TABLE OF CONTENTS
GP. General Preamble
Introduction ..................................................................................................................................................................................... GP1
Definitions ....................................................................................................................................................................................... GP2
General Information ........................................................................................................................................................................ GP6
Constituent and Common Elements of Insured Services................................................................................................................ GP9
Specific Elements of Assessments ............................................................................................................................................... GP11
Consultations ................................................................................................................................................................................ GP12
Assessments................................................................................................................................................................................. GP14
Hospital and Institutional Consultations and Assessments........................................................................................................... GP26
Psychotherapy, Psychiatric and Counselling Services ................................................................................................................. GP37
Interviews ...................................................................................................................................................................................... GP41
Delegated Procedure .................................................................................................................................................................... GP42
Age-Based Fee Premiums ............................................................................................................................................................ GP43
Special Visit Premiums ................................................................................................................................................................. GP44
Team Care in Teaching Units ....................................................................................................................................................... GP53
Surgical Assistants’ Services ........................................................................................................................................................ GP54
Anaesthesiologists’ Services......................................................................................................................................................... GP58
Supportive Care/Monitoring By Surgical Assistant or Anaesthesiologist ...................................................................................... GP64
Other Premiums ............................................................................................................................................................................ GP65
Emergency Department Sessional Fees....................................................................................................................................... GP69
Emergency Department Alternative Funding Agreements............................................................................................................ GP71
A. Consultations and Visits
Family Practice & Practice in General (00) ....................................................................................................................................... A1
Anaesthesia (01) ............................................................................................................................................................................. A45
Cardiology (60)................................................................................................................................................................................ A47
Cardiac Surgery (09)....................................................................................................................................................................... A49
Clinical Immunology (62)................................................................................................................................................................. A50
Community Medicine (05) ............................................................................................................................................................... A51
Dermatology (02) ............................................................................................................................................................................ A53
Emergency Medicine (12) ............................................................................................................................................................... A56
Endocrinology & Metabolism (15) ................................................................................................................................................... A57
Gastroenterology (41) ..................................................................................................................................................................... A62
General Surgery (03) ...................................................................................................................................................................... A64
General Thoracic Surgery (64)........................................................................................................................................................ A66
Genetics (22)................................................................................................................................................................................... A67
Geriatrics (07) ................................................................................................................................................................................. A71
Haematology (61)............................................................................................................................................................................ A75
Infectious Disease (46) ................................................................................................................................................................... A76
Internal and Occupational Medicine (13) ........................................................................................................................................ A78
Laboratory Medicine (28) ................................................................................................................................................................ A81
Medical Oncology (44) .................................................................................................................................................................... A82
Nephrology (16) .............................................................................................................................................................................. A84
Neurology (18) ................................................................................................................................................................................ A86
Neurosurgery (04) ........................................................................................................................................................................... A89
Nuclear Medicine (63) ..................................................................................................................................................................... A90
Obstetrics and Gynaecology (20).................................................................................................................................................... A91
Ophthalmology (23)......................................................................................................................................................................... A92
Orthopaedic Surgery (06)................................................................................................................................................................ A97
Otolaryngology (24)......................................................................................................................................................................... A99
Paediatrics (26) ............................................................................................................................................................................. A100
Physical Medicine & Rehabilitation (31)........................................................................................................................................ A105
Plastic Surgery (08)....................................................................................................................................................................... A110
Psychiatry (19) .............................................................................................................................................................................. A111
Diagnostic Radiology (33) ............................................................................................................................................................. A117
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Radiation Oncology (34) ...............................................................................................................................................................
Respiratory Disease (47) ..............................................................................................................................................................
Rheumatology (48)........................................................................................................................................................................
Urology (35) ..................................................................................................................................................................................
Vascular Surgery (17) ...................................................................................................................................................................
A119
A120
A122
A126
A127
B. Nuclear Medicine - IN VIVO
Preamble........................................................................................................................................................................................... B1
Cardiovascular System ..................................................................................................................................................................... B3
Endocrine System ............................................................................................................................................................................. B4
Gastrointestinal System .................................................................................................................................................................... B5
Genitourinary System........................................................................................................................................................................ B6
Haematopoietic System .................................................................................................................................................................... B7
Musculoskeletal System.................................................................................................................................................................... B8
Nervous System and Respiratory System ........................................................................................................................................ B9
Miscellaneous ................................................................................................................................................................................. B10
Scintimammography ....................................................................................................................................................................... B11
Clinical Procedures Associated With Diagnostic Nuclear Medicine................................................................................................ B12
B. Positron Emission Tomography (PET)
Preamble......................................................................................................................................................................................... B14
........................................................................................................................................................................................................ B17
C. Radiation Oncology
Preamble...........................................................................................................................................................................................
Radiotherapy.....................................................................................................................................................................................
Radium and Radioisotopes (Sealed Sources) ..................................................................................................................................
Radioisotopes (Non-sealed Sources) ...............................................................................................................................................
C1
C2
C5
C6
D. Diagnostic Radiology
Preamble........................................................................................................................................................................................... D1
Head and Neck ................................................................................................................................................................................. D4
Spine and Pelvis ............................................................................................................................................................................... D5
Upper Extremities.............................................................................................................................................................................. D6
Lower Extremities.............................................................................................................................................................................. D7
Skeletal Surveys ............................................................................................................................................................................... D8
Chest and Abdomen ......................................................................................................................................................................... D9
Gastrointestinal Tract ...................................................................................................................................................................... D10
Genitourinary Tract ......................................................................................................................................................................... D11
Obstetrics and Gynaecology ........................................................................................................................................................... D12
Fluoroscopy - By physician With or Without Spot Films.................................................................................................................. D13
Special Examinations...................................................................................................................................................................... D14
Bone Mineral Density (BMD) Measurement.................................................................................................................................... D15
Computed Tomography (CT) .......................................................................................................................................................... D17
Miscellaneous Examinations........................................................................................................................................................... D21
E. Clinical Procedures associated with Diagnostic Radiological Examinations
Preamble........................................................................................................................................................................................... E1
Angiography ...................................................................................................................................................................................... E2
Miscellaneous Procedures ................................................................................................................................................................ E3
F. Magnetic Resonance Imaging (MRI)
Preamble............................................................................................................................................................................................ F1
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G. Diagnostic Ultrasound
Preamble........................................................................................................................................................................................... G1
Head and Neck ................................................................................................................................................................................. G3
Thorax, Abdomen and Retroperitoneum........................................................................................................................................... G4
Pregnancy ......................................................................................................................................................................................... G5
Pelvis................................................................................................................................................................................................. G6
Vascular System ............................................................................................................................................................................... G7
Vascular Laboratory Fees ................................................................................................................................................................. G9
Miscellaneous ................................................................................................................................................................................. G10
Ultrasonic Guidance........................................................................................................................................................................ G11
H. Pulmonary Function Studies
Preamble........................................................................................................................................................................................... H1
J. Diagnostic and Therapeutic Procedures
Preamble............................................................................................................................................................................................ J1
Allergy ................................................................................................................................................................................................ J4
Anaesthesia ....................................................................................................................................................................................... J6
Cardiovascular ................................................................................................................................................................................... J7
Electrocardiography (ECG) .............................................................................................................................................................. J12
Non-Invasive Cardiography.............................................................................................................................................................. J16
Echocardiography ............................................................................................................................................................................ J17
Echocardiography ............................................................................................................................................................................ J18
Critical Care ..................................................................................................................................................................................... J21
Dermatology..................................................................................................................................................................................... J29
Dialysis............................................................................................................................................................................................. J30
Endocrinology and Metabolism ........................................................................................................................................................ J33
Gastroenterology.............................................................................................................................................................................. J35
Gynaecology .................................................................................................................................................................................... J37
Haematology .................................................................................................................................................................................... J39
Home and Self Care Services.......................................................................................................................................................... J40
Injections or Infusions ...................................................................................................................................................................... J41
Laboratory Medicine......................................................................................................................................................................... J47
Nephrology....................................................................................................................................................................................... J53
Nerve Blocks for Acute Pain Management ...................................................................................................................................... J54
Nerve Blocks - Interventional Pain Injections................................................................................................................................... J58
Nerve Blocks - Peripheral/Other Injections ...................................................................................................................................... J62
Neurology......................................................................................................................................................................................... J65
Neurosurgery ................................................................................................................................................................................... J68
Ophthalmology ................................................................................................................................................................................. J70
Otolaryngology ................................................................................................................................................................................. J77
Palliative Care .................................................................................................................................................................................. J81
Physical Medicine ............................................................................................................................................................................ J83
Psychiatry and Respiratory Disease ................................................................................................................................................ J85
Sleep Studies ................................................................................................................................................................................... J86
Urology............................................................................................................................................................................................. J92
K. Obstetrics
Preamble........................................................................................................................................................................................... K1
Prenatal Care .................................................................................................................................................................................... K4
Labour - Delivery............................................................................................................................................................................... K6
Obstetrical Anaesthesia .................................................................................................................................................................... K8
High Risk Pregnancies...................................................................................................................................................................... K9
Maternal - Fetal Procedures............................................................................................................................................................ K10
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SP. Surgical Preamble
Preamble......................................................................................................................................................................................... SP1
M. Integumentary System Surgical Procedures
Skin and Subcutaneous Tissue......................................................................................................................................................... M1
Operations of the Breast ................................................................................................................................................................. M18
N. Musculoskeletal System Surgical Procedures
Preamble........................................................................................................................................................................................... N1
General Fees .................................................................................................................................................................................... N3
Hand and Wrist ................................................................................................................................................................................. N6
Elbow and Forearm......................................................................................................................................................................... N13
Shoulder, Arm and Chest................................................................................................................................................................ N18
Skull and Mandible.......................................................................................................................................................................... N22
Pelvis and Hip ................................................................................................................................................................................. N31
Femur.............................................................................................................................................................................................. N35
Knee................................................................................................................................................................................................ N37
Fibula and Tibia............................................................................................................................................................................... N41
Foot and Ankle ................................................................................................................................................................................ N43
P. Respiratory Surgical Procedures
Nose..................................................................................................................................................................................................
