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Aviva Procedure Codes & Fee Schedule:
Need to claim for private treatment with Aviva? You’ll be asked for a procedure code and sometimes a diagnostic code before Aviva issues pre-authorisation. Those codes usually come from the CCSD schedule (Clinical Coding & Schedule Development). In this guide, we explain exactly how Aviva procedure codes work in 2025, how fees are set, and how to navigate pre-authorisation without surprise shortfalls.
We also include practical scripts, a quick checklist, and links to related insurer guides: How to Claim on Aviva, Aviva Hospital List & Expert Select, and our general Pre-Authorisation Codes (UK 2025) explainer.
What are CCSD and Aviva procedure codes?
CCSD (Clinical Coding & Schedule Development) is a joint industry group used by UK private insurers, hospitals and consultants to standardise procedure descriptions and codes. Aviva relies on CCSD coding to identify your treatment and align it to the correct benefit and fee schedule.
- Procedure code: identifies the operation or treatment (e.g., arthroscopy, colonoscopy, hernia repair).
- Diagnostic code (when used): supports medical necessity — particularly for scans and tests.
- Fee schedule: Aviva’s agreed maximums for surgeon, anaesthetist (and sometimes assistant) fees for each code.
Want to read more about CCSD? See the official schedule information at the CCSD website.
Aviva fee schedule (2025): how it actually works
When a consultant proposes treatment, Aviva maps the CCSD code to its payment schedule. That schedule includes:
- Surgeon’s fee limit for that code (or code combination).
- Anaesthetist’s fee limit (often grade-based).
- Assistant surgeon guidance (if applicable).
- Multiple procedure rules (reductions when more than one procedure is performed in the same session).
- Bundling rules (when a second code is considered part of the main code and not paid separately).
Important: Hospitals invoice separate facility fees (theatre time, nursing, consumables, implants), which Aviva pays directly to the hospital when authorised. The consultant fees are usually invoiced to Aviva at the agreed schedule rate. If your consultant charges above Aviva’s limits, the difference is a shortfall that you may need to pay.
Compare how other insurers handle coding and fees: Bupa Procedure Codes & Fee Schedule (2025) and How to Claim on AXA.
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Want cover that’s easy to use at claim time? Compare Aviva with Bupa, AXA, Vitality and WPA — check hospital access, excess options and outpatient limits before you buy.🔍 Compare UK Health Insurance Quotes
Pre-authorisation with Aviva: step-by-step (patient & consultant)
Patient checklist (what you’ll need on the call)
- Policy number and policyholder details.
- Referral (GP or approved virtual GP) — name and date.
- Consultant full name and hospital site (ensure both are recognised by Aviva).
- CCSD procedure code(s) and planned date (ask your consultant/secretary).
- Clinical indication (why the procedure is necessary) and any diagnostic results (MRI/CT/ultrasound).
Call script you can use:
“Hi, I’m calling for pre-authorisation. My consultant, Dr [Name], at [Hospital] has recommended [Procedure description]. The CCSD code is [Code]. My policy number is [X]. Could you confirm my benefits, any excess, and whether the hospital and consultant are within my Aviva network? Please provide my authorisation code and note the hospital and consultant on the record.”
Consultant/secretary checklist
- Double-check recognition status with Aviva for the specific hospital site.
- Provide the patient with the CCSD code(s), expected length of stay and whether additional codes (e.g., implants) are anticipated.
- Flag if there are multiple procedures or bilateral work (as reductions may apply).
- Confirm if a GP referral is required for the policy and attach clinic notes where requested.
New to Aviva’s network rules? Read: Aviva Hospital List & Expert Select.
Common coding scenarios (and how to avoid shortfalls)
1) Multiple procedures in one sitting
If two or more procedures are performed in the same session, Aviva typically pays the main procedure in full and applies a reduced rate to additional procedures. If your consultant bills each at 100%, you may see a shortfall. Always ask, “Is this a combined or multiple procedure under Aviva’s rules?”
2) Bundled procedures (“inclusive” items)
Some codes are bundled — meaning a minor procedure is considered part of the main one and is not paid separately. This is common with endoscopy add-ons and certain orthopaedic steps. Your consultant secretary should check whether a second code is inclusive in Aviva’s schedule.
