This is an official version.

Copyright © 2006: Queen’s Printer,
St. John's, Newfoundland and Labrador, Canada

Important Information
(Includes details about the availability of printed and electronic versions of the Statutes.)

Newfoundland Regulation 1997


NEWFOUNDLAND REGULATION 128/97

NEWFOUNDLAND REGULATION 128/97

Medical Care Insurance Physicians and
Fees Regulations (Amendment)

under the
Medical Care Insurance Act

(Filed October 24, 1997)

Under the authority of section 48 of the Medical Care Insurance Act, the Newfoundland Medical Care Commission with the approval of the Minister of Health makes the following regulations.

Dated at St. John’s, October 15, 1997.

R.M. Crosbie
Chairman
Newfoundland Medical Care Commission

REGULATIONS

Analysis


        1.   Sch A Amdt.
In-Hospital Diagnostic
Procedure Added


CNR 1193/96
as amended

        1. (1) Section 1.1 of the Preamble to Schedule A of the Medical Care Insurance Physicians and Fees Regulations is amended by deleting the sentence “The remaining portion of Payment Schedule I is represented by the “MCP In-Hospital Diagnostic Schedule.”.

             (2)  Section 1.3 of the Preamble to Schedule A of the regulations is amended by adding immediately after the word and comma “Procedures,” the words and comma “In-Hospital Diagnostic Procedures,”.

             (3)  Schedule A of the regulations is amended by adding immediately after the section referring to “Diagnostic and Therapeutic Procedures” the following:

                                                                                                                                                                                        April 1, 1990

 

IN-HOSPITAL DIAGNOSTIC PROCEDURES

 

INTRODUCTION

 

 

 

1.   In-Hospital Diagnostic Procedures are insured services by MCP and are payable according to the rates outlined in this schedule.

 

2.   Only those providers who are recognized by the Newfoundland Medical Board as specialists in that particular field, e.g. Cardiologists interpreting ECG’s, are permitted to bill for these services.

 

3.   The procedures listed in this section are to be billed only when the services are rendered in-hospital.  If the same procedures are performed in a non-hospital environment and are insured services by MCP, they must be billed using the fee codes and fees in the Diagnostic and Therapeutic section of the Medical Payment Schedule.

 

4.   Claims must be submitted within 90 days from the date the service is completed.  When claims are returned to you for additional information or correction, a further three months is granted for resubmission.

 

5.   Hospital Number - This is a three digit number which identifies the hospital where services are rendered.  It must be inserted on the claim form.



                                                                                                                                                                                        April 1, 1990

ELECTROCARDIOGRAMS

 

 


Code

 

 

  Fee     

 

 

 

 


 

 

 

 

 


56000

 

Electrocardiogram interpretation........................................................................................

 

      6.84

 

 

 

 

 

56010

 

Stress electrocardiogram (Physician present during testing procedure)

Before and after exercise (Master's criteria, Levy Ischemia or Frasher Exercise test) includes complete resting tracing and multiple leads taken immediately and 3 and 6 minutes post exercise...............................................................................

 

 

 

 

      20.70

 

 

 

 

 

56020

 

Maximal stress testing ‑ with treadmill or ergometer and oscilloscopic continuous monitoring, including E.C.G.'s taken during the procedure and resting E.C.G.'s before and after the procedure.................................

 

 

 

      41.40

 

 

 

 

 

 

 

 

CONTINUOUS AMBULATORY E.C.G. MONITORING

 

 

 

 

 

 

 

 

56050

 

Interpretation of continuous ambulatory E.C.G. scan....................................................

 

      25.30

 

 

 

 

 

56060

 

Partial review of scan and interpretation..........................................................................

 

      37.40

 

 

 

 

 

56070

 

Complete review of scan.....................................................................................................

 

      63.25

 

 

 

 NOTE:    All E.C.G.  tracings performed in hospital are to be claimed using this schedule, regardless of where the interpretation is performed.

 

 

 

 



                                                                                                                                                                                        April 1, 1990

ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES

 


Code

 

 

Fee

 

 

 

 


 

 

 

 

 

56500

 

Schedule A:

Complete procedure, e.g. conduction studies on two or more nerves and E.M.G. of multiple muscles; detailed study of neuromuscular transmission...

