Billing code
G461A — Ocular photodynamic therapy – bilateral
Eye photodynamic therapy, both eyes
Bill G461 for photodynamic therapy with verteporfin to both eyes on the same day for qualifying subfoveal choroidal neovascularization.
Watch for: Bill G461 rather than G460 for both eyes; a G460 the same day pays nil.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $500.00 | $0.00 | $0.00 | $0.00 |
- Code
- G461A
- Description
- Ocular photodynamic therapy – bilateral
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Apr 1, 2025
- Termination date
- No end date
Explanation
Updated October 26, 2026
Photodynamic therapy with verteporfin to both eyes on the same day for qualifying subfoveal choroidal neovascularization.
What it covers
Ocular photodynamic therapy (PDT) must be done by an ophthalmologist and includes the patient registration and drug requisition forms, IV access, supervising the drug infusion and personally applying the non-thermal diode laser to activate verteporfin (J96).
PDT is insured only for predominantly classic subfoveal choroidal neovascularization (at least 50% of the lesion, by fluorescein angiography with retinal photos kept on file) from AMD, presumed ocular histoplasmosis or pathologic myopia, started within 30 months of diagnosis, with visual acuity of 20/40 or worse. Each repeat needs recurrent or persistent leakage on angiography with photos (J96).
Billing rules
- Retinal photographs must be taken before the procedure and kept in the chart, or PDT is not payable (J96).
- Maximum one PDT (unilateral or bilateral) per patient per day (J96).
- G379 with PDT is insured but pays nil (J96).
- Assessments and angiography are payable in addition; retinal photography is part of the assessment and not billed separately (J96).
- Commentary: PDT is normally not given to each eye more often than once every 3 months. PDT for other conditions is uninsured (J96).
- Bill G461 rather than G460 for both eyes; a G460 on the same day pays nil (J96).
Often billed with
- Fluorescein angiography G853/G425 (J96).
Related codes: G460, G853, G425, G379, E186, E187
Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Ophthalmology, page J96.
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