G493 – ACTH test
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Performs an Adrenocorticotropic hormone (ACTH) test, which involves administering ACTH via one or more injections to evaluate the adrenal gland's response. This service is payable for each injection administered, as per the description 'single or multiple, per injection' on page of the Schedule. The service includes all common elements of an insured service as defined on pages -.
When to Use
- Use G493 for each individual ACTH injection administered during a stimulation test, ensuring the number of units billed matches the number of injections performed.
- Select G493 when performing the diagnostic procedure in a clinic or hospital setting where the physician is directly administering the agent to assess adrenal insufficiency.
Common Pitfalls
- Billing G493 as a single flat fee for the entire test rather than per injection, which leads to significant underpayment.
- Failing to document the specific time and dosage for each injection, which is required to justify multiple units of G493 during an audit.
Billing Tips
- Always bill the total number of injections as units of G493 on a single line item to ensure the claim is processed correctly for the full procedure duration.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The fee for G493 is payable per injection, for single or multiple injections.
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