G208

PDF page 211 / A83

Initiation of Food Allergy Immunotherapy (FAIT)
       Initiation of Food Allergy Immunotherapy (FAIT) is an assessment service rendered by a
       specialist in Clinical Immunology where the physician spends a minimum of 30 minutes
       (consecutive or non-consecutive) in direct in-person contact with the patient, exclusive of time
       spent rendering any other separately billable intervention to the patient, for the purpose of
       establishing and initiating:
                • the FAIT treatment protocol (mono- or poly-allergen), and
                • initial therapy doses.
       The physician must be physically present on-site and immediately available to intervene for the
       duration of the treatment session, or the service is not eligible for payment.
   A620 Initiation of Food Allergy Immunotherapy ...............................        190.60
       Payment rules:
       1.No other services listed under the "Consultations and Visits" section of the Schedule are
          eligible for payment for the same patient on the same date of service as A620
          2.Provocation testing (G208 and G190) is not eligible for payment for the same patient on the
            same date of service as A620.
          3.Time used to establish the minimum time requirements for one patient cannot overlap with
            time used to establish time units or minimum time requirements for any other patient
          4.Limited to a maximum of once per patient per allergen per lifetime
          5.Limited to a maximum of once per treatment protocol whether initiating mono-allergen or
            poly-allergen therapy
          6.A620 is only eligible for payment in circumstances where a clinical history consistent with
            IgE-mediated food allergy has been supported by appropriate diagnostic evaluation,
            including skin prick testing, allergen-specific IgE testing, oral food challenge, or a
            combination thereof
          7.A written FAIT treatment protocol must be recorded in the patient’s permanent medical
            record, including the allergens involved, initial dosing schedule, and risk assessment
          8.In circumstances where the above payment rules have not been met, the service will be
            adjusted to a lesser paying fee
          Medical record requirements:
          The service is eligible for payment only if start and stop times of the service are recorded in the
          patient's permanent medical record.

PDF page 418 / J4

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ALLERGY
                                                                                                               Fee
     Note:
     If a patient presents for an allergy injection and has an acute infectious condition, albeit of the
     respiratory system, or some other unrelated condition which would have otherwise required a
     separate office visit, the physician is entitled to claim the appropriate assessment fee as well as
     the injection fee. If a patient requires a brief assessment of his allergic condition as well as the
     allergy injection, the physician should claim the injection and the basic fee, in which case the
     specific elements of the service include those of an assessment (see General Preamble
     GP15).
# G185 Drug(s) desensitisation - in a hospital where full
           cardioresuscitative equipment is readily available because a
           significant risk of life-threatening anaphylaxis exists. The
           service must be performed under direct and ongoing
           physician attendance.......................................................... 184.95
+ G200 Acute desensitisation, e.g. ATS, penicillin ..............................           8.65
+ G201 Direct nasal tests, to a maximum of 3 per year .......... per test                                         1.60
    Hyposensitisation
  G202 - each injection .....................................................................                    7.15
  G212 - when sole reason for visit (including first injection) ............                                    12.85
         Payment rules:
         G202 is limited to a maximum of 2 when an assessment is eligible for payment for the same
         visit and a maximum of 1 in addition to the injection included in G212 when sole reason for visit.
  G205 Insect venom desensitisation (immunotherapy) - per injection
          (maximum of 5 per day). In addition to G205, after the initial
          major assessment only, a minor or partial assessment may
          be claimed once per day if rendered ..................................                                13.15
    Ophthalmic tests
+ G203 - direct, to maximum of 3 per year............................ per test                                   1.60
+ G204 - quantitative .........................................................................                 12.40
    Patch test
  G206 - maximum of 90 per patient, per year ..................... per test                                       2.39
  G198 - for industrial or occupational dermatoses, to a maximum of
          125 per patient, per year ........................................ per test                             2.39
+ G207 Bronchial provocative testing - per session, to a maximum of 6
         per year ..............................................................................                14.15
    Provocation testing
     For foods, food additives and medications, by blinded or open technique, maximum 5 testing
     sessions per 12 month period.
  G208 Provocation testing .................................................... per unit 21.90
     Payment rules:
     1. G208 is a time base service. Unit means one hour or major part thereof.
         2. In the event the allergic response is respiratory, only one pulmonary function test is eligible
           for payment the same day as G208.

PDF page 419 / J5

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 ALLERGY
                                                                                                              Fee
      [Commentary:
      See General Preamble GP7 for definitions and time keeping requirements.]
   G190 Serial oral or parenteral provocation testing to a food, drug or
          other substance when the service is rendered in a hospital,
          when an anaphylactic reaction is considered likely based on
          a documented history and the service is performed under
          direct and ongoing physician attendance ...........................  184.95
          [Commentary:
          See G208 for similar services rendered in office.]
                                                                                                       T       P
     Skin testing
   G209 - technical component, to a maximum of 50 per year
            ............................................................................... per test   0.80
   G197 - professional component, to a maximum of 50 per year
            ............................................................................... per test           0.39
                                                                                                              Fee
        Venom allergy testing
         Investigations including skin prick test(s), intracutaneous test(s) and any other procedures
         necessary to establish the role of venom allergy in contributing to a patient's illness(es).
   G199 Venom allergy testing, maximum of 2 per patient per physician
          per 12 month period ..........................................................                      40.00
   G195 Local anaesthetic hypersensitivity skin test, maximum of 2 per
          patient per physician per 12 month period ........................                                  17.00
   G196 Hypersensitivity skin test for validated drugs or agents
          excluding foods and inhalants, maximum of 3 per patient per
          physician per 12 month period ..........................................                            17.00
   E582   - when testing with penicillin minor determinant mixture
            outside a hospital setting, to G196............................. add                              32.20
        Physical urticaria challenges - to include at least 3 of the following:
         a. assessment of dermographic challenge with 100, 250 or 500 gm needle, measuring
            immediate and delayed responses,
         b. assessment of pressure challenge with 15 lbs. weight recording onset, peak, duration of
            response - immediate and delayed,
         c. assessment of ice cube cold challenges,
         d. assessment of cholinergic exercise challenge with use of treadmill or bicycle to target pulse
            rate greater or equal to 120 per minute and profuse sweating,
         e. vibration effect of light and water,
         f. histamine or methacholine

Master, record 1922. Record Layout PDF, page 1.

G20820260401999999990000021900000000000000000000000000000000000000000000000

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.