Short answer
Use premiums when the schedule’s timing, care setting, or patient-acuity conditions are met. Use manual review when the schedule requires supporting explanation for adjudication. Use independent consideration for unlisted or specially justified claims. Use prior approval for Part III services when hospitalization is medically necessary and OHIP approval is required before service, except where the schedule states an exception.
T809 applies when a non-elective dental surgical procedure begins after 5:00 p.m. and before midnight, or on a Saturday, Sunday, or holiday. The schedule says the amount payable is increased by 30%. T810 applies when such a service begins between midnight and 7:00 a.m., and the amount payable is increased by 50%.
These are surgical timing premiums. They are not general “after-hours bonuses” for any dental service. Clerks should attach them only when the base service and the start-time condition both fit the schedule. Supporting documentation may be requested for T809 and T810 according to Ontario’s technical specifications for specialized submissions.
The dental schedule and Ontario regulation references identify these in-person premiums:
T811 - consultation or visit between 5:00 p.m. and midnight, or on Saturday, Sunday, or holiday, 30% of amount payable.
T812 - consultation or visit to a patient in an intensive care facility, 30% of amount payable.
T813 - consultation or visit between midnight and 7:00 a.m., 50% of amount payable.
The schedule contains the permanent virtual-care code family T655, T656, T814, T815, T816. Ontario’s 2025 dental fee bulletin explicitly notes that these virtual-care codes are now on a permanent basis and that temporary code T657A ended March 31, 2025.
For virtual care:
T655 - virtual consultation.
T656 - virtual follow-up assessment within 12 months of the initial consultation for the same diagnosis.
T814 - virtual consultation/visit premium for evening/weekend/holiday timing, 30%.
T815 - virtual consultation/visit premium for patient in intensive care facility, 30%.
T816 - virtual consultation/visit premium for midnight to 7:00 a.m., 50%.
The schedule also says T655/T656 require the dental surgeon to be located in a public acute-care hospital when the service is rendered, the patient may be at the location of their choice, and the chart must include start and stop times or the service is not eligible for payment. The schedule commentary also points users to the RCDSO virtual care standard.
In clerk language, a manual review claim is one where OHIP needs supporting documentation or explanation before it can adjudicate properly. Ontario’s technical specifications state that the manual review indicator brings the claim to the ministry’s attention and that supporting documentation is required for that kind of specialized submission. Ontario’s eSubmit bulletin also says attachments are no longer mandatory on Supporting Documentation (manual review) eSubmit tickets, reducing redundancy, but supporting material may still be requested or needed depending on the case.
A key dental example is same-day T650 with odontectomy. The schedule says an emergency consultation report or prior approval form must support the same-day consultation rationale, otherwise the claim will not be paid.
T800 is the schedule’s unlisted-procedure route. The schedule says independent consideration will be given to claims for other dental and oral and maxillofacial surgery procedures not listed in the schedule. This is the code family clerks should think of when the oral surgeon performed a valid insured hospital dental procedure that does not map neatly to a listed service code.
Independent consideration also appears in other schedule contexts. For example, Ontario’s schedule snippet notes that some assistant claims require the surgeon’s explanation to accompany the claim for independent consideration or they will be paid at zero.
Part III is the big prior approval section for dental clerks. The schedule says these services are insured only when hospitalization is medically necessary and prior approval has been given by the OHIP Dental or Medical Consultant. Approved procedures must be completed within one year of the approval date. The request for prior approval must normally be provided before the date of service except for an emergency procedure or exceptional circumstances.
Ontario’s technical specifications also identify the main Part III dental codes as specialized submissions requiring prior authorization: T901-T912, T925-T928, and T936.
A major clerk rule: when T650 is rendered in conjunction with Part III procedures for which prior approval has been granted, the amount payable for T650 is zero. That catches many beginners.
When a claim lands on your desk, ask these questions in order:
Is it just a routine listed service?
If yes, bill normally with the correct base code.
Does a premium apply?
Check surgical start time, visit/consult timing, ICU status, or the virtual-care premium rules.
Does the claim need manual review support?
Think same-day T650 with odontectomy, unclear emergency rationale, or other specialized submission situations.
Is it unlisted or exceptionally justified?
Consider T800 / independent consideration.
Is it a Part III procedure?
Check whether prior approval was needed and obtained, and whether the approval is still within one year.
Schedule of Benefits - Dental Services under the Health Insurance Act.
Ontario dental fee bulletin confirming permanent virtual dental codes.
Ontario technical specifications for specialized submissions, manual review, and prior authorization code handling.
Ontario eSubmit service delivery enhancement bulletin.
RCDSO virtual care guidance and standards landing pages.