G520 – Diabetes management - 4 or more contacts
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Management of diabetes for each additional month after the initial month (G500), involving four or more contacts between the patient and the physician. A 'contact' for the purpose of this service involves medical advice, direction, or information provided by the physician leading to clinical decisions. This service is intended for adjustments in insulin therapy.
When to Use
- Use G520 when you have completed four or more distinct clinical contacts in a calendar month specifically to titrate insulin dosages for a patient with unstable diabetes.
- Use this code for patients requiring intensive, frequent monitoring of blood glucose logs and subsequent insulin adjustments that exceed the scope of a standard office visit.
Common Pitfalls
- Billing G520 on the same day as an office assessment (e.g., A007) is a common rejection trigger, as the contact does not count toward the four-contact requirement.
- Claiming G520 when the four contacts are not documented as separate, dated entries in the chart will lead to clawbacks during an audit.
- Attempting to bill G520 in the same month as G500 or G514 for the same patient will result in a payment adjustment or rejection, as only one monthly management fee is permitted.
Billing Tips
- Ensure your EMR has a specific template for 'Diabetes Management Contacts' to track the four required dates and the specific insulin adjustment made at each touchpoint.
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.
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