G864 – Home peritoneal dialysis
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G864 is the chronic dialysis weekly team fee for home peritoneal dialysis. It is paid on a weekly basis. The note on page states to claim the code representing the predominant location and modality of dialysis for that 7-day period.
When to Use
- Use G864 when the patient is managed on home peritoneal dialysis for the majority of the 7-day billing period.
- Select G864 instead of G860 or G861 when the patient is not receiving in-centre hemodialysis or hospital-based peritoneal dialysis for the predominant portion of the week.
Common Pitfalls
- Claiming G864 in the same 7-day window as G860, G861, G862, G863, G865, or G866 will result in an automatic rejection due to mutual exclusivity.
- Billing G864 when the patient has transitioned to a different modality (e.g., in-centre hemodialysis) for more than 3 days of the week, as this violates the 'predominant location' requirement.
Billing Tips
- Ensure your billing cycle aligns with a 7-day period to accurately reflect the predominant modality, as the Ministry audits these claims based on the weekly team fee structure.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
Claim the code representing the predominant location and modality.
Where 3 or more treatments are rendered per 7-day period at an auxiliary treatment centre, the service comprises the chronic dialysis weekly team fee paid at the full amount, regardless of the number of treatments rendered.
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