X112

PDF page 118 / GP104

GENERAL PREAMBLE
OTHER PREMIUMS
    Non-elective Surgical Procedures (including fractures or dislocations), Obstetrical Deliveries,
    Clinical Procedures Associated with Diagnostic Radiological Examinations, Ground Ambulance
    Transfer (K101), Air Ambulance Transfer (K111), Transport of Donor Organs (K102), Return
    Trip (K112), or one of the following Major Invasive Procedures:
    G060, G061, G062, G065, G066, G067, G068, G082, G083, G085, G090, G099, G117, G118,
    G119, G125, G176, G177, G178, G179, G211, G224, G246, G248, G249, G260, G261, G262,
    G263, G268, G269, G275, G277, G279, G280, G282, G287, G288, G290, G297, G298, G303,
    G309, G322, G323, G324, G330, G331, G336, G347, G348, G349, G356, G376, G379, G380,
    G509, J001 to J068, and X112 when required for intussusception

PDF page 369 / D11

DIAGNOSTIC RADIOLOGY
 GASTROINTESTINAL TRACT
                                                                                                       H      P
     Palatopharyngeal analysis
   X105 - cine or videotape ................................................................          29.50   40.25
     Pharynx and oesophagus
   X106 - cine or videotape ................................................................          29.50   40.25
   X107 Oesophagus when X103, X104, X108 or X109 not claimed...                                       26.70   32.80
     Oesophagus, stomach and duodenum
   X108 - including survey film, if taken .............................................               46.30   41.65
   X104 - double contrast, including survey film, if taken...................                         48.50   50.65
   X103 - double contrast, including survey film, if taken, and small
          bowel ..................................................................................    60.95   63.75
   X110 Hypotonic duodenogram.........................................................                39.35   35.95
   X109 Oesophagus, stomach and small bowel .................................                         59.10   54.35
     Small bowel only
   X111 - when only examination performed during patient’s visit.....                                 26.40   23.80
     Colon
   X112 - barium enema including survey film, if taken .....................                          48.40   32.10
   X113 - air contrast, primary or secondary, including survey films, if
           taken...................................................................................   61.30   54.35
     Gallbladder
   X114 - one or multiple day examinations.......................................                     29.95   12.65
   X120 - one or multiple day examinations with preliminary plain film                                39.80   12.65
   X116 T-tube cholangiogram .............................................................            21.70   10.80
   X117 Operative cholangiogram........................................................               21.70   12.10
   X123 Operative pancreatogram or ERCP........................................                       21.70    9.80

Master, record 6563. Record Layout PDF, page 1.

X11220260401999999990000000000000000605500000000000000000000000000000321000

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.