Weekday daytime: 08:00–17:00
Weekday evening: 17:00–24:00
Weekend / Holiday: 08:00–24:00
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| Time period | Service type | H-code | Fee ($) | Key rule (plain English) |
|---|---|---|---|---|
| Weekday 08:00–17:00 | Minor assessment | H101 | 17.10 | Use for ED “minor” assessment in weekday daytime. |
| Weekday 08:00–17:00 | Comprehensive assessment | H102 | 43.05 | Use for ED “comprehensive” assessment in weekday daytime. |
| Weekday 08:00–17:00 | Multi-system assessment | H103 | 40.00 | Use for ED “multi-system” assessment in weekday daytime. |
| Weekday 08:00–17:00 | Re-assessment | H104 | 17.10 | Use only if the re-assessment rules are met (see below). |
| Weekday 17:00–24:00 | Minor assessment | H131 | 20.95 | Same service as H101, but for weekday evening. |
| Weekday 17:00–24:00 | Comprehensive assessment | H132 | 52.55 | Same service as H102, but for weekday evening. |
| Weekday 17:00–24:00 | Multi-system assessment | H133 | 47.45 | Same service as H103, but for weekday evening. |
| Weekday 17:00–24:00 | Re-assessment | H134 | 20.95 | Same service as H104, but for weekday evening. |
| Weekend/Holiday 08:00–24:00 | Minor assessment | H151 | 26.35 | Same service as H101, but for weekend/holiday. |
| Weekend/Holiday 08:00–24:00 | Comprehensive assessment | H152 | 66.15 | Same service as H102, but for weekend/holiday. |
| Weekend/Holiday 08:00–24:00 | Multi-system assessment | H153 | 58.90 | Same service as H103, but for weekend/holiday. |
| Weekend/Holiday 08:00–24:00 | Re-assessment | H154 | 26.35 | Same service as H104, but for weekend/holiday. |
| Night 00:00–08:00 | Minor assessment | H121 | 30.70 | Same service as H101, but for nights. |
| Night 00:00–08:00 | Comprehensive assessment | H122 | 76.95 | Same service as H102, but for nights. |
| Night 00:00–08:00 | Multi-system assessment | H123 | 68.00 | Same service as H103, but for nights. |
| Night 00:00–08:00 | Re-assessment | H124 | 30.70 | Same service as H104, but for nights. |
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Re-assessment is only for the same problem when the patient is still in the ED and needs further assessment. Key rules include:
Must be at least 2 hours after the previous assessment by the same physician.
Must be for the same presenting complaint/diagnosis that has not yet resolved.
Not eligible if it is done for discharge purposes only.
Not eligible if the ED physician admits the patient.
Not eligible if the re-assessment is immediately followed by a referral/consult, and the referral is billed.
Maximums: no more than 3 ED re-assessments per patient per day, and no more than 2 per physician per patient per day.
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| Time period | Premium code | Fee ($) | Key rule |
|---|---|---|---|
| Night 00:00–08:00 | H112 | 35.15 | Payable only if another service is rendered during premium hours; ED assessments may not be claimed during premium hours when using this premium rule. |
| Sat/Sun/Holiday 08:00–24:00 | H113 | 20.35 | Same rule as H112, but for Sat/Sun/holiday daytime/evening. |
Premium amounts and the core payment rule (premium payable only when another service is rendered; assessments may not be claimed during premium hours) are stated in the SoB table notes.
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| Time period | Premium code | Adds | Key rule |
|---|---|---|---|
| Mon–Fri 17:00–24:00 OR Sat/Sun/Holiday 07:00–24:00 | E412 | +20% | Only for procedures rendered by an Emergency Department Physician who is required to submit claims using “H” prefix emergency services. |
| Night 00:00–07:00 | E413 | +40% | Same eligibility rule as E412. |
Important payment rule: E409/E410 are NOT payable for procedures rendered by an Emergency Department Physician; E412/E413 are the ED-physician versions (and only payable when the ED physician is required to use “H” prefix emergency services).