What is OHIP billing code N555?

N555 is "Insertion, revision, or removal of implantable infusion pump", an OHIP Otolaryngology code from the Ontario Schedule of Benefits (Physician Services).

How much does N555 pay?

The current OHIP fee for N555 is $590.40, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill N555 to OHIP?

N555 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates N555 claims against the Schedule of Benefits rules before submission.

All codes

N555

N555 – Insertion, revision, or removal of implantable infusion pump

OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits

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N555 is for the insertion or revision of an implantable infusion pump. This is a surgical procedure listed under the Spinal Surgical Procedures section of the Schedule of Benefits. Payment is for the surgeon (suffix A) and anaesthetist (suffix C). The anaesthesia fee is calculated based on 8 base units plus time units. See the General Preamble for full rules on surgical services, anaesthesia services, and applicable premiums.

When to Use

Use N555 when performing the primary surgical implantation of an intrathecal drug delivery system for chronic pain or spasticity management.
Use N555 for the surgical revision or complete removal of an existing pump system, provided the procedure meets the definition of a surgical intervention rather than a simple percutaneous needle access.

Common Pitfalls

Billing N555 in conjunction with a standard office visit code (A007) is a common rejection; the surgical fee is intended to be comprehensive for the procedure.
Attempting to bill N555 for percutaneous pump programming or simple reservoir refills, which are not surgical procedures and should be billed under appropriate non-surgical consultation or assessment codes.

Billing Tips

Ensure the anaesthesia time units are accurately recorded and submitted with suffix C, as the base units are fixed at 8 for this specific procedure.
If the procedure is performed in an emergency setting, ensure the appropriate emergency department premium is applied to the surgical code if the patient was not previously admitted for the surgery.

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Provider Fee$590.40

Anaesthetist Fee$123.92

Non-Anaesthetist Fee$123.92

Effective: April 1, 2025

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