J890

PDF page 498 / J84

Sleep-deprived/induced EEG
    A sleep-deprived/induced EEG is an EEG recording (with or without video monitoring)
    performed after an overnight period of sleep deprivation of greater than 4 hours; or the
    administration of a sedative/hypnotic agent prior to the EEG recording for the purposes of sleep
    induction, and must include all of the following:
       a.at least 60 minutes of EEG recording time;
       b.a minimum of 16 channels of EEG; and
       c.recordings of at least two physiological parameters.
G541      - technical component .......................................................   45.30
G543      - professional component..................................................                   120.00
   EEG with time-locked video recording
     An EEG with time-locked video recording must include all of the following:
    a. at least 30 minutes of EEG recording time;
    b. a minimum of 16 channels of EEG;
    c. recordings of at least two physiological parameters; and
    d. a time-locked video recording
G541    - technical component ........................................................ 45.30
G496    - professional component...................................................          120.00
   Note:
   1.The amount payable for a sleep-deprived/induced EEG, or an EEG with time-locked video
     recording that does not meet the above requirements will be reduced to that for a routine
     EEG fees (i.e. G414 and G415/G418).
   2.G414 is not eligible for payment with G541.
   3.Only one of G415, G418, G543 or G496 are eligible for payment per day.
   4.EEG services (i.e. G414, G415, G418, G496, G541, G543, G540, G545, G542, G546, G554,
     G555, or G544) are not eligible for payment with any overnight or daytime sleep study (i.e.
     J898, J899, J990, J896, J897, J895, J890, J889, J893 or J894).

PDF page 521 / J107

OTHER TERMS AND CONDITIONS
For services rendered outside a hospital or off-site premises, the only fees payable under the Health
Insurance Act are for the professional component listed under the “P” column (use suffix C). Costs for
the technical component of these services are only payable under the Integrated Community Health
Services Centres Act, 2023 and are listed in the Schedule of Facility Costs.
Sleep studies are subject to limits or maximums set out below. Unless otherwise specifically provided,
service(s) in excess of limits are not insured services except when prior approval to exceed the limit is
obtained from the MOH. Despite the foregoing, where prior approval to exceed a limit is not requested
from the MOH but the service would otherwise satisfy one or more of the conditions for which prior
approval to exceed the limit is routinely granted (had prior approval been requested) any service in
excess of the limit is not eligible for payment.
          [Commentary:
          For definitions of maximum and limits see GP7.]
          Claims submission instructions:
          Submit claims for professional and technical components separately. Submit claims for the
          technical component H using listed fee code with suffix B. Submit claims for professional
          component using listed fee code with suffix C. (e.g. J890C)

PDF page 528 / J114

Level 1
      Overnight sleep study with continuous monitoring of oxygen saturation, ECG and Ventilation
      (airflow and respiratory effort) and additional monitoring to stage sleep (including all of the
      following: EEG, EOG and sub-mental EMG).
    Specialized facility diagnostic study
  J890 - diagnostic study..................................................................   370.75         97.50
    Specialized facility therapeutic study
  J889 - therapeutic study ................................................................ 370.75 97.50
      Payment rules:
      1. J889 rendered to the same patient during the same 12 - hour period as J890 is not eligible
        for payment.
        2. Except where prior approval is given, overnight sleep studies rendered in specialized
          facilities are limited to two per patient, per 12 month period for any combination of such
          studies.
        3. For services rendered on or after July 1, 2010, the 12 month period is determined from July
          1, 2009 onwards.

PDF page 528 / J114

D. Daytime sleep studies
  J893 Multiple sleep latency test.......................................................      68.95         49.90
  J894 Maintenance of wakefulness test............................................             68.95         49.90
        Payment rules:
        1. J894 rendered to same patient same day as J893 is not eligible for payment.
        2. A maximum of one J893 and a maximum of one J894 are payable per 12 month period per
          facility per patient.
        3. If the recording does not contain information sufficient for a diagnostic interpretation as
          determined in accordance with CPSO Standards, the service is not eligible for payment.
        4. EEG services (i.e. G414, G415, G418, G541, G543, G540, G545, G542, G546, G554,
          G555, or G544) are not eligible for payment with any overnight or daytime sleep study (i.e.
          J898, J899, J990, J896, J897, J895, J890, J889, J893 or J894).

Master, record 2865. Record Layout PDF, page 1.

J89020260401999999990000000000000004306000000000000000000097500000000975000

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.