H055 – Emergency Department Physician on Duty Consultation
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An Emergency Room (ER) Physician Consultation rendered by a specialist in emergency medicine (FRCP). Per the General Preamble on page , a consultation by an ER Physician is claimed using H055 for a specialist in emergency medicine (FRCP) or H065 for all other physicians. As defined on page , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital. The request is made because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or their representative. A consultation includes all services necessary for the consultant to prepare a written report to the referring practitioner, including findings, opinions, and recommendations.
When to Use
- Use H055 when you are an FRCP-certified emergency physician providing a formal consultation for a patient in the ED following a written request from a primary care provider or nurse practitioner.
- Use H055 for complex cases where the referring practitioner specifically requests your specialist expertise to manage a diagnostic or therapeutic dilemma in the emergency setting.
Common Pitfalls
- Claiming H055 when the patient is referred by another emergency physician within the same hospital, which triggers an automatic downgrade to a lesser assessment fee.
- Failing to document or transmit the formal consultation report to the referring provider, which results in the claim being adjusted down to a standard assessment fee.
- Attempting to bill Special Visit Premiums (e.g., K990 series) alongside H055, as these are explicitly prohibited for all 'H' prefix emergency department fee codes.
Billing Tips
- Ensure your documentation explicitly references the written referral request and confirms the report was sent to the referring practitioner to protect the full consultation fee.
- Verify that your FRCP status is correctly registered with OHIP, as H055 is restricted to specialists in emergency medicine, while H065 must be used by all other physicians.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In a hospital, long-term care institution or multi-specialty clinic with common medical records, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out relevant information and specify the service(s) required.
ER reports constitute adequate documentation of the written report of the consultation as long as the rendering of all constituent elements is clearly documented on all copies of the report.
See for definitions and conditions for physicians on duty.
All other consultations and visits - use the listings for Family Practice & Practice In General.
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