G381 – Standard chemotherapy
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G381 is for standard chemotherapy, defined as the pharmacologic therapy of malignancy or autoimmune disease with administration supervised by a physician for intravenous infusion. The physician must be available to intervene in a timely fashion at the initiation and for the duration of the prescribed therapy to manage immediate and delayed toxicities. Chemotherapy and patient assessment provided by a physician includes all patient assessments by any physician for a 24 hour period following treatment administration. The service includes venipuncture and establishment of any vascular access line. Examples of standard chemotherapy agents include cyclophosphamide, methotrexate, fluorouracil, leucovorin, and zoledronic acid. See also G281 for additional agents, G345 for complex therapy, and G359 for special agent therapy.
When to Use
- Use G381 for the initial administration of a standard chemotherapy agent such as cyclophosphamide or methotrexate for malignancy or autoimmune disease.
- Use G381 when providing physician supervision for intravenous infusion of qualifying agents, which includes the establishment of vascular access and all related patient assessments for the subsequent 24-hour period.
Common Pitfalls
- Billing an assessment code (e.g., A007) on the same day as G381 is a common error, as G381 includes all patient assessments for 24 hours post-administration.
- Attempting to bill G381 for non-biologic agents like blood products or insulin will result in rejection, as the code is strictly limited to specific pharmacologic therapies for malignancy or autoimmune disease.
- Submitting G381 alongside restricted codes G489 or G379 will trigger an automatic rejection due to billing interaction rules.
Billing Tips
- If multiple qualifying agents are administered in the same session, bill G381 for the first agent and use G281 for each subsequent qualifying monoclonal antibody or cytokine agent.
- Ensure documentation explicitly states the physician's presence and availability to manage toxicities throughout the infusion, as this is a mandatory requirement for the G381 fee.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The medical record must document that the physician supervised the administration and was available to intervene in a timely fashion at the initiation and for the duration of the prescribed therapy to manage toxicities.
As per general requirements on , all insured services must be documented in the medical record to establish that the service was provided, is the service for which the account is submitted, and was medically necessary.
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