G514 – Diabetes management - each additional month, 1 to 3 contacts
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Represents the management of a patient's diabetes mellitus for each additional month following an initial period. This service involves 1 to 3 contacts with the patient via telephone or electronic communication. It is only payable to the physician most responsible for the patient's diabetes care. The clinical decisions must be personally formulated by the physician. Contacts that occur on the same day as a consultation or assessment by the same physician are not counted. This fee is not applicable for simply reviewing reports or communicating results if no change in the frequency or dose of insulin therapy is required. For this service to be eligible for payment, a dated summary of each contact must be recorded in the patient's permanent medical record.
When to Use
- Use G514 when you have actively adjusted a patient's insulin frequency or dosage via 1-3 telephone or electronic contacts during a calendar month.
- Use this code for ongoing diabetes management in months following the initial setup period covered by G500.
Common Pitfalls
- Billing G514 on the same day you perform a consultation or assessment (e.g., A007, K030) for the same patient, which renders the G514 ineligible.
- Claiming G514 for routine communication of lab results or report reviews where no specific change to insulin therapy was required.
- Failing to document a dated summary of each specific contact in the chart, which is a mandatory requirement for audit compliance.
Billing Tips
- Ensure your documentation explicitly states the change made to the insulin regimen, as the Ministry strictly prohibits payment for G514 without a therapeutic adjustment.
- If you perform more than 3 contacts in a month, switch to G520 to capture the higher service volume, as only one of G500, G514, or G520 is payable per patient per month.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
A dated summary of each contact must be recorded in the patient's permanent medical record.
Payment rules: 1. G500 is limited to a maximum of two per patient per lifetime.
Payment rules: 2. G500, G514 and G520 are only eligible for payment when rendered by the physician most responsible for the patient's diabetes care or by a physician substituting for that physician ('the substitute physician').
Payment rules: 3. The clinical decision(s) pertaining to the medical advice, direction or information provided must be formulated personally by the physician or substitute physician.
Payment rules: 4. A contact rendered on the same day as a consultation or assessment by the same physician to the same patient does not constitute a contact for the purpose of G500, G514 or G520.
Payment rules: 5. G500, G514 and G520 are not eligible for payment for reviewing laboratory reports, patient created reports, or for communicating results to a patient when no change in the frequency or dose of insulin therapy is required.
Payment rules: 6. Only one of G500, G514 and G520 is eligible for payment per patient per physician per month.
Medical record requirements: G500/G514/G520 is only eligible for payment when a dated summary of each contact is recorded in the patient's permanent medical record.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.