G021 – HCG (human chorionic gonadotrophins) quantitative
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
A laboratory service for the quantitative measurement of HCG (human chorionic gonadotrophins). This test is an insured service only when rendered by a physician, or a substituting physician, in their own office for their own patient. It is specifically noted that G021 is not eligible for payment for pregnancy tests (see G005). This service is only payable to physicians for whom point of care testing is necessary for their practice. This service is uninsured when rendered to support in-vitro fertilization or artificial insemination services.
When to Use
- Use G021 for monitoring gestational trophoblastic disease or non-seminomatous germ cell tumors where quantitative serial HCG levels are clinically required for immediate management.
- Use G021 for the urgent assessment of suspected ectopic pregnancy in a point-of-care setting when immediate quantitative data is required to determine the necessity of transfer or intervention.
Common Pitfalls
- Billing G021 for routine pregnancy confirmation or screening will trigger an automatic rejection, as G005 is the mandated code for pregnancy testing.
- Submitting G021 for tests related to fertility treatments, including IVF or artificial insemination, is a violation of the Schedule of Benefits and will result in recovery during an audit.
- Claiming G021 for laboratory services performed by an external lab rather than in your own office will result in a rejection, as this code is restricted to point-of-care testing.
Billing Tips
- Ensure the clinical indication for the quantitative measurement is clearly documented in the chart to justify why a qualitative G005 test was insufficient for the patient's management.
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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