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Billing code

G521A — Life Threatening emergency situation - first 1/4 hour

Critical care, first 15 minutes

Bill G521 for the first quarter hour of bedside care for a patient with vital organ failure and imminent life-threatening deterioration.

Watch for: Record start and stop times in the chart or it isn't payable; not payable on a critical care per diem day.

Code

G521A

Description

Life Threatening emergency situation - first 1/4 hour

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

First quarter hour of life-threatening critical care for a patient with vital organ system failure, for each of the first three physicians.

What it covers

G521 is the first ¼ hour (or part) of 'life threatening critical care': care of a critically ill or injured patient whose illness or injury acutely impairs one or more vital organ systems, causing failure, so that imminent life-threatening deterioration is highly probable (J26).

The second ¼ hour is G523 and each ¼ hour after the first ½ hour is G522, for each of the first three physicians; the fourth and later physicians bill G391 (J26).

Billing rules

• Time counts only when you are fully devoted to the patient at the bedside, in the ED or on the hospital floor where the patient is, and excludes separately billable procedures; it may be consecutive or not (J26).
• You can't provide services to other patients during the time claimed (J26).
• Start and stop times must be recorded in the patient's permanent medical record, or the service is not payable (J27).
• The same day, same physician, these are included and not billed separately: assessment and ongoing monitoring, IV lines, cutdowns, arterial or venous catheters, CVP lines, endotracheal intubation, tracheal toilet, blood gases, nasogastric intubation, urinary catheters, pressure infusion sets and drugs, defibrillation and cardioversion (J26).
• Not payable on a day you are paid a Critical Care, Ventilatory Support, Comprehensive Care or Neonatal Intensive Care per diem; a consultation or assessment before or after may be payable otherwise (J27).
• Not payable with A384 or K181 (J27) or with G395 the same day (J28); G261, G259 and G115 are not payable with G521 (J12, J13).
• Newborn resuscitation in a life-threatening emergency is billed under G521, G522 and G523; when only intubation and tracheo-bronchial toilet are needed, bill G211 instead (K3).
• Submit manually when total critical care time is more than 2 hours (J29). The E420 trauma premium (add 50%) applies to G521 when rendered on the day of or within 24 hours of the trauma, the Injury Severity Score is over 15 (age 16 or more) or over 12 (under 16), and the ISS is recorded in the medical record (GP109).

Often billed with

• G523 for the second ¼ hour and G522 for each ¼ hour after the first ½ hour (J26).
• A003 or another consultation or assessment rendered before or after the critical care (J27).

Related codes: G523, G522, G391, G395, G211, E420, G557

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Critical Care — Life threatening critical care, pages J26–J27 and J29; Obstetrics preamble K3; trauma premium GP109

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