G265 – Occipital nerve - each additional unilateral block
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
When to Use
- Use G265 for the second and third occipital nerve blocks performed on the same patient during the same session as the primary G264 block.
- Use this code when performing bilateral occipital nerve blocks, where G264 covers the first side and G265 covers the second side.
Common Pitfalls
- Billing G265 without a corresponding G264 on the same claim will result in an automatic rejection, as G265 is dependent on the primary code.
- Exceeding the maximum of 3 blocks per day or 48 blocks per calendar year will trigger a rejection or audit flag.
- Attempting to bill G292 on the same day as G265 is prohibited; G265 renders G292 payable at nil.
Billing Tips
- Ensure your claim includes G264 as the primary procedure to trigger payment for the additional G265 units.
- If performing multiple blocks, clearly document the specific nerves targeted to justify the use of the additional G265 units within the daily maximum.
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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