G023 – Testosterone, free
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Per the heading for LABORATORY MEDICINE IN PHYSICIAN'S OFFICE, a laboratory service ('test') 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. G023 is for a free testosterone test. It is listed under the 'Reproductive medicine' subsection. A note specifies that tests under this subsection are only payable to those physicians where point of care testing is necessary for their practice. This service is uninsured when rendered to support in-vitro fertilization services or artificial insemination services.
When to Use
- Use G023 when performing point-of-care free testosterone testing in your own office for a patient where immediate results are clinically necessary for management.
- Use this code for in-office monitoring of patients on testosterone replacement therapy where immediate titration decisions are required during the visit.
Common Pitfalls
- Billing G023 for tests sent to an external laboratory will result in rejection, as this code is strictly for point-of-care testing performed in your own office.
- Submitting G023 for patients undergoing fertility treatments or artificial insemination will trigger a rejection, as these are specifically excluded under Regulation 552.
- Failure to document the specific test result and your clinical interpretation in the chart will lead to clawbacks during an audit of laboratory services.
Billing Tips
- Ensure your practice profile supports the necessity of point-of-care testing, as the Ministry restricts payment for reproductive medicine codes to physicians where this is a demonstrated clinical requirement.
Effective: April 1, 2025
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.
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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