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G426
G426 – Glaucoma provocative tests
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
A diagnostic procedure listed as 'Glaucoma provocative tests, including water drinking tests' in the OHIP Schedule of Benefits.
When to Use
- Use G426 when performing a water drinking test to assess for suspected narrow-angle glaucoma or to evaluate intraocular pressure fluctuations.
- Use G426 as a diagnostic adjunct when standard tonometry is inconclusive in a patient with clinical signs of glaucoma.
Common Pitfalls
- Do not bill G426 in conjunction with a comprehensive eye exam (A035) if the test is considered a routine part of the assessment rather than a distinct diagnostic procedure.
- Avoid billing G426 for routine intraocular pressure checks, as these are included in the global fee for general ophthalmological assessments.
Billing Tips
- Ensure the medical necessity for the provocative test is clearly linked to a specific diagnostic suspicion, as G426 is subject to audit if billed frequently without supporting clinical findings.
Provider Fee$9.70
Effective: April 1, 2025
Category
J. Diagnostic and Therapeutic Procedures
Subcategory
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Service Type
Procedure
Code Classes
Diagnostic and Therapeutic Procedures
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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