Accessory Nasal Sinuses..................................................................................................................................................................
Larynx ...............................................................................................................................................................................................
Trachea and Bronchi.........................................................................................................................................................................
Chest Wall and Mediastinum ............................................................................................................................................................
Lungs and Pleura ..............................................................................................................................................................................
P1
P3
P5
P6
P8
P9
Q. Cardiovascular Surgical Procedures
Preamble........................................................................................................................................................................................... Q1
Heart and Pericardium ...................................................................................................................................................................... Q2
Valves ............................................................................................................................................................................................... Q8
Arteries.............................................................................................................................................................................................. Q9
Veins ............................................................................................................................................................................................... Q14
R. Haematic and Lymphatic Surgical Procedures
Spleen and Marrow ........................................................................................................................................................................... R1
Lymph Channels ............................................................................................................................................................................... R2
S. Digestive System Surgical Procedures
Oral Cavity and Pharynx ................................................................................................................................................................... S1
Salivary Glands and Ducts................................................................................................................................................................ S3
Lips.................................................................................................................................................................................................... S4
Endoscopic Ultrasound ..................................................................................................................................................................... S5
Oesophagus...................................................................................................................................................................................... S6
Stomach ............................................................................................................................................................................................ S9
Intestines (Except Rectum) ............................................................................................................................................................. S13
Miscellaneous ................................................................................................................................................................................. S19
Rectum............................................................................................................................................................................................ S20
Liver ................................................................................................................................................................................................ S23
Biliary Tract ..................................................................................................................................................................................... S24
Pancreas ......................................................................................................................................................................................... S26
Abdomen, Peritoneum and Omentum............................................................................................................................................. S27
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T. Urogenital and Urinary Surgical Procedures
Preamble - Kidney and Upper Urinary Tract ...................................................................................................................................... T1
Kidney and Upper Urinary Tract......................................................................................................................................................... T2
Preamble - Bladder and Urethra ........................................................................................................................................................ T6
Bladder............................................................................................................................................................................................... T7
Urethra ............................................................................................................................................................................................. T10
U. Male Genital Surgical Procedures
Penis .................................................................................................................................................................................................
Testis.................................................................................................................................................................................................
Epididymis and Tunica Vaginalis ......................................................................................................................................................
Scrotum.............................................................................................................................................................................................
Vas Deferens ....................................................................................................................................................................................
Spermatic Cord and Seminal Vesicles..............................................................................................................................................
Prostate.............................................................................................................................................................................................
