Emergency Medicine (ED) Billing FAQs (OHIP): H-Codes, Re-Assessments, Premiums, Consults, Critical Care, After-Hours Procedure Premiums, Phone Consults

Emergency Medicine (ED) Billing FAQs (OHIP): H-Codes, Re-Assessments, Premiums, Consults, Critical Care, After-Hours Procedure Premiums, Phone Consults

SUMMARY / DESCRIPTION
Quick answers for Ontario OHIP Emergency Medicine billing: which H-code to use by time period, when re-assessments are payable, how H112/H113 premiums work, how to bill ED consultations, critical care time, after-hours procedure premiums (E412/E413), and ED phone consults (K734/K735).

Which H-code do I use for an ED assessment on weekdays 08:00–17:00?

Use the Monday–Friday daytime (08:00–17:00) ED assessment H-codes:

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  • H101 — Minor assessment

  • H102 — Comprehensive assessment and care

  • H103 — Multiple systems assessment

  • H104 — Re-assessment

Pick the code that matches the assessment type, and document to support it (history/exam/decision-making, and any required elements for that service).

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When can I bill an ED re-assessment (H104 or H134)?

Yes — but only if it meets the Schedule definition and payment rules.

A re-assessment is payable when it is rendered at least two hours after the original assessment (or a prior re-assessment), and further care and/or investigation is required and performed.

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Not payable for:

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  • Discharge assessments

  • When the patient is admitted by the Emergency Department Physician

  • When the re-assessment leads directly to a referral for consultation

Limits: max 3 per patient per day, and max 2 per physician per patient per day (services beyond these limits are not eligible).

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When do H112 or H113 ED premiums apply?

They apply when an Emergency Department Physician renders any other service during the premium hours — and ED assessments may not be claimed in that premium window.

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Premiums (per patient visit):

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  • H112 — Nights 00:00–08:00

  • H113 — 08:00–24:00 on Saturdays, Sundays, or Holidays

Practical rule: during those premium hours, bill the other payable service(s) as appropriate, and add H112 or H113 (but do not also bill H101–H104 / H131–H134 as an assessment in that premium window).

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How do I bill an Emergency Department physician consultation (H065 / H055)?

Use the ER Physician consultation billing rules:

  • Claims submission: H055 (specialist in Emergency Medicine FRCP) and H065 (all other physicians).

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  • Fee listing: H065 Consultation in Emergency Medicine is listed in the ED “H” prefix section.

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Key payment rules (what can reduce/adjust payment):

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  • If referred by another ER physician in the same hospital, payment may be adjusted to a lesser assessment fee.

  • If rendered outside the ED or other critical care area, payment may be adjusted.

  • ER reports can count as the written report if all constituent elements are clearly documented, and a copy is sent to the referring physician/NP (otherwise payment may be adjusted).

How do I bill ED critical care time (G521/G523/G522)?

Bill life-threatening critical care in ¼-hour (15-minute) units:

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  • G521 — first ¼ hour (or part thereof)

  • G523 — second ¼ hour (or part thereof)

  • G522 — after the first ½ hour, each additional ¼ hour (or part thereof)

Time rules and documentation:

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  • Count only physician time fully devoted to that patient.

  • Time may be consecutive or non-consecutive, but you cannot provide services to other patients during the claimed time.

  • Start/stop times must be recorded in the permanent medical record.

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When can I bill after-hours procedure premiums (E409/E410/E412/E413)?

Use the correct premium based on whether the physician is an Emergency Department Physician.

Emergency Department Physician after-hours procedure premiums:

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  • E412 — Evenings (Mon–Fri 17:00–24:00) and daytime/evenings on Sat/Sun/Holidays (premium increases the procedure fee by 20%)

  • E413 — Nights (00:00–07:00) (premium increases the procedure fee by 40%)

Important ED rule:

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  • E409/E410 are NOT payable for a procedure rendered by an Emergency Department Physician.

  • E412/E413 are ONLY payable for a procedure rendered by an Emergency Department Physician who is required to submit claims using “H” prefix emergency services.

Also note: after-hours procedure premiums are only payable when the criteria in the Schedule are met (eligible service type + timing + non-elective/elective-delayed conditions).

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Which phone consultation codes should I use while on ED duty (K734/K735)?

Use K734/K735 for physician-to-physician telephone consults while on duty in an emergency department or hospital urgent care clinic.

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Core payment rules:

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  • Minimum 10 minutes of patient-related discussion.

  • Max one K734 per patient per day (referring) and max one K735 per patient per day (consultant).

  • Not payable in several common situations (e.g., arranging transfer of care, primarily discussing test results, or if the consultant sees the patient the same/next day, etc.).

Charting requirements include patient identifiers, start/stop times, who participated, reason, and the consultant’s opinion/recommendations.