication of other ocular prosthetic devices,
implants and grafts Conditions listed in T82.0 due to
corneal graft; Conditions listed in T82.0 due to prosthetic
orbit of eye
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.5
Mechanical complication of gastrointestinal prosthetic
devices implants and grafts; Conditions listed in T82.0 due
to Bile-duct prosthesis; Conditions listed in T82.0
oesophageal anti-reflux device
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.6
Mechanical complication of other specified internal
prosthetic devices, Implants and grafts; Conditions listed in
T82.0 due to epidural and subdural infusion catheter;
Conditions listed in T82.0 due to intraperitonael dialysis
catheter; Conditions listed
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.7Infection and inflammatory reaction due to other internal
prosthetic devices, implants and graftsPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.8Other complications of internal prosthetic devices, implants
and grafts, not elsewhere classifiedPOSTPROCEDURAL DISORDERS 10,300 3,090 7,210
T85.9
Unspecified complication of internal prosthetic device,
implant and graft; Complication of internal prosthetic
device, implants and graft NOS
POSTPROCEDURAL DISORDERS 10,300 3,090 7,210
N40
Hyperplasia of prostate; Adenofibromatous hypertrophy of
prostate; Adenoma (benign)of prostate ; Enlargement of
prostate (benign); Fibroadenoma of prostate; Fibroma of
prostate; Hypertrophy of prostate (benign); Myoma of
prostate; Median bar (prostate); Prostatic obstruction NOS
PROSTATE DISORDERS 9,200 2,760 6,440
N41.0 Acute prostatitis PROSTATE DISORDERS 9,200 2,760 6,440
N41.1 Chronic prostatitis PROSTATE DISORDERS 9,200 2,760 6,440
N41.2 Abscess of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N41.3 Prostatocystitis PROSTATE DISORDERS 9,200 2,760 6,440
N41.8 Other inflammatory diseases of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N41.9Inflammatory disease of prostate, unspecified; Prostatitis
NOSPROSTATE DISORDERS 9,200 2,760 6,440
N42.0 Calculus of prostate; Prostatic stone PROSTATE DISORDERS 9,200 2,760 6,440
N42.1 Congestion and haemorrhage of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N42.2 Atrophy of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N42.8 Other specified disorders of prostate PROSTATE DISORDERS 9,200 2,760 6,440
N42.9 Disorder of prostate, unspecified PROSTATE DISORDERS 9,200 2,760 6,440
O15.2 Eclampsia in the puerperium PUERPERAL COMPLICATIONS 6,800 2,040 4,760
O85
Puerperal sepsis; Puerperal endometritis; Puerperal fever;
Puerperal peritonitis; Puerperal septicaemia; Postpartum
sepsis
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
Page 109 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
O86.0
Infection of obstetric surgical wound; Infected caesarean
section wound following delivery; Infected perineal repair
following delivery
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O86.1Other infection of genital tract following delivery; Cervicitis
following delivery; Vaginitis following deliveryPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O86.2 Urinary tract infection following delivery PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O86.3Other genitourinary tract infections following delivery;
Puerperal genitourinary tract infection NOSPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O86.4Pyrexia of unknown origin following delivery; Puerperal
infection NOS; Puerperal pyrexia NOSPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O86.8 Other specified puerpera linfections PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O87.0 Superficial thrombophlebitis in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O87.1
Deep phlebothrombosis in the puerperium; Deep-vein
thrombosis, postpartum; Pelvic thrombophlebitis,
postpartum
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O87.2 Haemorrhoids in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O87.8Other venous complications in the puerperium; Genital
varices in the puerperiumPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O88.1 Amniotic fluid embolism PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O88.2Obstetric blood-clot embolism; Obstetric pulmonary
embolism NOS; Puerperal pulmonary embolism NOSPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O89.0
Pulmonary complications of anaesthesia during the
puerperium; Aspiration pneumonitis due to anaesthesia
during the puerperium; Chemical pneumonitis due to
aspiration, due to anaesthesia during the puerperium;
Inhalation of stomach contents or secretions NOS due to
anaestheisa during the puerperium; Mendelson syndrome
due to anaesthesia during the puerperium; Pressure
collapse of lung due to anaesthesia during the puerperium
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O89.1
Cardiac complications of anaesthesia during the
puerperium; Cardiac arrest due to anaesthesia during the
puerperium; Cardiac failure due to anaesthesia during the
puerperium
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O89.2
Central nervous system complications of anaesthesia
during the puerperium; Cerebral anoxia due to anaesthesia
during the puerperium
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O89.4Spinal and epidural anaesthesia-induced headache during
the puerperiumPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O89.8 Other complications of anaesthesia during the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O89.9Complication of anaesthesia during the puerperium,
unspecifiedPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.0 Disruption of caesarean section wound PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.1
Disruption of perineal obstetric wound; Disruption of
wound of episiotomy; Disruption of wound of perineal
laceration; Secondary perineal tear
PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.2 Haematoma of obstetric wound PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.3 Cardiomyopathy in the puerperium PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.4Postpartum acute renal failure; Hepatorenal syndrome
following labour and deliveryPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.5 Postpartum thyroiditis PUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.8Other complications of the puerperium, not elsewhere
classified; Placental polypPUERPERAL COMPLICATIONS 10,600 3,180 7,420
O90.9 Complication of the puerperium, unspecified PUERPERAL COMPLICATIONS 10,600 3,180 7,420
P20.0 Intrauterine hypoxia first noted before onset of labour PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P20.1 Intrauterine hypoxia first noted during labour and delivery PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P20.9 Intrauterine hypoxia, unspecified PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P21.0
Severe birth asphyxia; Pulse less than 100 per minute at
birth and falling or steady, respiration absent or gasping,
colour poor, tone absent; Asphyxia with 1-minute apgar
score 0-3; White asphyxia
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P21.1
Mild and moderate birth asphyxia; Normal respiration not
established within one minute, but heart rate 100 or above,
some muscle tone present, some response to stimulation;
Asphyxia with 1-minute Apgar score 4-7; Blue asphyxia
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P21.9Birth asphyxia, unspecified; Anoxia, NOS; Asphyxia, NOS;
Hypoxia, NOSPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P22.0
Respiratory distress syndrome of newborn; Hyaline
membrane disease
Respiratory distress syndrome, child
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
Page 110 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
P22.1 Transient tachypnoea of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P22.8 Other respiratory distress of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P22.9 Respiratory distress of newborn, unspecified PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.0 Neonatal aspiration of meconium PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.1Neonatal aspiration of amniotic fluid and mucus;Aspiration
of liquor (amnii)PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.2 Neonatal aspiration of blood PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.3 Neonatal aspiration of milk and regurgitated food PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.8 Other neonatal aspiration syndromes PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P24.9Neonatal aspiration syndrome, unspecified; Neonatal
aspiration pneumonia NOSPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P25.0 Interstitial emphysema originating in the perinatal period PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P25.1
Pneumothorax originating in the perinatal period
Pneumothorax of fetus
Pneumothorax of newborn
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P25.2 Pneumomediastinum originating in the perinatal period PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P25.8Other conditions related to interstitial emphysema
originating in the perinatal periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P26.0Tracheobronchial haemorrhage originating in the perinatal
periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P26.1Massive pulmonary haemorrhage originating in the
perinatal periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P26.8Other pulmonary haemorrhages originating in the perinatal
periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P26.9Unspecified pulmonary haemorrhage originating in the
perinatal periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P27.0 Wilson-Mikity syndrome; Pulmonary dysmaturity PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P27.1Bronchopulmonary dysplasia originating in the perinatal
periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P27.8
Other chronic respiratory diseases originating in the
perinatal period; Congenital pulmonary fibrosis; Ventilator
lung in newborn
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P27.9Unspecified chronic respiratory disease originating in the
perinatal periodPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.0
Primary atelectasis of newborn; Primary failure to expand
terminal respiratory units; Pulmonary hypoplasia associated
with short gestation; Pulmonary immaturity NOS
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.1
Other and unspecified atelectasis of newborn; Atelectasis,
NOS; Atelectasis, partial; Atelectasis, secondary; Resorption
atelectasis without respiratory distress syndrome
PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.2 Cyanotic attacks of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.3Primary sleep apnoea of newborn; leep apnoea of newborn
NOSPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.4 Other apnoea of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.5 Respiratory failure of newborn PULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P28.8Other specified respiratory conditions of newborn;
