G900

PDF page 402 / G6

DIAGNOSTIC ULTRASOUND
PELVIS
                                                                                                   H             P
   Pelvis
 J162 - complete* ...........................................................................     48.75         26.55
 J138 Intracavitary ultrasound* (e.g. transrectal, transvaginal) ........            48.75 26.50
     Note:
     *For ovulation induction purposes, the limit is one per cycle. Additional ultrasounds may be
     claimed as J164.
 J165 Transvaginal sonohysterography - may include saline or other
          intracavitary contrast media except Echovist for
          demonstration of tubal patency ..........................................  99.95 33.15
 J476 Transvaginal sonohysterography - including Echovist contrast
          media for demonstration of tubal patency ..........................       232.90 30.65
     Note:
     J138 and J161 rendered in conjunction with J165 are insured services payable at nil.
       [Commentary:
       See Diagnostic and Therapeutic Procedures section page J46 for Transvaginal
       sonohysterography, introduction of catheter with or without injection or contrast media (G399).]
 J163       - limited study - for other than pregnancy .............................              32.10         17.55
   Intracavitary ultrasound
 J161 - limited - for other than pregnancy....................................... 32.10 16.25
     Note:
     1.For residual urine measurement by ultrasound (G900), see Diagnostic and Therapeutic
       Procedures, section J, Urology.
     2.Residual urine measurement by ultrasound (G900) is not eligible for payment when rendered
       with an ultrasound of the pelvis or intracavitary ultrasound.
 J164 Follicle monitoring studies ......................................................          24.40         12.30
       [Commentary:
       Ultrasound services are not insured when rendered to support in-vitro fertilization services or
       artificial insemination services. See Regulation 552 section 24(1) paragraph 23 and 29 under
       the Act.]

PDF page 529 / J115

UROLOGY
                                                                                                                      Fee           P
  # G900 Residual urine measurement by ultrasound ...........................                                         12.70
       Note:
       Residual urine measurement by ultrasound (G900) is not eligible for payment in addition to an
       ultrasound of the pelvis, intracavity ultrasound, G192 - G194, or G475 when cystometrogram
       and/or voiding pressure studies are rendered.
                                          [Commentary:
                                          G475 is payable with G900 when uroflow studies are performed (flow rate with or without
                                          postural studies) with residual urine measurement by ultrasound.]
  + G475 Cystometrogram and/or voiding pressure studies and/or flow
           rate with or without postural studies and/or urethral pressure
           profile including interpretation ............................................                              23.75
               G192 Video fluoroscopic multichannel urodynamic assessment to
                       include monitoring of intravesicular, intra-abdominal, and
                       urethral pressures, with simultaneous fluoroscope imaging
                       and recording of filling and voiding phases including
                       interpretation ......................................................................          73.65
  # G193 Complete multichannel urodynamic assessment - to include
           monitoring of intravesicular, intra-abdominal, and urethral
           pressures, with or without pressure-flow studies................                                           43.85
  # G194   - with EMG ................................................................... add                          8.35
    G477 Interpretation of comprehensive urodynamic studies (when the
            procedure is done by paramedical personnel) ...................                                                         5.40
  + G476 Prostatic massage ..................................................................                           5.40

Master, record 2411. Record Layout PDF, page 1.

G90020250401999999990000012700000000000000000000000000000000000000000000000

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.