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Billing code

G818A — Oct Unilateral Or Bilateral - Retinal Disease, When The Physician Interprets The Results And Either Performs The Procedure Or Supervises The Performance Of The Procedure

Retinal OCT

Bill G818 for OCT of retinal disease when a listed finding is present, such as macular hemorrhage, macular hole or unexplained vision loss.

Watch for: G818, G820 and G821 together are limited to 4 per 12 months; not payable under 18, so use G823.

Code

G818A

Description

Oct Unilateral Or Bilateral - Retinal Disease, When The Physician Interprets The Results And Either Performs The Procedure Or Supervises The Performance Of The Procedure

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

OCT for retinal disease, interpreted by the ophthalmologist who performs or supervises it. Specific clinical findings required.

What it covers

OCT, unilateral or bilateral, for retinal disease (J93).

The physician interprets the results and either performs or supervises the test; it may be unilateral or bilateral (J93).

Billing rules

• OCT is insured only for diagnosing and managing retinal disease and/or glaucoma, by the ophthalmologist most responsible for that care (J93).
• OCT done in whole or in part to prepare for cataract surgery is not payable (J93).
• The same physician must claim a consultation or assessment for the same condition; it doesn't have to be on the same day (J94).
• Only one of G818, G820, G821, G822 or G823 per patient per day (J94).
• Payable only for: macular hemorrhage or exudate; retinal folds or wrinkling; macular hole or pseudohole; vision loss not explained by a dilated exam; or presence or reasonable suspicion of choroidal neovascular membrane, subretinal fluid or cystoid macular edema (J94).
• G818, G820 and G821 combined are limited to 4 per patient per 12 months (J94).
• Not payable for patients under 18; use G823 (J93).

Often billed with

• A consultation or assessment by the same physician for the same condition (J94).

Common rejections

• AM1: Service limit exceeded: G818, G820 and G821 together are limited to 4 per patient per 12 months (J94).
• A2A: Outside of age limit: G818 is not payable for patients under 18; use G823 (J93).

Related codes: G820, G821, G822, G823, G425, G853

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Ophthalmology, page J93.

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