Billing Queries
Let us know if you have any billing questions or suggestions, and our Tariff Committee will respond.
Latest Section/Billing Corner Update: Billing Blog (gated)
OHIP Schedule of Benefits (February 14, 2025 – effective March 3, 2025): download
OHIP Resources for Physicians: details
2025 OMA Schedule of Fees (OMA Suggested Fees for Uninsured Services): download
OMA Schedule of Benefits Mobile App: details
OHIP Schedule of Benefits: Codes Relevant to General Surgery
NOTE: After several requests, this table has been revised. It now has links to PDF page excerpts from the current Schedule of Benefits. If you encounter any technical issues or incorrect information, please let us know on the contact page or submit a query above.
| Procedures | Keywords | Common Codes | Section# | Page # | Page Link |
|---|---|---|---|---|---|
| Consultations & Visits | consult, consultation, assessment, | A034, A035, C034, C122, C123, C124, C142, C143, A645, C645, W645, E083, | A102-103, GP15-78 | 230-233, 29-2 | Download |
| Most Responsible Physician (MRP) | MRP, responsible, | C122,C123, C124, C142, C143, E082, E083 | A102, GP42-47 | 230, 56-62 | Download |
| Counselling | counsel, primary, mental, relatives | K013, K033, K040, K041, K014, K015 | A17, GP54-55 | 145, 68-69 | Download |
| Travel Premiums | special visit, travel, home, off-site, | K960-K96*, K990-K99*, U960-U96*, U990-U99*, C960-C96*, C990-C99*, W960-W96*, W990-W99*, H960-H96*, H980-H98*, B960-B96*, B986-B98*, B990-B99*, A960-A96*, A990-A99*, Q960-Q96*, Q990-Q99*, | GP65-78 | 84-92 | Download |
| Assistant Fees | assist, assistant, after hours, second, | E400B, E401B, C988B, C998B,C983B, C999B | GP85-91 | 99-105 | Download |
| After-Hours Premiums | after hours, evenings, nights, weekends, holidays | E409, E410 | GP87, GP104 | 118-120, 101 | Download |
| Upper Endoscopy | stomach, digestive, oesophagoscopy, hernia, hiatus, gastrotomy, gastrostomy, gastroscopy, sigmoidoscopy, colonoscopy, endoscopy, | Z399, Z400, Z529, Z530, Z560, Z580, Z497 | S7-24 | 675-684, 698 | Download |
| Colonoscopy & Sigmoidoscopy | digestive, oesophagus, endoscopy, hiatus, hernia, gastoscopy, gastro, gastrostomy, gastrotomy, sigmoidoscopy, colonoscopy, biliary, intestinal, | Z535, Z580, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499, Z555, S091, S098, | S15-S22 | 683-688, 693-4 | Download |
| Stomach | stomach, endoscopy, gastroscopy, gastrotomy, gastrostomy, gastrectomy, vagotomy, gastric bypass, Roux-en-Y, pyloroplasty, gastroduodenostomy | Z527, S120, S122, S131, S132, S134, | S11-S14 | 679-682 | Download |
| Colorectal | intestinal, hydrostatic, fulgaration, enterotomy, colonoscopy, colostomy, ileostomy, cecostomy, resection, duodenum, colectomy, anastomosis, bowel resection, prolapse, Meckel's diverticulum, mesentery, | S213, S214, S215, S216, S217, S218, S247, Z756, Z758, Z550, Z535 | S19-S22 | 687-696 | Download |
| Hernia & Abdominal | hernia, abdomen, peritoneum, omentum, endoscopy, repair, | S312, S321, S314, S332 S323 | S33-S38 | 705-6 | Download |
| Hepatobiliary | hepatectomy, liver transplant, donor, endoscopy, cholecystectomy, biliary, duct, Whipple, pancreatic, distal | Z554, S269, S278, S287, Z762, S298, S300, | S29-S32 | 697-700 | Download |
| Breast | integumentary, breast, needle biopsy, aspiration, lumpectomy, mastectomy, nipple, flaps, axillary, lymph nodes, sentinel, | Z141, Z139, R107, R111, R108, R117 | M24-M28 | 560-564, 668 | Download |
| Skin & Subcutaneous Tissue | abscess, haematoma, biopsy, cyst, lesion, plantar, pilonidal, tattoo removal, scalp, face, neck, wound, ulcer, debridement, burn, hand, foot, necrotizing, fasciitis, nail, finger, toe, | Z101, Z102, Z116, Z080, | M1-M23 | 537-564 | Download |
