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Critical Care Medicine OHIP billing codes
ICU consultations and visits, per-diem critical care and ventilatory support, life-threatening critical care, and ICU procedures.
43 codes in 6 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 11 is in the full Critical Care listing.
Consultations & assessments
- A715ConsultationConsultation - Critical Care Medicine—
- A710Comprehensive Critical Care Medicine Consultation—
- A915Limited consultationLimited consultation - Critical Care Medicine—
- A116Repeat consultationRepeat consultation - Critical Care Medicine—
- A713Medical Specific AssessmentMedical Specific Assessment - Critical Care Medicine—
- A114Medical specific re-assessment—
- A111Complex medical specific re-assessment—
- A118Concurrent careA partial assessment by a Critical Care Medicine specialist, which is a limited service constituting a history of the presenting complaint, necessary physical examination, advice to the patient, and an appropriate record.—
Hospital in-patient
- C715ConsultationA consultation provided by a specialist in Critical Care Medicine to a non-emergency hospital in-patient, following a written request from a referring practitioner.—
- C710Comprehensive Critical Care Medicine ConsultationA comprehensive consultation for a non-emergency hospital in-patient by a Critical Care Medicine specialist, requiring a minimum of 75 minutes of direct patient contact. This service follows the general rules for consultations, including the need for a written referral.—
- C915Limited consultationA limited consultation rendered by a Critical Care Medicine specialist for a non-emergency hospital in-patient. This service is less demanding and requires less time than a full consultation but must meet all other requirements for a consultation.—
- C116Repeat consultation - non-emergency hospital in-patientRepeat consultation—
- C112Subsequent visit - first five weeks—
- C117Subsequent visit - sixth to thirteenth week inclusiveSubsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week) (per visit)—
- C119Subsequent visit - after thirteenth week—
- C118Concurrent careA routine assessment for a hospital in-patient by a consulting specialist, requested by the most responsible physician (MRP) for continued directive care.—
- C114Medical specific re-assessment—
- C111Complex medical specific re-assessmentComplex medical specific re-assessment (Critical Care Medicine)—
- C713Medical Specific AssessmentA medical specific assessment for a non-emergency hospital in-patient, rendered by a specialist in Critical Care Medicine. This service is subject to specific frequency limits.—
Critical care — per diem
- G557Critical care - 1st dayPer diem fee for the physician-in-charge managing a critically ill patient on the first day of critical care in an intensive care setting.$429.30
- G558Critical care - 2nd to 30th dayA per diem fee for the physician-in-charge for managing a critically ill patient from the 2nd to the 30th day of their critical care stay.$256.25
- G559Critical care - 31st day onwardsPer diem fee for the physician-in-charge managing a critically ill patient, payable for each day from the 31st day of care onwards.$122.80
- G400Critical Care - 1st dayCritical Care - 1st day in an Intensive Care Area, for critically ill patients, excluding ventilatory support and insertion of ICP measuring device.$223.10
- G401Critical Care - 2nd to 30th dayThis code represents a diagnostic and therapeutic procedure. Specific details for G401 were not found in the provided context.$146.45
- G402Critical care - 31st day onwards$58.60
Ventilatory support
- G405Ventilatory support - 1st dayVentilatory support in an Intensive Care Area, including initial consultation, assessment, intubation, tracheal toilet, use of artificial ventilator, and monitoring.$183.80
- G406Ventilatory support - 2nd to 30th day2nd to 30th day, inclusive$96.45
- G407Ventilatory support - 31st day onwardsVentilatory Support includes provision of ventilatory care including initial consultation and assessment of the patient, intravenous lines, endotracheal intubation with positive pressure ventilation including insertion of arterial C.V.P lines, tracheal toilet, use of artificial ventilator and all necessary measures for its supervision, obtaining and interpretation of blood gases, oximetry, transcutaneous blood gases and assessment.$64.20
Life-threatening critical care & resuscitation
- G521Life threatening critical care - first 1/4 hourThe first quarter-hour of critical care provided by a physician to a critically ill or injured patient experiencing acute, life-threatening vital organ system failure.$125.10
- G523Life threatening critical care - second 1/4 hourPayable for the second 15-minute interval (or part thereof) of life-threatening critical care for a patient with an illness or injury that acutely impairs one or more vital organ systems.$64.50
