G525 – Pure tone threshold audiometry - professional component
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Represents the professional component of a pure tone threshold audiometry test, which may include bone conduction testing. As defined on page , the professional component involves the physician's interpretation of the test results and the preparation of a report. This service is intended to be billed in conjunction with G440, which represents the technical component of the test. As per , this diagnostic service is insured when referred by a physician, or when referred by a Nurse Practitioner or Oral and Maxillofacial Surgeon under specific settings. This service includes all common elements of insured services as described on pages and .
When to Use
- Use G525 when you have personally interpreted the pure tone audiometry results and generated a formal report, while G440 is billed for the technical performance of the test.
- Bill G525 when performing professional interpretation of threshold audiometry for patients referred by a physician, Nurse Practitioner, or Oral and Maxillofacial Surgeon.
Common Pitfalls
- Billing G525 on the same day as G448 or G450 will result in a nil payment for the sound field audiometry codes due to the mandatory restriction.
- Submitting G525 without a corresponding G440 claim for the technical component often triggers audit flags regarding the completeness of the diagnostic service.
Billing Tips
- Ensure your clinical notes explicitly include the formal interpretation and report of the audiogram to satisfy the professional component requirement for G525.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Diagnostic
Diagnostic and Therapeutic Procedures
As per , the medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
A written report of the interpretation and findings is required as part of the professional component of a diagnostic service.
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