G460 – Unilateral ocular photodynamic therapy
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Ocular photodynamic therapy (PDT) is, subject to the limitations set out below, an insured service when rendered by an ophthalmologist. PDT must include completion and submission of patient registration and drug requisition forms, establishment of intravenous access, supervision of drug infusion and personal application of non-thermal diode laser for activation of verteporfin.
When to Use
- Use G460 when performing unilateral ocular photodynamic therapy for predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration, pathologic myopia, or ocular histoplasmosis.
- Use G460 for repeat therapy sessions provided that recurrent or persistent CNV leakage is confirmed via fluorescein angiography and documented by retinal photographs.
Common Pitfalls
- Billing G460 on the same day as G461 (bilateral PDT) will result in a rejection or payment at nil, as G460 is strictly for unilateral application.
- Failure to retain retinal photographs in the permanent medical record prior to the procedure is a common audit trigger that leads to full recovery of the $330 fee.
- Attempting to bill G379 in conjunction with G460 will result in the G379 being paid at nil, as it is considered bundled into the PDT service.
Billing Tips
- Always bill your assessment and the necessary fluorescein angiography alongside G460, as these are explicitly permitted as add-ons despite the comprehensive nature of the PDT procedure.
- Ensure the documentation explicitly states the classic subfoveal CNV area is >= 50% of the total lesion, as this is the primary clinical requirement for OHIP eligibility.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
Completion and submission of patient registration and drug requisition forms.
The area of classic subfoveal CNV being equal to or greater than 50% of the total CNV lesion must be determined by fluorescein angiography and documented by retinal photographs retained on the patient's permanent medical record.
For each repeat therapy, recurrent or persistent CNV leakage must be detected by fluorescein angiography and documented by retinal photographs retained on the patient's permanent medical record.
If retinal photographs are not made prior to the procedure and retained on the patient's permanent medical record, the procedure is not eligible for payment.
1. G379 rendered to same patient in conjunction with G460 or G461 is an insured service payable at nil.
2. G460 rendered to same patient same day as G461 is an insured service payable at nil.
3. Assessments and angiography are payable in addition to PDT. Retinal photography is insured as a specific element of the assessment and is not payable separately.
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