Chapter 21 / Outpatient Diagnostic Tests
AXA Definition Of Outpatient Diagnostic Tests
An outpatient diagnostic test (OPDT) must be performed by the consultant or someone directly employed by them, in their own room, using their own equipment, that is maintained and insured by themselves. This means that we would not receive a bill from a clinic or hospital for the same OPDT.
This chapter contains codes for investigations and diagnostic procedures that may be used in the diagnosis of a disease, illness or injury or in order to identify if interventions or treatment has been effective.
Please note that the presence of a code in this chapter does not imply eligibility and, in many cases, individual medical professionals may not be entitled to bill for a procedure where our hospital contract already includes an amount for carrying out, interpreting and reporting on a diagnostic test.
All fees contained within this chapter are inclusive of any reporting charges.
|
Code
|
Description
|
Hospital Complexity
|
Procedure Fees
|
Fee For General Anaesthesia
|
|
Unacceptable Combinations
|
|
|
|
Additional Information
|
|
|
| AU003
|
Diagnostic speech audiometry
|
Minor
|
£50.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £40 - £50. The published fee is the maximum fee we will pay for this code. |
| |
| |
| AU005
|
Tympanometry (as sole procedure)
|
Minor
|
£35.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £28 - £35. The published fee is the maximum fee we will pay for this code. |
| |
| |
| AU034
|
Cervical vestibular evoked EMG (cVEMP)
|
Minor
|
£195.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £156 - £195. The published fee is the maximum fee we will pay for this code. |
| |
| |
| AU035
|
Ocular vestibular evoked EMG (oVEMP)
|
Minor
|
£195.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £156 - £195. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| 20210
|
Pure tone audiogram (air conduction) - including masking
|
Minor
|
£50.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 20220
|
Pure tone audiogram (air and bone conduction) - including masking
|
| |
we expect the fee for this procedure to be £40- £50. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| 20220
|
Pure tone audiogram (air and bone conduction) - including masking
|
minor
|
£50.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 20210
|
Pure tone audiogram (air conduction) - including masking
|
| |
we expect the fee for this procedure to be £40 - £50. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| 20230
|
Impedance audiogram
|
Minor
|
£60.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £48- £60. The published fee is the maximum fee we will pay for this code. |
| |
| |
|
Code
|
Description
|
Hospital Complexity
|
Procedure Fees
|
Fee For General Anaesthesia
|
|
Unacceptable Combinations
|
|
|
|
Additional Information
|
|
|
| 20110
|
ECG (including reporting)
|
Minor
|
£29.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 20130
|
Exercise ECG (including base line 12 lead ECG and reporting)
|
| |
| 20140
|
24 hour ECG Holter (including reporting)
|
| |
we expect the fee for this procedure to be £23 - £29. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| 20140
|
24 hour ECG Holter (including reporting)
|
Minor
|
£50.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 20140
|
24 hour ECG Holter (including reporting)
|
| |
| 20144
|
Continuous ambulatory ECG for over 72 hours and up to 7 days (including reporting)
|
| |
we expect the fee for this procedure to be £40 - £50. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| 20141
|
Continuous ambulatory ECG for up to 72 hours (including reporting)
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 20144
|
Continuous ambulatory ECG for over 72 hours and up to 7 days (including reporting)
|
| |
| 20140
|
24 hour ECG Holter (including reporting)
|
| |
| we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code. |
| |
| |
| 20144
|
Continuous ambulatory ECG for over 72 hours and up to 7 days (including reporting)
|
Minor
|
£200.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 20141
|
Continuous ambulatory ECG for up to 72 hours (including reporting)
|
| |
| 20140
|
24 hour ECG Holter (including reporting)
|
| |
| we expect the fee for this procedure to be £160-£200 . The published fee is the maximum fee we will pay for this code. |
| |
| |
| 64300
|
Echocardiography (including reporting) as sole procedure
|
Minor
|
£225.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| CD021
|
Paediatric echocardiogram (including recording and reporting)
|
| |
| CD020
|
Infant echocardiogram (including recording and reporting)
|
| |
| K2280
|
Percutaneous occlusion of left atrial appendage
|
| |
| CD019
|
Bubble study with transthoracic echocardiogram
|
| |
| we expect the fee for this procedure to be £180 - £225. The published fee is the maximum fee we will pay for this code. |
| |
| |
| 64301
|
ECHOCARDIOGRAPHY INCLUDING BUBBLE CONTRAST (INCLUDING REPORTING) AS SOLE PROCEDURE
|
Minor
|
£225.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| CD029
|
Full transthoracic echocardiogram
|
| |
| CD019
|
Bubble study with transthoracic echocardiogram
|
| |
| K2280
|
Percutaneous occlusion of left atrial appendage
|
| |
| we expect the fee for this procedure to be £180- £225. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD004
|
Pacing check (single chamber pacemaker)
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| CD005
|
Pacing check (dual chamber pacemaker)
|
| |
| we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD005
|
Pacing check (dual chamber pacemaker)
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| CD004
|
Pacing check (single chamber pacemaker)
|
| |
| we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD019
|
Bubble study with transthoracic echocardiogram
|
Minor
|
£225.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 64301
|
ECHOCARDIOGRAPHY INCLUDING BUBBLE CONTRAST (INCLUDING REPORTING) AS SOLE PROCEDURE
|
| |
| CD029
|
Full transthoracic echocardiogram
|
| |
| 64301
|
Echocardiography including bubble contrast (including reporting) as sole procedure
|
| |
| 64300
|
Echocardiography (including reporting) as sole procedure
|
| |
| we expect the fee for this procedure to be £180 - £225. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD020
|