congenital laryngeal stridor NOS; Snuffles in newbornPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P29.3Persistent fetal circulation; Delayed closure of ductus
arteriosus; Persistent pulmonary hypertension of newbornPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
P29.9Cardiovascular disorder originating in the perinatal period,
unspecifiedPULMONARY COMPLICATIONS IN THE NEWBORN 10,900 3,270 7,630
I26.0Pulmonary embolism with mention of acute cor pulmonale;
Acute cor pulmonale NOSPULMONARY EMBOLISM 24,300 7,290 17,010
I26.9Pulmonary embolism without mention of acute cor
pulmonale; Pulmonary embolism NOSPULMONARY EMBOLISM 24,300 7,290 17,010
I27.0Primary pulmonary hypertension; Primary idiopathic
pulmonary artery hypertensionPULMONARY HEART DISEASE 14,100 4,230 9,870
I27.1 Kyphoscoliotic heart disease PULMONARY HEART DISEASE 14,100 4,230 9,870
I27.2Other secondary pulmonary hypertension; Pulmonary
artery hypertensionPULMONARY HEART DISEASE 14,100 4,230 9,870
I27.8 Other specified pulmonary heart diseases PULMONARY HEART DISEASE 14,100 4,230 9,870
Page 111 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I27.9Pulmonary heart disease, unspecified; Chronic
cardiopulmonary disease; Chronic Cor pulmonale NOSPULMONARY HEART DISEASE 14,100 4,230 9,870
N11.0Nonobstructive reflux-associated chronic pyelonephritis;
Chronic Pyelonephritis associated with vesicoureteral refluxPYELONEPHRITIS 10,900 3,270 7,630
N11.1
Chronic obstructive pyelonephritis; Chronic pyelonephritis
associated with anomaly of [pelviureteric junction,
pyeloureteric junction, ureter]; Chronic pyelonephritis
associated with kinking of [pelviureteric junction,
pyeloureteric junction, ureter]; Chronic pyelonephritis
associated with stircture of[pelviureteric junction,
pyeloureteric junction, ureter]
PYELONEPHRITIS 10,900 3,270 7,630
N11.8Other chronic tubulo-interstitial nephritis; Nonobstructive
chronic pyelonephritis NOSPYELONEPHRITIS 10,900 3,270 7,630
D60.0 Chronic acquired pure red cell aplasia RED CELL APLASIA 7,300 2,190 5,110
D60.8 Other acquired pure red cell aplasias RED CELL APLASIA 7,300 2,190 5,110
D60.9 Acquired pure red cell aplasia, unspecified RED CELL APLASIA 7,300 2,190 5,110
N28.0
Ischaemia and infarction of kidney; Embolism of renal
artery; Obstruction of renal artery; Occlusion of renal
artery; Thrombosis of renal artery; Renal infarct
RENAL INFARCT 9,600 2,880 6,720
N15.1 Renal and perinephric abscess RENAL/BLADDER ABSCESS 13,900 4,170 9,730
N30.8 Other cystitis; Abscess of bladder RENAL/BLADDER ABSCESS 13,900 4,170 9,730
N34.0
Urethral abscess; Abscess of Cowper's gland; Abscess of
Littré's gland; Periurethral Abscess ; Abscess of urethral
gland
RENAL/BLADDER ABSCESS 13,900 4,170 9,730
J60Coalworker's pneumoconiosis; Anthracosilicosis;
Anthracosis; Coalworker's lung
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J61Pneumoconiosis due to asbestos and other mineral fibres;
Asbestosis
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J62.0 Pneumoconiosis due to talc dustRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J62.8Pneumoconiosis due to other dust containing silica; Silicosis
NOS
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J63.0 Aluminosis (of lung)RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J63.3 Graphite fibrosis (of lung)RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J63.4 SiderosisRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J63.8 Pneumoconiosis due to other specified inorganic dustsRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J64 Unspecified pneumoconiosisRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J65 Pneumoconiosis associated with tuberculosisRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J66.2 CannabinosisRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J66.8 Airway disease due to other specific organic dustsRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J67.0Farmer's lung; Harvester's lung; Haymaker's lung; Mouldy
hay disease
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J67.1 Bagassosis; Bagasse disease; Bagasse pneumonitisRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J67.5 Mushroom-worker's lungRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J67.7
Air-conditioner and humidifier lung; Allergic alveolitis due
to fungi, thermophilic actinomycetees and other organisms
growing in ventilation (air-conditioning) systems
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J67.8
Hypersensitivity pneumonitis due to other organic dusts;
Cheese-washer's lung; Coffee-worker's lung; Fishmeal-
worker's lung; Furrier's lung; Sequoiosis
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J67.9
Hypersensitivity pneumonitis due to unspecified organic
dust; Extrinsic allergic alveolitis NOS; Hypersensitivity
pneumonitis NOS
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J68.0Bronchitis and pneumonitis due to chemicals, gases, fumes
and vapours; Acute chemical bronchitis
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J68.1Acute pulmonary oedema due to chemicals, gases, fumes
and vapours; Acute Chemical pulmonary oedema
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J68.2Upper respiratory inflammation due to chemicals, gases,
fumes and vapours, not elsewhere classified
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J68.3
Other acute and subacute respiratory conditions due to
chemicals, gases, fumes and vapours; Reactive airways
dysfunction syndrome; Hyperactive airway disease
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
Page 112 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
J68.4
Chronic respiratory conditions due to chemicals, gases,
fumes and vapours; Diffuse emphysema due to inhalation
of chemicals, gases, fumes and vapours; Chronic
emphysema due to inhalation of chemicals, gases, fumes
and vapours; Chronic obliterative bronchiolitis due to
inhalation of chemicals, gases, fumes and vapours;
Subacute obliterative bronchiolitis due to inhalation of
chemicals, gases, fumes and vapours; Chronic pulmonary
fibrosis due to inhalation of chemicals, gases, fumes and
vapours
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J68.8Other respiratory conditions due to chemicals, gases, fumes
and vapours
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J68.9Unspecified respiratory condition due to chemicals, gases,
fumes and vapours
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J69.0
Pneumonitis due to food and vomit; Aspiration pneumonia
due to NOS; Aspiration pneumonia due to regurgitated
food; Aspiration pneumonia due to gastric secretions;
Aspiration pneumonia due to milk; Aspiration pneumonia
due to vomit
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J69.1 Pneumonitis due to oils and essences; Lipid pneumoniaRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J69.8Pneumonitis due to other solids and liquids; Pneumonitis
due to aspiration of blood
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J70.0Acute pulmonary manifestations due to radiation;
Radiation pneumonitis
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J70.2 Acute drug-induced interstitial lung disordersRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J70.4 Drug-induced interstitial lung disorders, unspecifiedRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J70.8Respiratory conditions due to other specified external
agents
RESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J70.9 Respiratory conditions due to unspecified external agentRESPIRATORY CONDITIONS DUE TO EXTERNAL
AGENTS14,700 4,410 10,290
J96.0 Acute respiratory failure RESPIRATORY FAILURE 32,000 9,600 22,400
J96.1 Chronic respiratory failure RESPIRATORY FAILURE 32,000 9,600 22,400
J96.9 Respiratory failure, unspecified RESPIRATORY FAILURE 32,000 9,600 22,400
H34.1 Central retinal artery occlusion RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
H34.2
Other retinal artery occlusions; Hollenhorst's plaque;
Retinal artery occlusion; Retinal artery branch occlusion ;
Retinal artery partial occlusion; Retinal microembolism
RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
H34.8
Other retinal vascular occlusions; Retinal central vein
occlusion ; Retinal vein occlusion incipient; Retinal vein
occlusion partial; Retinal vein occlusion tributary
RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
H34.9 Retinal vascular occlusion, unspecified RETINAL VASCULAR OCCLUSION 7,700 2,310 5,390
I00Rheumatic fever without mention of heart involvement;
Arthritis, rheumatic, acute or subacute involvementRHEUMATIC FEVER 10,100 3,030 7,070
I01.0 Acute rheumatic pericarditis; Acute rheumatic pericarditis RHEUMATIC FEVER 10,100 3,030 7,070
I01.1 Acute rheumatic endocarditis; Acute rheumatic valvulitis RHEUMATIC FEVER 10,100 3,030 7,070
I01.2 Acute rheumatic myocarditis; RHEUMATIC FEVER 10,100 3,030 7,070
I01.8Other acute rheumatic heart disease; Acute rheumatic
pancarditisRHEUMATIC FEVER 10,100 3,030 7,070
I01.9
Acute rheumatic heart disease unspecified; Acute
rheumatic carditis; Active rheumatic heart disease; Acute
rheumatic heart disease
Rheumatic fever with heart involvement
RHEUMATIC FEVER 10,100 3,030 7,070
I02.0Rheumatic chorea with heart involvement; Chorea NOS
with heart involvementRHEUMATIC FEVER 10,100 3,030 7,070
I02.9Rheumatic chorea without heart involvement; Rheumatic
chorea NOSRHEUMATIC FEVER 10,100 3,030 7,070
I05.0 Mitral stenosis; Rheumatic mitral valve obstruction RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I05.1Rheumatic mitral insufficiency; Rheumatic mitral
incompetence; Rheumatic mitral regurgitationRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I05.2Mitral stenosis with insufficiency; Mitral stenosis with
incompetence or regurgitationRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I05.8 Other mitral valve diseases; Mitral valve failure RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I05.9Mitral valve disease unspecified; Chronic mitral valve
disorder NOSRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I06.0Rheumatic aortic stenosis; Rheumatic aortic valve
obstructionRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I06.1Rheumatic aortic insufficiency; Rheumatic aortic
incompetence; Rheumatic aortic regurgitationRHEUMATIC HEART DISEASE 12,800 3,840 8,960
Page 113 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I06.2Rheumatic aortic stenosis with insufficiency; Rheumatic
aortic stenosis with incompetence or regurgitationRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I06.8 Other rheumatic aortic valve diseases RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I06.9Rheumatic aortic valve disease unspecified; Rheumatic
aortic valve disease NOSRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I07.0 Tricuspid stenosis; Rheumatic tricuspid valve stenosis RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I07.1Tricuspid insufficiency; Rheumatic tricuspid valve
insufficiencyRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I07.9Tricuspid valve disease unspecified; Tricuspid valve disorder
NOSRHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.0
Disorders of both mitral and aortic valves; Involvement of
both mitral and aortic valves whether specified as
rheumatic or of unspecified origin
RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.1 Disorders of both mitral and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.2 Disorders of both aortic and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.3 Combined disorders of mitral aortic and tricuspid valves RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.8 Other multiple valve diseases RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I08.9 Multiple valve disease, unspecified RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I09.0 Rheumatic myocarditis RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I09.1
Rheumatic diseases of endocardium, valve unspecified;
Chronic rheumatic endocarditis; Chronic rheumatic
valvulitis
RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I09.2
Chronic rheumatic pericarditis; Rheumatic adherent
pericardium; Chronic rheumatic mediastinopericarditis;
Chronic rheumatic myopericarditis
RHEUMATIC HEART DISEASE 12,800 3,840 8,960
I09.8Other specified rheumatic heart diseases; Rheumatic
disease of pulmonary valveRHEUMATIC HEART DISEASE 12,800 3,840 8,960
A75.0
Epidemic louse-borne typhus fever due to Rickettsia
prowazekii; Classical typhus fever;
Epidemic louse-borne typhus
RICKETTSIOSES 7,000 2,100 4,900
A75.9 Typhus fever, unspecified RICKETTSIOSES 7,000 2,100 4,900
A77.0Spotted fever due to Rickettsia rickettsii; Rocky Mountain
spotted fever; Sao Paulo feverRICKETTSIOSES 7,000 2,100 4,900
A79.0 Trench fever ; Quintan fever; Wolhynian fever RICKETTSIOSES 7,000 2,100 4,900
A79.9 Rickettsiosis, unspecified; Rickettsial infection NOS RICKETTSIOSES 7,000 2,100 4,900
U04.9 Severe Acute Respiratory Syndrome (SARS) SARS
A38 Scarlet fever; Scarlatina SCARLET FEVER 8,300 2,490 5,810
A40.0 Sepsis due to streptococcus, group A SEPSIS 32,000 9,600 22,400
A40.1 Sepsis due to streptococcus, group B SEPSIS 32,000 9,600 22,400
A40.3Sepsis due to Streptococcus pneumoniae; Pneumococcal
septicaemiaSEPSIS 32,000 9,600 22,400
A40.8 Other streptococcal sepsis SEPSIS 32,000 9,600 22,400
A40.9 Streptococcal septicaemia, unspecified SEPSIS 32,000 9,600 22,400
A41.0 Sepsis due to Staphylococcus aureus SEPSIS 32,000 9,600 22,400
A41.1Sepsis due to other specified staphylococcus; Sepsis due
to coagulase-negative staphylococcusSEPSIS 32,000 9,600 22,400
A41.2 Sepsis due to unspecified staphylococcus SEPSIS 32,000 9,600 22,400
A41.3 Sepsis due to Haemophilus influenzae SEPSIS 32,000 9,600 22,400
A41.4 Sepsis due to anaerobes SEPSIS 32,000 9,600 22,400
A41.5Sepsis due to other Gram-negative organisms; Gram-
negative septicaemia NOSSEPSIS 32,000 9,600 22,400
A41.8 Other specified septicaemia SEPSIS 32,000 9,600 22,400
A41.9 Sepsis , unspecified; Septic shock SEPSIS 32,000 9,600 22,400
A48.3 Toxic shock syndrome SEPSIS 32,000 9,600 22,400
I69.0 Sequelae of subarachnoid haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.1 Sequelae of intracerebral haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.2 Sequelae of other nontraumatic intracranial haemorrhage SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.3 Sequelae of cerebral infarction SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.4Sequelae of stroke, not specified as haemorrhage or
infarctionSEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
I69.8 Sequelae of other and unspecified cerebrovascular diseases SEQUELAE OF CEREBROVASCULAR DISEASES 10,300 3,090 7,210
B90.0 Sequelae of central nervous system tuberculosisSEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
B90.8 Sequelae of tuberculosis of other organsSEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
B90.9Sequelae of respiratory and unspecified tuberculosis;
sequelae of tuberculosis NOS
SEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
B94.1 Sequelae of viral encephalitisSEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
B94.2 Sequelae of viral hepatitisSEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
Page 114 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
B94.8 Sequelae of other specified infectious and parasitic diseasesSEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
B94.9 Sequelae of unspecified infectious or parasitic diseaseSEQUELAE OF INFECTIOUS AND PARASITIC
DISEASES10,700 3,210 7,490
G09Sequelae of inflammatory diseases of central nervous
system
SEQUELAE OF INFLAMMATORY DISEASE OF THE
CENTRAL NERVOUS SYSTEM8,000 2,400 5,600
E64.8 Sequelae of other nutritional deficiencies SEQUELAE OF NUTRITIONAL DEFICIENCIES 8,800 2,640 6,160
T90.0 Sequelae of superficial injury of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.1 Sequelae of open wound of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.2 Sequelae of fracture of skull and facial bones SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.5 Sequelae of intra cranial injury SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.8 Sequelae of other specified injuries of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T90.9 Sequelae of unspecified injury of head SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T91.0Sequelae of superficial injury and open wound of neck and
trunkSEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T91.1 Sequelae of fracture of spine SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T91.2 Sequelae of other fracture of thorax and pelvis SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T91.3 Sequelae of injury of spinal cord SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T92.0 Sequelae of open wound of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T92.1 Sequelae of fracture of arm SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T92.8 Sequelae of other specified injuries of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.0 Sequelae of open wound of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.1 Sequelae of fracture of femur SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.2 Sequelae of other fractures of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.3 Sequelae of dislocation sprain and strain of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T93.8 Sequelae of other specified injuries of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T94.0 Sequelae of injuries involving multiple body regions SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T94.1 Sequelae of injuries, not specified by body regions SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.0 Sequelae of burn, corrosion and frostbite of head and neck SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.2 Sequelae of burn, corrosion and frostbite of upper limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.3 Sequelae of burn, corrosion and frostbite of lower limb SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.8 Sequelae of other specified burn corrosion and frostbite SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T95.9 Sequelae of unspecified burn, corrosion and frostbite SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
T98.2 Sequelae of certain early complications of trauma SEQUELAE OF TRAUMA INJURIES 8,500 2,550 5,950
R57.0 Cardiogenic shock SHOCK 32,000 9,600 22,400
R57.1 Hypovolaemic shock SHOCK 32,000 9,600 22,400
R57.8 Other shock; Endotoxic shock SHOCK 32,000 9,600 22,400
R57.9 Shock, unspecified; Failure of peripheral circulation NOS SHOCK 32,000 9,600 22,400
T88.2Shock due to anaesthesia; Shock due to anaesthesia in
which the correct sustance was properly administeredSHOCK 32,000 9,600 22,400
Q89.3
Situs inversus; Dextrocardia with situs inversus; Mirror-
image atrial arrangement with situs inversus; Situs inversus
or transverses abdominalis; Situs inversus or transversus
thoracis; Transposition of abdominal viscera; Transposition
of thoracic visce
SITUS INVERSUS 6,700 2,010 4,690
S02.0Fracture o f vault of skull; Fracture of Frontal bone;
Fracture of Parietal boneSKULL FRACTURES 10,700 3,210 7,490
S02.00Closed fracture o f vault of skull; Fracture of Frontal bone;
Fracture of Parietal bone SKULL FRACTURES 10,700 3,210 7,490
S02.01Open fracture o f vault of skull; Fracture of Frontal bone;
Fracture of Parietal bone SKULL FRACTURES 10,700 3,210 7,490
S02.1
Fracture of base of skull: Fracture of anterior fossa, middle
fossa, posterior fossa; Fracture of Occiput; Fracture of
orbital roof; Fracture of ethmoid sinus & frontal sinus;
Fracture of Sphenoid; Fracture of temporal bone
SKULL FRACTURES 10,700 3,210 7,490
S02.10
Closed fracture of base of skull; fracture of anterior fossa;
fracture of middle fossa; fracture of posterior fossa;
fracture of occiput; fracture of orbital roof; fracture of
ethmoid sinus; fracture of frontal sinus; fracture of
sphenoid; fracture of temporal bone
SKULL FRACTURES 10,700 3,210 7,490
S02.11
Opem fracture of base of skull; fracture of anterior fossa;
fracture of middle fossa; fracture of posterior fossa;
fracture of occiput; fracture of orbital roof; fracture of
ethmoid sinus; fracture of frontal sinus; fracture of
sphenoid; fracture of temporal bone
SKULL FRACTURES 10,700 3,210 7,490
S02.20 closed fracture of nasal bones SKULL FRACTURES 10,700 3,210 7,490
S02.21 open fracture of nasal bones SKULL FRACTURES 10,700 3,210 7,490
S02.30 Closed fracture of orbital floor SKULL FRACTURES 10,700 3,210 7,490
S02.31 Open fracture of orbital floor SKULL FRACTURES 10,700 3,210 7,490
S02.40Closed Fracture of malar and maxillary bones; superior
maxilla; upper jaw (bone); zygomaSKULL FRACTURES 10,700 3,210 7,490
S02.41Open Fracture of malar and maxillary bones; superior
maxilla; upper jaw (bone); zygomaSKULL FRACTURES 10,700 3,210 7,490
Page 115 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
S02.50 Closed Fracture of tooth SKULL FRACTURES 10,700 3,210 7,490
S02.60 Closed Fracture of mandible SKULL FRACTURES 10,700 3,210 7,490
S02.61 Open Fracture of mandible SKULL FRACTURES 10,700 3,210 7,490
S02.70 Closed Multiple fractures involving skull and facial bones SKULL FRACTURES 10,700 3,210 7,490
S02.71 Open Multiple fractures involving skull and facial bones SKULL FRACTURES 10,700 3,210 7,490
S02.80closed Fractures of other skull and facial bones including
Alveolus, Orbit NOS, PalateSKULL FRACTURES 10,700 3,210 7,490
S02.81open Fractures of other skull and facial bones including
Alveolus, Orbit NOS, PalateSKULL FRACTURES 10,700 3,210 7,490
S02.90 Closed Fracture of skull and facial bones, part unspecified SKULL FRACTURES 10,700 3,210 7,490
S02.91 Open Fracture of skull and facial bones, part unspecified SKULL FRACTURES 10,700 3,210 7,490
G47.3Sleep apnoea; Central sleep apnoea; obstructive sleep
