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Guide to Consultants

This page is designed to provide Consultant/Specialists with guidance on how we apply the terms of the 'your choice' policy in relation to treatment and fees.

Fee Reimbursement
Surgeons Fees - this is the level of reimbursement for the principal practitioner performing the procedure, which could be a Consultant surgeon, physician, radiologist or anaesthetist. The listed fee will cover all pre and post operative assessments directly associated with a day case or in-patient stay and is also to cover those common variances and complications related to the original surgery or procedure such as:

• Bleeding (with the exception of returning to theatre where a further appropriate code may be charged).
• Provision of IV fluids and management of medications.
• Infection & management of deep vein thrombosis.
• Management of catheters and drains.
• Removal of sutures and simple wound care.

Anaesthetist Fees – the level of reimbursement for the anaesthetist is to cover a general or regional anaesthetic (including epidurals), the listed fee is to include:

• A simple pre-operative assessment.
• The induction and maintenance of the anaesthesia, and related life support.
• Pain relief post operatively and until discharge.
• Intravenous / Central Line Management independent of:
• High dependency / Intensive Care / Critical Care up to 24hrs post-operatively.

Epidural for analgesia set up in the period preceding surgery or 24 hours after the surgery will be settled in full according to the listed level of reimbursement.

Local anaesthesia, with or without IV sedation performed by the principal practitioner is covered by code AC100 and will be reimbursed in full in addition to the appropriate procedure code.

Please note: Where a patient requires a separate consultation prior to the admission for surgery, because they have co-morbidities which may need investigating, or discussion as to the type of anaesthesia and aftercare or whether they are suitable for a procedure. Subject to CS Healthcare being notified of the need, this will be covered.

Multiple Procedure Policy
For a single procedure we will pay the 100% customary and reasonable fee according to the required CCSD code and its recognised complexity.

• Primary procedure - up to 100% of the listed fee price.
• 2nd procedure - up to 50% in addition to the primary procedure.
• 3rd procedure - up to 25% in addition to the primary and second procedure.
• For bilateral procedures not identified within a specific CCSD code we will pay 100% of the actual procedure plus an additional 66%.