 

 

     

 

      90.00

 

 

 

 

 

56525

 

Schedule B:

Limited procedure, e.g. conduction studies on a single nerve plus limited needle electrode, examination in one area; conduction studies on two nerves without E.M.G..............................................................................................

 

 

 

 

      60.00

 

 

 

 

 

56550

 

Schedule C:

Short procedure, e.g. stimulation of a single nerve; repeat E.M.G. of one or two muscles without nerve conduction................................................................

 

 

 

24.15

 

 

 

 

 

56575

 

Single fibre E.M.G...........................................................................................................

 

70.00

 

 

 

 

NOTE: When claiming for the above procedures, consultation or other assessment may not also be claimed unless such assessment is specifically requested by the referring physician or the nature of the illness requires such assessment.

 

 

 

 



                                                                                                                                                                                        April 1, 1990

ELECTROENCEPHALOGRAPHY

 


Code

 

 

Fee

 

 

 

 


 

 

 

 

 


57000

 

Electroencephalogram interpretation................................................................................

 

      19.85

 

 

 

 

 

57010

 

With activating of sleep inducing drugs and/or sleep deprivation (add)...................

 

      13.69


 

 

 

 

 


57020

 

Inserting subtemporal needle electrodes (add).............................................................

 

      13.69

 

 

 

 

 

 

 

Polygraphic recording of three parameters in addition to E.E.G. (such as re-spiration, eye movement, E.C.G. muscle movement)

 

 

57030

 

- one item.......................................................................................................................

 

      7.82

 

 

 

 

 

57035

 

‑ two items.....................................................................................................................

 

      15.64

 

 

 

 

 

57040

 

‑ three or more items.....................................................................................................

 

      22.77

 

 

 

 

 

 

 

 

SLEEP APNEA STUDIES

 

 

 

 

 

 

 

 

57050

 

Sleep apnea (overnight study) with continuous monitoring of oxygen saturation and ventilation ‑ to include physician attendance at set up, mon-itoring and interpretation (extra or special visits not chargeable)

 

 

 

      114.71

 

 

 

 

 

57060

 

Interpretation of above only.............................................................................................

 

      42.67

 



                                                                                                                                                                                        April 1, 1990

EVOKED POTENTIAL STUDIES

 


Code

 

 

  Fee

 

 

 

 


 

 

 

 

 

57500

 

Simple average evoked potential studies with one sensory modality of stimulation (interpretation by physician)......................................

 

 

      20.59

 

 

 

 

 

57510

 

Complex evoked potential studies involving several sensory modalities, multiple threshold determinations of more than four simultaneous channels of recording (partial supervision by physician and interpretation)..........................................................

 

 

 

      53.82

 

 

 

 

 

57520

 

Complex evoked potential studies performed completely under the direct supervision of a physician and interpretation.............................

 

 

      107.93

 

 

 

 

 

 

 

 

OBSTETRICS

 

 

 

 

 

 

 

 

57700

 

*Non‑stress test ‑ interpretation only.........................................................................

 

      6.84

 

 

 

*    If the non‑stress test is done in conjunction with a consultation, the interpretation is considered to be included in the consultation fee.

 

 

 



 

 

Amount includes professional fee only. The technical aspect is not an insured service by MCP.

 

Professional fee ‑ The benefit for professional services including responsibility for quality control and technician training, interpretation of the results of the tests and consultation between the physician responsible for the tests and the referring physician concerning the results of the tests.

 

NOTES:

 

1.   The benefits for simple spirometry and standard lung mechanics represent the best of three recorded tests results with or without bronchodilator.

 

2.   The following tests are considered to be specific and require the individual ordering notation for each test parameter.

 

3.   The benefit for standard lung mechanics includes simple spirometry.

 

4.   Vital capacity and flow volume loop cannot be claimed at the same time.

 


Code

 

 

    Fee

 

 

 

 

58000

Simple spirometry e.g. vital capacity, without permanent record by transducer equipment FVC, FEV, MVV (MBC) etc................................................

 

 

      1.61

 

 

Standard lung mechanics (with permanent record)

 

 

58010

- Vital capacity, FEV, FEV/FVC..............................................................................

