G020 – Progesterone
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G020 is for a quantitative progesterone laboratory test. According to the Schedule of Benefits, this test is an insured service eligible for payment only when rendered by a physician in their own office for their own patient. It is specifically listed under 'Reproductive medicine' and is only payable to physicians for whom point-of-care testing is necessary for their practice. This service is not insured when rendered to support in-vitro fertilization or artificial insemination services.
When to Use
- Use G020 for point-of-care monitoring of luteal phase progesterone levels in patients with recurrent pregnancy loss or luteal phase deficiency where immediate clinical decision-making is required.
- Use G020 when assessing ovulation induction efficacy in a non-IVF/non-IUI clinical setting where the physician performs the analysis in-office.
Common Pitfalls
- Billing G020 for patients undergoing IVF or artificial insemination will trigger automatic rejections or audit recovery, as these services are explicitly excluded under Regulation 552.
- Submitting G020 when the test is sent to an external laboratory rather than performed as point-of-care in the physician's office is a violation of the Schedule of Benefits.
- Failing to document the specific numerical result and the subsequent clinical action taken based on that value will lead to recovery of the $14.50 fee during a Ministry audit.
Billing Tips
- Ensure your practice is registered and recognized for point-of-care testing, as G020 is only payable to physicians for whom this testing is deemed necessary for their specific practice profile.
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 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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