H152 – Comprehensive assessment and care
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a comprehensive assessment and care provided by an Emergency Department Physician. According to , an Emergency Department Physician is a physician working in a hospital emergency department or Hospital Urgent Care Clinic specifically for rendering services to unscheduled patients. These 'H' prefix services apply when a physician is working a pre-arranged shift or is on-call and the service does not qualify for a special visit premium. This specific code, H152, applies when the service is rendered on Saturdays, Sundays, and Holidays during daytime and evenings, from 08:00h to 24:00h. An age-based premium is applicable for patients aged 65 and older as per .
When to Use
- Use H152 for comprehensive assessments of unscheduled patients in an Emergency Department or Hospital Urgent Care Clinic during weekends or holidays between 08:00h and 24:00h.
- Use this code when the patient's clinical presentation requires a full assessment, distinguishing it from the minor assessment code H151.
Common Pitfalls
- Do not attempt to bill a Special Visit Premium (e.g., K963) with H152, as 'H' prefix codes are explicitly excluded from these premiums.
- Avoid billing H152 if you are also claiming the H113 premium for the same patient visit, as H113 is only for services where an assessment code cannot be claimed.
- Do not bill H152 for patients under 65 without ensuring the base code is appropriate, as the 15% age premium is only applicable to specific codes including H152.
Billing Tips
- Always add the 15% age premium for patients 65 and older, as it is not automatically calculated by the system.
- You may claim H105 in addition to H152 if you provide separate in-patient interim admission orders, provided you are not also billing a formal hospital admission assessment.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary. (Source: :)
Note 1: H105 is payable in addition to the initial consultation or assessment rendered in the emergency department or Hospital Urgent Care Clinic provided that each service is rendered separately by the Emergency Department Physician.
Note 2: H105 is an insured service payable at nil if the hospital admission assessment is payable to the Emergency Department Physician.
Note 3: 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.
Note 4: 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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