G287

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 423 / J9

BLOOD TRANSFUSIONS
# G275 Exchange transfusion .............................................................         205.45
     Note:
     Assistant at exchange transfusion (see General Preamble GP85).
# G280 Intra-uterine fetal transfusion - initial or subsequent...............                     186.90
  G276 Donor cell pheresis (platelets or leukocytes) ..........................                    15.35
    Therapeutic plasma exchange
# G277 - initial and repeat, to a maximum of 5 per year ............each                           82.00
# G278 - more than 5 per year ..................................................each               41.80
# G272 Manual plasmapheresis (see General Preamble GP12) ........                                 I.C
    LDL apheresis
# G287 - initial and repeat, to a maximum of 5 per year ...........each              82.00
# G290 - more than 5 per year ..................................................each 41.80
     Note:
     LDL apheresis is an insured service only for the treatment of homozygous familial
     hypercholesterolemia.
    CARDIOVERSION
# Z437 Cardioversion (electrical and/or chemical) - maximum of three
         sessions per patient, per day .............................................               92.45    6
        CARDIAC CATHETERIZATION
          Note:
          1.Cardiac catheterization procedures (Z439 to G288) include insertion of catheter (including
            cutdown and repair of vessels if rendered), catheter placement, contrast injection, imaging
            and interpretation.
          2.When more than one procedure is carried out at one sitting, the additional procedures are
            payable at 50% of the listed benefits. (Z439 to G288, excluding G262 and G263).

Master, record 2000. Record Layout PDF, page 1.

G28720250401999999990000082000000000000000000000000000000000000000000000000

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.