J802

PDF page 340 / B2

NUCLEAR MEDICINE - IN VIVO
      PREAMBLE
  OTHER TERMS AND DEFINITIONS
    1. Professional and technical components are claimed separately. Claims for the technical
       component H are submitted using listed fee code with suffix B. Claims for professional
       component are submitted using listed fee code with suffix C. (e.g. J802C)
                   2. For services rendered outside a hospital setting the only fees billable under the Health
                      Insurance Act are listed under P (use suffix C). Costs for the technical component of these
                      services are only billable under the Integrated Community Health Services Centres Act, 2023.
                   3. With the exception of J818, J835, J834, J880 or when SPECT is claimed, if quantification or
                      data manipulation is carried out in addition to visual inspection of imaging studies, add 30% to
                      the appropriate professional benefit. For claim purposes, use prefix “Y”. Such activity must add
                      significant diagnostic information not available by inspection alone and does not include simple
                      image enhancement techniques such as smoothing, background subtraction, etc. Recording of
                      images on videotape for replay and production of images on the video display of a computer do
                      not in themselves justify the additional benefit. The claims for cardiac wall motion studies and
                      calculation of ventricular ejection fraction (J811 and J813) already include an allowance for data
                      manipulation as a general rule and no additional benefit may be claimed. The additional
                      computer benefit may be claimed only when additional cardiac quantifications are performed
                      i.e. stroke volume ratio and volume response curves and/or phase analysis.
                    4. If examination of Brain, Lung, Liver or Spleen is limited to one view, the benefit (H and P) is to
                       be reduced by 50%.
                    5. Repeat studies on the same day may be claimed only after exercise or drug intervention.
                    6. When tomographic examination (SPECT) is billed, the 30% add-on referred to in paragraph 3
                       may not be claimed.
                    7. Interpretation of a computed tomography (CT) scan performed as a component of a Nuclear
                       Medicine examination (e.g. SPECT/CT) is not eligible for payment.
                    8. Costs for the technical component of services rendered in an ICHSC are listed in the Schedule
                       of Facility Costs.
                    9. The technical and professional fee components for myocardial perfusion imaging,
                       echocardiography, and exercise stress testing are not eligible for payment in the routine
                       preoperative preparation or screening of a patient for surgery where the patient will undergo a
                       low-risk procedure or has a low risk of perioperative cardiac complications, unless there is a
                       clinical indication for such investigations other than solely for preoperative preparation of the
                       patient.
                                          [Commentary:
                                          1.Studies have indicated that for non-cardiac surgery, there may be no clinical benefit and
                                            there may be harm in performing functional cardiac testing in patients with low operative risk
                                            and little or limited benefit in moderate risk patients. Ordering of functional cardiac testing
                                            should done in accordance with accepted clinical guidelines such as those produced by the
                                            American College of Cardiology and American Heart Association.]

PDF page 341 / B3

NUCLEAR MEDICINE - IN VIVO
 CARDIOVASCULAR SYSTEM
                                                                                                           H      P
     Venography
   J802 - peripheral and superior vena cava .....................................                         96.35   45.85
     First Transit
   J804 - without blood pool images..................................................                     16.10   18.85
   J867 - with blood pool images.......................................................                   57.30   26.45
     Cardioangiography
   J806 - first pass for shunt detection, cardiac output and transit
           studies ................................................................................       95.10   47.45
     Myocardial Perfusion Scintigraphy
   J807 - resting, immediate post stress............................................                     217.55   38.10
   J900         - application of PET for myocardial perfusion (maximum 1
                  per examination), to J807 .......................................... add                43.50   23.65
   J808       - delayed...............................................................................    80.10   20.90
   J809       - application of SPECT to J807 or J808 ......................... add                        43.50   23.65
   J901       - application of Rubidium PET for cardiac perfusion
                (maximum 1 per examination), to J808 ........................ add                         43.50   23.65
         Payment rules:
         1.J809 is limited to a maximum of 1 service with J807 per examination and a maximum of 2
           services with J808 per examination.
         2.J900 and J901 are only eligible for payment when performed for an indication listed as an
           approved “Routine PET Scan” on the PET Scans Ontario website on the date that the service
           was rendered. Please refer to the PET section of the Schedule of Benefits for more details
         3.J900 and J901 are not eligible for payment when performed for an indication listed as
           evidence-building on the PET Scans Ontario website including PET Registry and/or PET
           Access Program indications.
     Myocardial scintigraphy
   J810 - acute infarction, injury, inflammation, infiltration .................                          88.25   43.15
      Myocardial wall motion
   J811   - studies ................................................................................      95.10   43.25
   J812     - repeat same day (to a maximum of three repeats) ..........                                  48.15   20.90
   J813 - studies with ejection fraction ..............................................                  135.15   62.50
   J814 - repeat same day (to a maximum of three repeats) ............                       48.15 33.00
       Note:
       J811 and/or J812 rendered in conjunction with J813 and/or J814 are insured services payable
       at nil.
   J815 Detection of venous thrombosis using radioiodinated
             fibrinogen up to ten days .................................................... 131.70 45.85

Master, record 2785. Record Layout PDF, page 1.

J80220260401999999990000000000000001119000000000000000000000000000000458500

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.