G264 – Occipital nerve - first block
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Occipital nerve - first block per day, with a maximum of 1 per day and a maximum of 16 first blocks per calendar year.
When to Use
- Use G264 as the primary code for the first unilateral occipital nerve block performed on a patient during a single encounter.
- Use G264 when performing the initial block in a series of up to four total blocks (one G264 and three G265) per spinal level per day.
Common Pitfalls
- Billing G291 on the same day as G264 will result in a zero-dollar payment for G291, as G264 takes precedence.
- Exceeding the annual limit of 16 G264 claims per patient will trigger automatic rejections; track these carefully if managing chronic pain patients.
- Attempting to bill G265 without a payable G264 on the same day will cause the G265 claim to be rejected or paid at nil.
Billing Tips
- Always sequence G264 as the first procedure code to ensure the primary block is recognized before any G265 add-on units.
- If performing the procedure after hours, ensure you append the appropriate E409 or E410 premium to the G264 claim to capture the 50% or 75% fee increase.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
1. G265 and G292 are insured services payable at nil unless an amount is payable for G264 or G291 rendered to the same patient the same day.
2. When an amount is payable for G264, the amount payable for G291 rendered to the same patient on the same day is nil.
3. When an amount is payable for G265, the amount payable for G292 rendered to the same patient on the same day is nil.
4. For the purpose of G291, independent expert in respect of a patient is a physician who: a. has special knowledge and expertise in multidisciplinary management of chronic non-malignant pain; b. did not refer the patient for treatment; c. is not actively involved in management of the patient; and d. receives no direct or indirect financial benefit for the nerve block services being rendered to the patient.
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