G016 – TSH (thyroid stimulating hormone)
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
A laboratory service (“test”) set out in this section is an insured service eligible for payment only when rendered by a physician (“the original physician”), or by a physician substituting for the original physician, who performs the test in the original physician's own office for the physician's own patient. This specific test is for TSH (thyroid stimulating hormone).
When to Use
- Use G016 when performing an in-office TSH test for a patient where the specimen is processed within your own office rather than sent to an external laboratory.
- Use this code for point-of-care thyroid monitoring where immediate results are required to guide an urgent medication adjustment during the same patient encounter.
Common Pitfalls
- Billing G016 for tests sent to an external laboratory like LifeLabs or Dynacare is a common error; these must be billed by the laboratory, not the physician.
- Failing to document the specific test result, your interpretation, and the resulting clinical decision in the chart will lead to clawbacks during an audit.
- Submitting G016 for tests related to fertility treatments or artificial insemination is prohibited under Regulation 552 and will result in automatic rejection.
Billing Tips
- Ensure your office is equipped to perform the test on-site, as G016 is strictly for physician-performed office testing and not for requisitioning external services.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Laboratory
Diagnostic and Therapeutic Procedures
Laboratory services are only eligible for payment if the result of the test(s), the physician's interpretation of the results of the test(s) and the treatment decision based on the test results are documented in the patient's permanent medical record.
Tests listed under 'Reproductive medicine' and 'Point of care drug testing' are only payable to those physicians where point of care testing is necessary for their practice.
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