J896

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 523 / J109

Level 1
                                    Is an 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).
                                   Initial diagnostic study
                                     “Initial diagnostic study” means the first overnight sleep study rendered to an insured person as
                                     an insured service in Ontario for the purpose of establishing the diagnosis of a sleep disorder
                                     (and includes a split night study). Every overnight diagnostic sleep study rendered before July
                                     1, 2010 for which a claim was submitted and paid as an insured service under the Health
                                     Insurance Act constitutes an “initial diagnostic study” and is deemed to have been rendered on
                                     July 1, 2010.
                 Initial diagnostic study - Level 1
               J896 - diagnostic study.................................................................. 370.75 97.50
                   Note:
                   1.A maximum of one initial diagnostic study is eligible for payment per patient per lifetime.
                                          2.All subsequent overnight sleep studies constitute “repeat diagnostic” or “therapeutic” studies.

PDF page 526 / J112

SLEEP STUDIES
                                                                                                                   H              P
                 Therapeutic study for sleep related breathing disorders - Level 1
               J895 - therapeutic study ................................................................ 370.75 97.50
                   Payment rules:
                   1. There is a limit of one therapeutic study per patient during any two consecutive 12 month
                     periods except where prior approval has been given.
                                          2. J895 rendered to the same patient during the same 12 - hour period as J896 or J897 is not
                                            eligible for payment.
                                          [Commentary:
                                          Subject to the prior approval requirements, an additional therapeutic study in excess of the
                                          above limits may be payable when necessary to evaluate a change in the treatment modality
                                          for a sleep related breathing disorder.]
                                          Note:
                                          1.For payment purposes, repeat diagnostic studies or therapeutic studies for indications or in
                                            circumstances other than listed above, or in excess of the limits set out above require prior
                                            approval.
                                          2.A repeat diagnostic study rendered without the required pre-study assessment by a
                                            physician practicing sleep medicine, is not eligible for payment.
                                          3.A therapeutic study rendered without a pre-study assessment by a physician practicing sleep
                                            medicine is not eligible for payment except:
                                             a.For the therapeutic study that immediately follows an initial diagnostic or repeat
                                                diagnostic study where:
                                                 i. the time interval is such that it is unlikely the clinical circumstances of the patient has
                                                     changed; and
                                                 ii. the physician practicing sleep medicine has previously assessed the patient and
                                                     documented the applicable decisions with respect to the performance of the
                                                     therapeutic study; or
                                             b.In exceptional circumstances where the physician can demonstrate to the ministry upon
                                                request that the CPSO standards are satisfied with the use of a clinical protocol or
                                                approved medical directive.
                                          [Commentary:
                                          1.An example of an exceptional circumstance may be where a patient is required to travel a
                                            long distance to a sleep facility and requires an initial diagnostic or repeat diagnostic study
                                            followed by a therapeutic study on a subsequent night. For payment purposes, a pre-study
                                            assessment by a physician practicing sleep medicine is not required provided the therapeutic
                                            study is rendered in accordance with a clinical protocol or medical directive that has been
                                            approved by an authority other than a physician affiliated with the sleep facility (e.g. a
                                            Medical Advisory Committee for a sleep clinic affiliated with a hospital). The physician should
                                            be prepared to provide any necessary supporting documentation to the ministry upon
                                            request.
                                          2.Prior approval, where required, will typically be dependent on the physician demonstrating
                                            that the study is generally accepted as necessary for the patient under the circumstances.
                                          3.Sleep studies that require prior approval also require a pre-study assessment by a physician
                                            practicing sleep medicine. It is this assessment upon which the request for prior approval is
                                            considered.

PDF page 527 / J113

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 SLEEP STUDIES
                                                                               H           P
          4.Prior approval requires a written request accompanied by supporting documentation
            including the pre-study assessment and the relevant previous sleep study reports.
          5.Split-night sleep studies are claimed as J896 or J897 only, as appropriate to the study
            rendered.]

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 2871. Record Layout PDF, page 1.

J89620260401999999990000000000000004305500000000000000000097500000000975000

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.