OHIP Billing Codes — Schedule of Benefits
Search the complete Ontario Schedule of Benefits for Physician Services. Look up any OHIP billing code — fee schedules, billing rules, and claim guidelines.
Browse by Category
General Listings
Assessments, consultations, and general visits
Paediatrics
Paediatric assessments and procedures
Surgical Procedures
General and specialized surgical codes
Orthopaedic Surgery
Musculoskeletal and orthopaedic procedures
Surgical Assists
Assistant and support procedure codes
Anaesthesia
Anaesthesia services and time-based codes
Diagnostic & Therapeutic Procedures
Diagnostic imaging and therapeutic interventions
Obstetrics
Prenatal, delivery, and postnatal care
Cardio-Thoracic Surgery
Cardiac and thoracic surgical procedures
Consultation & Visit Premium Codes
Premiums for consultations and special visits
Dermatology
Skin conditions and dermatological procedures
Ophthalmology
Eye examinations and ophthalmic procedures
Otolaryngology
Ear, nose, and throat procedures
Plastic Surgery
Reconstructive and plastic surgical codes
Critical Care
ICU and critical care management codes
Radiology
Imaging and radiological procedures
Urology
Urological procedures and assessments
Neurology
Neurological assessments and procedures
Laboratory
Laboratory tests and analyses
Psychiatric
Psychiatric assessments and therapy codes
Browse by Specialty
View all specialtiesUnderstanding the Ontario Schedule of Benefits
The Schedule of Benefits for Physician Services is the Ontario Ministry of Health document that defines every service OHIP insures, what each one pays, and the conditions under which it can be claimed. It is issued under the Health Insurance Act and it is the document OHIP adjudicates against — a service that isn't in the Schedule, or that doesn't meet the requirements printed beside it, doesn't get paid. In practice most physicians only ever work with a small slice of it, which is exactly how money gets left behind.
Every code here is drawn from the current Schedule, including the fee, the effective date, the specialties the code is restricted to, and the billing rules and premiums that attach to it. Search by code if you know it, or by plain-language description if you don't — “house call after hours” and A007 both get you to the same place.
The Schedule is organised into sections by the first letter of the code. A codes cover consultations and assessments — the bread-and-butter of office practice. G codes cover diagnostic and therapeutic procedures. K codes cover counselling, forms, and special services. E codes are add-ons that ride along with a base service rather than standing on their own. Browsing by section is a reliable way to find the codes you should be billing but aren't.
Common questions
What is the OHIP Schedule of Benefits?
The Schedule of Benefits for Physician Services is the Ontario Ministry of Health document, issued under the Health Insurance Act, that lists every insured physician service, its billing code, its fee, and the rules governing when it can be claimed. It is the authority OHIP pays from — if a service is not in the Schedule, OHIP does not pay it.
How are OHIP billing codes structured?
An OHIP billing code is five characters: a four-character base code plus a one-letter role suffix. The first letter of the base code identifies the section of the Schedule (A for consultations and visits, G for diagnostic and therapeutic procedures, K for counselling and special services, and so on). The suffix identifies your role in the service — A for the physician who rendered it, B for a surgical assistant, and C for an anaesthetist.
How often do OHIP fees change?
The Ministry updates the Schedule of Benefits periodically through amendments, usually alongside the Physician Services Agreement. Fee changes take effect on a stated date, and claims are paid at the fee in force on the service date — not the date you submit. Every code page here shows the current fee and its effective date, with fee history where we have it.
How long do I have to submit an OHIP claim?
OHIP claims must be submitted within six months of the service date. Past that, the claim is stale-dated and will be rejected. Within each month, claims received by the 18th are adjudicated in that cycle and paid on the 15th of the following month; anything after the 18th rolls into the next cycle.
What is the difference between a billing code and a diagnostic code?
The billing code says what service you performed and determines what you are paid. The OHIP diagnostic code — a three-digit code from the Ministry's own list — says why you performed it. Most claim items require both, and a mismatch between them is one of the more common causes of rejection.
Are these fees the same for every physician?
Not always. Some codes are restricted to particular specialties, and some pay a different amount depending on the specialty of the physician claiming them. Premiums layer on top: age-based premiums, after-hours and special visit premiums, and time-based units all change what a given service actually pays. Each code page lists the restrictions and eligible premiums we hold for that code.
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