G857

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 505 / J91

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 OPHTHALMOLOGY
                                                                                                  T       P
     Visual fields - kinetic (with permanent record)
   G857 - technical component ..........................................................           5.10
   G436 - professional component .....................................................                    14.50
        Visual fields - static
         Visual fields static perimetry, is only eligible for payment where underlying pathology is present
         or suspected and the following services are rendered: permanent record with measurement of
         a minimum of 50 points per eye, quantification of deficient points and monitoring of fixation/
         reliability.
   G858        - technical component ..........................................................   15.45
   G432        - professional component .....................................................             26.95

Master, record 2390. Record Layout PDF, page 1.

G85720260401999999990000005100000000000000000000000000000000000000000000000

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.