H154 – Re-assessment
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A re-assessment rendered by an Emergency Department Physician for a patient in an emergency department or hospital urgent care clinic. This service applies under the following conditions: - Timing: The service is rendered on Saturdays, Sundays, or Holidays between 08:00h and 24:00h. - Provider: Per , an 'Emergency Department Physician' is a physician working in a hospital emergency department or a Hospital Urgent Care Clinic for the purpose of rendering services to unscheduled patients. With the exception of consultation fee H055 for a specialist in emergency medicine, any physician on duty (regardless of specialty) in the emergency department must submit claims using these 'H' prefix listings. - Context: The 'H' prefix listings apply when a full- or part-time Emergency Department Physician is working a pre-arranged shift, or for services by an on-call physician where a special visit premium is not claimed ().
When to Use
- Use H154 for a follow-up assessment of a patient already in the ED during the same shift on a weekend or holiday when a full assessment (H134) is not clinically indicated.
- Use this code for a reassessment of a patient awaiting diagnostic results or specialist consultation when the service occurs between 08:00 and 24:00 on a Saturday, Sunday, or Holiday.
Common Pitfalls
- Billing H154 in conjunction with H113 is a common rejection because H113 is a premium intended for when an assessment code cannot be claimed.
- Attempting to bill H154 on a weekday will result in a rejection, as this code is strictly restricted to weekends and holidays.
- Claiming H154 alongside a special visit premium is prohibited, as the 'H' series codes are specifically designed for shift-based ED work where premiums do not apply.
Billing Tips
- Ensure your documentation clearly distinguishes the reassessment from the initial H134 to justify the necessity of the additional service during the same ED encounter.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
The “H” prefix listings under the heading, “Emergency Department Physician” on pages , in the Consultations and Visits section of the Schedule, apply in the following circumstances: a. when a full- or part-time Emergency Department Physician is working for a pre-arranged designated period of time or shift; or b. for services rendered by an on-call physician where the service does not qualify for claiming a special visit premium.
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