U1
U2
U3
U4
U5
U6
U7
V. Female Genital Surgical Procedures
Preamble........................................................................................................................................................................................... V1
Vulva and Introitus ............................................................................................................................................................................ V2
Vagina ............................................................................................................................................................................................... V3
Cervix Uteri ....................................................................................................................................................................................... V6
Corpus Uteri ...................................................................................................................................................................................... V7
Fallopian Tube .................................................................................................................................................................................. V9
Ovary............................................................................................................................................................................................... V10
W. Endocrine Surgical Procedures
Thyroid Gland................................................................................................................................................................................... W1
Parathyroid, Thymus and Adrenal Glands ....................................................................................................................................... W2
X. Neurological Surgical Procedures
Cranial............................................................................................................................................................................................... X1
Peripheral Nerves ............................................................................................................................................................................. X8
Y. Ocular and Aural Surgical Procedures
Eyeball .............................................................................................................................................................................................. Y1
Cornea .............................................................................................................................................................................................. Y2
Sclera, Iris and Ciliary Body .............................................................................................................................................................. Y3
Crystalline Lens................................................................................................................................................................................. Y4
Vitreous ............................................................................................................................................................................................. Y5
Retina and Extra Ocular Muscles...................................................................................................................................................... Y6
Orbit .................................................................................................................................................................................................. Y7
Eyelids............................................................................................................................................................................................... Y8
Conjunctiva ..................................................................................................................................................................................... Y10
Lacrimal tract................................................................................................................................................................................... Y11
External Ear .................................................................................................................................................................................... Y12
Middle Ear ....................................................................................................................................................................................... Y14
Inner Ear ......................................................................................................................................................................................... Y15
Z. Spinal Surgical Procedures
Preamble............................................................................................................................................................................................ Z1
Anterior Spinal Decompression.......................................................................................................................................................... Z2
Anterior Spinal Arthrodesis Following Decompression ...................................................................................................................... Z3
Anterior Spinal Arthrodesis With Instrumentation Without Decompression ....................................................................................... Z4
Posterior Spinal Decompression........................................................................................................................................................ Z5
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Posterior Spinal Arthrodesis Following Decompression or Osteotomy.............................................................................................. Z6
Posterior Spinal Arthrodesis As Sole Procedure................................................................................................................................ Z7
Fractures of the Spine........................................................................................................................................................................ Z8
Tumours/Infections of the Spine ........................................................................................................................................................ Z9
Deformities of the Spine................................................................................................................................................................... Z10
Revision Procedures for Spinal Surgery .......................................................................................................................................... Z11
Procedures on Musculoskeletal Elements ....................................................................................................................................... Z12
Procedures Involving Neural Elements ............................................................................................................................................ Z13
Meningocoele and Myelomeningocoele........................................................................................................................................... Z15
AA. Appendix A
AB. Appendix B
AC. Appendix C
AD. Appendix D
Surface Pathology........................................................................................................................................................................... AD2
Sub-Surface Pathology ................................................................................................................................................................... AD5
AF. Appendix F
AG. Appendix G
AH. Appendix H
AQ. Appendix Q
NI. Numeric Index
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GENERAL PREAMBLE
Introduction ................................................................................................................................................................................................1
Definitions...................................................................................................................................................................................................2
General Definitions ............................................................................................................................................................................2
Maximums, Minimums and Time or Unit-Based Services .................................................................................................................5
General Information ...................................................................................................................................................................................6
Services Insured by OHIP ................................................................................................................................................................6
Modifications to the Schedule...........................................................................................................................................................6
Medical Research.............................................................................................................................................................................6
Medical Records...............................................................................................................................................................................6
General Payment rules......................................................................................................................................................................7
Specialist services....................................................................................................................................................................7
Use of Codes, Prefixes and Suffixes........................................................................................................................................7
Independent Consideration (IC) ........................................................................................................................................................8
Constituent and Common Elements of Insured Services ......................................................................................................................9
Specific Elements of Assessments ........................................................................................................................................................11
Consultations ...........................................................................................................................................................................................12
Consultation.....................................................................................................................................................................................12
Repeat Consultation ........................................................................................................................................................................13
Limited Consultation ........................................................................................................................................................................13
Emergency Room (ER) Physician Consultation ..............................................................................................................................13
Special Surgical Consultation..........................................................................................................................................................13
Assessments ............................................................................................................................................................................................14
General Assessment .......................................................................................................................................................................14
Periodic Health Visit ........................................................................................................................................................................14
General Re-Assessment .................................................................................................................................................................14
Pre-dental/Pre-operative assessments ...........................................................................................................................................15
Specific Assessment and Medical Specific Assessment.................................................................................................................15
Specific Re-Assessment and Medical Specific Re-Assessment .....................................................................................................15
Complex Medical Specific Re-Assessment .....................................................................................................................................15
Partial Assessment..........................................................................................................................................................................16
Chronic Disease Assessment Premium ..........................................................................................................................................16
Level 1 Paediatric Assessment .......................................................................................................................................................18