apnoea, SLEEP APNEA 10,800 3,240 7,560
M43.0 Spondylolysis SPONDYLOPATHIES 8,300 2,490 5,810
M43.1 Spondylolisthesis SPONDYLOPATHIES 8,300 2,490 5,810
M43.2 Other fusion of spine; Ankylosis of spinal joint SPONDYLOPATHIES 8,300 2,490 5,810
M43.5 Other recurrent vertebral subluxation SPONDYLOPATHIES 8,300 2,490 5,810
M43.6 Torticollis SPONDYLOPATHIES 8,300 2,490 5,810
M45 Ankylosing spondylitis; Rheumatoid arthritis of spine SPONDYLOPATHIES 8,300 2,490 5,810
M46.0Spinal enthesopathy; Disorder of ligamentous or muscular
attachments of spine SPONDYLOPATHIES 8,300 2,490 5,810
M46.1 Sacroiliitis, not elsewhere classified SPONDYLOPATHIES 8,300 2,490 5,810
M46.16 Sacroiliitis, not elsewhere classified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M46.19 Sacroiliitis, not elsewhere classified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.2 Osteomyelitis of vertebra SPONDYLOPATHIES 8,300 2,490 5,810
M46.28 Osteomyelitis of vertebra sacral and sacrococcygeal region SPONDYLOPATHIES 8,300 2,490 5,810
M46.29 Osteomyelitis of vertebra site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.3 Infection of intervertebral disc (pyogenic) SPONDYLOPATHIES 8,300 2,490 5,810
M46.36 Infection of intervertebral disc (pyogenic) lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M46.4 Discitis, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.46 Discitis, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M46.47 Discitis, unspecified lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M46.49 Discitis, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.5 Other infective spondylopathies SPONDYLOPATHIES 8,300 2,490 5,810
M46.8 Other specified inflammatory spondylopathies SPONDYLOPATHIES 8,300 2,490 5,810
M46.87Other specified inflammatory spondylopathies lumbosacral
regionSPONDYLOPATHIES 8,300 2,490 5,810
M46.9 Inflammatory spondylopathy, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M46.92 Inflammatory spondylopathy, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M46.97Inflammatory spondylopathy, unspecified lumbosacral
regionSPONDYLOPATHIES 8,300 2,490 5,810
M46.98Inflammatory spondylopathy, unspecified sacral and
sacrococcygeal regionSPONDYLOPATHIES 8,300 2,490 5,810
M46.99 Inflammatory spondylopathy, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M47.1 Other spondylosis with myelopathy SPONDYLOPATHIES 8,300 2,490 5,810
M47.1+G99.2* Myelopathy in Other spondylosis with myelopathy SPONDYLOPATHIES 8,300 2,490 5,810
M47.2 Other spondylosis with radiculopathy SPONDYLOPATHIES 8,300 2,490 5,810
M47.20Other spondylosis with radiculopathy Multiple sites in
spineSPONDYLOPATHIES 8,300 2,490 5,810
M47.22 Other spondylosis with radiculopathy cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M47.26 Other spondylosis with radiculopathy lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M47.27 Other spondylosis with radiculopathy lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M47.29 Other spondylosis with radiculopathy site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M47.8
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy
SPONDYLOPATHIES 8,300 2,490 5,810
M47.80
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy Multiple sites in spine
SPONDYLOPATHIES 8,300 2,490 5,810
M47.81
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy occipito-atlanto-axial region
SPONDYLOPATHIES 8,300 2,490 5,810
Page 116 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M47.82
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy cervical region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.83
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy cervicothoracic region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.84
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy thoracic region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.85
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy thoracolumbar region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.86
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy lumbar region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.87
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy lumbosacral region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.88
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy sacral and sacrococcygeal region
SPONDYLOPATHIES 8,300 2,490 5,810
M47.89
Cervical spondylosis without myelopathy or radiculopathy;
Lumbosacral spondylosis without myelopathy or
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy site unspecified
SPONDYLOPATHIES 8,300 2,490 5,810
M47.9 Spondylosis, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M47.90 Spondylosis, unspecified Multiple sites in spine SPONDYLOPATHIES 8,300 2,490 5,810
M47.92 Spondylosis, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M47.94 Spondylosis, unspecified thoracic region SPONDYLOPATHIES 8,300 2,490 5,810
M47.95 Spondylosis, unspecified thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M47.96 Spondylosis, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M47.97 Spondylosis, unspecified lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M47.99 Spondylosis, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M48.0 Spinal stenosis; Caudal stenosis SPONDYLOPATHIES 8,300 2,490 5,810
M48.00 Spinal stenosis; Caudal stenosis Multiple sites in spine SPONDYLOPATHIES 8,300 2,490 5,810
M48.02 Spinal stenosis; Caudal stenosis cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M48.03 Spinal stenosis; Caudal stenosis cervicothoracic region SPONDYLOPATHIES 8,300 2,490 5,810
M48.04 Spinal stenosis; Caudal stenosis thoracic region SPONDYLOPATHIES 8,300 2,490 5,810
M48.05 Spinal stenosis; Caudal stenosis thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.06 Spinal stenosis; Caudal stenosis lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.07 Spinal stenosis; Caudal stenosis lumbosacral region SPONDYLOPATHIES 8,300 2,490 5,810
M48.08Spinal stenosis; Caudal stenosis sacral and sacrococcygeal
regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.09 Spinal stenosis; Caudal stenosis site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M48.1Ankylosing hyperostosis [Forestier]; Diffuse idiopathic
skeletal hyperostosis [DISH]SPONDYLOPATHIES 8,300 2,490 5,810
M48.16Ankylosing hyperostosis [Forestier]; Diffuse idiopathic
skeletal hyperostosis [DISH] lumbar regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.2 Kissing spine SPONDYLOPATHIES 8,300 2,490 5,810
M48.3 Traumatic spondylopathy SPONDYLOPATHIES 8,300 2,490 5,810
M48.32 Traumatic spondylopathy cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M48.4 Fatigue fracture of vertebra; Stress fracture of vertebra SPONDYLOPATHIES 8,300 2,490 5,810
M48.5Collapsed vertebra, not elsewhere classified; Collapsed
vertebra NOS; Wedging of vertebra NOSSPONDYLOPATHIES 8,300 2,490 5,810
M48.54Collapsed vertebra NOS; Wedging of vertebra NOS thoracic
regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.56Collapsed vertebra NOS; Wedging of vertebra NOS lumbar
regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.57Collapsed vertebra NOS; Wedging of vertebra NOS
lumbosacral regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.8Other specified spondylopathies; Ossification of posterior
longitudinal ligamentSPONDYLOPATHIES 8,300 2,490 5,810
M48.80Ossification of posterior longitudinal ligament Multiple sites
in spineSPONDYLOPATHIES 8,300 2,490 5,810
M48.85Ossification of posterior longitudinal ligament
thoracolumbar regionSPONDYLOPATHIES 8,300 2,490 5,810
Page 117 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
M48.86Ossification of posterior longitudinal ligament lumbar
regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.89Ossification of posterior longitudinal ligament site
unspecifiedSPONDYLOPATHIES 8,300 2,490 5,810
M48.9 Spondylopathy, unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M48.92 Spondylopathy, unspecified cervical region SPONDYLOPATHIES 8,300 2,490 5,810
M48.95 Spondylopathy, unspecified thoracolumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.96 Spondylopathy, unspecified lumbar region SPONDYLOPATHIES 8,300 2,490 5,810
M48.98Spondylopathy, unspecified sacral and sacrococcygeal
regionSPONDYLOPATHIES 8,300 2,490 5,810
M48.99 Spondylopathy, unspecified site unspecified SPONDYLOPATHIES 8,300 2,490 5,810
M49.0* Tuberculosis of spine; Pott's curvature SPONDYLOPATHIES 8,300 2,490 5,810
M49.8* Spondylopathy in other diseases classified elsewhere SPONDYLOPATHIES 8,300 2,490 5,810
L00Staphylococcal scalded skin syndrome; Pemphigus
neonatorum; Ritter's diseaseSTAPHYLOCCOCAL SCALDED SKIN SYNDROME 10,200 3,060 7,140
G41.0 Grand mal status epilepticus; Tonic-clonic status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920
G41.1 Petit mal status epilepticus; Epileptic absence status STATUS EPILEPTICUS 15,600 4,680 10,920
G41.2 Complex partial status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920
G41.8 Other status epilepticus STATUS EPILEPTICUS 15,600 4,680 10,920
G41.9 Status epilepticus, unspecified STATUS EPILEPTICUS 15,600 4,680 10,920
L51.1 Bullous erythema multiforme; Stevens-Johnson syndrome STEVEN JOHNSONS SYNDROME 12,300 3,690 8,610
I60.0Subarachnoid haemorrhage from carotid siphon and
bifurcationSTROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.1 Subarachnoid haemorrhage from middle cerebral artery STROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.2Subarachnoid haemorrhage from anterior communicating
arterySTROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.3Subarachnoid haemorrhage from posterior communicating
arterySTROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.4 Subarachnoid haemorrhage from basilar artery STROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.5 Subarachnoid haemorrhage from vertebral artery STROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.6Subarachnoid haemorrhage from other intracranial
arteries; Multiple involvement of intracranial arteriesSTROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.7
Subarachnoid haemorrhage from intracranial artery,
unspecified; Congenital ruptured berry aneurysm NOS;
Subarachnoid haemorrhage from cerebral artery NOS;
Subarachnoid haemorrhage from communicating artery
NOS
STROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.8
Other subarachnoid haemorrhage; Meningeal
haemorrhage; Rupture of cerebral arteriovenous
malformation
STROKE - HEMORRHAGIC 38,000 11,400 26,600
I60.9Subarachnoid haemorrhage, unspecified; Congenital
ruptured cerebral aneurysm NOSSTROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.0Intracerebral haemorrhage in hemisphere, subcortical;
Deep intracerebral haemorrhageSTROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.1
Intracerebral haemorrhage in hemisphere, cortical;
Cerebral lobe haemorrhage; Superficial intracerebral
haemorrhage
STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.2 Intracerebral haemorrhage in hemisphere, unspecified STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.3 Intracerebral haemorrhage in brain stem STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.4 Intracerebral haemorrhage in cerebellum STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.5 Intracerebral haemorrhage, intraventricular STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.6 Intracerebral haemorrhage, multiple localized STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.8 Other intracerebral haemorrhage STROKE - HEMORRHAGIC 38,000 11,400 26,600
I61.9Intracerebral haemorrhage, unspecified
Cerebrovascular Accident hemorrhage STROKE - HEMORRHAGIC 38,000 11,400 26,600
I62.0Acute Subdural haemorrhage; Nontraumatic Subdural
haemorrhageSTROKE - HEMORRHAGIC 38,000 11,400 26,600
I62.1Nontraumatic extradural haemorrhage; Nontraumatic
epidural haemorrhageSTROKE - HEMORRHAGIC 38,000 11,400 26,600
I62.9 Intracranial haemorrhage (nontraumatic), unspecified STROKE - HEMORRHAGIC 38,000 11,400 26,600
I63.0Cerebral infarction due to thrombosis of precerebral
arteriesSTROKE - INFARCTION 28,000 8,400 19,600
I63.1 Cerebral infarction due to embolism of precerebral arteries STROKE - INFARCTION 28,000 8,400 19,600
I63.2Cerebral infarction due to unspecified occlusion or stenosis
of precerebral arteriesSTROKE - INFARCTION 28,000 8,400 19,600
I63.3Cerebral infarction due to thrombosis of cerebral arteries
Cerebrovascular disease (CVD), thrombotic infarctSTROKE - INFARCTION 28,000 8,400 19,600
I63.4 Cerebral infarction due to embolism of cerebral arteries STROKE - INFARCTION 28,000 8,400 19,600
I63.5Cerebral infarction due to unspecified occlusion or stenosis
of cerebral arteriesSTROKE - INFARCTION 28,000 8,400 19,600
Page 118 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
I63.6Cerebral infarction due to cerebral venous thrombosis,
nonpyogenicSTROKE - INFARCTION 28,000 8,400 19,600
I63.8 Other cerebral infarction STROKE - INFARCTION 28,000 8,400 19,600
I63.9
Cerebral infarction, unspecified
Reversible Ischemic Neurologic Deficit (RIND)
CVA with infarction
STROKE - INFARCTION 28,000 8,400 19,600
I63.9+G46.7* Other lacunar syndrome in unspecified cerebral infarction STROKE - INFARCTION 28,000 8,400 19,600
I64
Stroke, not specified as hemorrhage or infarction;
Cerebrovascular Accident (CVA)
Cardioembolic CVA
STROKE - INFARCTION 28,000 8,400 19,600
G10 Huntington's disease; Huntington's choreaSYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G11.0 Congenital nonprogressive ataxiaSYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G11.1
Early-onset cerebellar ataxia including Early-onset
cerebellar ataxia with essential tremor; Early-onset
cerebellar ataxia with myoclonus [Hunt's ataxia]; Early-
onset cerebellar ataxia with retained tendon reflexes;
Friedreich's ataxia (autosomal recessiv
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G11.3Cerebellar ataxia with defective DNA repair; Ataxia
telangiectasia [Louis-Bar]
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G11.9
Hereditary ataxia, unspecified; Hereditary cerebellar ataxia
NOS; Hereditary cerebellar degeneration; Hereditary
cerebellar disease; Hereditary cerebellar syndrome
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G12.0 Infantile spinal muscular atrophy, type I [Werdnig-Hoffman]SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G12.1
Other inherited spinal muscular atrophy; Progressive bulbar
palsy of childhood [Fazio-Londe]; Spinal muscular atrophy
adult form;
Spinal muscular atrophy childhood form, type II; Spinal
muscular atrophy distal; Spinal muscular atrophy juvenile
form, type III [Kugelberg-FWelander]; Spinal muscular
atrophy scapuloperoneal form
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G12.2
Motor neuron disease; Familial motor neuron disease;
AmyotrophicLateral sclerosis; Primary Lateral sclerosis ;
Progressive bulbar palsy; Progressive spinal muscular
atrophy
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G12.9 Spinal muscular atrophy, unspecifiedSYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
G20
Parkinson's disease; Hemiparkinsonism; Paralysis agitans;
Parkinsonism or Parkinson's disease NOS; Idiopathic
Parkinsonism or Parkinson's disease; Primary Parkinsonism
or Parkinson's disease
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM10,400 3,120 7,280
L93.0 Discoid lupus erythematosus; Lupus erythematosus NOS SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
L93.1 Subacute cutaneous lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
L93.2Other local lupus erythematosus; Lupus erymatosus
profundus; Lupus panniculitisSYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
M32.0 Drug-induced systemic lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
M32.8 Other forms of systemic lupus erythematosus SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
M32.9 Systemic lupus erythematosus, unspecified SYSTEMIC LUPUS ERYTHEMATOSUS 11,900 3,570 8,330
A33 Tetanus neonatorum TETANUS 16,500 4,950 11,550
A34 Obstetrical tetanus TETANUS 16,500 4,950 11,550
A35 Other tetanus; Tetanus NOS TETANUS 16,500 4,950 11,550
R29.0 Tetany; Carpopedal spasm TETANUS 16,500 4,950 11,550
D56.0 Alpha thalassaemia THALASSEMIA 5,600 1,680 3,920
D56.1
Beta thalassaemia; Cooley's anaemia; Severe beta
thalassaemia; Sickle-cell bet thalassaemia; Thalassaemia
intermedia; Thalassaemia major;
THALASSEMIA 5,600 1,680 3,920
D56.2 Delta-beta thalassaemia THALASSEMIA 5,600 1,680 3,920
D56.3 Thalassaemia trait THALASSEMIA 5,600 1,680 3,920
D56.4 Hereditary persistence of fetal haemoglobin [HPFH] THALASSEMIA 5,600 1,680 3,920
D56.8 Other thalassaemias THALASSEMIA 5,600 1,680 3,920
L51.2 Toxic epidermal necrolysis [Lyell] TOXIC EPIDERMAL NECROLYSIS 15,900 4,770 11,130
G45.0 Vertebro-basilar artery syndrome TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.1 Carotid artery syndrome (Hemispheric) TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.2 Multiple and bilateral precerebral artery syndromes TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.3 Amaurosis fugax TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.4 Transient global amnesia TRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.8Other transient cerebral ischaemic attacks and related
syndromesTRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
G45.9Transient cerebral ischaemic attack, unspecified; Spasm of
cerebral artery; Transient cerebral ischaemia NOSTRANSIENT CEREBRAL ISCHEMIC ATTACKS 7,300 2,190 5,110
Page 119 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
P10.0Subdural haemorrhage due to birth injury; Subdural
haematoma (localized) due to birth injuryTRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.1 Cerebral haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.2 Intraventricular haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.3 Subarachnoid haemorrhage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.4 Tentorial tear due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P10.9Unspecified intracranial laceration and haemorrhage due to
birth injuryTRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P11.1 Other specified brain damage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P11.2 Unspecified brain damage due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P11.9 Birth injury to central nervous system, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.0 Cephalhaematoma due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.3 Bruising of scalp due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.8 Other birth injuries to scalp TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P12.9 Birth injury to scalp, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.2 Birth injury to femur TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.4 Fracture of clavicle due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.8 Birth injuries to other parts of skeleton TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P13.9 Birth injury to skeleton, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P14.0 Erb's paralysis due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P14.3 Other brachial plexus birth injuries TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.4 Birth injury to face; Facial congestion due to birth injury TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.5 Birth injury to external genitalia TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.8 Other specified birth injuries TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
P15.9 Birth injury, unspecified TRAUMA RELATED TO BIRTH PROCESS 13,800 4,140 9,660
A15.4
Tuberculosis of intrathoracic lymph nodes, confirmed
bacteriologically & histologicaly; Tuberculosis of hilar
lymph nodes, confirmed bacteriologically & histologicaly;
Tuberculosis of mediastinal lymph nodes, confirmed
bacteriologically & histologicaly; Tuberculosis of
tracheobronchial lymph nodes, confirmed bacteriologically
& histologicaly
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A15.5
Tuberculosis of larynx, trachea and bronchus, confirmed
bacteriologically
and histologically; Tuberculosis of bronchus confirmed
bacteriologically and histologically; Tuberculosis of glottis
confirmed bacteriologically and histologically; Tuberculosis
of larynx confirmed bacteriologically and histologically;
Tuberculosis of trachea, confirmed bacteriologically and
histologically
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A15.6
Tuberculous pleurisy, confirmed bacteriologically and
histologically; Tuberculosis of pleura, confirmed
bacteriologically and histologically; Tuberculous empyema,
confirmed bacteriologically & histologically
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A15.8
Other respiratory tuberculosis, confirmed bacteriologically
and histologically; Mediastinal tuberculosis, confirmed
bacteriologically and histologically; Nasopharyngeal
tuberculosis, confirmed bacteriologically and histologically;
Tuberculosis of nose confirmed bacteriologically and
histologically; Tuberculosis of sinus (any nasal) confirmed
bacteriologically and histologically
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A16.3
Tuberculosis of intrathoracic lymph nodes, without
mention of bacteriological or histological confirmation;
Tuberculosis of hillar lymph nodes NOS (without mention
of bacteriological or histological confirmation);
Tuberculosis of intrathoracic lymph nodes NOS (without
mention of bacteriological or histological confirmation);
Tuberculosis of mediastinal lymp nodes NOS (without
mention of bacteriological or histological confirmation);
Tuberculosis of tracheobronchial lymph nodes NOS
(without mention of bacteriological or histological
confirmation)
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A16.4
Tuberculosis of larynx, trachea, glottis and bronchus,
without mention of bacteriological or histological
onfirmation; Tuberculosis of bronchus NOS (without
