< Billing codes

Billing code

G820A — Oct Unilateral Or Bilateral - Glaucoma, When The Physician Interprets The Results And Either Performs The Procedure Or Supervises The Performance Of The Procedure

Glaucoma OCT

Bill G820 for OCT for glaucoma when glaucoma is suspected, eye pressure is raised, or an immediate family member has glaucoma.

Watch for: Limited to 2 per 12 months and counts toward the combined limit of 4; not payable under 18.

Code

G820A

Description

Oct Unilateral Or Bilateral - Glaucoma, 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 glaucoma, interpreted by the ophthalmologist who performs or supervises it. Up to 2 per patient per 12 months.

What it covers

OCT, unilateral or bilateral, for glaucoma (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: suspected glaucoma from optic nerve appearance on dilated exam; suspected glaucoma from visual field testing; elevated intraocular pressure; or glaucoma in an immediate family member (J94).
• Limited to 2 per patient per 12 months, and counts toward the combined limit of 4 for G818, G820 and G821 (J94).
• Not payable for patients under 18; use G823 (J93).

Often billed with

• Visual fields G858/G432 (J91).
• G813 corneal pachymetry, once per lifetime, to identify glaucoma risk (J92).

Common rejections

• AM1: Service limit exceeded: G820 is limited to 2 per patient per 12 months (J94).
• A2A: Outside of age limit: G820 is not payable for patients under 18; use G823 (J93).

Related codes: G818, G821, G823, G858, G432, G813

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

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing