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Schedule of Benefits Changes - February 1, 2003

Botulinum Toxin - intramuscular injection with botulinum toxin into peripheral muscle for treatment of focal spasticity secondary to an upper motor neuron disorder. The procedure is an insured service payable at nil unless rendered personally by a pediatrician, neurologist or physical medicine specialist or a physician with equivalent post-graduate training and experience with neuromuscular disorders. Maximum one botulinum treatment of one or more muscles per patient every 10 weeks.

G597 - Injection into first muscle per day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $20.00

G598 - each additional muscle same day as G597 when G597 is payable in full
(maximum 8 per day) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .add . . . . . $10.00

G599 - with electromyographic (EMG) guidance of injection into one or more muscles when G597 is payable in full (maximum 1 per day) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .add . . . . . . $20.00

E543 - use of disposable EMG hypodermic electrode outside hospital when G599 is payable in full (maximum 1 per patient per day) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30.00

Note : Any EMG code other than G599 claimed for the same day same patient as botulinum toxin injection is performed is an insured service payable at nil.

[Commentary :
The above definitions and fees for botulinum toxin injection have been introduced on an interim basis and will be subject to a joint review by the ministry and the Ontario Medical Association on or before February 1, 2004.]

The content under location and injection of peripheral motor nerves for reduction of spasticity under the Physical Medicine sub-section on page J49 will be changed to the following on February 1, 2003 :

Chemodenervation injection of individual peripheral motor nerve using phenol, ethyl alcohol or similar non-anesthetic chemical agents for reduction of focal spasticity, and may include electromyography (EMG) guidance of injection(s):

G485 - first major nerve and/or its branches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $44.55

G486 - each additional major nerve and/or its branches same day . . . . . . . . . . . . . . . add . . . . $27.95

Repeat or additional procedure within 30 days of previous chemodenervation injection :

G487 - first major nerve and/or its branches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $27.95

G488- each additional major nerve and/or its branches same day . . . . . . . . . . . . . . . add . . . . .$18.45


Ontario Ministry of Health and Long-Term Care
© 2002 Queen's Printer for Ontario  |  Last Modified:  06/27/2012 17:29:36