G804

PDF page 448 / J34

Physician in hyperbaric unit but not in chamber(s) with patient(s), per session per patient
# G804 - first ¼ hour ........................................................................ 71.85
# G805 - after first ¼ hour (per ¼ hour or major part thereof)...........                      35.90
         Payment rules:
         1. A consultation or assessment is eligible for payment with HBOT when rendered.
         2. If the physician is in the chamber, time calculated for HBOT may include time the physician
           devotes to separately billable interventions rendered to a patient provided that such
           interventions take place in the chamber during a period of continuous, uninterrupted HBOT.
         [Commentary:
         1.If the physician is outside the chamber, the time eligible for payment of HBOT does not
           include time spent rendering any separately billable intervention(s) during which the HBOT is
           interrupted or discontinued.
         2.For multi-patient sessions, the time eligible for payment of HBOT is measured as the period
           of physician supervision (either inside or outside of the chamber) for each patient, subject to
           payment rule #2.]
         Medical record requirements:
         The service is eligible for payment only if the start and stop times of the service are recorded in
         each patient's permanent medical record.
         Note:
         1.HBOT is insured only for the treatment of those internationally recognized indications
           approved by the ministry.
         2.HBOT is only eligible for payment for idiopathic sudden sensorineural hearing loss (ISSHL)
           when the following conditions are met:
            a.The patient is treated concurrently with corticosteroid unless corticosteroids are
              contraindicated;
            b.The treatment is initiated within 30 days of a diagnosis of ISSHL; and
            c.The diagnosis of ISSHL is made or confirmed by an Otolaryngologist prior to the initiation
              of treatment.
         3.HBOT is only eligible for payment for avascular necrosis (AVN) of bone following diagnostic
           imaging confirmation of symptomatic early to mid-stage AVN, e.g. Ficat stage I, II, or III or
           equivalent.

Master, record 2355. Record Layout PDF, page 1.

G80420250401999999990000071850000000000000000000000000000000000000000000000

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.