All codes
Q538
Q538 – Q538
OHIP Critical Care Code · Schedule of Benefits
When to Use
- Use Q538 as a mandatory administrative code when billing for the administration of the COVID-19 vaccine to patients aged 6 months and older.
- Apply this code in conjunction with the appropriate vaccine product code (e.g., Q539, Q540) to indicate the professional service of vaccine delivery.
Common Pitfalls
- Billing Q538 without an accompanying vaccine product code will result in an automatic rejection as the service is considered incomplete.
- Attempting to bill an office visit fee (e.g., A007) on the same day as Q538 is often flagged for audit unless a separate, unrelated medical issue is addressed and documented.
Billing Tips
- Ensure the patient's OHIP number is active and valid at the time of service, as Q538 claims are strictly validated against the Ministry's eligibility database.
Provider Fee$0.00
Effective: November 1, 2007
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