G390

PDF page 471 / J57

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.]

PDF page 472 / J58

G390 Supervision of chemotherapy for induction phase of acute
        leukemia or myeloablative therapy prior to bone marrow
        transplantation (maximum of 1 per induction phase or
        myeloablative therapy); and/or supervision of biologic
        agent(s) such as Chimeric Antigen Receptor T-Cell Therapy
        (CAR-T) infusion (maximum of 1 per infusion); and/or
        supervision of bispecific antibody infusion, during initial
        dosing phase, where there is a high risk of cytokine release
        syndrome (maximum of 3 per initial dosing phase)............                                         262.40

Master, record 2101. Record Layout PDF, page 1.

G39020250401999999990000262400000000000000000000000000000000000000000000000

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.