Medicare Benefits Schedule - Note TN.8.196

• Removal of prominent bone or osteophytes can be billed as an isolated procedure under 48430 or when through a separate incision to other procedures. 
• When an osteotomy is performed through the bone to correct a deformity then the appropriate number is chosen from 48400, 48403, 48406, 48409, 48418 or 48421. 
• Not to be used when performing joint arthroscopy (49703, 49730 or 49732), bunion correction (49827, 49830, 49833, 49836, 49837 or 49838), neurolysis (39330), wound debridement (30023) or an arthrodesis procedure unless performed at a site separate to the excluded items.

Related Items: 39330 48400 48403 48406 48409 48421 48430 49703 49827 49833 49836 49837 49838

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Multiple Operation Rule

Operation on foot:

(a) with either or both of the following:

(i) osteotomy of phalanx or metatarsal for correction of deformity;

(ii) excision of accessory bone or sesamoid bone; and

(b) including any of the following (if performed):

(i) removal of bone;

(ii) excision of surrounding osteophytes;

(iii) synovectomy;

(iv) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $362.75 Benefit: 75% = $272.10

(See para TN.8.168, TN.8.196, TN.8.199, TN.8.200, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Osteotomy of phalanx of first toe or metatarsal, for correction of deformity, with internal fixation, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $569.95 Benefit: 75% = $427.50

(See para TN.8.168, TN.8.196, TN.8.199, TN.8.200, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Osteotomy of fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, for correction of deformity, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $362.75 Benefit: 75% = $272.10

(See para TN.8.168, TN.8.190, TN.8.196, TN.8.200 of explanatory notes to this Category)

Multiple Operation Rule

Osteotomy of fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, for correction of deformity, with internal fixation, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $569.95 Benefit: 75% = $427.50

(See para TN.8.168, TN.8.190, TN.8.196, TN.8.200 of explanatory notes to this Category)

Multiple Operation Rule

Osteotomy of proximal tibia, to alter lower limb alignment or rotation (or both), with internal or external fixation (or both) (H)

(Anaes.) (Assist.)

Fee: $1,011.65 Benefit: 75% = $758.75

(See para TN.8.168, TN.8.196 of explanatory notes to this Category)

Multiple Operation Rule

Excision of one or more osteophytes of the foot or ankle, or simple removal of bunion, including any of the following (if performed):

(a) capsulotomy;

(b) excision of surrounding osteophytes;

(c) release of ligaments;

(d) removal of one or more associated bursae or ganglia;

(e) removal of bone;

(f) synovectomy;

—each incision (H)

(Anaes.) (Assist.)

Fee: $295.30 Benefit: 75% = $221.50

(See para TN.8.196, TN.8.199, TN.8.200, TN.8.201, TN.8.292 of explanatory notes to this Category)

Multiple Operation Rule

Surgery of ankle joint, by arthroscopic means, including any of the following (if performed):

(a) cartilage treatment;

(b) removal of loose bodies;

(c) synovectomy;

(d) excision of joint osteophytes;

other than a service associated with a service to which another item in this Group applies if the service described in the other item is for the purpose of performing a procedure on the ankle by arthroscopic means (H)

(Anaes.) (Assist.)

Fee: $673.60 Benefit: 75% = $505.20

(See para TN.8.196, TN.8.199, TN.8.202 of explanatory notes to this Category)

Multiple Operation Rule

Unilateral correction of hallux valgus or varus deformity of the foot, by local tendon transfer, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $518.10 Benefit: 75% = $388.60

(See para TN.8.194, TN.8.196, TN.8.199, TN.8.201, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Unilateral correction of hallux valgus or varus deformity of the foot, by osteotomy of first metatarsal, without internal fixation, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $569.95 Benefit: 75% = $427.50

(See para TN.8.194, TN.8.196, TN.8.199, TN.8.201, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral correction of hallux valgus or varus deformity of the foot by osteotomy of first metatarsal, without internal fixation, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $984.50 Benefit: 75% = $738.40

(See para TN.8.194, TN.8.196, TN.8.199, TN.8.201, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Unilateral correction of hallux valgus or varus deformity of the foot, by osteotomy of first metatarsal, with internal fixation, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $712.45 Benefit: 75% = $534.35

(See para TN.8.194, TN.8.196, TN.8.199, TN.8.201, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral correction of hallux valgus or varus deformity of the foot by osteotomy of first metatarsal, with internal fixation or arthrodesis of first metatarsophalangeal  joint, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $1,230.30 Benefit: 75% = $922.75

(See para TN.8.194, TN.8.196, TN.8.199, TN.8.201, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Neurolysis by open operation without transposition, other than a service associated with:

(a) a service to which item 39321, 39328, 39329, 39332, 39336, 39339, 39342, 39345, 49774 or 49775 applies; or

(b) a service to which item 30023 applies that is performed at the same site

(H)

(Anaes.) (Assist.)

Fee: $304.65 Benefit: 75% = $228.50

(See para TN.8.196, TN.8.200, TN.8.254, TN.8.283 of explanatory notes to this Category)