X304

PDF page 353 / C1

OTHER TERMS AND CONDITIONS
    1. Treatment Planning (X310, X311, X312, X313) for radiotherapy that is rendered in a place other
       than an Ontario public hospital funded by Ontario Health to provide radiotherapy is an insured
       service payable at nil.
                   2. X305, X306, X322, X323, X324, X325 and X334 rendered in a place other than an Ontario
                      public hospital are insured services payable at nil.
                   3. When Radiation Treatment Planning Levels 1-4 (X310, X311, X312, X313) are eligible for
                      payment, any additional radiation oncology planning or treatment services rendered to a patient
                      during the same course of treatment are not eligible for payment.
                   4. X302, X304 may not be claimed by the staff of an Ontario public hospital funded by Ontario
                      Health to provide radiotherapy.

PDF page 356 / C4

X313 Level 4 - per patient, per course of treatment.........................                                  811.15
# X302 Teleradiotherapy - x-ray, 150 KVP or higher, radium, cobalt,
          cesium betatron linear accelerator - amount payable per
          treatment visit .....................................................................                   15.90
  X304 Minor teleradiotherapy - x-ray, 150 KVP or less - amount
          payable per treatment visit .................................................                           11.95
      Intracavitary treatment planning for contact x-ray therapy including sigmoidoscopy or
      proctoscopy
# X305 - first application ................................................................... 170.85
# X306 - repeat application ...............................................................     85.50
# X337 Placement of fiducial markers into the prostate......................                   122.30
# X338 Placement of rectal spacer .....................................................        223.65
# X339 Placement of fiducial markers into the vagina ........................                   76.45
      Payment rules:
      X337, X338 and X339 include any imaging or other guidance required – if performed.
      Obtaining and interpreting any images in conjunction with X337, X338 and X339 are not
      eligible for payment to any physician.

Master, record 6687. Record Layout PDF, page 1.

X30420250401999999990000011950000000000000000000000000000000000000000000000

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.