G287 – LDL apheresis - initial and repeat
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G287 is for initial and repeat LDL apheresis sessions. It is limited to a maximum of 5 services per patient per year. As stated in the note on , LDL apheresis is an insured service only for the treatment of homozygous familial hypercholesterolemia. Services in excess of this limit should be claimed using G290.
When to Use
- Use G287 for the first five sessions of LDL apheresis per calendar year specifically for patients with a confirmed diagnosis of homozygous familial hypercholesterolemia.
- Use G287 for subsequent sessions within the same year until the five-session limit is reached, at which point you must transition to G290.
Common Pitfalls
- Billing G287 for patients with heterozygous familial hypercholesterolemia or other lipid disorders will result in automatic rejection, as it is strictly limited to the homozygous diagnosis.
- Exceeding the five-session annual limit under G287 will trigger a rejection; ensure you track the cumulative count across the calendar year to switch to G290 appropriately.
- Failing to document the specific diagnosis of homozygous familial hypercholesterolemia in the patient record creates a high audit risk for this procedure.
Billing Tips
- If the procedure is performed after-hours or on weekends, ensure you append the appropriate E-code (E409 or E410) to the G287 claim to capture the 50% or 75% premium, provided the non-elective criteria are met.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
LDL apheresis is an insured service only for the treatment of homozygous familial hypercholesterolemia.
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