| Appendix | appendix, Mesentery, Meckel's diverticulum, small intestine, bowel transplant, | S204, S207, S152, | S23-S24 | 691-692 | Download |
| Endocrine | aspiration, thyroid, thyroidectomy, adrenalectomy, cyst, abscess, gland, parathyroid, thymus, adrenal, adrenalectomy, nodule, | Z726, S787, S788, S798, S800 | W1-W2 | 739-740 | Download |
| Vascular | artery, ligation, abdominal aorta, femoral repair, suprarenal, supraceliac, thoracic, aneurysm, vascular, vein, anastomosis, renal, | R880, R799, R800, R803, R802, R817, R877, E986, E986, R797 | Q11-Q17 | 657-666 | Download |
| Thoracic | trachea, bronchi, bronchoscopy, lung, tracheotomy, chest, pleura, endoscopy, thoracic, pneumonectomy, segmental | M142, M143, M149, M144, | P8-P16 | 638-646 | Download |
| Morbid Obesity Premium | obesity, morbid, obese, | E676 | SP6 | 534 | Download |
| Trauma Premium | trauma, ISS, injury severity score, urgent, after hours | E406, E407, E408, E420 | GP109 | 123 | Download |
| Tedious Adhesions Premium | lysis, cancelled surgery, bariatric, BMI, body mass, transplant, premium, tedious, gastric bypass | E673, E676 | SP7-SP8 | 535-536 | Download |
| Nerve Blocks | nerve, block, pain, management, therapeutic, infusion, anaesthesia, | G061, G224, G247, E023C | J70, J72, GP100 | 471-473, 114-115 | Download |
| TPN Fee | injection, infusion, TPN, diagnostic, therapeutic, intravenous, sclerotherapy, parenteral, alimentation, | G510 | J55, J56 | 456-457 | Download |
| Varicose Veins | veins, varicose, cardiovascular, injection, infusion, TPN, diagnostic, therapeutic, intravenous, sclerotherapy, | Z745, R868, G536, G537 | Q18, Q19, J55 | 664-5, 455-57 | Download |
| ICU Visit Premium | intensive care, ICU, after hours, | C101, E409, E410, | GP103-GP104 | 117-18 | Download |
| Home Care Forms & Advice | neurocognitive assessment, home care application, home care supervision, acute home care, mandatory reporting, | K070, K071, K035, | A53, A54, | 181-82 | Download |
| Physician Telephone Consult | telephone consultation, physician to physician, consultant physician, | K730, K731, K734, K735 | A37, A38 | 165-66 | Download |
| Criticall | criticall, telephone, consultant physician, | K732, K733, K736, K737, | A40, A41, A42 | 168-69 | Download |
| Multidisciplinary Cancer Conference | MCC, multidisciplinary cancer conference, discussion, | K708, K709, K710, K711 | A25-A28 | 153-56 | Download |
| Necrotizing Faciitis | necrotizing faciitis, debridement, fasciotomy, burn, skin, subcutaneous, tissue, | R691, R692, R693, R660, R661, R662, R637, R698, R690 | M12, M13 | 548-49 | Download |
| Critical Care | G521, G395, G400, G559 | J27-J33 | 427-433 | Download | |
| Section GP: General Preamble | general preamble | GP1-GP111 | 15-125 | Download | |
| Section SP: Surgical Preamble | SP1-SP8 | 529-536 | Download | ||
| Section A: Consultations & Visits | consults, visits, | A1-A195 | 129-323 | Download | |
| Section J: Diagnostic & Therapeutic Procedures | diagnostic, therapeutic, | J1-J115 | 401-516 | Download | |
| Section M: Integumentary System | M1-M28 | 537-564 | Download | ||
| Secion N: Muscoskeletal System | N1-N65 | 565-629 | Download | ||
| Section R: Haematic and Lymphatic Surgical Procedures | R1-R2 | 667-8 | Download | ||
| Section S: Digestive | S1-S38 | 669-706 | Download | ||
| Section T: Urogenital & Urinary | T1-T13 | 707-719 | Download | ||
| Section U: Male Genital | U1-U7 | 721-27 | Download | ||
| Section V: Female Genital | V1-V10 | 729-738 | Download | ||
| Section W: Endocrine | W1-W2 | 739-40 | Download | ||
| SOB Numeric Index | NI1-NI150 | 829-978 | Download | ||
| Table of Contents | i-vii | 3-13 | Download | ||