J167

PDF page 401 / G5

DIAGNOSTIC ULTRASOUND
 PREGNANCY
                                                                                                  H      P
     Complete
   J159 - on or after 16 weeks gestation (maximum one per normal
          pregnancy) .........................................................................   48.75   33.80
   J160 - for high risk pregnancy or complications of pregnancy ......                           48.75   32.25
   J166   - multiple gestation, for each additional fetus, to J160 add                           41.45   22.10
     Gestational age for Maternal Serum Screening Program
   J157 - before 16 weeks gestation (maximum one per normal
          pregnancy) .........................................................................   32.10   17.55
     Limited
   J158 - for high risk pregnancy or complications of pregnancy ......                           32.10   17.55
   J167      - fetal Doppler evaluation of middle cerebral artery and/or
               ductus venosus, to J160 or J158 ............................... add 32.10 30.00
         Payment rules:
         J167 is only eligible for payment when rendered by a physician for assessment of:
              a. fetal anemia, or
              b. intrauterine growth retardation
                i. with estimated fetal weight OR abdominal circumference measuring below the 10th
                      percentile, or
                ii. >=30 percentile decrease in estimated fetal weight since previous imaging, or
              c. in high-risk pregnancies.
   J168       - nuchal translucency for Prenatal Genetic Screening
                (maximum one per pregnancy) ..........................................           39.00   20.85
   J169         - multiple gestation, for each additional fetus, to J168 . add                   33.15   16.35

Master, record 2572. Record Layout PDF, page 1.

J16720260401999999990000000000000000373000000000000000000030000000000300000

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.