OHIP Billing by Services
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 ...
Which OHIP Special Visit Premium time period applies right now? (Quick Decision Guide)
Summary / Description Use this quick decision guide to choose the correct OHIP Special Visit Premium time window (weekdays daytime, sacrifice of office hours, weekday evening, weekend/holiday, or night). Then select the matching Travel Premium and ...
OHIP Special Visit Premiums — Quick Lookup (K990/K991/K994/K995/K998/K999/K996/K997 + Travel Premiums)
Summary / Description: One-screen quick lookup for OHIP Special Visit Premiums using K-codes (first person seen + additional persons seen) and Travel Premiums by time period. Includes the max-per-time-period rules and required chart documentation ...
Emergency Department “H” Codes – Quick Lookup (Time Period → H-Code → Fee → Key Rule)
Summary / Description: Quick lookup for Emergency Department “H” assessment codes by time period, plus ED-physician premiums and after-hours procedure premiums. Use this to pick the right H-code and confirm the key payment rules. Emergency Department ...
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, ...
General Preamble – Assessments (GP21 - GP39): General, Periodic, Specific & Paediatric Assessments – Definitions and Limits
Summary / Description This article explains OHIP “General Preamble” assessment types defined on pages GP21–GP39, including general, specific, paediatric, chronic disease, newborn and e-assessments, plus detention, ambulance detention and organ ...
Consultations (GP16) – OHIP Rules, Limits and Definitions for All Specialties
Summary / Description This article explains how OHIP defines a consultation, repeat consultation and limited consultation, how often consultations can be billed, and how emergency room and special surgical consultations work. It is based on the ...
Diagnostic Radiology (33) – OHIP Consults, Assessments, Components & After-Hours Premiums (2025)
Summary / Description Diagnostic radiology (33) bills for the professional interpretation and technical performance of imaging studies, plus specific consultations, second opinions, minor assessments and after-hours premiums. This article explains ...
Anaesthesia (01) – OHIP Consults, Assessments, Units & After-Hours Premiums (2025)
What does Anaesthesia (01) bill under OHIP? Anaesthesia (01) covers: Pre-anaesthetic evaluation The general anaesthesia service includes a pre-anaesthetic evaluation, the anaesthetic procedure itself, and post-anaesthetic follow-up. ...
AT3 - Which service codes qualify as virtual codes with a K301A vs. a K300A?
Virtual care claims must include one of the following tracking codes: K300A – services provided by phone K301A – services provided by video The following service codes are eligible for virtual billing when submitted with K300A (phone) or K301A ...
What are the new phone and video virtual service codes effective Dec.01,2022?
How do I bill virtual codes? Why are my K08*A codes being rejected? An excllent MOHLTC guide released on Nov. 24, 2022; introduction to new OHIP Virtual Care Services and fee codes
OTN - Telemedicine
This article has been updated on Dec 01, 2022 by ... What are the new phone and video virtual service codes effective Dec.01,2022? Expired KB article How do physicians qualify for telemedicine? To qualify physicians must sign and complete an “OHIP ...
OHIP Explanation Codes 55 and 57
There are cases where OHIP determines that certain service codes were “not paid properly” on past claims. The processes that OHIP uses to fix such cases can seem to be confusing. Explanation codes 55 and 57 seem to show that OHIP pays and then takes ...