mention of bacteriological or histological onfirmation):
Tuberculosis of glottis NOS (without mention of
bacteriological or histological onfirmation); Tuberculosis of
larynx NOS (without mention of bacteriological or
histological onfirmation); Tuberculosis of trachea NOS
(without mention of bacteriological or histological
onfirmation)
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
Page 120 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
A16.5
Tuberculous pleurisy, without mention of bacteriological or
histological
confirmation; Tuberculosis of pleura, NOS (without
mention of bacteriological or histological confirmation);
Tuberculous empyema NOS (without mention of
bacteriological or histological confirmation); Tuberculous
plurisy NOS (without mention of bacteriological or
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A16.8
Other respiratory tuberculosis, without mention of
bacteriological or histological confirmation; Mediastinal
tuberculosis, NOS without mention of bacteriological or
histological confirmation; Nasopharyngeal tuberculosis,
NOS without mention of bacteriological or histological
confirmation; Tuberculosis of nose; sinus (any nasal), NOS
without mention of bacteriological or histological
confirmation
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A18.2Tuberculous peripheral lymphadenopathy; Tuberculous
adenitisTUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A18.3
Tuberculosis of intestines, peritoneum and mesenteric
glands; Tuberculosis of anus and rectum; Tuberculosis of
intestine (large)(small); Tuberculosis of retroperitoneal
(lymph nodes); Tuberculous ascites; Tuberculous enteritis;
Tuberculous peritonitis
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A18.4
Tuberculosis of skin and subcutaneous tissue; Erythema
tuberculous induratum, ; Lupus exedens; Lupus vulgaris;
Lupus exedens, NOS; Lupus vulgaris, NOS; Scrofuloderma
TUBERCULOSIS, EXTRAPULMONARY 11,900 3,570 8,330
A19.0 Acute miliary tuberculosis of a single specified site TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.1 Acute miliary tuberculosis of multiple sites TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.2 Acute miliary tuberculosis, unspecified TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.8 Other miliary tuberculosis TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A19.9 Miliary tuberculosis, unspecified TUBERCULOSIS, MILIARY 15,100 4,530 10,570
A15.0
Tuberculosis of lung, confirmed by sputum microscopy with
or without culture; Tuberculous Bronchiectasis' confirmed
by sputum microscopy with or without culture;
Tuberculous fibrosis of lung, confirmed by sputum
microscopy with or without culture; Tuberculous
pneumonia, confirmed by sputum microscopy with or
without culture; Tuberculous pneumothorax, confirmed by
sputum microscopy with or without culture
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A15.1
Tuberculosis of lung, confirmed by culture only;
Tuberculous: Bronchiectasis; fibrosis of lung; pneumonia;
pneumothorax, confirmed by culture onlyTUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A15.2
Tuberculosis of lung, confirmed histologically; Tuberculous:
Bronchiectasis; fibrosis of lung; pneumonia; pneumothorax,
confirmed histologically only
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A15.3
Tuberculosis of lung, confirmed by unspecified means;
Tuberculous: Bronchiectasis; fibrosis of lung; pneumonia;
pneumothorax, confirmed but unspecified whether
bacteriologically or histologically
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A15.7
Primary respiratory tuberculosis, confirmed
bacteriologically and histologically
Childhood type (first infection) pulmonary tuberculosis
confirmed bacteriologically and histologically
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A15.9Respiratory tuberculosis unspecified, confirmed
bacteriologically and histologicallyTUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A16.0
Tuberculosis of lung, bacteriologically and histologically
negative;
Tuberculous Bronchiectasis , bacteriologically and
histologically negative; Tuberculous fibrosis of lung,
bacteriologically and histologically negative; Tuberculous
pneumonia, bacteriologically and histologically negative;
Tuberculous pneumothorax, bacteriologically and
histologically negative
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A16.1Tuberculosis of lung, bacteriological and histological
examination not doneTUBERCULOSIS, PULMONARY 9,800 2,940 6,860
Page 121 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
A16.2
Tuberculosis of lung, without mention of bacteriological or
histological confirmation; Tuberculous: bronchiectasis;
fibrosis of lung; pneumonia; pneumothorax; NOS (
without mention of bacteriological or histological
confirmation)
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A16.7
Primary respiratory tuberculosis without mention of
bacteriological or histological confirmation; Primary
respiratory tuberculosis NOS; Primary tuberculous
complex
Childhood type (first infection) pulmonary tuberculosis
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A16.9
Respiratory tuberculosis unspecified, without mention of
bacteriological or histological confirmation; Respiratory
tuberculosis NOS; Tuberculosis NOS
Koch's Infection; Koch's Disease
TUBERCULOSIS, PULMONARY 9,800 2,940 6,860
A01.0 Typhoid fever; infection due to Salmonella typhi TYPHOID FEVER 10,000 3,000 7,000
A01.1 Paratyphoid fever A TYPHOID FEVER 10,000 3,000 7,000
A01.2 Paratyphoid fever B TYPHOID FEVER 10,000 3,000 7,000
A01.3 Paratyphoid fever C TYPHOID FEVER 10,000 3,000 7,000
A01.4Paratyphoid fever, unspecified; Infection due to Salmonella
paratyphi NOSTYPHOID FEVER 10,000 3,000 7,000
A02.0 Salmonella enteritis; Salmonellosis TYPHOID FEVER 10,000 3,000 7,000
A02.1 Salmonella sepsis TYPHOID FEVER 10,000 3,000 7,000
A02.2
Localized salmonella infections; Salmonella arthritis;
salmonella meningitis; salmonella osteomyelitis; salmonella
pneumonia; salmonella renal tubulo-interstitial disease
TYPHOID FEVER 10,000 3,000 7,000
A02.8 Other specified salmonella infections TYPHOID FEVER 10,000 3,000 7,000
A02.9 Salmonella infection, unspecified TYPHOID FEVER 10,000 3,000 7,000
N26Unspecified contracted kidney; Atrophy of kidney
(terminal); Renal sclerosis NOSURINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N27.0 Small kidney, unilateral URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N27.1 Small kidney, bilateral URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N27.9 Small kidney, unspecified URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N28.8
Other specified disorders of kidney and ureter;
Hypertrophy of kidney; Megaloureter; Nephroptosis;
Pyelitis cystica; Pyeloureteritis cystica; Ureteritis cystica;
Ureterocele
URINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N28.9Disorder of kidney and ureter, unspecified; Nephropathy
NOS; Renal disease NOSURINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N29.8*Other disorders of kidney and ureter in other diseases
classified elsewhereURINARY TRACT ATROPHY/HYPERTROPHY 11,300 3,390 7,910
N30.0 Acute cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.1 Chronic Interstitial cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.2 Other chronic cystitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.3 Trigonitis; Urethrotrigonitis URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N30.9 Cystitis, unspecified URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
N39.0 Urinary tract infection, site not specified URINARY TRACT INFECTION [ADMISSIBLE] 7,500 2,250 5,250
M50.1 Cervical disc disorder with radiculopathy VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M50.2 Other cervical disc displacement VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M50.3 Other cervical disc degeneration VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M50.8 Other cervical vertebral disc disorders VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.1Lumbar and other intervertebral disc disorders with
radiculopathy; Sciatica due to intervertebral disc disorderVERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.2Other specified intervertebral disc displacement
Lumbago due to displacement of intervertebral discVERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.3 Other specified intervertebral disc degenerations VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.4 Schmorl's node VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M51.8 Other specified intervertebral disc disorders VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.0 Segmental and somatic dysfunction, rib cage VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.1 Subluxation complex (vertebral) VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.3 Osseous stenosis of neural canal VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.5 Intervertebral disc stenosis of neural canal VERTEBRAL DISC DISORDERS 7,800 2,340 5,460
M99.7Connective tissue and disc stenosis of intervertebral
foraminaVERTEBRAL DISC DISORDERS 7,800 2,340 5,460
H81.0Ménière's disease; Labyrinthine hydrops; Ménière's
syndrome or vertigoVERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.1 Benign paroxysmal vertigo VERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.2 Vestibular neuronitis VERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.3Other peripheral vertigo; Lermoyez' syndrome; Aural
Vertigo ; Otogenic Vertigo; Peripheral NOS VertigoVERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.4 Vertigo of central origin; Central positional nystagmus VERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.8 Other disorders of vestibular function VERTIGINOUS DISORDERS 5,700 1,710 3,990
H81.9Disorder of vestibular function, unspecified; Vertiginous
syndrome NOSVERTIGINOUS DISORDERS 5,700 1,710 3,990
H83.1 Labyrinthine fistula VERTIGINOUS DISORDERS 5,700 1,710 3,990
Page 122 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
H83.2Labyrinthine dysfunction; Hypersensitivity of labyrinth;
Hypofunction of labyrinth; Loss of function Of labyrinthVERTIGINOUS DISORDERS 5,700 1,710 3,990
R42 Dizziness and giddiness; Light-headedness; Vertigo NOS VERTIGINOUS DISORDERS 5,700 1,710 3,990
A96.0 Junin haemorrhagic fever; Argentinian haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
A96.1 Machupo haemorrhagic fever; Bolivian haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
A98.8 Other specified viral haemorrhagic fevers VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
A99 Unspecified viral haemorrhagic fever VIRAL HEMORRHAGIC FEVER 7,900 2,370 5,530
B15.0 Acute Hepatitis A with hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260
B15.9Acute hepatitis A without hepatic coma; Hepatitis A
(acute)(viral) NOSVIRAL HEPATITIS 11,800 3,540 8,260
B16.0Acute hepatitis B with delta-agent (coinfection) with
hepatic comaVIRAL HEPATITIS 11,800 3,540 8,260
