Why are my G codes being rejected?
MOH will automatically accept the first physician’s billing. If other physicians were involved in the patient’s care, their G-codes may be rejected unless supporting notes are submitted with the claim.
For emergency or critical care physicians, common rejection reasons include:
Exceeded Limits
- A maximum of 3 physicians can bill G521 for the same patient on the same day.
- If you are the 4th physician, you must bill G395 instead.
Exceeded Time Limits
- G395 and G391 have strict time limits. If you bill more units than allowed, the entire claim line may be rejected. Exceeding 9 units of G391 will result in a rejection.
Premium Codes: Resuscitation codes cannot be billed with certain special visit premiums or standard counselling codes.
No Admission Date: If resuscitation occurs during an inpatient stay or upon admission, the Admission Date must be included, or the claim will be automatically rejected.
- To help prevent these rejections, you can easily add your notes directly in the Agent+ app: Open the claim and scroll down to “Manual Review.”
- Select the applicable service code(s).
- Choose “Add Document” and attach your notes.
Providing your notes at the time of billing helps MOH verify the services and can reduce delays in payment.