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L803
L803 – Karyotype
OHIP Dermatology Code — Laboratory Medicine · Schedule of Benefits
Karyotype is a laboratory medicine service listed under Diagnostic and Therapeutic Procedures, specifically within the Cytogenetics subcategory.
When to Use
- Use L803 for standard constitutional cytogenetic analysis when investigating suspected chromosomal abnormalities in patients with developmental delay or dysmorphic features.
- Select L803 when performing diagnostic karyotyping for recurrent pregnancy loss or infertility workups where a chromosomal translocation is suspected.
- Use L803 for follow-up testing of known chromosomal variants identified in family members, provided the clinical indication meets provincial medical necessity criteria.
Common Pitfalls
- Billing L803 for molecular genetic tests or microarray analysis (which are distinct laboratory services) will result in rejection or audit recovery.
- Submitting L803 without a valid referral from a physician, nurse practitioner, or midwife as required by the Schedule of Benefits will lead to claim denial.
- Attempting to bill L803 alongside L807 or L811 for the same patient encounter without distinct clinical indications for each specific test will trigger duplicate billing flags.
Billing Tips
- Ensure the laboratory requisition clearly specifies the clinical indication for the karyotype to support the medical necessity requirements mandated by the Ministry.
- Verify that the laboratory facility is an OHIP-approved site for cytogenetic testing, as L803 is a technical fee for the laboratory service rather than a professional consultation fee.
Provider Fee$73.95
Specialist Fee$0.00
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$0.00
Effective: April 1, 2025
Category
Diagnostic and Therapeutic Procedures
Subcategory
Laboratory Medicine
Service Type
Laboratory
Code Classes
Diagnostic and Therapeutic Procedures
Referral RequiredFrom: Physician, NursePractitioner, Midwife, OralMaxillofacialSurgeon
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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