B16.1Acute hepatitis B with delta-agent (coinfection) without
hepatic comaVIRAL HEPATITIS 11,800 3,540 8,260
B16.2 Acute hepatitis B without delta-agent with hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260
B16.9Acute hepatitis B without delta-agent and without hepatic
coma; Acute hepatitis B (viral) NOSVIRAL HEPATITIS 11,800 3,540 8,260
B17.0 Acute delta-(super) infection of hepatitis B carrier VIRAL HEPATITIS 11,800 3,540 8,260
B17.1 Acute hepatitis C VIRAL HEPATITIS 11,800 3,540 8,260
B17.2 Acute hepatitis E VIRAL HEPATITIS 11,800 3,540 8,260
B17.8Other specified acute viral hepatitis; Hepatitis non-A non-B
(acute)(viral) NECVIRAL HEPATITIS 11,800 3,540 8,260
B18.0 Chronic viral hepatitis B with delta-agent VIRAL HEPATITIS 11,800 3,540 8,260
B18.1Chronic viral hepatitis B wtihout delta-agent: Hepatitis B
(viral) NOSVIRAL HEPATITIS 11,800 3,540 8,260
B18.2 Chronic viral hepatitis C VIRAL HEPATITIS 11,800 3,540 8,260
B18.8 Other chronic viral hepatitis VIRAL HEPATITIS 11,800 3,540 8,260
B18.9 Chronic viral hepatitis, unspecified VIRAL HEPATITIS 11,800 3,540 8,260
B19.0 Unspecified viral hepatitis hepatic coma VIRAL HEPATITIS 11,800 3,540 8,260
B19.9Unspecified viral hepatitis without hepatic coma; Viral
Hepatitis NOS VIRAL HEPATITIS 11,800 3,540 8,260
A80.1 Acute paralytic poliomyelitis, wild virus, imported VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A80.2 Acute paralytic poliomyelitis, wild virus, indigenous VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A80.9 Acute poliomyelitis, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A81.0Creutzfeldt-Jakob disease; Subacute spongiform
encephalopathyVIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A81.1
Subacute sclerosing panencephalitis; Dawson's inclusion
body encephalitis ; Van Bogaert's sclerosing
leukoencephalopathy
VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A81.2Progressive multifocal leukoencephalopathy; Multifocal
leukoencephalopathy NOSVIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A81.9Atypical virus infection of central nervous system,
unspecified; Prion disease of central nervous system NOSVIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A82.0 Sylvatic rabies VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A82.1 Urban rabies VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A82.9 Rabies, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.0 Japanese encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.2 Eastern equine encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.5California encephalitis; California meningoencephalitis
La Crosse encephalitisVIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.8 Other mosquito-borne viral encephalitis VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A83.9 Mosquito-borne viral encephalitis, unspecified VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A85.2 Arthropod-borne viral encephalitis, unspecified; VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A85.8Other specified viral encephalitis; Encephalitis lethargica;
Von Economo-Cruchet diseaseVIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A86Unspecified viral encephalitis; Viral encephalomyelitis NOS;
Viral meningoencephalitis NOSVIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A88.8 Other specified viral infections of central nervous system VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
Page 123 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
A89 Unspecified viral infection of central nervous system VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 21,100 6,330 14,770
A37.0 Whooping cough due to Bordetella pertussis WHOOPING COUGH 10,600 3,180 7,420
A37.1 Whooping cough due to Bordetella parapertussis WHOOPING COUGH 10,600 3,180 7,420
A37.8 Whooping cough due to other Bordetella species WHOOPING COUGH 10,600 3,180 7,420
A37.9 Whooping cough, unspecified WHOOPING COUGH 10,600 3,180 7,420
A20.0 Bubonic plague ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A20.9 Plague, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.0 Ulceroglandular tularaemia; Ophthalmic tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.1 Oculoglandular tularaemia; Ophthalmic tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.2 Pulmonary tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.3 Gastrointestinal tularaemia; Abdominal tularaemia ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A21.9 Tularaemia, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A22.0Cutaneous anthrax; Malignant carbuncle; Malignant
pustuleZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A22.2 Gastrointestinal anthrax ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A22.7 Anthrax sepsis ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A22.9 Anthrax, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A23.1 Brucellosis due to Brucella abortus ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A23.9 Brucellosis, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A24.0 Glanders; Infection due to Pseudomonas mallei; Malleus ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A24.1Acute and fulminating melioidosis; Melioidosis pneumonia
; Melioidosis septicaemiaZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A25.9 Rat-bite fever, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A26.8 Other forms of erysipeloid ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A26.9 Erysipeloid, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A28.0 Pasteurellosis ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A28.1 Cat-scratch disease; Cat-scratch fever ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A28.8Other specified zoonotic bacterial diseases, not elsewhere
classifiedZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
A28.9 Zoonotic bacterial disease, unspecified ZOONOTIC BACTERIAL DISEASES 11,700 3,510 8,190
E10.2+ N08.3*
Insulin-dependent diabetes mellitus with renal
complications: diabetic nephropathy; Glomerular disorders
in diabetes mellitus; Brittle diabetes (mellitus); Juvenile-
onset diabetes (mellitus); Ketosis-prone diabetes (mellitus);
Type I diabetes (mellitus)
Insulin-dependent diabetes mellitus nephropathy
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E11.2+ N08.3*
Non-insulin-dependent diabetes mellitus with renal
complications: diabetic nephropathy; Glomerular disorders
in diabetes mellitus; Adult-onset diabetes
(mellitus)(nonobese)(obese); Maturity-onset diabetes
(mellitus)(nonobese)(obese); Nonketonic diabetes
(mellitus)(nonobese)(obese); Stable diabetes
(mellitus)(nonobese)(obese); Type II diabetes
(mellitus)(nonobese)(obese); Non-insulin-dependent
diabetes of the young
Non - insulin-dependent diabetes mellitus nephropathy
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E12.2+ N08.3*
Malnutrition-related diabetes mellitus with renal
complications: diabetic nephropathy; Glomerular disorders
in diabetes mellitus;
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E13.2+ N08.3*
Other specified diabetes mellitus with renal complications:
diabetic nephropathy;Glomerular disorders in diabetes
mellitus
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
E14.2+ N08.3*
Unspecified diabetes mellitus with renal complications:
diabetic nephropathy; Glomerular disorders in diabetes
mellitus
DIABETES MELLITUS WITH COMPLICATIONS
OTHER THAN COMA AND KETOSIS12,600 3,780 8,820
B05.8Measles with other complications; Measles keratitis and
keratoconjunctivitisVIRAL INFECTION (ADMISSIBLE) 7,700 2,310 5,390
B05.9 Measles without complications; Measles NOS VIRAL INFECTION (ADMISSIBLE) 7,700 2,310 5,390
B01.9 Varicella [chickenpox] without complication; Varicella NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B06.8 Rubella with other complications; Encephalitis Rubella;
Meningitis Rubella; Meningoencephalitis RubellaVIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B06.9 Rubella without complication; Rubella NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B09
Unspecified viral infection characterized by skin and
mucous membrane lesions; Viral enanthema NOS; Viral
exanthem
VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.1 Enterovirus infection, unspecified; Coxsackievirus infection
NOS; Echovirus infection NOS VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.2 Coronavirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.3 Parvovirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.4 Papovavirus infection, unspecified VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.8 Other viral infections of unspecified site VIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B34.9Viral infection, unspecified; Viraemia NOS
Systemic Viral InfectionVIRAL INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
Page 124 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
B50.9 Plasmodium falciparum malaria, unspecified MALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800
B51.9Plasmodium vivax malaria without complications;
Plasmodium vivax malaria NOSMALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800
B52.9Plasmodium malariae malaria without complications;
Plasmodium malariae malaria NOSMALARIA WITHOUT COMPLICATIONS 4,000 1,200 2,800
B65.1Schistosomiasis due to Schistosoma mansoni [intestinal
schistosomiasis]PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B65.2Schistosomiasis due to Schistosoma japonicum; Asiatic
schistosomiasisPARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B65.3 Cercarial dermatitis; Swimmer's itch PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B65.8Infection due to Schistosoma intercalatum, Schistosoma
mattheei , Schistosoma mekongi PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B65.9 Schistosomiasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B77.9 Ascariasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B82.0 Intestinal helminthiasis, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
B82.9 Intestinal parasitism, unspecified PARASITIC INFECTION WITHOUT COMPLICATIONS 4,000 1,200 2,800
E11.9
Non-insulin-dependent diabetes mellitus without
complications (NIDDM)
Type II diabetes mellitus
DIABETES MELLITUS WITHOUT COMPLICATIONS 4,000 1,200 2,800
E10.9
Insulin dependent diabetes mellitus without complications
(IDDM)
Type I diabetes mellitus
DIABETES MELLITUS WITHOUT COMPLICATIONS 4,000 1,200 2,800
E16.2 Hypoglycemia, unspecified HYPOGLYCEMIA 4,000 1,200 2,800
E86.1 Moderate dehydration DEHYDRATION 4,000 1,200 2,800
E86.2 Severe dehydration DEHYDRATION 4,000 1,200 2,800
I25.0 Atherosclerotic cardiovascular disease (ASCVD)CHRONIC HEART DISEASES WITHOUT
COMPLICATIONS4,000 1,200 2,800
I25.1
Atherosclerotic heart disease; Coronary artery atheroma;
Coronary artery atherosclerosis; Coronary artery disease;
Coronary artery sclerosis
Arteriosclerotic heart disease (ASHD)
Coronary artery disease (CAD)
Cardiac sclresosis
CHRONIC HEART DISEASES WITHOUT
COMPLICATIONS4,000 1,200 2,800
