P001 – Medical management of non-viable fetus or intra-uterine fetal demise between 14 and 20 weeks gestation
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
Medical management of a non-viable fetus or intra-uterine fetal demise when the gestation is between 14 and 20 weeks. This service is only payable for the active medical management of the patient and is not payable when the fetus delivers spontaneously prior to initiating intervention. Services that are generally accepted components of this service, such as cervical ripening and oxytocin infusion, are included and not billed separately if rendered.
When to Use
- Use P001 for the active induction of labor for a confirmed intra-uterine fetal demise between 14 and 20 weeks gestation.
- Use P001 when medical management (e.g., misoprostol or oxytocin) is required to evacuate the uterus for a non-viable fetus within the 14-20 week window.
Common Pitfalls
- Billing P001 if the fetus delivers spontaneously before you initiate any medical intervention; this is considered a spontaneous miscarriage and is not eligible for this procedural fee.
- Attempting to bill separate fees for cervical ripening agents or oxytocin infusion, as these are considered inclusive components of the P001 global fee.
- Billing a same-day assessment or counselling code alongside P001, which will trigger an automatic rejection as these are restricted on the day of the procedure.
Billing Tips
- Ensure your documentation explicitly references the ultrasound confirmation of gestational age, as this is a mandatory requirement for claim validation.
- If the patient requires a subsequent uterine curettage for retained products causing hemorrhage, bill Z774 in addition to P001 to ensure appropriate compensation for the secondary procedure.
Effective: April 1, 2026
K. Obstetrics
OBSTETRICS
Procedure
Obstetrics, Diagnostic and Therapeutic Procedures
The length of gestation must be confirmed by ultrasound.
P001 is only eligible for payment if the length of gestation is confirmed by ultrasound.
Services described as consultations, assessments or counselling (and those procedures that are generally accepted components of this service, including cervical ripening and oxytocin infusion if rendered) are not eligible for payment when rendered the same day to the same patient by the same physician as P001.
Z774 is eligible for payment in addition to P001 if uterine curettage is required for postpartum hemorrhage due to retained products.
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