J804

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

PDF page 346 / B8

NUCLEAR MEDICINE - IN VIVO
MUSCULOSKELETAL SYSTEM
                                                                                                           H            P
  Bone scintigraphy
J850 - general survey....................................................................              103.70          56.55
J851       - single site ...........................................................................     84.85         45.85
  Gallium scintigraphy
J852 - general survey....................................................................              177.55          56.55
J853       - single site ...........................................................................   123.70          45.85
  Application of tomography (SPECT)
J819    - where each SPECT image represents a different organ or
          body area, to J852, maximum 3 images per examination
          ................................................................................... add        43.50         28.05
      Note:
      J850 and J851 are not to be billed together. J804 may be claimed in addition to J850 or J851
      for blood pool study.

Master, record 2786. Record Layout PDF, page 1.

J80420260401999999990000000000000000187000000000000000000000000000000188500

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.