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G421

G421Subconjunctival or sub-Tenons capsule injection

OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits

G421 is a diagnostic and therapeutic procedure for a subconjunctival or sub-Tenon's capsule injection. A note on page specifies that for bilateral procedures, 50% of the listed benefit should be added to the claim. This rule also applies to G429 and G430.

When to Use

  • Use G421 for the administration of subconjunctival antibiotics or steroids to treat localized ocular inflammation or post-operative infection.
  • Use G421 when performing a sub-Tenon's injection of anesthetic or corticosteroid for ocular surgery or management of chronic uveitis.

Common Pitfalls

  • Failing to apply the 50% bilateral premium when injecting both eyes during the same encounter, which leads to underpayment.
  • Billing G421 in conjunction with a minor procedure code that already includes the injection as a component of the global fee, resulting in a rejection for duplicate billing.
  • Attempting to bill an office visit code (A007) on the same day as G421 without documenting a separate, medically necessary assessment unrelated to the injection procedure.

Billing Tips

  • Ensure the claim includes the bilateral indicator if performing the procedure on both eyes to trigger the 50% additional benefit correctly.
  • If the injection is performed during an emergency visit, append the appropriate Special Visit Premium from Tables I-X to maximize the claim value.
Provider Fee$27.70

Effective: April 1, 2025

Category

J. Diagnostic and Therapeutic Procedures

Subcategory

DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Service Type

Procedure

Code Classes

Diagnostic and Therapeutic Procedures

for bilateral procedures, add 50% of the listed benefit.

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