G126 – Digital photoplethysmography - professional component
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Digital photoplethysmography (G126) represents the professional component for a non-invasive cardiography test used to evaluate blood flow. This service is billable on a per-extremity basis. The fee covers the physician's work in interpreting the test results and preparing a report. The corresponding technical component is billed separately using G127. As per the General Preamble (, ), this service is a 'professional component' and must be rendered accordingly.
When to Use
- Use G126 when you are providing the formal interpretation and written report for digital photoplethysmography performed in a clinical setting.
- Bill G126 per extremity when evaluating peripheral vascular status, ensuring the number of units claimed matches the number of limbs assessed.
Common Pitfalls
- Billing G126 without a corresponding G127 technical component claim often triggers an audit, as the professional component requires a completed technical procedure.
- Claiming G126 for a screening purpose without a documented clinical indication of vascular insufficiency will lead to rejection for lack of medical necessity.
Billing Tips
- Ensure your report is signed and dated separately from the technical tracing to satisfy the requirements for the professional component.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Diagnostic
Diagnostic and Therapeutic Procedures
The medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
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