I25.3 Aneurysm of heart; Mural aneurysm; Venticular aneurysmCHRONIC HEART DISEASES WITHOUT
COMPLICATIONS4,000 1,200 2,800
I25.4Coronary artery aneurysm; Coronary arteriovenous fistula,
acquired
CHRONIC HEART DISEASES WITHOUT
COMPLICATIONS4,000 1,200 2,800
J03.0 Streptococcal tonsillitis UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J03.8 Acute tonsillitis due to other specified organisms UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J03.9
Acute tonsillitis, unspecified; Acute tonsillitis NOS; Acute
Follicular tonsillitis; Acute Gangrenous tonsillitis; Acute
Infective tonsillitis; Acute Ulcerative tonsillitis; Septic
tonsillitis
UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J06.0 Acute laryngopharyngitis UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J06.8Other acute upper respiratory infections of multiple sites
Acute tonsillopharyngitisUPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J06.9
Acute upper respiratory infection, unspecified; Acute upper
respiratory disease; Upper respiratory infection NOS
Upper Respiratory Tract Infection
UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.0 Acute bronchitis due to Mycoplasma pneumoniae UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.1 Acute bronchitis due to Haemophilus influenzae UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.2 Acute bronchitis due to streptococcus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.3 Acute bronchitis due to coxsackievirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.4 Acute bronchitis due to parainfluenza virus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.5 Acute bronchitis due to respiratory syncytial virus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.6 Acute bronchitis due to rhinovirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.7 Acute bronchitis due to echovirus UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.8 Acute bronchitis due to other specified organisms UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J20.9 Acute bronchitis, unspecified UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J22
Unspecified acute lower respiratory infection; Acute
(lower) respiratory (tract) infection NOS
Acute Respiratory Infection
Severe Acute Respiratory Infection
LOWER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
J40
Bronchitis, not specified as acute or chronic; Bronchitis
NOS; Catarrhal Bronchitis; Bronchitis with tracheitis NOS;
Trancheobronchitis NOS
UPPER RESPIRATORY TRACT INFECTION 4,000 1,200 2,800
K04.0
Pulpitis; Pulpal abscess; Pulpal polyp; Acute pulpitis;
Hyperplastic chronic pulpitis; Ulcerative chronic pulpitis;
Supparative pulpitis
DENTAL DISORDERS 4,000 1,200 2,800
K04.1 Necrosis of pulp; Pulpal gangrene DENTAL DISORDERS 4,000 1,200 2,800
Page 125 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
K04.2Pulp degeneration; Denticles; Pulpal calcifications; Pulpal
stonesDENTAL DISORDERS 4,000 1,200 2,800
K04.3Abnormal hard tissue formation in pulp; Secondary or
irregular dentineDENTAL DISORDERS 4,000 1,200 2,800
K04.4Acute apical periodontitis of pulpal origin; Acute apical
periodontitis NOSDENTAL DISORDERS 4,000 1,200 2,800
K04.5Chronic apical periodontitis; Apical or periapical granuloma;
Apical periodontitis NOSDENTAL DISORDERS 4,000 1,200 2,800
K04.6Periapical abscess with sinus; Dental abscess with sinus;
Dentoalveolar abscess with sinusDENTAL DISORDERS 4,000 1,200 2,800
K04.7Periapical abscess without sinus; Dental abscess NOS;
Dentoalveolar abscess NOS; Periapical abscess NOSDENTAL DISORDERS 4,000 1,200 2,800
K04.8Radicular cyst; Periodontal apical cyst; Periapical cyst;
Residual radicular cystDENTAL DISORDERS 4,000 1,200 2,800
K04.9Other and unspecified diseases of pulp and periapical
tissuesDENTAL DISORDERS 4,000 1,200 2,800
K30 Dyspepsia; Indigestion BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
K31.0 Acute dilatation of stomach; Acute distension of stomach BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
K31.9 Disease of stomach and duodenum, unspecified BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
K59.0 Constipation BOWEL MOVEMENT DISORDERS 4,000 1,200 2,800
L02.0 Cutaneous abscess, furuncle and carbuncle of face SKIN INFECTIONS 4,000 1,200 2,800
L02.1 Cutaneous abscess, furuncle and carbuncle of neck SKIN INFECTIONS 4,000 1,200 2,800
L02.2
Cutaneous abscess, furuncle and carbuncle of trunk;
Cutaneous abscess, furuncle and carbuncle of Abdominal
wall; Cutaneous abscess, furuncle and carbuncle of Back
[any part, except buttock]; Cutaneous abscess, furuncle and
carbuncle of Chest wall; Cutaneous abscess, furuncle and
carbuncle of Groin; Cutaneous abscess, furuncle and
carbuncle of Perineum; Cutaneous abscess, furuncle and
carbuncle of Umbilicus
SKIN INFECTIONS 4,000 1,200 2,800
L02.3
Cutaneous abscess, furuncle and carbuncle of buttock;
Cutaneous abscess, furuncle and carbuncle of Gluteal
region
SKIN INFECTIONS 4,000 1,200 2,800
L02.4Cutaneous abscess, furuncle and carbuncle of limb, Axilla,
Hip & Shoulder SKIN INFECTIONS 4,000 1,200 2,800
L02.8Cutaneous abscess, furuncle and carbuncle of other sites:
Head [any part, except face]; Scalp SKIN INFECTIONS 4,000 1,200 2,800
L02.9Cutaneous abscess, furuncle and carbuncle, unspecified;
Furunculosis NOS SKIN INFECTIONS 4,000 1,200 2,800
L72.0 Epidermal cyst CUTANEOUS CYSTS 4,000 1,200 2,800
L72.1 Trichilemmal cyst; Pilar cyst; Sebaceous cyst CUTANEOUS CYSTS 4,000 1,200 2,800
L72.2 Steatocystoma multiplex CUTANEOUS CYSTS 4,000 1,200 2,800
L72.8 Other follicular cysts of skin and subcutaneous tissue CUTANEOUS CYSTS 4,000 1,200 2,800
L72.9 Follicular cyst of skin and subcutaneous tissue, unspecified CUTANEOUS CYSTS 4,000 1,200 2,800
N20.0Calculus of kidney; Nephrolithiasis NOS; Renal calculus or
stone; Staghorn calculus; Stone in kidney UROLITHIASIS 4,000 1,200 2,800
N20.1 Calculus of ureter; Ureteric stone UROLITHIASIS 4,000 1,200 2,800
N20.2 Calculus of kidney with calculus of ureter UROLITHIASIS 4,000 1,200 2,800
N20.9 Urinary calculus, unspecified; Calculous pyelonephritis UROLITHIASIS 4,000 1,200 2,800
N30.4 Irradiation cystitis IRRADIATION CYSTITIS 4,000 1,200 2,800
O23.1 Infections of bladder in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.2 Infections of urethra in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.4 Unspecified infection of urinary tract in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.5 Infections of the genital tract in pregnancy URINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
O23.9Other and unspecified genitourinary tract infection in
pregnancy; Genitourinary tract infection in pregnancy NOSURINARY TRACT INFECTION IN PREGNANCY 4,000 1,200 2,800
S00.0 Superficial injury of scalp SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.1 Contusion of eyelid and periocular area; Black eye SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.2 Other superficial injuries of eyelid and periocular area SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.3 Superficial injury of nose SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.4 Superficial injury of ear SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.5 Superficial injury of lip and oral cavity SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.7 Multiple superficial injuries of head SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.8 Superficial injury of other parts of head SUPERFICIAL INJURIES 4,000 1,200 2,800
S00.9 Superficial injury of head, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.0 Open wound of scalp SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.1 Open wound of eyelid and periocular area SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.2 Open wound of nose SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.3 Open wound of ear SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.4 Open wound of cheek and temporomandibular area SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.5 Open wound of lip and oral cavity SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.7 Multiple open wounds of head SUPERFICIAL INJURIES 4,000 1,200 2,800
S01.8 Open wound of other parts of head SUPERFICIAL INJURIES 4,000 1,200 2,800
Page 126 of 127
Case Rate Professional
Fee
Health Care
Institution Fee
List of Medical Case Rates (Updated February 2017)
ICD 10 CODE DESCRIPTION GROUP
FIRST CASE RATE
S01.9 Open wound of head, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.0Open wound of finger(s) without damage to nail; Open
wound of finger(s) NOSSUPERFICIAL INJURIES 4,000 1,200 2,800
S61.1 Open wound of finger(s) with damage to nail SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.7 Multiple open wounds of wrist and hand SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.8 Open wound of other parts of wrist and hand SUPERFICIAL INJURIES 4,000 1,200 2,800
S61.9 Open wound of wrist and hand part, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.0 Open wound of knee SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.7 Multiple open wounds of lower leg SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.8 Open wound of other parts of lower leg SUPERFICIAL INJURIES 4,000 1,200 2,800
S81.9 Open wound of lower leg, part unspecified SUPERFICIAL INJURIES 4,000 1,200 2,800
S91.0 Open wound of ankle SUPERFICIAL INJURIES 4,000 1,200 2,800
S91.1Open wound of toe(s) without damage to nail; open wound
of toe (s) NOSSUPERFICIAL INJURIES 4,000 1,200 2,800
S91.2 Open wound of toe(s) with damage to nail SUPERFICIAL INJURIES 4,000 1,200 2,800
S91.3Open wound of other parts of foot; open wound of foot
NOSSUPERFICIAL INJURIES 4,000 1,200 2,800
S91.7 Multiple open wounds of ankle and foot SUPERFICIAL INJURIES 4,000 1,200 2,800
T00.0 Superficial injuries involving head with neck SUPERFICIAL INJURIES 4,000 1,200 2,800
T00.1Superficial injuries involving thorax with abdomen lower
back and pelvisSUPERFICIAL INJURIES 4,000 1,200 2,800
T00.2Superficial injuries involving multiple regions of upper
limb(s)SUPERFICIAL INJURIES 4,000 1,200 2,800
T00.3Superficial injuries involving multiple regions of lower
limb(s)SUPERFICIAL INJURIES 4,000 1,200 2,800
T00.6Superficial injuries involving multiple regions of upper
limb(s) with lower limb(s)SUPERFICIAL INJURIES 4,000 1,200 2,800
T00.8Superficial injuries involving other combinations of body
regionsSUPERFICIAL INJURIES 4,000 1,200 2,800
T00.9
Multiple superficial injuries, unspecified; Multiple abrasions
NOS; Multiple nonthermal blisters NOS; Multiple bruises
NOS; Multiple contusions NOS; Multiple haematomas NOS;
Multiple nonvenomous insect bite NOS
SUPERFICIAL INJURIES 4,000 1,200 2,800
J12.8, B97.2 Middle East Respiratory Syndrome (MERS-CoV) MIDDLE EAST RESPIRATORY SYNDROME 50,000 up to
100,000
A98.4 Ebola Virus Disease (EVD) EBOLA VIRUS DISEASE 110,000 up to
222,000
U06.9Zika virus disease, unspecified; Zika; Zika virus fever; Zika
virus infectionZIKA VIRUS DISEASE 8,100 2,430 5,670
Page 127 of 127