G174

PDF page 25 / GP11

Payment for Diagnostic and Therapeutic Services Rendered at a Hospital
  The technical component of a diagnostic and therapeutic service listed below and rendered in a
  hospital is payable at 86.10% of the listed fee in the column headed “T”.
  G104A, G111A, G121A, G127A, G140A, G143A, G146A, G149A, G152A, G153A, G167A,
  G174A,G181A, G209A, G284A, G308A, G310A, G311A, G315A, G414A, G440A, G441A, G442A,
  G443A,G448A, G451A, G455A, G466A, G471A, G519A, G540A, G541A, G542A, G544A, G554A,
  G570A,G574A, G582A, G585A, G647A, G648A, G651A, G652A, G654A, G655A, G682A, G683A,
  G684A,G685A, G686A, G687A, G688A, G689A, G694A, G695A, G815A, G850A, G851A, G852A,
  G853A,G854A, G855A, G856A, G857A, G858A, J301B, J304B, J324B, J327B

PDF page 429 / J15

STRESS TESTING
        Maximal stress ECG
         Maximal stress ECG (exhaustion, symptoms or ECG changes) or submaximal stress ECG (to
         target heart rate for patient) by a standard technique - with treadmill or ergometer and
         oscilloscopic continuous monitoring including ECGs taken during the procedure and resting
         ECGs before and after the procedure - physician must be in attendance at all times. The
         professional component includes the necessary clinical assessment immediately prior to
         testing.
   G315        - technical component ..........................................................       50.55
   G319        - professional component .....................................................                 62.05
     Dobutamine stress test
   G174   - technical component, when rendered outside of hospital
            ................................................................................... add   54.25
     Dipyramidole Thallium stress test
   G111 - technical component .......................................................... 58.95
   G112 - professional component .....................................................         74.25
       Note:
       1.The technical and professional fee components for maximal stress ECG are not eligible for
         payment in the routine preoperative preparation or screening of a patient for surgery where
         the patient will undergo a low risk procedure or has a low risk of perioperative cardiac
         complications, unless there is a clinical indication requiring a exercise stress test study other
         than solely for preoperative preparation of the patient.
          2.G315, G319, G174, G111 and G112 are uninsured services for routine annual stress tests in
            asymptomatic patients where the patient's 10 year risk of coronary heart disease is less than
            10% calculated by generally accepted methodology.
          [Commentary:
          An example of a generally accepted methodology for determining 10 year risk of coronary
          heart disease is the Framingham Risk Score.
          1.Studies have indicated that for non cardiac surgery, there may be no clinical benefit and
            there may be harm in performing functional cardiac testing in patients with low operative risk
            and little or limited benefit in moderate risk patients. BMJ 2010, Jan 28; 340.
          2.One example of a generally accepted guideline is the American College of Cardiology
            (ACC)/ American Heart Association (AHA) Guidelines that states:
              a.Non invasive testing could be considered in patients with 1 to 2 risk factors and poor
                functional capacity (less than 4 mets) who require intermediate risk surgery if it will
                change management (class IIb)
              b.Non invasive testing has not been show to be useful in patients with no clinical risk factors
                undergoing intermediate risk non cardiac surgery (class III).
              c.Non invasive testing has not been shown to useful in patients undergoing low risk non
                cardiac surgery (class III).]

Master, record 1895. Record Layout PDF, page 1.

G17420260401999999990000054250000000000000000000000000000000000000000000000

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.