What is OHIP billing code F055?

F055 is "Open reduction of shoulder neck fracture", an OHIP Anaesthesia code from the Ontario Schedule of Benefits (Physician Services).

How much does F055 pay?

The current OHIP fee for F055 is $775.95, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill F055 to OHIP?

F055 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates F055 claims against the Schedule of Benefits rules before submission.

What codes are related to F055?

Codes related to F055 in the Schedule of Benefits include F053, F054, F050, F051, F052.

All codes

F055

F055 – Open reduction of shoulder neck fracture

OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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F055 is a fee code for the open reduction of a fracture of the humeral neck, specifically when there is no dislocation of the humeral head. This service falls under the Musculoskeletal System Surgical Procedures section of the Schedule of Benefits. As a surgical procedure, it is eligible for surgeon (A), assistant (B), and anaesthetist (C) fees. The calculation of assistant and anaesthesia fees is based on a combination of basic units and time units as outlined in the General Preamble (:, :).

When to Use

Use F055 for open reduction of a humeral neck fracture when the humeral head remains in the glenoid fossa, distinguishing it from F053 which involves a fracture-dislocation.
Select F055 when the surgical approach requires an open incision to achieve anatomical reduction of the humeral neck, as opposed to closed reduction techniques (F050) or percutaneous fixation (F051).

Common Pitfalls

Billing F055 when the procedure involves a dislocation of the humeral head, which is specifically excluded from this code and requires the use of F053.
Attempting to claim F055 alongside other fracture management codes for the same anatomical site; the Schedule of Benefits generally prohibits multiple procedural fees for the same fracture unless specifically permitted.

Billing Tips

Ensure the operative report explicitly confirms the absence of humeral head dislocation to support the use of F055 over F053 during potential audits.
If the procedure is performed after hours, remember that the 50% (E409) or 75% (E410) premium applies only to the surgeon's fee, while assistant and anaesthesia premiums must be claimed using their respective E-series codes.

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Provider Fee$775.95

Surgical Assistant Fee$77.46

Anaesthetist Fee$95.76

Non-Anaesthetist Fee$95.76

Effective: April 1, 2026

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