G248

PDF page 118 / GP104

GENERAL PREAMBLE
OTHER PREMIUMS
    Non-elective Surgical Procedures (including fractures or dislocations), Obstetrical Deliveries,
    Clinical Procedures Associated with Diagnostic Radiological Examinations, Ground Ambulance
    Transfer (K101), Air Ambulance Transfer (K111), Transport of Donor Organs (K102), Return
    Trip (K112), or one of the following Major Invasive Procedures:
    G060, G061, G062, G065, G066, G067, G068, G082, G083, G085, G090, G099, G117, G118,
    G119, G125, G176, G177, G178, G179, G211, G224, G246, G248, G249, G260, G261, G262,
    G263, G268, G269, G275, G277, G279, G280, G282, G287, G288, G290, G297, G298, G303,
    G309, G322, G323, G324, G330, G331, G336, G347, G348, G349, G356, G376, G379, G380,
    G509, J001 to J068, and X112 when required for intussusception

PDF page 485 / J71

Neuraxial
# G248 Caudal, single injection...........................................................      55.00
# G125 Caudal/lumbar epidural with catheter .....................................              100.00
# G118 Thoracic epidural with catheter...............................................          130.00
# G062 Cervical epidural with catheter................................................         160.00
  G260 Major plexus block ..................................................................    80.00
          Payment rules:
          1. The G260 service is a block of one of the following: brachial plexus, lumbar plexus, sacral
            plexus, deep cervical plexus, or a combined 3-in-1 block which must include the femoral,
            obturator and lateral femoral cutaneous nerves.
          2. When a major plexus block is rendered, additional blocks of one or more nerves within the
            same nerve distribution are not eligible for payment.
          [Commentary:
          If a peripheral nerve block is performed that is not within the same nerve distribution of a major
          plexus block, then both blocks are eligible for payment. For example, a sciatic nerve block
          performed in addition to a combined 3-in-1 block.]
          3. When 2 or more nerve blocks of major and/or minor peripheral nerves that are within the
            distribution of a major plexus are rendered individually, only G260 is eligible for payment.
          [Commentary:
          For example, if radial, median and ulnar nerve blocks are performed individually, only the
          brachial plexus block (i.e. major plexus block) is eligible for payment. If femoral, obturator and
          lateral femoral cutaneous blocks are performed individually, only the combined 3-in-1 (i.e.
          major plexus) block is eligible for payment.]
   G060 Peripheral nerve block, major .................................................         55.00
      Payment rules:
      1. The G060 service must consist of one of the following:
             a.a block of one of: radial, median, ulnar, musculocutaneous, femoral, sciatic, common
               peroneal and/or tibial, obturator, suprascapular, pudendal (uni or bilateral), trigeminal or
               facial nerve;
             b.a paravertebral block – first injection only;
             c.an ankle block (must include 2 or more of the following: deep peroneal, superficial
               peroneal, posterior tibial, saphenous or sural nerve); or
             d.a fascia iliaca block.
          2. G060 is limited to a maximum of 4 services per patient per physician per day.
          3. When a major peripheral nerve block is rendered, additional blocks of one or more nerves
            within the same nerve distribution are not eligible for payment.

Master, record 1962. Record Layout PDF, page 1.

G24820250401999999990000055000000000000000000000000000000000000000000000000

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.