Chapter 1 / Consultations, Practitioner Fees, Simple Investigations and Procedures and General Procedures
1.1 - Investigations
| Code | Description | Complexity | Procedure fees | Fee for general anaesthesia |
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| 20110 | ECG (Including reporting) | £25.00 | £0.00 |
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| 20150 | Patch testing (Inclusive of application, reading & reporting) | £25.00 | £0.00 |
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| 20210 | Pure tone audiogram (air conduction) - including masking | £25.00 | £0.00 |
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| 20141 | Continuous ambulatory ECG for up to 72 hours (including reporting) | £75.00 | £0.00 |
| 20220 | Pure tone audiogram (air and bone conduction) - including masking | £25.00 | £0.00 |
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| 20230 | Impedance audiogram | £25.00 | £0.00 |
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| 20240 | Impedance audiogram as part of other procedure | £25.00 | £0.00 |
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| 64301 | Echocardiography including bubble contrast (including reporting) as sole procedure | £150.00 | £0.00 |
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1.2 - Simple procedures
| Code | Description | Complexity | Procedure fees | Fee for general anaesthesia |
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| 20144 | Continuous ambulatory ECG for over 72 hours and up to 7 days (including reporting) | £125.00 | £0.00 |
| 25000 | Incision and drainage (not elsewhere covered) | £75.00 | £0.00 |
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| 25022 | Stellate ganglion block (local anaesthetic) +/- Image Guidance | £150.00 | £142.00 |
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| C6180 | Bleb needling +/- antimetabolites (including topical or local anaesthetic) | £100.00 | £0.00 |
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| C6181 | Laser suture lysis (including topical or local anaesthetic) | £100.00 | £0.00 |
| E2880 | Epley manoeuvre (code for specialist use only) | £25.00 | £0.00 |
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| F2621 | Frenotomy /frenectomy of tongue under local anaesthetic | £150.00 | £0.00 |
| H2510 | Rigid sigmoidoscopy including proctoscopy and biopsy | £75.00 | £0.00 |
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| H5230 | Injection of sclerosing substance into haemorrhoids | £75.00 | £129.00 |
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| H5240 | Banding of haemorrhoids | £75.00 | £71.00 |
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| H5260 | Low voltage treatment of internal haemorrhoids | £75.00 | £0.00 |
| L8600 | Unilateral varicose vein injection sclerotherapy | £75.00 | £0.00 |
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| S1110 | Curettage/cryotherapy of lesion of skin including cauterisation - up to three | £75.00 | £0.00 |
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| S1500 | Biopsy of skin or subcutaneous tissue | £75.00 | £0.00 |
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| S1510 | Needle/tru-cut biopsy of muscle (as sole procedure) | £75.00 | £0.00 |
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| S4780 | Aspiration of subcutaneous haematoma | £75.00 | £0.00 |
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| S5322 | Injection of therapeutic substance into keloid scar | £75.00 | £0.00 |
| X3520 | IV sedation administered by anaesthetist (as sole procedure) | £100.00 | £0.00 |
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| X3530 | Sedation or general anaesthesia for MRI or CT scan | £0.00 | £129.00 |
| W9040 | Injection(s) +/- aspiration, into joint, cyst, bursa | Minor | £50.00 | £129.00 |
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| S5211 | Injection of Botulinum Toxin for Hyperhidrosis | £100.00 | £0.00 |
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| W9282 | Joint fluid examination (eg polarising microscopy) performed by consultant including aspiration of fluid | £75.00 | £129.00 |
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| X3060 | Sub-tenons anaesthesia administered by anaesthetist (as sole procedure) | MIN | £100.00 | £0.00 |
| X4810 | Change of cast without general anaesthetic (as sole procedure) | £75.00 | £0.00 |
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1.3 - General procedures
| Code | Description | Complexity | Procedure fees | Fee for general anaesthesia |
