G852

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 504 / J90

Colour vision detailed assessment
   Colour vision detailed assessment (not to be claimed for screening tests such as Ishihara,
   HRR and University, etc.) only where underlying pathology is present or suspected. Requires
   that the following services are rendered: one of the screening tests and at least two (2) of the
   following detailed tests: 100 Hue, D-15, Lathony New Colour Test or anomaloscope test. To be
   performed where underlying pathology is present or suspect. Not to be performed as a routine
   screening test.
G850 - technical component .......................................................... 23.65
G438 - professional component .....................................................         22.15
  Dark adaptation curve (Goldmann adaptometer or equivalent)
G851 - technical component ..........................................................         35.50
G437 - professional component .....................................................                           22.90
  Electro-retinography with report
G852 Full field or multi-focal electro-retinography - technical
        component..........................................................................   38.50
G439 Full field electro-retinography - professional component ........                                        75.00
G524 Multi-focal electro-retinography - professional component .....                                          75.00
   Payment rules:
   1. G852 is limited to 4 services per patient per 12 month period.
      2. G439 is limited to 2 services per patient per 12 month period.
      3. G524 is limited to 2 services per patient per 12 month period.
      4. G524 is only eligible for payment for the evaluation of disorders of the retina involving high
        resolution vision function (i.e. cone function).
      5. Electro-retinography includes any pupil dilation and refraction necessary to complete the
        study.
  Fluorescein angiography
G853 - technical component ..........................................................         25.50
G425 - professional component .....................................................                           44.40
  Fluorescein angioscopy
G854 - technical component .......................................................... 7.50
G444 - professional component .....................................................        7.00
    Note:
    G425, G853, G444, G854 - for bilateral procedures, add 50% of the listed benefit.

Master, record 2385. Record Layout PDF, page 1.

G85220260401999999990000038500000000000000000000000000000000000000000000000

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.