G540

PDF page 25 / GP11

Payment for Diagnostic and Therapeutic Services Rendered at a Hospital
  The technical component of a diagnostic and therapeutic service listed below and rendered in a
  hospital is payable at 86.10% of the listed fee in the column headed “T”.
  G104A, G111A, G121A, G127A, G140A, G143A, G146A, G149A, G152A, G153A, G167A,
  G174A,G181A, G209A, G284A, G308A, G310A, G311A, G315A, G414A, G440A, G441A, G442A,
  G443A,G448A, G451A, G455A, G466A, G471A, G519A, G540A, G541A, G542A, G544A, G554A,
  G570A,G574A, G582A, G585A, G647A, G648A, G651A, G652A, G654A, G655A, G682A, G683A,
  G684A,G685A, G686A, G687A, G688A, G689A, G694A, G695A, G815A, G850A, G851A, G852A,
  G853A,G854A, G855A, G856A, G857A, G858A, J301B, J304B, J324B, J327B

PDF page 498 / J84

Sleep-deprived/induced EEG
    A sleep-deprived/induced EEG is an EEG recording (with or without video monitoring)
    performed after an overnight period of sleep deprivation of greater than 4 hours; or the
    administration of a sedative/hypnotic agent prior to the EEG recording for the purposes of sleep
    induction, and must include all of the following:
       a.at least 60 minutes of EEG recording time;
       b.a minimum of 16 channels of EEG; and
       c.recordings of at least two physiological parameters.
G541      - technical component .......................................................   45.30
G543      - professional component..................................................                   120.00
   EEG with time-locked video recording
     An EEG with time-locked video recording must include all of the following:
    a. at least 30 minutes of EEG recording time;
    b. a minimum of 16 channels of EEG;
    c. recordings of at least two physiological parameters; and
    d. a time-locked video recording
G541    - technical component ........................................................ 45.30
G496    - professional component...................................................          120.00
   Note:
   1.The amount payable for a sleep-deprived/induced EEG, or an EEG with time-locked video
     recording that does not meet the above requirements will be reduced to that for a routine
     EEG fees (i.e. G414 and G415/G418).
   2.G414 is not eligible for payment with G541.
   3.Only one of G415, G418, G543 or G496 are eligible for payment per day.
   4.EEG services (i.e. G414, G415, G418, G496, G541, G543, G540, G545, G542, G546, G554,
     G555, or G544) are not eligible for payment with any overnight or daytime sleep study (i.e.
     J898, J899, J990, J896, J897, J895, J890, J889, J893 or J894).

PDF page 499 / J85

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 NEUROLOGY
                                                                               T         P
     Prolonged EEG monitoring
      Videotape recording of clinical signs in association with spontaneous EEG. Unit means ¼ hour
      or major part thereof. See General Preamble GP7 for definitions and time-keeping
      requirements. Payable at nil if claimed with any baseline EEG.
   G540 - technical component .............................................. per unit 10.50
   G545 - professional component ......................................... per unit         14.70
      Payment rules:
      1. G540 is limited to a maximum of 12 units.
          2. G545 is limited to a maximum of 18 units per patient per service date, and to a maximum of
            14 services per hospital admission.
          3. G545 is not eligible for payment for EEG monitoring performed for routine physiologic
            surveillance, including depth of sedation or anaesthesia.
          4. G545 is not eligible for payment on any service date where any other professional EEG
            service is eligible for payment.
      Radiotelemetry or portable recordings to monitor spontaneous EEG from a freely moving
      patient, add to routine fees.
   G542 - technical component .......................................................... 26.85
   G546 - professional component .....................................................         30.45
     Ambulatory EEG monitoring
      This is to include 12 to 24 hours of EEG monitoring. The fee includes EEG electrodes and other
      physiological parameters felt necessary to arrive at an appropriate electrographic diagnosis.
   G554 - technical component .......................................................... 53.75
   G555 - professional component .....................................................         120.00
      Polygraphic recording of parameters in addition to EEG (such as respiration, eye movement,
      EKG, muscle movements, etc.)
   G544 - technical component, per item ..................................... add 9.60
      Note:
      G544 limited to a maximum of 3.
          [Commentary:
          Examples of physiological parameters include ECG, respirations, EMG, extra-ocular
          movements, oxygen saturation, and temperature.]

PDF page 528 / J114

D. Daytime sleep studies
  J893 Multiple sleep latency test.......................................................      68.95         49.90
  J894 Maintenance of wakefulness test............................................             68.95         49.90
        Payment rules:
        1. J894 rendered to same patient same day as J893 is not eligible for payment.
        2. A maximum of one J893 and a maximum of one J894 are payable per 12 month period per
          facility per patient.
        3. If the recording does not contain information sufficient for a diagnostic interpretation as
          determined in accordance with CPSO Standards, the service is not eligible for payment.
        4. EEG services (i.e. G414, G415, G418, G541, G543, G540, G545, G542, G546, G554,
          G555, or G544) are not eligible for payment with any overnight or daytime sleep study (i.e.
          J898, J899, J990, J896, J897, J895, J890, J889, J893 or J894).

Master, record 2251. Record Layout PDF, page 1.

G54020260401999999990000010500000000000000000000000000000000000000000000000

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.