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Billing code

G823A — Oct Unilateral Or Bilateral - Evaluation Of An Infant/child/adolescent With Retinal Disease And/or Glaucoma (including Genetic Retinal Anomalies And Cancer)

OCT for patients under 18

Bill G823 for OCT in a patient under 18 with retinal disease, glaucoma, or low vision linked to developmental delay.

Watch for: For patients under 18 only, up to 12 per 12 months; the same physician must claim a consultation or assessment.

Code

G823A

Description

Oct Unilateral Or Bilateral - Evaluation Of An Infant/child/adolescent With Retinal Disease And/or Glaucoma (including Genetic Retinal Anomalies And Cancer)

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 a patient under 18 with retinal disease and/or glaucoma, or low vision linked to developmental delay. Up to 12 per 12 months.

What it covers

OCT, unilateral or bilateral, to evaluate an infant, child or adolescent younger than 18 with retinal disease and/or glaucoma (including genetic retinal anomalies and cancer), or low vision associated with or resulting in developmental delay (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).
• Patients younger than 18 only; G818, G820, G821 and G822 are not payable under 18 (J93).
• Limited to 12 per 12 months (J93).

Often billed with

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

Common rejections

• AM1: Service limit exceeded: G823 is limited to 12 per 12 months (J93).
• A2A: Outside of age limit: G823 is only for patients younger than 18 (J93).

Related codes: G818, G820, G821, G822, A251, C250

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

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