G489 – Venipuncture - adolescent or adult
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Performance of venipuncture on a patient who is an adolescent (16 or 17 years of age) or an adult (18 years of age and older). This procedure is not insured when rendered for the monitoring of adverse effects resulting from a calorie restricted weight loss program. As a diagnostic and therapeutic procedure, this service includes the common and specific elements of an insured service as defined in the Schedule of Benefits. This procedure may be delegated to a physician's employee under specific conditions outlined in .
When to Use
- Use G489 when performing a standalone venipuncture for diagnostic purposes, such as drawing blood for routine laboratory investigations.
- Bill G489 when the procedure is performed on a patient aged 16 or older, distinguishing it from G480 which is reserved for children under 16.
Common Pitfalls
- Billing G489 for blood draws related to calorie-restricted weight loss programs will result in a rejection as these are considered non-insured services.
- Submitting G489 in the same month as W010 by any physician will trigger an automatic rejection due to the monthly management restriction.
- Attempting to bill G489 alongside a visit code that already includes the venipuncture as part of the procedure's inherent value can lead to audit scrutiny for unbundling.
Billing Tips
- G489 is eligible for payment on the same day as a counselling service, provided the venipuncture is medically necessary and distinct from the counselling encounter.
- Ensure that if the procedure is delegated to an employee, the requirements under GP62 are fully met to avoid clawbacks during a Ministry audit.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures, Delegated Procedure
Adolescent or adult
`G489` is not insured when rendered for the monitoring of adverse effects resulting from a calorie restricted weight loss program.
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