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G204
G204 – Ophthalmic test - quantitative
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Quantitative ophthalmic tests performed as a diagnostic procedure for allergies.
When to Use
- Use G204 when performing quantitative diagnostic testing specifically for ocular allergies, distinct from the qualitative assessment covered by G203.
- Apply this code when the clinical documentation confirms a quantitative measurement of the allergic response rather than a simple screening or observation.
Common Pitfalls
- Billing G204 in conjunction with a general office visit (A007) is often flagged if the documentation does not clearly delineate the diagnostic procedure from the assessment.
- Submitting G204 for routine vision screening or non-allergic ophthalmic examinations will result in rejection as it is strictly restricted to allergy diagnostics.
Billing Tips
- Ensure the diagnostic report explicitly states the quantitative nature of the test to support the claim against potential post-payment audits.
- If performing multiple tests, verify that the clinical record justifies the quantitative approach over the qualitative G203 to avoid duplicate billing scrutiny.
Provider Fee$12.40
Effective: April 1, 2025
Category
J. Diagnostic and Therapeutic Procedures
Subcategory
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Service Type
Diagnostic
Code Classes
Diagnostic and Therapeutic Procedures
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