G261

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 421 / J7

Vascular cannulation
  Z459 Arterial puncture ...................................................................... 10.20
# G268 Cannulation of artery for pressure measurements including cut
          down as necessary..............................................................       31.25
      Note:
      G268 is not eligible for payment with G249, G259, G261, G176, G177, G178, G288,
      Z443 or Z440.
# G269 Cannulation of central vein for pressure measurements or for
         feeding line - not to be billed with right heart catheterization
         (Z439) or with Swan-Ganz catheter insertion......................                           31.25
# G270 Intraosseous infusion...............................................................          23.90
# G309 Umbilical artery catheterization (including obtaining of blood
          sample)................................................................................    45.55
    Venipuncture
+ G480 - infant....................................................................................  9.90
+ G482 - child ..................................................................................... 7.35
+ G489 - adolescent or adult ..............................................................          3.54
     Note:
     G489 is not insured when rendered for the monitoring of adverse effects resulting from a calorie
     restricted weight loss program.
+ G483 Therapeutic venisection...........................................................             9.70
  G282 Umbilical vein catheterization (including obtaining of blood
          sample)................................................................................    43.60
# Z438 Insertion of Swan-Ganz catheter (not included in respiratory or
          critical care benefits) ...........................................................       162.50    6
          Note:
          1.Swan-Ganz catheter insertion is included in the anaesthesia basic units of any surgical
            services where anaesthesia basic units are listed
          2.Z438 includes dye dilution densitometry and/or thermal dilution studies, when rendered
            (except in the setting of a cardiac catheterization laboratory).
          [Commentary:
          See G285 for dye dilution densitometry and G286 for thermal dilution studies performed using a
          Swan-Ganz catheter in a cardiac catheterization laboratory.]
# Z456 Insertion of implantable central venous catheter .....................                       296.50    6
# Z457 Surgical removal or repair of tunneled central venous catheter                                60.00    6
# Z446 Insertion of subcutaneous venous access reservoir ...............                            168.00    6
# Z447 - revision same site................................................................         130.70    6
# E684           - when performed in infant or child, to Z456 or Z446 ....add                       233.65

PDF page 426 / J12

Arrhythmia induction
     To include programmed electrical stimulation, drug provocation and termination of arrhythmia, if
     necessary - once per patient per 24 hours.
# G261 - atrial.................................................................................... 331.05
# G259 - ventricular...........................................................................     383.30
       Note:
       G261and/or G259 are not eligible for payment with G521, G522, G523, G395 and G391.

PDF page 427 / J13

Electrophysiologic pacing, mapping and ablation
# G178 - catheter ablation therapy....................................................            352.05
# G179 - repeat pacing, mapping and catheter ablation for additional
          distinct arrhythmia(s) without the use of an advanced
          mapping system .................................................................        111.20
          Note:
          G179 is not eligible for payment with Z423.
# Z424         - transseptal left heart catheterization, with or without
                 pressure measurements, with or without dye injection.......                      297.15    6
          Note:
          1.Z424 is only eligible for payment when rendered with G176, G177 and/or G178.
          2.Z424 is eligible for payment for each transseptal catheter placement to a maximum of 2.
# Z422         - retrograde aortic left heart catheterization with or without
                 pressure measurement(s) ..................................................       210.55    6
          Note:
          1.Z422 is only eligible for payment when rendered with G176, G177 and/or G178.
          2.Z422 is limited to a maximum of one per electrophysiological pacing, mapping and/or
            ablation sitting.
   G115 External cardiac pacing (temporary transthoracic) once per 24-
          hour period .........................................................................    46.30
      Note:
      G115 is not eligible for payment with G521, G522, G523, G395 and G391.
# G366 Testing of arrhythmia inducibility by acute administration of
         anti-arrhythmic or adrenergic drugs to a maximum of 2 per
         24 hours .............................................................................   148.50
          Note:
          G366 is not eligible for payment for the use of isoproterenol for arrhythmia induction when
          rendered with G261 and/or G259.
# Z443 Insertion of temporary endocardial electrode .........................                     154.10    6
# Z431 Repositioning of temporary endocardial electrode .................                          64.25    6
    Endomyocardial Biopsy
# G288 - transvascular, right or left ...................................................         200.00
    Tilt table testing of vasomotor syncope
# G314 - to include arterial cannulation, provocative and blocking
           drugs, physician must be continually present.....................                      112.00

Master, record 1975. Record Layout PDF, page 1.

G26120250401999999990000331050000001655300000000000000000000000000000000000

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.