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Billing code

G821A — 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

OCT during retinal treatment

Bill G821 for OCT during active laser or intravitreal injection treatment of retinal disease, interpreted by the treating ophthalmologist.

Watch for: G818, G820 and G821 together are limited to 4 per 12 months; once reached, bill G822.

Code

G821A

Description

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

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 during active treatment of retinal disease with laser or intravitreal injections, interpreted by the treating ophthalmologist.

What it covers

Optical coherence tomography (OCT), unilateral or bilateral, for active management of retinal disease with laser or intravitreal injections (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).
• G818, G820 and G821 combined are limited to 4 per patient per 12 months (J94).
• Once that limit is reached, further OCT for neovascular disease under active laser or injection treatment is G822 (J93).
• Not payable for patients under 18; use G823 (J93).

Often billed with

• E186/E187 or E149 intravitreal injections, or E154 photocoagulation (Y6, Y8).
• 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: G821 is not payable for patients under 18; use G823 (J93).

Related codes: G818, G820, G822, G823, E186, E187, E154

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

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