Body Mass Index (BMI) supplemental payments are claimable by the primary Surgeon and the primary Anesthesiologist for certain eligible surgical services on morbidly obese patients. To claim a BMI supplement, the corresponding tariff must be listed as a BMI supplement tariff.
The primary Surgeon may claim one of either Tariff 0021, 0022, 0023 or 0024, while the primary Anesthesiologist may claim one of Tariffs 0025, 0026, 0027 or 0028.
For these tariffs, morbidly obese patients are adults with a BMI greater than 40 or a BMI greater than 45 if pregnant. For patients under eighteen (18) years of age, the supplements may be claimed for patients above the 97th percentile for BMI based on an approved paediatric growth curve.
Only one supplement may be claimed per patient per day by each primary surgeon and the primary anesthesiologist. If there is more than one eligible surgical service provided, claim the supplement associated with the highest value surgical service.
The patient’s weight, height, and BMI must be included with your claim and documented in the OR report.
For hysterectomy services, do not claim the BMI supplement in conjunction with claims for Tariff 4620.
To determine the appropriate surgical assistant benefits for the first surgical assistant, include the BMI supplement when choosing the total of all benefits paid to the principal surgeon.
Do not include the BMI supplement when determining the benefit for a second surgical assistant.
After Hours or Out of Hours premiums do not apply to BMI supplements.