G423 – Contact lens fitting - One eye only
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G423 is for the fitting of a contact lens for one eye only, when the other eye has been previously fitted by the same physician. This service includes all follow-up care related to the fitting for a period of 3 months. As noted on , payment for contact lens fitting under G423 and G424 is restricted to specific medical conditions. It is not a universally insured benefit, and physicians must check with a Ministry of Health Medical Consultant to confirm patient eligibility before billing.
When to Use
- Use G423 when performing a follow-up fitting for a single eye in a patient with keratoconus who has already had the fellow eye fitted by you within the global period.
- Use G423 for patients with documented aphakia requiring a contact lens fitting for one eye after the other eye has been previously stabilized.
Common Pitfalls
- Billing G423 without prior written approval from a Ministry of Health Medical Consultant will result in automatic rejection or recovery during audit.
- Attempting to bill G423 for routine refractive errors like simple myopia or hyperopia is a non-insured service and will lead to claim rejection.
- Submitting G423 within the 90-day post-op period of a previous fitting for the same eye is considered double-billing, as follow-up is included in the initial fee.
Billing Tips
- Ensure the patient's specific medical condition (e.g., keratoconus, aphakia) is clearly documented in the chart to support the pre-authorization requirement.
- Always reference the Ministry of Health pre-authorization approval number in the claim notes to expedite processing and prevent manual review delays.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
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