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| 20130 | Exercise ECG (including base line 12 lead ECG and reporting) | £75.00 | £0.00 |
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| 20132 | Exercise or dobutamine stress echocardiography (including ECG and reporting) | £100.00 | £0.00 |
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| 20140 | 24 hour ECG Holter (including reporting) | £75.00 | £0.00 |
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| 20142 | Insertion of implantable ECG loop recorder (including reporting) | £200.00 | £0.00 |
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| 20143 | Removal of implantable ECG loop recorder (including reporting) | £200.00 | £0.00 |
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| 22000 | Routine electroencephalography (EEG) in adult or child aged over 5 (including reporting) | £75.00 | £0.00 |
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| 25010 | Paravertebral block up to two levels (without X-ray control) | £120.00 | £0.00 |
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| 64300 | Echocardiography (including reporting) as sole procedure | £100.00 | £0.00 |
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| G2180 | Ambulatory 24h pH and impedance monitoring | £100.00 | £0.00 |
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| D0702 | Aural toilet (including microsuction and/or suction of exteriorised mastoid cavity) including bilateral | £50.00 | £0.00 |
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| P2730 | Colposcopy (+/- biopsy, polypectomy or vulvoscopy) | £100.00 | £129.00 |
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| Q1280 | Introduction of a Mirena coil | £50.00 | £129.00 |
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| Q2020 | Endometrial biopsy or aspiration | £100.00 | £0.00 |
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| S4760 | Fine needle aspiration cytology | £100.00 | £0.00 |
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1.4 - Consultations and Physicians’ fees
In-patient care fees are only claimable by the person in primary charge of the case.... Other specialists may claim for specific consultations for specific purposes. ITU fees are expected to include insertion of central lines, arterial lines, dialysis lines, pulmonary artery catheters and similar.
| Surgeon | Physician | Psychiatrist | ||
| 20300 | Initial out-patient consultation - face to face | £130 | £175 | £250 |
| 20310 | Follow-up out-patient consultation - face to face | £100 | £120 | £170 |
| 20355 | Initial Outpatient Consultation - Remote | £130 | £175 | £250 |
| 20365 | Follow-up Outpatient Consultation - Remote | £100 | £120 | £170 |
| 20320 | In & day-patient care | £50 | £60 | £50 |
| ITU (see policy) | £200 | |||
| Family therapy | £290 | |||
| Psychological therapy | £100 |
1.5 - Practitioner and Therapist fees
We will pay fees up to the contracted or agreed rate which we have in-place with the individual recognised practitioner who provides the treatment. The member will not be responsible for any shortfall (subject to any policy or benefit limitations).
The following fees are reimbursable per session of treatment. No more than one session can be claimed on the same day.
Neuropsychological and Neuropsychiatric Assessment
We will pay a fee of up to £600 for an eligible assessment. To qualify, the assessment must be pre authorised by our customer service department. If not pre authorised, the reimbursement limit of £100 for psychologists and £250 for psychiatrists will apply, and we will shortfall the claim. The payment we make is to include all preparation, report writing, travel and any other administrative costs.
The following fees are reimbursable per session of treatment. No more than one session can be claimed on the same day.
| Orthoptist | £45 | Physiotherapist | £35 |
| Osteopath | £35 | Chiropractor | £35 |
| Nurse practitioner | £60 | Dietician | £60 |
| Psychologist | £100 | Speech therapist | £75 |
| Neuropsychologist | £100 | Psychotherapist | £85 |
| Acupuncturist | £60 | Homeopath | £60 |
| Audiologist | £150 |
Neuropsychological and Neuropsychiatric Assessment
We will pay a fee of up to £600 for an eligible assessment. To qualify, the assessment must be pre authorised by our customer service department. If not pre authorised, the reimbursement limit of £100 for psychologists and £250 for psychiatrists will apply, and we will shortfall the claim. The payment we make is to include all preparation, report writing, travel and any other administrative costs.