G017 – Prolactin
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. 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.
When to Use
- Use G017 when performing an in-office point-of-care prolactin test that is clinically necessary for immediate management, provided you are not referring the specimen to an external laboratory.
- Use this code for urgent diagnostic assessment where the result directly dictates an immediate treatment decision within the same encounter.
Common Pitfalls
- Billing G017 for tests performed by an external laboratory or a private lab licensed under the Laboratory and Specimen Collection Centre Licensing Act is a direct violation of the Schedule of Benefits.
- Claiming G017 for prolactin testing related to in-vitro fertilization or artificial insemination services is strictly prohibited and will result in recovery during audit.
- Failure to document the specific test result, your interpretation, and the resulting treatment plan in the patient's record is a common cause for claim reversal.
Billing Tips
- Ensure your office equipment meets the criteria for point-of-care testing; G017 is only payable when the test is performed in your own office for your own patient.
- You may bill the appropriate Special Visit Premium (e.g., A990, A994) if the G017 service is provided during a qualifying special visit to your office.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Laboratory
Diagnostic and Therapeutic Procedures
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 must be documented in the patient's permanent medical record.
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