J162

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.]

Master, record 2567. Record Layout PDF, page 1.

J16220260401999999990000000000000000566500000000000000000026550000000265500

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.