G855 – Hess screen examination - technical component
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
The technical component for a Hess screen examination. This service is a diagnostic and therapeutic procedure under ophthalmology, typically performed with its professional component counterpart, G428. As per -, all insured services include common elements such as making appointments, reviewing patient information, obtaining consent, maintaining records, and providing prescriptions if necessary. The technical component fee is subject to a reduction to 86.10% of the listed fee when rendered in a hospital ().
When to Use
- Use G855 in conjunction with G428 when you personally perform the technical setup and administration of the Hess screen test in your office.
- Bill this code when the diagnostic equipment is owned or leased by your practice and you are responsible for the quality assurance of the test results.
Common Pitfalls
- Billing G855 without the corresponding professional component G428 will result in a rejection or audit flag for an incomplete service.
- Claiming the full fee for G855 when the procedure is performed within a hospital setting, as it must be reduced to 86.10% per GP11.
- Failing to maintain the required quality assurance documentation for the technical equipment, which is a mandatory requirement for claiming technical components.
Billing Tips
- Ensure your billing software is configured to automatically apply the 86.10% reduction when the service location indicator is set to hospital.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
As per , the physician submitting a claim for the technical component must have the necessary training and experience to personally render the technical component of the service and must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
As per , all insured services must be documented in the patient's medical record to establish that the service was provided, was medically necessary, and matches the service for which the account is submitted.
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