G818 – OCT unilateral or bilateral - retinal disease
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
OCT unilateral or bilateral - retinal disease, when the physician interprets the results and either performs the procedure or supervises the performance of the procedure. According to the payment rules on page , OCT services are insured only for the diagnosis and management of retinal disease and/or glaucoma, and must be performed by the ophthalmologist most responsible for the patient's care. Any OCT service rendered in whole or in part for preparation related to cataract surgery is not eligible for payment. This service is not eligible for payment for patients under 18 years of age.
When to Use
- Use G818 for monitoring progression of diagnosed glaucoma or retinal pathology such as macular degeneration or diabetic retinopathy.
- Use G818 when performing an OCT to evaluate a new retinal symptom, such as metamorphopsia or sudden vision loss, in a patient aged 18 or older.
Common Pitfalls
- Billing G818 for OCT scans performed as part of a pre-operative workup for cataract surgery will result in automatic rejection or audit recovery.
- Submitting G818 for patients under 18 years of age is strictly prohibited and will be rejected by the Ministry.
- Attempting to bill G818 alongside G820, G821, G822, or G823 on the same day is disallowed as only one diagnostic imaging code from this group is payable.
Billing Tips
- Ensure the clinical record explicitly states the retinal or glaucoma diagnosis being managed to justify the medical necessity of the OCT.
- If you are not the physician primarily managing the patient's retinal disease or glaucoma, you are ineligible to bill G818.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Diagnostic
Diagnostic and Therapeutic Procedures
Patient must be 18 years of age or older
Except as described in payment rule #2, OCT is an insured service only: a. for the diagnosis and management of retinal disease and/or glaucoma; and b. when the ophthalmologist performing the service is the physician most responsible for the care of the patient's retinal disease and/or glaucoma.
Any OCT service rendered in whole or in part for preparation related to cataract surgery is not eligible for payment.
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