Delaware Administrative Code
Title 18 - Insurance
1300 - Health Insurance General Provisions
1311 - Standards of Payment for Multiple Surgical Procedures [Formerly Regulation 82]
Section 1311-5.0 - Procedure for payment of multiple surgical services
Universal Citation: 18 DE Admin Code 1311-5.0
Current through Register Vol. 28, No. 3, September 1, 2024
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.
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