G541

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 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 2252. Record Layout PDF, page 1.

G54120260401999999990000045300000000000000000000000000000000000000000000000

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.