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G290
G290 – LDL apheresis - more than 5 per year
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G290 is for LDL apheresis, specifically for services more than 5 per year. Note: LDL apheresis is an insured service only for the treatment of homozygous familial hypercholesterolemia.
When to Use
- Use G290 for the sixth or subsequent LDL apheresis session performed within a single calendar year for a patient with confirmed homozygous familial hypercholesterolemia.
- Use G287 for the first five sessions of LDL apheresis in a calendar year, then switch to G290 for all subsequent sessions.
Common Pitfalls
- Billing G290 for patients without a documented diagnosis of homozygous familial hypercholesterolemia will result in automatic rejection or clawbacks during audit.
- Failing to track the cumulative count of G287 and G290 sessions per calendar year often leads to incorrect code selection for the sixth procedure.
- Attempting to bill G290 for hypercholesterolemia that is not homozygous is a non-insured service and will be rejected.
Billing Tips
- Ensure your billing software tracks the annual count of G287/G290 sessions to trigger the switch to G290 automatically after the fifth session.
- If the procedure is performed after hours, remember to append the appropriate premium (E409, E410, E412, or E413) to the G290 claim to capture the 20-75% procedural fee increase.
Provider Fee$41.80
Effective: April 1, 2025
Category
J. Diagnostic and Therapeutic Procedures
Subcategory
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Service Type
Procedure
Code Classes
Diagnostic and Therapeutic Procedures
LDL apheresis is an insured service only for the treatment of homozygous familial hypercholesterolemia.
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