State Law

Title 18 Insurance-1300-1311. Standards of Payment for Multiple Surgical Procedures

08/01/2023 Delaware Section 5.0

Procedure for payment of multiple surgical services

Payment Rules

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.