Infant echocardiogram (including recording and reporting)
|
Minor
|
£225.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 64300
|
Echocardiography (including reporting) as sole procedure
|
| |
| CD021
|
Paediatric echocardiogram (including recording and reporting)
|
| |
| we expect the fee for this procedure to be £180 - £225. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD021
|
Paediatric echocardiogram (including recording and reporting)
|
Minor
|
£225.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| CD020
|
Infant echocardiogram (including recording and reporting)
|
| |
| 64300
|
Echocardiography (including reporting) as sole procedure
|
| |
| we expect the fee for this procedure to be £180 - £225. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD026
|
Paediatric 24 hour ECG Holter recording (including reporting)
|
Minor
|
£65.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £62 - £65. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD027
|
Paediatric 72 hour ECG Holter recording (event recording) (including reporting)
|
Minor
|
£85.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £68 - £85. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD029
|
Full transthoracic echocardiogram
|
Minor
|
£225.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| 64301
|
ECHOCARDIOGRAPHY INCLUDING BUBBLE CONTRAST (INCLUDING REPORTING) AS SOLE PROCEDURE
|
| |
| CD019
|
Bubble study with transthoracic echocardiogram
|
| |
| we expect the fee for this procedure to be £180 - £225. The published fee is the maximum fee we will pay for this code. |
| |
| |
| CD030
|
Wireless patch continuous 1 lead ECG recorder for up to 14 days
|
Minor
|
£355.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £284 - £355. The published fee is the maximum fee we will pay for this code. |
| |
| |
|
Code
|
Description
|
Hospital Complexity
|
Procedure Fees
|
Fee For General Anaesthesia
|
|
Unacceptable Combinations
|
|
|
|
Additional Information
|
|
|
| OP006
|
Corneal pachymetry (including bilateral)
|
Minor
|
£90.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £72 - £90. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| OP007
|
Corneal Topography (including Pentacam)(including bilateral)
|
Minor
|
£90.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £72-£90. The published fee is the maximum fee we will pay for this code. |
| |
| |
| OP014
|
A Scan biometry
|
Minor
|
£90.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| We expect the fee for this procedure to be £72-£90. The published fee is the maximum fee we will pay for this code. |
| |
| |
| OP015
|
B-scan ultrasound
|
Minor
|
£180.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £144 - £180. The published fee is the maximum fee we will pay for this code. |
| |
| |
| OP025
|
Posterior segment optical coherence tomography (OCT) (including bilateral)
|
Minor
|
£90.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £72- £90. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| OP034
|
Perimetry/Visual field testing (including bilateral)
|
|
£50.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £40 - £50. The published fee is the maximum fee we will pay for this code. |
| |
| |
| OP036
|
Corneal Keratometry
|
Minor
|
£50.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £40 - £50. The published fee is the maximum fee we will pay for this code. |
| |
| |
|
Code
|
Description
|
Hospital Complexity
|
Procedure Fees
|
Fee For General Anaesthesia
|
|
Unacceptable Combinations
|
|
|
|
Additional Information
|
|
|
| RE006
|
Exhaled nitric oxide testing
|
Minor
|
£50.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| we expect the fee for this procedure to be £40- £50. The published fee is the maximum fee we will pay for this code. |
| |
| |
|
Code
|
Description
|
Hospital Complexity
|
Procedure Fees
|
Fee For General Anaesthesia
|
|
Unacceptable Combinations
|
|
|
|
Additional Information
|
|
|
| IM265
|
US Doppler aorta (including duplex)
|
Minor
|
£120.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £96 - £120. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM266
|
US Doppler carotid artery (including bilateral)
|
Minor
|
£120.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £96 - £120. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM269
|
US Doppler vascular limb (including duplex)
|
Minor
|
£110.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM370
|
Vascular Doppler Ultrasound (not otherwise specified) - bilateral
|
| |
we expect the fee for this procedure to be £88 - £110. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM270
|
Ultrasound of The Abdomen
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM346
|
Ultrasound of abdomen and pelvis
|
| |
| IM347
|
Ultrasound of abdomen, pelvis and transvaginal/transrectal
|
| |
we expect the fee for this procedure to be £60-£75 . The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM271
|
Ultrasound pelvis
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM347
|
Ultrasound of abdomen, pelvis and transvaginal/transrectal
|
| |
| IM346
|
Ultrasound of abdomen and pelvis
|
| |
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM272
|
US Transvaginal
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM347
|
Ultrasound of abdomen, pelvis and transvaginal/transrectal
|
| |
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM274
|
US Breast (including bilateral)
|
Minor
|
£75.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM277
|
US Limb or Joint
|
Minor
|
£75.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM279
|
US Head & Neck
|
Minor
|
£75.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM281
|
US Soft tissue / tendon
|
Minor
|
£75.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM283
|
US Thyroid
|
Minor
|
£75.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM284
|
Urodynamic Studies/Urodynamic Assessment
|
Minor
|
£75.00
|
£0.00
|
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM338
|
US Transrectal
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM347
|
Ultrasound of abdomen, pelvis and transvaginal/transrectal
|
| |
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM342
|
US Musculo-skeletal - 1 part
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM343
|
US Musculo-skeletal - 2 parts
|
| |
we expect the fee for this procedure to be £60 - £75 . The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM343
