18 Del. Admin. Code § 1311-5.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1311-5.0 - Procedure for payment of multiple surgical services

5.1 When more than one surgical service is performed on the same patient, by the same physician and on the same day, insurers shall make payment to the providers as follows:

5.1.1 One hundred per cent (100%) of the fee schedule for the procedure which has the highest regular fee schedule amount; and

5.1.2 For each additional procedure, performed through the same incision or separate incisions, as set forth in the National Correct Coding Manual established by Administar Federal under contract with the Health Care Financing Administration, not less than fifty per cent (50%) of the fee schedule amount.

18 Del. Admin. Code § 1311-5.0