G291 – Occipital nerve - first block per day in excess of 16 per calendar year
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Occipital nerve - first block per day in excess of 16 per calendar year may be payable on an independent consideration (IC) basis upon submission to the ministry of a written recommendation of an independent expert as described below. (maximum 1 per day to a maximum of 16 blocks for a single IC request). A new written recommendation is required on an IC basis each time the number of first blocks exceeds 16
When to Use
- Use G291 only after the patient has exhausted the 16-block annual limit covered under G264.
- Use this code when you have obtained a formal written recommendation from an independent pain specialist confirming the clinical necessity for continued occipital nerve blocks beyond the standard annual threshold.
Common Pitfalls
- Billing G291 before the 16th instance of G264 is completed, which will result in an automatic rejection or recovery during audit.
- Failing to secure a fresh, independent expert recommendation for every new cycle of blocks exceeding the 16-count limit, as the ministry requires updated justification for ongoing treatment.
- Submitting G291 without the required IC documentation, as the claim will not process as a standard fee-for-service item.
Billing Tips
- Ensure the independent expert's recommendation explicitly addresses the multidisciplinary management of the patient's chronic pain to satisfy the specific criteria for G291.
- Remember that G292 is only payable when G291 is successfully processed, so ensure your billing software links these correctly to avoid nil payments on the secondary block.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
Payable on an independent consideration (IC) basis upon submission to the ministry of a written recommendation of an independent expert.
A new written recommendation is required on an IC basis each time the number of first blocks exceeds 16.
For the purpose of G291, an '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.
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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