All codes
Y865
Y865 – Y865
OHIP Other Code · Schedule of Benefits
When to Use
- Use Y865 as a mandatory administrative code to indicate that a patient has been enrolled in the Chronic Disease Management (CDM) incentive program.
- Apply this code when submitting the initial registration for a patient to the Ministry to initiate eligibility for subsequent CDM fee codes.
Common Pitfalls
- Billing Y865 without an accompanying valid diagnosis code from the Ministry's approved chronic disease list will result in an automatic rejection.
- Attempting to bill Y865 for a patient who is already enrolled in a different primary care model or rostered to another physician will trigger an error due to duplicate enrollment.
Billing Tips
- Ensure the patient's health card is validated at the time of submission, as Y865 requires an active OHIP number to successfully register the patient in the system.
Provider Fee$0.00
Surgical Assistant Fee$218.25
Non-Anaesthetist Fee$73.52
Effective: April 1, 2026
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