H261 – Newborn care in hospital or home
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Newborn care is the routine care of a well newborn for up to the first ten days of life in hospital or home and includes an initial general assessment and subsequent assessments, as may be indicated, and instructions to the caregiver(s) regarding the newborn's health care. As an assessment, this service includes the common elements of all insured services (as described in -) and the specific elements of assessments (as described in ), including a direct physical encounter, history taking, examination, making arrangements for related procedures or follow-up, and providing advice to the patient's representative.
When to Use
- Use H261 for the initial physical examination and subsequent routine daily assessments of a healthy newborn within the first 10 days of life.
- Use H261 when providing routine care for a well newborn in a hospital setting, including discharge planning and caregiver education.
- Use H261 for a home visit assessment of a well newborn within the 10-day window, provided the visit meets the criteria for a non-elective special visit.
Common Pitfalls
- Do not bill H261 for newborns requiring intensive care or complex medical management; use the appropriate neonatal intensive care codes (e.g., H262 or H263) instead.
- Avoid billing H261 beyond the 10th day of life; subsequent visits after day 10 must be billed as standard hospital visits (e.g., C002).
- Do not bill H261 in addition to a surgical procedure fee if the physician is the primary surgeon, as the newborn care is often considered included in the surgical global fee.
Billing Tips
- Ensure you append the appropriate Special Visit Premium (Table III for hospital or Table VI for home) when the visit is non-elective and meets the time-of-day criteria.
- If a newborn is transferred between facilities, H261 can be claimed by physicians at both the sending and receiving hospitals if both provided a distinct assessment.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
Routine care of a well newborn for up to the first ten days of life
In surgical cases requiring medical direction, standard in-hospital medical fees are to be claimed in addition to the surgical fee. This includes all operations on babies under one year of age, and all other older children who require medical supervision.
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