G101 – Home/self-care ventilation
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Home/self-care ventilation - to include positive and negative respirators and negative pressure respirators, diaphragmatic pacing devices and oscillating beds. The service includes: - Services rendered by the most responsible physician. - Routine clinic visits, home visits, telephone advice, communication with family and other medical personnel, care of supervised tracheostomy, counselling/psychotherapy of patients and relatives, and supervised ventilation when required. The specific elements of this service are all services performed by the most responsible physician during a one-week period in providing non-emergency care to the patient who is self administering ventilation therapy. This includes: - Providing any advice and supervision in regard to self-administration, whether by telephone or otherwise, even when initiated by the patient, patient's relative(s), or their representative. - Providing all premises, equipment, supplies and personnel used by the most responsible physician to perform these services.
When to Use
- Use G101 as a weekly management fee for patients stable on home positive pressure ventilation, such as CPAP or BiPAP, who require ongoing remote monitoring or periodic clinical oversight.
- Apply this code when managing patients with diaphragmatic pacing devices or oscillating beds to cover all routine communication, telephone advice, and non-emergency clinical supervision for that week.
Common Pitfalls
- Do not bill G101 for any week where the patient is admitted to a hospital, as this code is strictly for home/self-care; use daily hospital care codes instead.
- Avoid billing G101 in addition to standard office visit codes (A007) for the same patient in the same week, as G101 is an all-inclusive management fee intended to cover routine visits and communication.
- Do not attempt to bill G101 for emergency visits; these must be billed separately using appropriate visit codes and applicable Special Visit Premiums.
Billing Tips
- Bill G101 on a weekly basis to capture the comprehensive management of the patient's ventilation therapy, ensuring the date of service reflects the end of the seven-day period of care.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
When physicians are required to make emergency visits to see patients on home/self-care ventilation, the appropriate visit and premium fees may be claimed. When the patient requires hospitalization, the appropriate fees for daily care and in-hospital ventilation may be claimed instead of G101.
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