G381

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INTRAVENOUS
  + G376 Newborn or infant ................................................................... 10.20
  + G379 Child, adolescent or adult .......................................................     6.15
        Note:
        1.G376 or G379 apply to cryoprecipitate infusion.
        2.G376 or G379 may not be claimed with x-rays as they are included in the service.
        3.Except for G381, injections into established I.V. apparatus may not be claimed.
               G389 Preparation and infusion of gamma globulin, per patient, per
                      day......................................................................................           13.90
  + G380 Cutdown including cannulation as necessary.........................                                              27.05
    G387 Intravenous local anaesthetic infusion for central neuropathic
            pain.....................................................................................                   125.00
                                          Payment rules:
                                          1. G387 is only insured for patients with central neuropathic pain who have first undertaken but
                                            not responded to generally accepted medical therapy.
                                          2. The physician submitting the claim for this service must remain in constant attendance
                                            during the infusion and no part of the procedure may be delegated or G387 is not payable.
                                          3. G387 is limited to a maximum of 6 per patient per 12 month period.
                                          Medical record requirements:
                                          The medical record for the service must document the prior medical therapy that the patient did
                                          not respond to or G387 is not eligible for payment.

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Chemotherapy and patient assessment provided by a physician includes all patient
          assessments by any physician for a 24 hour period following treatment administration.
          Note:
          1.G381, G345 and G359 are only eligible for payment with respect to the following classes of
            biologic agents:
             a.monoclonal antibodies; and
             b.cytokines.
          2.G381, G345, G359, G075 and G390 include venipuncture, establishment of any vascular
            access line and administration of agent(s).
     [Commentary:
     Examples that are not considered biologic agents for payment purposes are blood products,
     insulin, and immunizing agents.]
+ G381 Standard chemotherapy - agents with minor toxicity that
          require physician monitoring, including any additional
          standard chemotherapy other than the initial agent ...........         54.50
          [Commentary:
          Examples of standard chemotherapy agents include cyclophosphamide, methotrexate,
          fluorouracil, leucovorin, and zoledronic acid.]
   G345 Complex single agent or multi-agent therapy – chemotherapy
          and/or biologic agent(s) that can cause vesicant damage,
          infusion reactions, cardiac, neurologic, marrow or renal
          toxicities that may require immediate intervention by the
          physician ............................................................................    75.00
          [Commentary:
          Examples of complex single agents include rituxamib, bevacizumab, trastuzumab,
          anthracyclines, bortezomib, taxanes, cisplatin, and etoposide fludarabine.]
   G359 Special single agent or multi-agent therapy – chemotherapy
          and/or biologic agent(s) with major toxicity that require
          frequent monitoring and prolonged administration periods
          and may require immediate intervention by the physician .                                105.15
          [Commentary:
          Examples of special agent therapy include high-dose methotrexate with folinic acid rescue,
          methotrexate given in a dose of greater than 1 g/m2, high dose cisplatin greater than 75 mg/m2
          given concurrently with hydration and osmotic diuresis, high dose cystosine, arabinoside
          (greater than 2 g/m2), high dose cyclophosphamide (greater than 1 g/m2), ifosfamide with
          MESNA protection, combination of biologic agents with complex chemotherapy, bispecific
          antibody.]

Master, record 2093. Record Layout PDF, page 1.

G38120260401999999990000054500000000000000000000000000000000000000000000000

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.