E441

PDF page 490 / J76

Epidural and spinal injections
      Percutaneous epidural injections
# G246 Lumbar....................................................................................                150.00
# G117 Thoracic ..................................................................................               170.00
# G119 Cervical...................................................................................               190.00
# G918 Caudal ....................................................................................                74.20
  E440    - with injection of contrast using fluoroscopy, to G246, G117,
            G119 or G918 ............................................................ add                         30.00
  E441    - when performed at same level of previous spinal surgery,
            to G246, G117, G119 or G918 ................................... add                                   16.60
  E442    - when performed using a transforaminal technique, to
            G246, G117, G119 or G918 ....................................... add                                  20.00
  E443    - with catheter for continuous infusion, to G246, G117, G119
            or G918 ...................................................................... add                    80.00
# E833    - with insertion of subcutaneous port, G117, G119, G246 or
            G918 .......................................................................... add                  116.10
         Payment rules:
         1. Percutaneous epidural injections are limited to 12 services per patient per 12 month period
           for any combination of G119, G117, G246 and G918. If, in the opinion of the treating
           physician, more frequent treatments are necessary, the physician may obtain written prior
           authorization from the MOH. Authorization will be dependent on the physician demonstrating
           that the increased frequency of the service is generally accepted as necessary for the patient
           under the circumstances.
         2. G246, G117, G119 or G918 are only eligible for payment same patient same day with G236,
           G234 and G920 if rendered to diagnose or treat a separate condition.
         [Commentary:
         The sympathetic block that may result from an epidural injection is not payable as G920, G234
         or G236.]
         3. G246, G117, G119 or G918 are not eligible for payment with any concurrent surgical
           procedure or any anaesthetic fee, except for E030C or E031C when indicated as described
           in the General Preamble Anaesthesiologist Services.
         [Commentary:
         1.For initiation and management services for outpatient palliative epidural infusion, refer to
           G063 and G064 page J73.
         2.For epidural blood patch, refer to G068 and G065 page J72.]
  G245 Lumbar epidural or intrathecal injection of sclerosing solution                                           180.00
  G239 Differential intrathecal spinal block .........................................                           127.60
# G919 Percutaneous epidural adhesiolysis by infusion with
          fluoroscopic guidance.........................................................                         400.00
         Note:
         G919 is only eligible for payment if the following conditions are met:
         1.it is used for the treatment of epidural fibrosis with symptoms of persistent back or radicular/
           neuropathic leg pain following spinal surgery;

PDF page 491 / J77

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 NERVE BLOCKS - INTERVENTIONAL PAIN INJECTIONS
                                                                                             Fee
          2.the patient has had inadequate symptom control following fluoroscopically-guided epidural
             steroid injections to the suspected site of pain generation and there is no alternate primary
             diagnosis, such as facet-mediated or sacroiliac joint-mediated pain; and
          3.it is rendered with fluoroscopic guidance using:
              a.a directional epidural catheter, with its final position confirmed using contrast;
              b.hypertonic saline and hyaluronidase, which are infused for at least one hour; and
              c.epidural corticosteroid, which is injected prior to catheter removal.
          [Commentary:
          If any of these conditions are not met, epidural adhesiolysis is only eligible for payment using
          another appropriate epidural injection service listed above. For example, if performing an
          interlaminar lumbar adhesiolysis at a previous surgical site using a bolus-through-needle
          technique rather than an infusion, and hypertonic saline, hyaluronidase, local anaesthetic and
          corticosteroid are injected following contrast injection to confirm needle placement, G246, E440
          and E441 are eligible for payment.]

PDF page 491 / J77

4.G919 is limited to a maximum of 4 services per patient per 12 month period.
          5.G246, G117, G119, G918, G245, E440, E441, E442, E443 or E833 are not eligible for
            payment with G919 for the same procedure for which G919 is payable.

Master, record 1162. Record Layout PDF, page 1.

E44120250401999999990000016600000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.