|
US Musculo-skeletal - 2 parts
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM342
|
US Musculo-skeletal - 1 part
|
| |
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM346
|
Ultrasound of abdomen and pelvis
|
Minor
|
£75.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM347
|
Ultrasound of abdomen, pelvis and transvaginal/transrectal
|
| |
| IM270
|
Ultrasound of The Abdomen
|
| |
we expect the fee for this procedure to be £60 - £75. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM347
|
Ultrasound of abdomen, pelvis and transvaginal/transrectal
|
Minor
|
£105.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| IM346
|
Ultrasound of abdomen and pelvis
|
| |
| IM270
|
Ultrasound of The Abdomen
|
| |
we expect the fee for this procedure to be £84 - £105. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| IM370
|
Vascular Doppler Ultrasound (not otherwise specified) - bilateral
|
Minor
|
£150.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
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Code
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Description
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| IM269
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US Doppler vascular limb (including duplex)
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we expect the fee for this procedure to be £120 - £150. The published fee is the maximum fee we will pay for this code.
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| IM383
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Ultrasound Kidney, Ureter, Bladder (KUB)
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Minor
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£75.00
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£0.00
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|
Show
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| Unacceptable Combinations |
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|
Code
|
Description
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|
we expect the fee for this procedure to be £60- £75. The published fee is the maximum fee we will pay for this code.
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Code
|
Description
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Hospital Complexity
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Procedure Fees
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Fee For General Anaesthesia
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Unacceptable Combinations
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Additional Information
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| MI001
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Skin prick test (up to 10 allergens)
|
Minor
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£60.00
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£0.00
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Show
|
Show
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| Unacceptable Combinations |
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|
Code
|
Description
|
|
| MI002
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Skin prick test (11-20 allergens)
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| MI003
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Skin prick test (21+ allergens)
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we expect the fee for this procedure to be £48-£60 . The published fee is the maximum fee we will pay for this code.
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| MI002
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Skin prick test (11-20 allergens)
|
Minor
|
£90.00
|
£0.00
|
Show
|
Show
|
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| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| MI001
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Skin prick test (up to 10 allergens)
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| MI003
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Skin prick test (21+ allergens)
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we expect the fee for this procedure to be £72 - £90. The published fee is the maximum fee we will pay for this code.
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| |
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| MI003
|
Skin prick test (21+ allergens)
|
Minor
|
£120.00
|
£0.00
|
Show
|
Show
|
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| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| MI002
|
Skin prick test (11-20 allergens)
|
| |
| MI001
|
Skin prick test (up to 10 allergens)
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we expect the fee for this procedure to be £96 - £120. The published fee is the maximum fee we will pay for this code.
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| MI004
|
Patch test (up to 10 allergens)
|
Minor
|
£60.00
|
£0.00
|
Show
|
Show
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| Unacceptable Combinations |
| |
|
Code
|
Description
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|
| MI006
|
Patch test (21+ allergens)
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| MI005
|
Patch test (11-20 allergens)
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we expect the fee for this procedure to be £48 - £60. The published fee is the maximum fee we will pay for this code.
|
| |
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| MI005
|
Patch test (11-20 allergens)
|
Minor
|
£90.00
|
£0.00
|
Show
|
Show
|
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| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| MI004
|
Patch test (up to 10 allergens)
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| |
| MI006
|
Patch test (21+ allergens)
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| |
we expect the fee for this procedure to be £72 - £90. The published fee is the maximum fee we will pay for this code.
|
| |
| |
| MI006
|
Patch test (21+ allergens)
|
Minor
|
£120.00
|
£0.00
|
Show
|
Show
|
| |
| Unacceptable Combinations |
| |
|
Code
|
Description
|
|
| MI004
|
Patch test (up to 10 allergens)
|
| |
| MI005
|
Patch test (11-20 allergens)
|
| |
we expect the fee for this procedure to be £96 - £120. The published fee is the maximum fee we will pay for this code.
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