 

      4.14

 

 

 

 

58015

- Repeat of 58010 after bronchodilator.................................................................

 

      1.67

 

 

 

 

58020

- 58010 plus MMEFR calculation..........................................................................

 

      6.87

 

 

 

 

58025

- Repeat of 58020 after bronchodilator.................................................................

 

      2.67

 

 

 

 

58030

- MVV done together with 58010 or 58020...........................................................

 

      .81


 

 

 

              NOTE:       58010 and 58020 cannot be billed together.

 

 

 

58040

 

- Flow volume loop (FVC, FEV, FEV/FVC, V30 V25)..........................................

 

      10.40

 

 

 

 

 

58050

 

- Repeat of 58040 after bronchodilator..............................................................

 

      3.67

 

 

 

 

 


 

 

Complex Lung Mechanics

 

 

58100

 

- Functional residual capacity by gas dilution method.......................................

 

      10.67

 

 

 

 

 

58110

 

- Functional residual capacity by body plethysmography................................

 

      10.67

 

 

 

 

 

58120

 

- Airways resistance by plethysmography or estimated using esophageal catheter...............................................................................................................

 

 

      5.87

 

 

 

 

 

58130

 

Lung Compliance (pressure volume curve of the lung from TLC to FRC)

 

      27.72

 

 

 

 

 

58140

 

Carbon monoxide diffusing capacity by steady state of rest..................................

 

      6.67

 

 

 

 

 


58150

 

Carbon monoxide diffusing capacity by single breath method...............................

 

 

      10.67Code 

 

 

 

     Fee

 

 

 

 

 

 

 

Pulmonary Function Response to O2 and CO2

 

 

58160

 

CO2 ventilatory response........................................................................................

 

      8.40

 

 

 

 

 

58170

 

O2 ventilatory response (physician must be present).........................................

 

      12.54

 

 

 

 

 

 

 

Exercise Assessment ‑ physician must be in attendance at all times

 

 

58180

 

Exercise diffusing capacity......................................................................................

 

      10.06

 

 

 

 

 

58200

 

Stage I: Graded exercise to maximum tolerance exercise (must include HR, ventilation and E.C.G. at rest and at each workload: E.C.G. monitored at least 5 minutes post exercise).........................................................................

 

 

 

      31.85

 

 

 

 

 

58210

 

Same as 58200 plus 58010, 58020 or 58040 before and after exercise................

 

      37.72

 

 

 

 

 

58220

 

Stage II: Repeated steady state graded exercise (must include heart rate, ventilation, VO2, VCO2, BP, E.C.G. endtidal and mixed venous CO2 at rest, 3 levels of exercise and recovery).............................................................................

 

 

 

      43.64

 

 

 

 

 

58230

 

Stage III: Same as 58220 plus arterial blood gases, PH and bicarbonate or lactate.........................................................................................................................

 

 

      65.44

 

 

 

 

 

58240

 

Exercise induced asthma assessment (workload sufficient to achieve a heart rate of 85% of max.; measurement of 58010, 58020 or 58040 before exercise and 5‑10 minutes post exercise)..............................................................................

 

 

 

      15.54

 

 

 

 

 

 

 

Gas Analysis

 

 

58270

 

Arterial puncture for blood gas analysis..............................................................

 

      6.52

 

 

 

 

 

58280

 

Blood gas analysis: pH, PO2, PCO2, bicarbonate and base excess

 

        -

 

 

 

 

 

58290

 

Arterialized venous blood sample collection (e.g. ear lobe)..............................

 

        

 

 

 

 

 

58300

 

A‑a oxygen gradient (measurement of RQ by sampling mixed expired gas and using alveolar air equation).............................................................................

 

 

      16.79

 

 

 

 

 

58310

 

Estimate of venous admixture (Qs/Qt) breathing pure oxygen..........................

 

      10.93

 

 

 

 

 

58320

 

Mixed venous PCO2 by the rebreathing method.................................................

 

      2.53

 

 

 

 

 

58330

 

O2 saturation by oximeter (at rest and exercise)...................................................

 

      6.52

 

 

 

 

 

58340

 

Standard O2 consumption and CO2 production...................................................

 

      5.52

 

 

 

 

 

58350

 

Histamine or methylcholine threshold test...........................................................

 

      22.54