G537 – Repeat sclerotherapy, unilateral
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Repeat sclerotherapy, unilateral. Sclerotherapy is only insured when performed for veins greater than 5 mm in diameter that are associated with physical symptomatology. The service must be rendered personally by the physician. Note: - This service includes multiple injections and the application of any necessary compression bandages. - Professional and/or technical fees for obtaining and/or interpreting images for the purpose of guidance are not eligible for payment in addition to G537.
When to Use
- Use G537 for subsequent sclerotherapy sessions on the same limb following an initial G536 procedure when veins remain symptomatic and exceed the 5 mm diameter threshold.
- Apply this code when treating a recurrence of symptomatic varicosities in a single limb that were previously addressed via G536.
Common Pitfalls
- Billing G537 for cosmetic spider vein treatment will lead to audit recovery, as the Schedule of Benefits strictly limits coverage to veins >5 mm with documented physical symptoms.
- Submitting a claim for ultrasound guidance fees alongside G537 will trigger an automatic rejection, as imaging is considered bundled into the procedure fee.
- Billing G537 for bilateral treatment in a single session is incorrect; you must bill G537 for one side and use the appropriate bilateral modifier or separate line items if permitted by the current Schedule rules for the specific limb.
Billing Tips
- Ensure your clinical notes explicitly state the vein diameter and the specific physical symptoms (e.g., pain, heaviness, edema) to justify the medical necessity required for G537.
- Since G537 is a per-session code, ensure the interval between G536 and G537 reflects a standard therapeutic course rather than an attempt to unbundle a single comprehensive treatment plan.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
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