G805 – Hyperbaric oxygen therapy - after first quarter hour
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Hyperbaric Oxygen Therapy (HBOT) is the service rendered when a physician administers and supervises HBOT. The specific elements of HBOT are those of an assessment, including ongoing monitoring of the patient's condition and intervening as appropriate. This specific fee code, G805, applies to the physician being in the hyperbaric unit but not in the chamber with the patient(s), per session per patient, for each quarter hour (or major part thereof) after the first quarter hour. The first quarter hour is claimed using G804. - Time is calculated based on the period of physician supervision while each patient receives HBOT. - A consultation or assessment is eligible for payment with HBOT when rendered. - If the physician is outside the chamber, the time eligible for payment of HBOT does not include time spent rendering any separately billable intervention(s) during which the HBOT is interrupted or discontinued. - For multi-patient sessions, the time eligible for payment of HBOT is measured as the period of physician supervision for each patient.
When to Use
- Use G805 for every 15-minute increment of physician supervision following the initial 15 minutes claimed under G804.
- Apply this code when supervising multiple patients simultaneously in a hyperbaric unit where you are physically present in the unit but outside the chamber itself.
Common Pitfalls
- Claiming G805 for time spent performing separate, billable procedures that interrupt the HBOT session, as this time must be excluded from the total duration.
- Exceeding the maximum of three units of G805 when billed in conjunction with G807 on the same day for the same patient.
- Failing to record exact start and stop times in the patient chart, which is a mandatory requirement for audit compliance and payment eligibility.
Billing Tips
- Ensure your documentation clearly distinguishes between the time spent on HBOT supervision and any time diverted to other billable interventions to avoid clawbacks.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The service is eligible for payment only if the start and stop times of the service are recorded in each patient's permanent medical record.
Based upon the number of 'units' of service rendered, the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If the patient's permanent medical record or chart does not include this required information, the service is not eligible for payment.
HBOT is insured only for the treatment of those internationally recognized indications approved by the ministry.
HBOT is only eligible for payment for idiopathic sudden sensorineural hearing loss (ISSHL) when the following conditions are met: a. The patient is treated concurrently with corticosteroid unless corticosteroids are contraindicated; b. The treatment is initiated within 30 days of a diagnosis of ISSHL; and c. The diagnosis of ISSHL is made or confirmed by an Otolaryngologist prior to the initiation of treatment.
HBOT is only eligible for payment for avascular necrosis (AVN) of bone following diagnostic imaging confirmation of symptomatic early to mid-stage AVN, e.g. Ficat stage I, II, or III or equivalent.
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