Level 2 Paediatric Assessment .......................................................................................................................................................18
Intermediate Assessment ................................................................................................................................................................18
Intermediate Assessment – Pronouncement of Death ....................................................................................................................18
Minor Assessment ...........................................................................................................................................................................18
Periodic Oculo-Visual Assessment..................................................................................................................................................19
First Visit by Primary Care Physician After Hospital Discharge.......................................................................................................19
Detention .........................................................................................................................................................................................20
Detention-in-Ambulance ..................................................................................................................................................................21
Detention for the Transport of Donor Organs ..................................................................................................................................21
Newborn Care .................................................................................................................................................................................21
Low Birth Weight Baby Care ...........................................................................................................................................................21
Well Baby Care................................................................................................................................................................................22
Psychiatric Assessment under the Mental Health Act .....................................................................................................................22
E-Assessments................................................................................................................................................................................23
Hospital and Institutional Consultations and Assessments................................................................................................................26
Acute Care Hospital – Non-Emergency In-Patient Services (“C” prefix services) ...........................................................................26
Admission Assessment – General Requirements ...........................................................................................................................26
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GENERAL PREAMBLE
Admission Assessments by Specialists:..........................................................................................................................................26
Admission Assessments by General and Family Practitioners: ......................................................................................................26
Admission Assessments by General and Family Practitioners in an Emergency Department Funded under an Emergency Depart­
ment Alternative Funding Agreement: .............................................................................................................................................26
Admission Assessments by Emergency Physicians: ......................................................................................................................27
Admission Assessment by the Most Responsible Physician (MRP) Premium................................................................................27
Subsequent Visit..............................................................................................................................................................................28
Subsequent visit by the MRP – day following the hospital admission assessment (C122) .............................................................29
Subsequent visit by the MRP – second day following the hospital admission assessment (C123) ................................................29
Subsequent visit by the MRP - day of discharge (C124).................................................................................................................30
First subsequent visit by the MRP following transfer from an Intensive Care Area (C142) .............................................................31
Second subsequent visit by the MRP following transfer from an Intensive Care Area (C143)........................................................31
Subsequent visit and palliative care visit by the MRP premium ......................................................................................................32
Concurrent Care ..............................................................................................................................................................................32
Supportive Care...............................................................................................................................................................................32
Long-Term Care Institution: Non-Emergency In-Patient Services...................................................................................................33
Admission Assessment ...................................................................................................................................................................33
Subsequent Visit..............................................................................................................................................................................33
Emergency Department - “H” prefix emergency department services ............................................................................................34
Palliative Care Assessment.............................................................................................................................................................34
Monthly Management of a Nursing Home or Home for the Aged Patient .......................................................................................35
Psychotherapy, Psychiatric and Counselling Services........................................................................................................................37
Psychotherapy/Family Psychotherapy ............................................................................................................................................38
Hypnotherapy ..................................................................................................................................................................................39
Counselling......................................................................................................................................................................................39
Individual Counselling ............................................................................................................................................................39
Group Counselling .................................................................................................................................................................39
Transplant Counselling ..........................................................................................................................................................40
Counselling of Relatives on Behalf of a Catastrophically or Terminally Ill Patient .................................................................40
Rehabilitation Counselling......................................................................................................................................................40
Interviews..................................................................................................................................................................................................41
Delegated Procedure ...............................................................................................................................................................................42
Age-Based Fee Premiums .......................................................................................................................................................................43
Special Visit Premiums............................................................................................................................................................................44
Team Care in Teaching Units ..................................................................................................................................................................53
Surgical Assistants’ Services .................................................................................................................................................................54
Calculation of Fee Payable: Basic Units and Time Units ................................................................................................................54
After Hours Premiums .....................................................................................................................................................................55
Replacement Surgical Assistant......................................................................................................................................................55
Special Visit Premiums....................................................................................................................................................................56
Cancelled Surgery – Assistant Services..........................................................................................................................................57
Second Assistant.............................................................................................................................................................................57
Surgical Assistant Standby..............................................................................................................................................................57
Anaesthesiologists’ Services..................................................................................................................................................................58
Calculation of Fee Payable – Basic and Time Units........................................................................................................................58
After Hours Premiums .....................................................................................................................................................................59
Special Visit Premiums....................................................................................................................................................................59
Cancelled Surgery - Anaesthesia Services .....................................................................................................................................60
Second Anaesthesiologist ...............................................................................................................................................................60
Replacement Anaesthesiologist ......................................................................................................................................................60
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GENERAL PREAMBLE
Obstetrics – Continuous Conduction Anaesthesia ..........................................................................................................................60
Extra Units .......................................................................................................................................................................................61
Replacement of Listed Basic Units..................................................................................................................................................62
Supportive Care/Monitoring By Surgical Assistant or Anaesthesiologist .........................................................................................64
Calculation of Fee Payable..............................................................................................................................................................64
Other Premiums .......................................................................................................................................................................................65
After Hours Procedure Premiums....................................................................................................................................................65
After Hours Special Visit Premiums.................................................................................................................................................67
Trauma Premium.............................................................................................................................................................................68
Emergency Department Sessional Fees ................................................................................................................................................69
Emergency Department Alternative Funding Agreements ..................................................................................................................71
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GENERAL PREAMBLE
NOT ALLOCATED
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