What is OHIP billing code P055?

P055 is "Insertion of fetal shunt - bladder to amniotic cavity", an OHIP Plastic Surgery code from the Ontario Schedule of Benefits (Physician Services).

How much does P055 pay?

The current OHIP fee for P055 is $398.10, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill P055 to OHIP?

P055 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates P055 claims against the Schedule of Benefits rules before submission.

What codes are related to P055?

Codes related to P055 in the Schedule of Benefits include P050, P051, P052, P060, P053, P054, P056, P057.

All codes

P055

P055 – Insertion of fetal shunt - bladder to amniotic cavity

OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits

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Insertion of a fetal shunt from the bladder to the amniotic cavity. This is a surgical procedure with fees payable for the surgeon (A), assistant (B), and anaesthetist (C). The fee for the surgeon is a set amount, while fees for the assistant and anaesthetist are calculated by combining 8 basic units with time-based units. Per the note on , this procedure is payable in addition to J149 (Ultrasonic Guidance) and/or Z552 (Diagnostic Laparoscopy) when applicable.

When to Use

Use P055 for the specific surgical placement of a vesico-amniotic shunt to treat fetal lower urinary tract obstruction.
Use this code when performing the procedure as a standalone surgical intervention, ensuring it is distinct from diagnostic amniocentesis or other fetal procedures.

Common Pitfalls

Billing for a second surgical assistant without prior written authorization from a medical consultant will result in automatic rejection, as P055 is not on the pre-approved list.
Failing to document the specific use of ultrasonic guidance (J149) or diagnostic laparoscopy (Z552) as separate, billable components can lead to under-billing for the full scope of the intervention.

Billing Tips

Always append J149 to the claim if ultrasonic guidance was utilized, as it is explicitly payable in addition to P055 per the K11 section notes.
Ensure that after-hours premiums (E400 series for assistants, E400C/E401C for anaesthesia) are applied based on the exact time of procedure commencement to maximize the unit-based fee structure.

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Provider Fee$398.10

Surgical Assistant Fee$100.08

Anaesthetist Fee$123.92

Non-Anaesthetist Fee$123.92

Effective: April 1, 2025

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