G821 – Optical coherence tomography (OCT) - active management of retinal disease
OHIP Diagnostic and Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Patient must be 18 years of age or older.
Payment rules: 1. 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. 2. Any OCT service rendered in whole or in part for preparation related to cataract surgery is not eligible for payment.
Payment rules: 1. G822 is limited to a maximum of 8 services per patient per 12 month period and a maximum of 16 services per patient for 24 consecutive months. 2. G822 is only eligible for payment when the limit of any combination of G818, G820 or G821 is reached.
Payment rules: 1. G823 is limited to a maximum of 12 services per 12 month period. 2. G818, G820, G821 and G822 are not eligible for payment when rendered on a patient younger than 18 years of age.
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