Short answer
OHIP dental billing is mainly for insured dental services rendered in the hospital setting. Clerks should first confirm that the service is actually an insured hospital dental service, that the service location and documentation fit the code, and that same-day or same-patient frequency limits are not being broken. In the dental schedule, insured dentist services are the services listed in Parts I, II and III, and a listed service includes in-hospital visits, the operative procedure, usual post-op care, and one post-discharge follow-up visit. Ontario also publicly describes hospital dental surgery as an OHIP-covered area.
Use this article when a dental billing clerk needs to decide:
whether a hospital dental service is insured,
which consultation or visit code applies,
whether the claim needs routine billing, manual review, or prior approval handling,
and why a claim may be rejected or paid at zero.
Start with four checkpoints:
1. Confirm the service is one of the insured dental services in the OHIP dental schedule.
The Schedule of Benefits - Dental Services is the core source document for hospital-based OHIP dental services, and the Ontario OHIP schedule page links to that schedule directly.
2. Confirm the setting fits the code.
A consultation is insured only when rendered in a hospital. The schedule specifically says a private dental office located inside a hospital is not considered “in a hospital” for consultation billing purposes. That is a very common clerk trap.
3. Confirm same-day frequency limits.
The schedule states that any T650 or T651 billings submitted in excess of one per patient per day per dentist are payable at zero. A duplicate same-day consult or follow-up by the same dentist is therefore a predictable no-pay outcome unless the second service is not billable as a separate T650/T651 in the first place.
4. Confirm documentation before submission.
Claims that trigger special adjudication often depend on the quality of the chart, referral, operative note, prior approval record, or emergency explanation. Ontario’s eSubmit workflow supports supporting documentation and manual review handling, and incorrectly submitted or incorrectly paid claims can also be addressed through a Remittance Advice Inquiry.
T650 - Consultation in hospital
Use for a true hospital consultation. The schedule describes consultation as an insured service in hospital, generally based on a written request from a referring dentist or physician and involving assessment plus review of relevant data. It is limited to one consultation per year per patient per dentist, unless the second referral is for a clearly unrelated diagnosis.
T651 - Follow-up assessment within 12 months of initial consultation, same diagnosis, in hospital/emergency/outpatient department
Use when the original consultation already exists and the patient is being reassessed for the same diagnosis within the stated follow-up framework. Same-day excess billing rules still apply.
T652 - Hospital visit, admitted bed patient
Use for a visit by a dentist to an admitted bed patient where the visit is for observing, assessing, or evaluating a patient after a prior consultation or surgical procedure, and where the chart contains the required progress note. One visit per patient per day is payable, starting the day after the initial consultation.
T653 and T654 - Examination under general anesthesia, and add-on imaging
T653 is the sole-procedure examination under general anesthesia. T654 may be billed in addition to T653 when diagnostic imaging applies. Clerks should verify that the chart supports the sole-procedure nature of T653 and the add-on relationship for T654.
For multiple procedures done at the same time, the major procedure is generally payable at 100% of the listed fee and additional procedures done at the same time are generally payable at 85% of the listed fee, unless the schedule provides a specific add-on code instead. This is one of the most important payment rules for clerks reviewing hospital oral surgery bundles.
Because Ontario issued a dental fee increase bulletin effective April 1, 2025 and also published fee schedule master updates in 2025, clerks should treat the code logic as stable but always confirm the current amount payable in the live fee master or current remittance environment rather than hard-coding 2024 figures into office cheat sheets.
Consult billed outside the proper setting
T650 is not payable as a consultation merely because the office is physically inside a hospital building. The service must meet the schedule’s hospital requirement.
Duplicate same-day T650/T651
A second same-day T650 or T651 for the same patient and dentist is payable at zero.
Same-day T650 with odontectomy but no emergency rationale/support
When T650 is billed with odontectomy codes, the schedule requires supporting documentation for manual review showing the emergency or exceptional rationale for same-day consultation. Without that support, the claim will not be paid.
Virtual code documentation missing
For T655/T656 virtual services, the record must include start and stop times or the service is not eligible for payment.
Late submission
Ontario changed the claims submission period for in-province OHIP fee-for-service insured and related services to three months from the date the service was rendered. Clerks should not let valid hospital dental claims stale-date.
Confirm the code is insured under the dental schedule.
Confirm the location fits the code, especially for T650/T651/T655/T656.
Check whether the service is a routine claim, a manual review claim, an independent consideration claim, or a prior approval claim.
Check for frequency limits, same-day conflicts, and zero-pay combinations.
Submit within the claim window and keep the supporting documentation organized.
Ontario OHIP Schedule of Benefits and fees page.
Schedule of Benefits - Dental Services under the Health Insurance Act, October 30, 2024 (effective April 1, 2024).
Ontario “What OHIP covers” page.
Ontario claim submission timeframe bulletins.
Ontario eSubmit/manual review guidance.
Ontario 2025 dental fee increase and fee schedule master update bulletins.