All codes
Z499
Z499 – Colonoscopy for risk evaluation (asymptomatic, family history)
OHIP Digestive System Surgical Procedures Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Z499 is a colonoscopy for risk evaluation, sigmoid to descending colon, for a patient with an absence of signs or symptoms and a family history associated with an increased risk of malignancy, in accordance with current Ontario generally accepted clinical practice guidelines (). Effective July 1, 2026, colonoscopy services were changed to align with updated ColonCancerCheck recommendations (INFOBulletin 260702): screening for a family history associated with an increased risk of malignancy is repeated every 5 years beginning at age 40, or 10 years earlier than the youngest age a relative was diagnosed, with a 5 to 10 year follow-up interval. Claims system updates were completed in August 2026 (INFOBulletin 260801). Payment rules:
• Z499 is only insured when rendered for a patient aged in accordance with current Ontario generally accepted clinical practice guidelines (). - Z580 (flexible sigmoidoscopy) is not eligible for payment with Z499 same patient same day (). - Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 is eligible for payment per patient per day (). - A follow-up of a normal Z499 colonoscopy with no intervening signs or symptoms is claimed as Z492 (). - Anaesthesia for Z499 is E032C: 4 basic units plus time units, which replaces the listed basic and time units for anaesthesia for this procedure ().
Documentation of the patient's family history that meets the criteria for increased risk of malignancy.
Usage limits
Family-history screening is repeated every 5 years, per current Ontario ColonCancerCheck guidance (INFOBulletin 260702).
Z499 is only insured for a patient 40 years of age or older or 10 years younger than the earliest age of diagnosis of the youngest affected relative.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.