< Billing codes

Billing code

G559A — Comprehensive care (intensive care area) – physician-in-charge – 31st day onwards (per diem)

Comprehensive ICU care, day 31+

Bill G559 per day from day 31 onwards for comprehensive ICU care as physician-in-charge, after G557 and G558.

Watch for: Not payable for stabilized or observation-only patients unless ventilated; no other critical care codes are payable that day.

Code

G559A

Description

Comprehensive care (intensive care area) – physician-in-charge – 31st day onwards (per diem)

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Comprehensive ICU care per diem (critical care plus ventilatory support) by the intensive care physician-in-charge, 31st day onwards (per diem).

What it covers

G559 is the comprehensive care fee for the physician-in-charge, 31st day onwards (per diem) (J32). It is marked #, so premises and equipment are hospital funded (J1).

Comprehensive care is complete care (both critical care and ventilatory support) by an intensive care physician. It includes the initial consultation and assessment, later examinations, intubation, ventilation, resuscitation, lines and catheters, CVP lines, defibrillation, cardioversion, urinary and nasogastric tubes, blood gases, lab tests, oximetry and ICP monitoring interpretation (J31).

Billing rules

• These are team fees: claim the daily formula as if there were one physician-in-charge, even if the physician-in-charge changes during treatment (J30).
• When claiming critical, ventilatory, comprehensive or neonatal intensive care fees, no other critical care codes are payable to the same physician(s) (J30).
• Not payable for stabilized patients or patients in the unit only for ECG monitoring or observation, except when the patient is on a ventilator; bill consultations, assessments and procedures instead (J30, J31).
• Bill G559 per day from day 31 onwards, after G557 (day 1) and G558 (days 2–30) (J32).
• If the patient is transferred from critical care to comprehensive care, the transfer day counts as the 2nd day of comprehensive care (J31).
• Cardioversion and defibrillation are included, so don't bill Z437 separately (J31).
• If the patient was discharged from the unit more than 48 hours earlier and is re-admitted, the 1st-day rate applies again on the day of re-admission (J30).
• Life-threatening (G521/G522/G523) and other critical care (G395/G391) aren't payable to a physician paid a per diem for the same patient that day (J27, J28). C101 ICU/CCU premium is not payable when team fees are claimed (GP103).

Related codes: G557, G558, G400, G405, Z437

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Critical Care (Comprehensive Care), page J32; definition J31; per diem rules J30.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing