H122 – Comprehensive assessment and care
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive assessment and care rendered by an Emergency Department Physician for an unscheduled patient. This service is specifically for visits occurring during night hours, from 00:00h to 08:00h. According to , 'H' prefix codes apply under the following circumstances: - When a full- or part-time Emergency Department Physician is working for a pre-arranged designated period of time or shift. - For services rendered by an on-call physician where the service does not qualify for claiming a special visit premium. An 'Emergency Department Physician' is defined as a physician working in a hospital emergency department or a Hospital Urgent Care Clinic for the purpose of rendering services to unscheduled patients.
When to Use
- Use H122 for a comprehensive assessment of an unscheduled patient presenting to the ED between 00:00h and 08:00h when you are working a designated ED shift.
- Select H122 when the patient's clinical complexity requires a full assessment, distinguishing it from the minor assessment code H121.
Common Pitfalls
- Billing H122 in combination with a special visit premium (e.g., K965) will result in a rejection, as H-prefix codes are explicitly ineligible for these premiums.
- Attempting to bill H122 alongside H112 for the same patient visit is a billing error, as H112 is intended for services where an assessment code cannot be claimed.
- Claiming additional ultrasound services (other than H100 or J149) while billing H122 will lead to automatic payment denials.
Billing Tips
- Always apply the 15% age premium for patients 65 and older to maximize the value of the H122 base fee.
- If you perform a procedure that does not qualify as a comprehensive assessment during the 00:00h to 08:00h window, bill H112 instead of attempting to force an assessment code.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate records that establish: an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
With the exception of ultrasound guidance, (J149) or emergency department investigative ultrasound (H100), ultrasound services listed in this Schedule rendered by an Emergency Department Physician are not eligible for payment.
When any other service is rendered by the Emergency Department Physician in premium hours (and assessments may not be claimed), apply one of the following premiums per patient visit. - H112: nights (00:00h to 08:00h) - 35.15 - H113: daytime and evenings (08:00h to 24:00h) on Saturdays, Sundays or Holidays - 20.35
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