G292 – Occipital nerve - each additional unilateral block
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Represents an additional unilateral occipital nerve block per spinal level, which is only payable when G291 (first block after exceeding annual limit) is also payable in full for the same patient on the same day. G292 has a maximum of 3 services per day. Billing Conditions: - If G265 (additional block within annual limit) is paid for the same patient on the same day, G292 is payable at nil.
When to Use
- Use G292 when you have already billed G291 for the first occipital nerve block and need to perform up to three additional unilateral blocks on the same patient during the same session.
- Apply this code only when the patient has exceeded their annual limit for nerve blocks, necessitating the use of the G291/G292 series rather than the G264/G265 series.
Common Pitfalls
- Billing G292 when G265 has been paid on the same day will result in a zero-dollar payment, as G292 is strictly dependent on the G291 pathway.
- Exceeding the maximum of 3 services per day for G292 will result in automatic rejection or adjustment by the Ministry.
- Attempting to bill G292 without a corresponding G291 claim on the same service date will cause the claim to be paid at nil.
Billing Tips
- Ensure your claim submission includes G291 as the primary procedure to trigger the eligibility for the secondary and tertiary G292 units.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
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.
When an amount is payable for G264, the amount payable for G291 rendered to the same patient on the same day is nil.
When an amount is payable for G265, the amount payable for G292 rendered to the same patient on the same day is nil.
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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