G820

PDF page 507 / J93

Optical coherence tomography (OCT) - retinal disease
                G818 OCT unilateral or bilateral - retinal disease, when the physician
                        interprets the results and either performs the procedure or
                        supervises the performance of the procedure....................                        35.00
                  Optical coherence tomography (OCT) - glaucoma
                G820 OCT unilateral or bilateral - glaucoma, when the physician
                        interprets the results and either performs the procedure or
                        supervises the performance of the procedure....................                        35.00
                G821 OCT unilateral or bilateral - active management of retinal
                       disease with laser or intravitreal injections when the
                       physician interprets the results and either performs the
                       procedure or supervises the performance of the procedure                                35.00
                G822 OCT unilateral or bilateral - active management with laser or
                       intravitreal injections for neovascularization associated with:                         25.00
                         i. retinal disease, e.g. wet acute macular degeneration;
                         ii. diabetic macular edema; or
                         iii. retinal vein occlusion
                     when the physician interprets the results and either performs
                       the procedure or supervises the performance of the
                       procedure ...........................................................................   25.00
                      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.

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G823 OCT unilateral or bilateral - evaluation of an infant/child/
                       adolescent with retinal disease and/or glaucoma (including
                       genetic retinal anomalies and cancer), or low vision
                       associated with or resulting in developmental delay when
                       the physician interprets the results and either performs the
                       procedure or supervises the performance of the procedure
                       on a patient younger than 18 years of age.........................                      35.00
                      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.
                      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.

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DIAGNOSTIC AND THERAPEUTIC PROCEDURES
OPHTHALMOLOGY
                                                                                           Fee
     3. G818 is eligible for payment only for one or more of the following:
        a.hemorrhage or exudate in the macula on clinical examination;
        b.retinal folds/wrinkling on clinical examination;
        c.macular hole/pseudohole on clinical examination;
        d.vision loss not explained by dilated clinical examination findings; or
        e.presence or reasonable suspicion of choroidal neovascular membrane, subretinal fluid or
          cystoid macular edema on clinical examination.
     4. G820 is eligible for payment only for one or more of the following:
        a.suspicion of glaucoma based on optic nerve appearance on dilated clinical examination;
        b.suspicion of glaucoma based on visual field testing;
        c.elevated intraocular pressure; or
        d.history of glaucoma in an immediate family member.
     5. G818, G820, G821, G822 or G823 is only eligible for payment when a consultation or
       assessment has been rendered by the same physician for the same patient in relation to the
       same condition for which OCT is being performed.
     [Commentary:
     For every claim for G818, G820, G822 or G823 there must be a separate consultation or
     assessment claimed by the same physician, but the services do not necessarily have to be
     rendered on the same day.]
     6. G820 is limited to a maximum of two services per patient per 12 month period.
     7. Any combination of G818, G820 or G821 is limited to a maximum of four services per patient
       per 12 month period.
     8. Only one of G818, G820, G821, G822 or G823 is eligible for payment per patient same day.
  Orthoptic examination
   Orthoptic examination must include quantitative measurement of all cardinal positions of gaze
   (straight ahead, left, right, up, down, tilt right and tilt left), sensory testing for binocular vision
   suppression, cyclodeviation, retinal correspondence and interpretation. Orthoptic examination
   is eligible for payment in addition to an ophthalmology consultation or visit. The examination
   must be rendered by an orthoptist who is certified by the Canadian Orthoptic Council and
   employed by the ophthalmologist or a public hospital. The interpretation component of the
   examination must be personally rendered by the ophthalmologist.
G814 Orthoptic examination.............................................................     25.00
   Note:
   G814 is only eligible for payment when all tests described under orthoptic examination are
   rendered and the results and measurements are documented in the patient’s permanent
   medical record.
     [Commentary:
     If the interpreting ophthalmologist is also rendering the examination, the service should be
     claimed as A230.]

Master, record 2369. Record Layout PDF, page 1.

G82020250401999999990000035000000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.