G805

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.

PDF page 449 / J35

Physician not in constant attendance
     The service rendered when a physician supervises HBOT but is not physically present in the
     hyperbaric unit with the patient, but present in the facility and available to intervene in a timely
     fashion.
# G807 - not in the hyperbaric unit, supervision................................         35.75
     Payment rules:
     1. G807 is limited to a maximum of one per patient per day.
          2. G807 is limited to a maximum of 3 per physician per day.
          3. G807 is not eligible for payment for the same patient, same day as G800, G801, or G802.
          4. G805 is limited to a maximum of three units when claimed with G807 same patient same
            day.
          Medical record requirements:
          The medical record must demonstrate that there has been contact and/or direction provided to
          the hyperbaric unit in circumstances where G807 is claimed, otherwise the service is not
          eligible for payment.
          [Commentary:
          As of April 1, 2026, the following indications were approved by the MOH.
                 • air or gas embolism
                 • carbon monoxide poisoning and/or cyanide poisoning
                 • clostridial myositis and myonecrosis (gas gangrene)
                 • crush injury, compartment syndrome, and other acute traumatic ischemias
                 • decompression sickness
                 • enhancement of healing in selected problem wounds
                 • exceptional blood loss
                 • intracranial abscess
                 • necrotizing soft tissue infections (subcutaneous tissue, muscle, fascia)
                 • osteomyelitis (refractory)
                 • delayed radiation injury (soft tissue and bony necrosis)
                 • skin grafts and flaps (compromised)
                 • thermal burns
                 • idiopathic sudden sensorineural hearing loss (ISSHL)
                 • avascular necrosis (AVN) of bone]
    Hypothermia induction
# G210 Hypothermia (therapeutic) induction and management..........                    190.75
     ICU/NICU admission assessment fee
   G556   - ICU/NICU admission assessment is an initial visit
            rendered during night time (00:00-07:00), to G400, G405,
            G557, G600, G603, G604, G610 or G620 ................. add                 136.40
          Payment rules:
          G556 is payable once per patient per hospital admission.

Master, record 2356. Record Layout PDF, page 1.

G80520250401999999990000035900000000000000000000000000000000000000000000000

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.