G026 – 17-OH progesterone
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
17-OH progesterone is a laboratory service ('test') that 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. As a 'Reproductive medicine' test, it is only payable to those physicians where point of care testing is necessary for their practice.
When to Use
- Use G026 when performing point-of-care 17-OH progesterone testing in-office for the monitoring of congenital adrenal hyperplasia in your own established patients.
- Use this code when immediate diagnostic results are clinically necessary for patient management, provided you are not utilizing an external laboratory facility.
Common Pitfalls
- Billing G026 for any testing related to IVF or artificial insemination cycles will result in automatic rejection and potential audit recovery as these are explicitly excluded.
- Submitting G026 when the specimen is sent to an external laboratory is incorrect; this code is strictly for in-office point-of-care testing performed by the physician or their substitute.
- Failure to document the specific test result and the subsequent clinical decision in the patient record is a frequent cause for clawbacks during OHIP audits.
Billing Tips
- Ensure your practice specialty aligns with the requirement for point-of-care reproductive medicine testing to avoid eligibility denials for G026.
- Do not bill G026 in conjunction with G015-G025 or G027-G029 if the testing was performed as part of a single diagnostic panel, as these codes are intended for specific, distinct laboratory procedures.
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.
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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