- G522Life threatening critical care - after first ½ hourA time-based fee for providing life-threatening critical care to a critically ill or injured patient, per quarter-hour (or part thereof), after the first half-hour of care has been provided with the physician in full devotion.$42.50
- G395Other critical care - first 1/4 hourThis code is for the first quarter-hour (or part thereof) of a resuscitation service for a patient in an emergency with a potential threat to life or limb, but not yet meeting the criteria for life-threatening critical care. It includes resuscitation assessment and procedures.$64.70
- G391Critical care - fourth and subsequent physiciansA time-based fee for providing critical care, billed per quarter-hour. This applies to the fourth and subsequent physicians in a life-threatening critical care situation, or to quarter-hours following the initial resuscitation period (`<billingCode>G395</billingCode>`) in other critical care scenarios.$34.35
ICU procedures
- G211Endotracheal intubation for resuscitationEndotracheal intubation performed for resuscitation. This service is not payable if performed as part of an anaesthetic procedure for a subsequent surgery.$38.35
- G268Cannulation of artery for pressure measurementsA procedure for the cannulation of an artery, which may include a cut down, for the purpose of taking pressure measurements. This code is subject to several billing restrictions with other vascular procedures.$31.25
- Z459Arterial punctureA procedure involving the puncture of an artery to obtain a blood sample, commonly for blood gas analysis.$10.20
- G085Continuous venovenous haemofiltration - initial and acuteProvides for the initial and acute management of continuous venovenous haemofiltration (CVVH), a type of continuous renal replacement therapy. This code is limited to the first three services per episode of care.$385.75
- G324Subclavian or jugular catheter for haemodialysis - insertionInsertion of a subclavian or external jugular catheter for the purpose of haemodialysis.$102.95
- G099Percutaneous insertion of permanent jugular/femoral dialysis catheterPercutaneous insertion of permanent jugular/femoral dialysis catheter (including subcutaneous positioning)$168.40
- G303Transthoracic pacemaker - insertionPerformance of a transthoracic pacemaker insertion. This is a critical care procedure which requires that the start and stop times be recorded in the patient's medical record for payment eligibility.$51.25
- Z341Tube thoracostomy for closed drainage (chest tube)A surgical procedure for the insertion of a chest tube for closed drainage, typically to remove air or fluid from the pleural space.$76.80
- Z332Aspiration for diagnosis or therapeutic drainagePerforms a therapeutic aspiration of the lung and pleura, also known as thoracentesis, to drain fluid, with or without taking a diagnostic sample. This is an Independent Operative Procedure (IOP).$104.40
- Z804Lumbar puncturePerforms a lumbar puncture (spinal tap), a procedure to collect cerebrospinal fluid. This service includes the injection of medication and the use of image guidance, if performed.$150.00
How to use this critical care code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to critical care medicine (specialty 11) — its own consultation and assessment codes, in-patient visits, premiums and the diagnostics or procedures that make up most of a day — sectioned the way a shift sheet reads. Codes open to every specialty that a critical care physician also bills (general assessments, forms, special visit premiums) live in the Family Practice and Special visit premiums sets.
Each code links to its full Schedule entry: fee history, restrictions, required diagnoses and the codes it can or cannot be billed with. Fees shown are the current provider or specialist fee; percentage premiums show the percentage they add to the base service.
Common questions
Which consultation or assessment code does critical care medicine bill?
The consultations & assessments section of this set starts with A715 (Consultation). 8 codes are listed in that section.
What is in the Critical Care Medicine code set?
43 OHIP billing codes across 6 sections: Consultations & assessments; Hospital in-patient; Critical care — per diem; Ventilatory support; Life-threatening critical care & resuscitation; ICU procedures. ICU consultations and visits, per-diem critical care and ventilatory support, life-threatening critical care, and ICU procedures.
Are these the current OHIP fees?
Fees are read from the current Ontario Schedule of Benefits for Physician Services and refreshed hourly. Claims are paid at the fee in force on the service date, so always confirm the effective date on the code page.
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