G236

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 492 / J78

Payment rules:
        1. G920 and G234 are each limited to a maximum of one unilateral or one bilateral procedure
          per patient per day to a limit of 24 services for any combination of unilateral and bilateral
          procedures per patient per 12 month period. G236 is limited to a maximum of one per patient
          per day to a limit of 12 per patient per 12 month period. 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. G920, G234 and G236 are only eligible for payment same patient same day with other nerve
          block and/or injection services if rendered to diagnose or treat a separate condition.
        3. G234 is not eligible for payment with G920 same patient same day.
        4. The sympathetic block that may result from epidural, spinal, plexus and peripheral nerve
          blocks is not payable as G920, G234 or G236.
    Miscellaneous
# G374 I.V. regional guanethidine .......................................................                        54.30
    Ganglion/Plexus injections
  G233 Percutaneous celiac, splanchnic or hypogastric ganglion/
         plexus block with fluoroscopic guidance ............................                                  200.00
  E444   - with radiofrequency ablation, to G233 .............. add 50%
  G217 Percutaneous trigeminal ganglion block with fluoroscopic
         guidance.............................................................................                 200.00
  G232 Percutaneous spheno-palatine ganglion block with
         fluoroscopic guidance.........................................................                        150.00
  E445   - when alcohol or other sclerosing solutions are used, to
           G920, G234, G236, G233, G217 or G232 ......... add 50%
  G921 Spheno-palatine ganglion block, transnasal topical, uni or
        bilateral...............................................................................                 12.50
     Payment rules:
     G921 is not eligble for payment same patient same day with G232.

Master, record 1950. Record Layout PDF, page 1.

G23620250401999999990000150000000000000000000000000000000000000000000000000

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.