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OHIP Emergency Department Physician Billing (EM) — H-Codes, Consultations, Critical Care, Premiums & After-Hours

Summary / Description:
Use this article to bill Emergency Department physician services under OHIP. It covers time-of-day H-assessment codes, Emergency Medicine consultations, critical care, special visit premiums, ambulance detention, physician-to-physician phone consults, and after-hours procedure premiums (E409/E410/E412/E413).

OHIP Emergency Department Physician Billing (Emergency Medicine)

What does an Emergency Department physician bill?

Emergency Department physician billing commonly includes:

  • ED assessments (H-codes) based on time of day and assessment type (minor / comprehensive / multi-system / re-assessment).

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  • Emergency Medicine consultations (when the ED physician is acting as a consultant).

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  • Critical care / resuscitation services billed in 15-minute units with stated maximums.

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  • Special visit premiums (H960/H990 series) when the service meets the premium rules.

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  • After-hours procedure premiums (E409/E410/E412/E413) when an eligible procedure starts in the premium window.

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  • Ambulance detention time (K101/K111/K001) when applicable.

  • Physician-to-physician telephone consults while on ED duty (K734/K735) and CritiCall ED codes (K736/K737) when criteria are met.

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Which Emergency Department assessment codes (H-codes) do I use by time of day?

Weekdays 08:00–17:00

  • H101 Minor assessment — $17.10

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  • H102 Comprehensive assessment and care — $43.05

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  • H103 Multiple systems assessment and care — $40.00

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  • H104 Re-assessment — $17.10 (see re-assessment rules below)

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Weekdays 17:00–24:00

  • H131 Minor assessment — $20.95

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  • H132 Comprehensive assessment and care — $52.55

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  • H133 Multiple systems assessment and care — $47.45

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  • H134 Re-assessment — $20.95

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Nights 00:00–08:00

  • H121 Minor assessment — $30.70

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  • H122 Comprehensive assessment and care — $76.95

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  • H123 Multiple systems assessment and care — $68.00

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  • H124 Re-assessment — $30.70

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Saturdays / Sundays / Holidays 08:00–24:00

  • H152 Comprehensive assessment and care — $66.15

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Tip for build-out: the same SoB table continues in this section for the rest of the weekend/holiday H-codes (minor / multi-system / re-assessment). Keep all weekend/holiday ED H-codes together in your KB for fast lookup.

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

You can bill H104 (day) or H134 (evening) only when the patient’s:

  • presenting complaint and diagnosis are the same, and

  • the earlier ED assessment issue has not yet resolved.

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When do ED premiums H112 and H113 apply?

H112 (night premium) and H113 (weekend/holiday day/evening premium) apply when:

  • a service other than ED assessment (H101–H103 or H131–H133) is rendered during the premium hours; and

  • the ED assessment codes are not claimed in that premium window.

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Which consultation codes can an Emergency Department physician bill?

Emergency Medicine consultations (in-person)

  • H065 — “Consultation in Emergency Medicine”: this is a consultation service provided by an Emergency Department physician meeting the consultation requirements.

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ED physician consultation — key payment rules

An ED physician consultation:

  • may be requested by another physician when the patient has a different/unknown diagnosis or needs a service beyond ED resources; and

  • the ED physician must provide the consultation service in person (not only by phone).

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How do critical care / resuscitation codes work in the ED?

Life-threatening resuscitation

  • G521 first 15 minutes — $111.80

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  • G523 second 15 minutes — $57.65

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  • G522 each additional 15 minutes (maximum 4) — $38.00

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Other resuscitation

  • G395 first 15 minutes — $57.45

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  • G391 each 15 minutes after (maximum 2) — $30.60

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Which Special Visit Premiums apply to ED physicians?

Use the ED physician special visit premium table when you meet the “special visit” requirements:

Travel premium (ED physician)

  • H960 / H962 / H963 / H964 — travel premium by time period (with stated maximums by period).

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First person seen / additional persons seen (ED physician)

  • H990 / H994 / H998 / H996 — first person seen by time period

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  • H991 / H995 / H999 / H997 — additional persons seen, with period maximums where stated

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When do after-hours procedure premiums apply (E409/E410/E412/E413)?

After-hours procedure premiums apply when an eligible procedure begins in the premium period.

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Procedure premiums and time windows

  • E409: when an eligible procedure begins 18:00–24:00 (increase by 50%)

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  • E410: when an eligible procedure begins 00:00–08:00 (increase by 75%)

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  • E412: Weekdays 17:00–00:00 and weekends/holidays 08:00–00:00 (increase by 20%)

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  • E413: Nights 00:00–08:00 (increase by 40%)

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Who can claim E409/E410/E412/E413?

These premiums are eligible for payment to:

  • physicians in Family Practice & Practice in General, and

  • physicians in Emergency Medicine who are emergency department physicians.

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How do physician-to-physician telephone consultation codes work in the ED (K734/K735)?

When physicians participate in physician-to-physician telephone consultations while on duty in an ED or urgent care clinic, use:

  • K734 (referring) and K735 (consultant).

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Key rules include:

  • minimum 10 minutes of patient-related discussion;

  • both physicians must be physically present in Ontario;

  • max one K734 per patient per day and max one K735 per patient per day;

  • not payable for transfer arrangement, arranging a consult/procedure, primarily discussing test results, or if a consult/visit is rendered same/next day by the consultant (see full rule list).

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When do CritiCall ED telephone consultation codes apply (K736/K737)?

For CritiCall telephone consultations while on ED duty, use:

  • K736 (referring) and K737 (consultant).

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Key limits:

  • max 2 K736 services per patient per day (any combination with K732)

  • max 1 K737 service per physician per patient per day (and max totals per patient/day apply)

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When is ambulance detention payable (K101/K111/K001/K112)?

Ambulance detention time codes include:

  • K101 Ground ambulance detention — per 15 minutes

  • K111 Air ambulance detention — per 15 minutes

  • K001 Non-ambulance detention — per 15 minutes

  • K112 Return without patient to place of origin — per 30 minutes