Z114

PDF page 455 / J41

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 ENDOCRINOLOGY AND METABOLISM
                                                                                                Fee
+ G493 ACTH test - single or multiple, per injection ...........................                 6.25
+ G337 Antidiuretic hormone response test including the 8 hour water
         deprivation test ...................................................................   16.95
+ G338 Clonidine suppression test (for the investigation of
         pheochromocytoma) - with physician present - includes
         venipunctures .....................................................................    24.90
    Glucagon test
+ G494 - (Type A) for carbohydrate response ...................................                 10.20
+ G495 - (Type B) for hypertension, pheochromocytoma and
         insulinoma provocative test (including cold pressor test) ...                          42.30
  G358 Growth hormone exercise stimulation test with physician
          present (includes venipunctures) .......................................              24.90
+ G340 Histamine test to include a control cold pressor test ..............                     45.45
+ G341 Hypertonic saline infusion test ................................................         16.95
+ G497 Insulin hypoglycemia pituitary function test with or without TRH
          and LHRH alone or in combination ....................................                 49.80
+ G318 Insertion of non-biodegradable long-acting subcutaneous
          medication implant .............................................................      42.00
          Payment rules:
          1. G318 is not eligible for payment when provided by injection.
          2. G318 is only eligible for payment when the service is personally rendered by the physician
          [Commentary:
          1.Nexplanon is an example of non-biodegradable long-acting subcutaneous medication
            implant.
          2.Zoladex is an example of a biodegradable medication implant for which G318 is not eligible
            for payment.
          3.See Z114 and Z115 for removal of long-acting subcutaneous medication implant.
          4.For injections that do not meet the above criteria for G318, see Injections listings on page
            J54 of the Schedule.]
Diabetes monthly management
The provision to a patient, patient's relative(s), patient's representative or other caregiver(s) of medical
advice, direction or information by telephone or otherwise, in which a change in the frequency or dose
of insulin therapy is initiated regarding a patient treated with insulin injections (2 or more daily) or
insulin by pump (a "contact").

PDF page 566 / M16

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
SKIN AND SUBCUTANEOUS TISSUE
                                                                              Asst        Surg          Anae
    Zone 1 repair of digit
      A complex repair of zone 1 of the digit is repair of an injury without soft tissue loss that requires
      a minimum of 20 minutes of time to perform the repair procedure.
  Z189 Complex repair, digit, zone 1 repair, without soft tissue loss,
          per digit............................................................................... 101.15
       Note:
       1.Other repair fee codes are not eligible for payment in addition to Z189 for the same zone 1
         injury.
       2.For digit tip amputations or a zone 1 injury with soft tissue loss that would requirement
         advancement, graft or other surgical method of closure, see specific listings for surgical
         repair in the Integumentary System or Musckuloskeletal System Surgical Procedures
         sections of this Schedule.
       Payment rules:
       1.Wound and ulcer debridement services, Z128, Z129, and Z114 are not eligible for payment in
         addition to Z187, Z188 or Z189 for the same repair.
       2.Z187, Z188, and Z189 include removal of any foreign bodies in the wound, irrigation and
         debridement when rendered.
       3.Plastic Surgery Procedure services (i.e. R150, R151, R152, R153 and R154) are not eligible
         for payment for any laceration repair.
       Medical record requirements:
       Z187, Z188, and Z189 are only eligible for payment where the minimum time requirements
       involved in the repair service are documented in the patient's permanent medical record. The
       time requirement includes time to perform the repair exclusive of time spent rendering any
       other separately billable service.
       [Commentary:
       For laceration repairs that do not meet the above criteria for a complex laceration repair, see
       Repair of Lacerations listings on page M15.]
    Muscle repair
# R525 - Simple muscle repair(s) to include repair of involved skin .           6           97.05          7
# R528 - Complex (see General Preamble GP12)............................        6           I.C            6

Master, record 6939. Record Layout PDF, page 1.

Z11420260401999999990000027650000000000000000000000000000000000000000000000

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.