3) Bilateral operations
When the same procedure is performed on both sides (e.g., left and right), Aviva may pay the second side at a reduced percentage. Confirm the bilateral rule for the CCSD code before theatre.
4) Day case vs inpatient
Some operations are expected as day case. If you stay overnight without clinical necessity, part of the hospital bill could be queried. Ensure the care setting (day case/inpatient) matches the authorisation.
5) Implants and prostheses
Implants (e.g., mesh, anchors, joint devices) are billed by the hospital. Aviva usually settles these to an agreed tariff when the indication and code align. If a device is unusual or high-cost, the hospital should obtain cost approval in advance to avoid patient shortfalls.
Who does what: patient, consultant, hospital, Aviva
| Role | Responsibility |
|---|---|
| Patient | Obtains referral, calls Aviva for pre-authorisation, confirms excess/outpatient limits, keeps authorisation code safe. |
| Consultant/Secretary | Provides CCSD code(s), clinical letter, planned setting (day case/inpatient), and checks recognition at the chosen hospital. |
| Hospital | Books theatre, raises facility bill, confirms device costs if relevant, invoices Aviva for authorised services. |
| Aviva | Validates benefits, applies fee schedule to codes, issues authorisation and settles eligible claims as per policy terms. |
First time claiming? Start here: How to Claim on Aviva (UK, 2025): Steps & Pitfalls.
How Expert Select affects coding & hospital choice
Aviva’s Expert Select steers you to a network of providers and quotes (often region-based). Your CCSD code informs which hospitals can deliver the procedure within the agreed budget. If you specifically want a central London hospital that sits outside the quote, upgrade costs could apply.
Not sure your chosen site is included? Read: Aviva Hospital List & Expert Select and compare alternative hospitals in our Private Hospitals Hub.
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Avoiding shortfalls: 7 quick tips
- Get the CCSD code in writing from your consultant before you call Aviva.
- Confirm the setting (day case/inpatient) and expected length of stay.
- Check recognition for both the consultant and the exact hospital site.
- Ask about multiple/bilateral rules if more than one code will be used.
- Clarify device costs (implants/mesh/anchors) if relevant to your procedure.
- Note your policy excess and outpatient limit (diagnostics and physio often sit here).
- Get the authorisation code and keep it — hospital bookings rely on that reference.
Need more? See our general guides: Outpatient Limits, Excess Explained, and Appealing a Rejected Claim.
FAQs: Aviva procedure codes & fee schedule (2025)
Where do Aviva procedure codes come from?
From the CCSD schedule, an industry-standard coding list used by UK private insurers. The code describes your procedure and links to Aviva’s fee limits.
How do I find the right code?
Your consultant or their secretary will provide the correct CCSD code. If you’re unsure, ask them to confirm it before you call Aviva.
Why did Aviva reduce the fee for my second procedure?
Aviva applies multiple-procedure reductions — common across insurers — when more than one code is billed in the same theatre session.
What if the code changes after surgery?
Sometimes the final code differs once the surgeon sees the full picture intra-operatively. The hospital/consultant submits the updated code; Aviva reassesses against policy benefits.
Can I choose any hospital with Aviva?
It depends on your plan. With Expert Select, Aviva proposes network options. You can request alternatives, but upgrades may apply. Check our Aviva hospital list guide.
What if my consultant charges above Aviva’s fee?
That creates a shortfall. You can ask the consultant to align to the schedule, choose a different recognised consultant, or pay the difference.
Useful resources
- CCSD (Clinical Coding & Schedule Development) — background on UK private medical coding.
- PHIN (Private Healthcare Information Network) — independent info on private hospitals and procedures.
- How to Claim on Aviva (UK, 2025)
- Aviva Hospital List & Expert Select
- Health Insurance Pre-Authorisation Codes (UK)
Disclaimer
This article is for general information only and does not replace your policy wording or medical advice. Coding rules, benefits, and fee limits can change and can vary by individual policy, underwriting, employer scheme and hospital/provider agreements. Always confirm your authorisation, code(s), consultant recognition and fees directly with Aviva before booking treatment.
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