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Endocrinology & Metabolism OHIP billing codes
Endocrinology consultations, diabetes management and insulin initiation, dynamic endocrine testing and thyroid procedures.
51 codes in 7 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 15 is in the full Endocrinology listing.
Consultations & assessments — office
- A155Consultation - Endocrinology—
- A150Comprehensive endocrinology consultation—
- A255Limited consultationLimited consultation - Endocrinology & Metabolism—
- A156Repeat consultationRepeat consultation - Endocrinology & Metabolism—
- A153Medical specific assessmentMedical specific assessment - Endocrinology & Metabolism—
- A154Medical specific re-assessment—
- A151Complex medical specific re-assessmentComplex medical specific re-assessment (Endocrinology & Metabolism)—
- A158Partial assessment—
- A760Complex Endocrine Neoplastic Disease AssessmentComplex endocrine neoplastic disease assessment—
Hospital in-patient
- C155Consultation - Endocrinology & Metabolism—
- C150Comprehensive endocrinology consultationComprehensive endocrinology consultation (In-patient)—
- C255Limited consultationA limited consultation rendered by an Endocrinology & Metabolism (<specialtyCode>15</specialtyCode>) specialist for a non-emergency hospital in-patient. This service is less demanding and requires less time than a full consultation but must otherwise meet all the requirements of a consultation as defined on <SectionPages>GP16</SectionPages> to <SectionPages>GP18</SectionPages>, including a written request from a referring practitioner.—
- C156Repeat consultationA repeat consultation for a non-emergency hospital in-patient, rendered by a specialist in Endocrinology & Metabolism. This service follows a previous consultation for the same issue after the patient has received interim care from another physician.—
- C153Medical specific assessmentMedical specific assessment - Endocrinology & Metabolism—
- C154Medical specific re-assessmentMedical specific re-assessment (Endocrinology & Metabolism)—
- C151Complex medical specific re-assessmentComplex medical specific re-assessment - Endocrinology & Metabolism—
- C152Subsequent visits - first 4 per patient per monthSubsequent visits - first five weeks (per visit)—
- C157Subsequent visit - sixth to thirteenth week inclusive—
- C158Subsequent visits per monthConcurrent care (per visit)—
- C159Subsequent visit - after thirteenth week (maximum 6 per patient per month)Subsequent visit - after 13th week (max 6/month)—
- C760Complex endocrine neoplastic disease assessmentA complex assessment for endocrine neoplastic disease for a non-emergency hospital in-patient, rendered by a specialist in Endocrinology & Metabolism. This service is subject to the same conditions as the corresponding general listing code, <billingCode>A760</billingCode>.—
Diabetes management
- K045Diabetes management by a specialistA yearly management fee for specialists in Endocrinology, Internal Medicine, or Paediatrics providing ongoing care for a diabetic patient. Payment requires at least 4 preceding visits in the 12-month period and documentation of care consistent with Canadian Diabetes Association guidelines.—
- K046Diabetes team managementAnnual fee for a specialist in Internal Medicine (13) or Endocrinology (15) for comprehensive, team-based care of a patient with diabetes, which must include at least one Certified Diabetes Educator (CDE). See page <SectionPages>A95</SectionPages> for full requirements.—
- G500Insulin initiation or initial specialist assessmentA monthly management fee for the month in which a patient initiates treatment with two or more daily insulin injections or an insulin pump, or for the month of the initial assessment by a specialist for a patient on such therapy. This service requires at least one contact for medical advice or insulin adjustment.$31.80
Dynamic endocrine tests
- G337Antidiuretic hormone response testA diagnostic test to evaluate antidiuretic hormone (ADH) function, which involves an 8-hour water deprivation test.$16.95
- G338Clonidine suppression testA diagnostic test for the investigation of pheochromocytoma which requires the physician to be physically present. The service includes any required venipunctures.$24.90
- G340Histamine test to include a control cold pressor testA diagnostic procedure involving a histamine test that includes a control cold pressor test, typically performed for endocrinological investigation.$45.45
- G341Hypertonic saline infusion testA diagnostic procedure involving the intravenous administration of hypertonic saline to assess endocrine and metabolic function.$16.95
- G344Phentolamine testA diagnostic procedure involving a phentolamine test, as listed under the Endocrinology and Metabolism section of the Schedule of Benefits.$42.30
- G490Saralasin testA Saralasin test, which is a diagnostic procedure performed to investigate conditions related to endocrinology and metabolism.$42.30
- G494Glucagon test - (Type A) for carbohydrate responseA diagnostic test involving glucagon to evaluate a patient's carbohydrate response.$10.20
- G495Glucagon test - (Type B)A provocative test using glucagon to investigate hypertension, pheochromocytoma, and insulinoma. This service also includes the cold pressor test.$42.30
- G497Insulin hypoglycemia pituitary function testA diagnostic test to assess pituitary function using insulin-induced hypoglycemia. This test may optionally include the administration of Thyrotropin-releasing hormone (TRH) and/or Luteinizing-hormone-releasing hormone (LHRH).$49.80
- G498Intravenous glucose tolerance testA diagnostic test involving the intravenous administration of glucose to evaluate a patient's glucose metabolism and insulin response.$10.20
- G499Intravenous tolbutamide testAn intravenous tolbutamide test is a diagnostic procedure used to assess insulin secretion by the pancreas.$49.80
- G501TRH or LHRH test, per injectionPayment for a Thyrotropin-releasing hormone (TRH) or Luteinizing-hormone-releasing hormone (LHRH) test, claimed on a per-injection basis. This is a diagnostic procedure within the Endocrinology and Metabolism category.$6.25
- G513Pentagastrin stimulation for calcitoninA diagnostic test involving the administration of pentagastrin to stimulate and measure calcitonin levels in a patient.$42.30
- G515Open circuit indirect calorimetryA diagnostic test to determine a patient's resting energy expenditure using an open circuit indirect calorimeter, which includes measuring oxygen consumption and carbon dioxide saturation. The procedure requires the patient to be 12-14 hours post-prandial and includes measurements of height, weight, and body fat.$46.30
- G358Growth hormone exercise stimulation testA diagnostic test involving exercise to stimulate growth hormone release. This service requires the physician to be present and includes any necessary venipunctures.$24.90
Thyroid procedures
- Z771Aspiration biopsy, thyroid gland or nodule fine needle methodPerforms a fine needle aspiration biopsy of the thyroid gland or a thyroid nodule for diagnostic purposes. This procedure is eligible for age-based and after-hours premiums.$38.00
- Z726Aspiration, thyroid cystA therapeutic procedure involving the aspiration of fluid from a thyroid cyst.$38.00
Long-term care
- W155ConsultationA specialist consultation in Endocrinology & Metabolism for a patient in a long-term care facility, such as a nursing home or chronic care hospital. This non-emergency service requires a written referral and includes providing a written report to the referring practitioner.—
- W156Repeat ConsultationA repeat endocrinology consultation for a patient in a long-term care institution. This service is an additional consultation by the same consultant for the same problem, requested after another physician has provided intervening care.—
- W255Limited consultationA limited consultation for a patient in a non-emergency long-term care setting, initiated by a written referral. This service is less demanding and time-consuming than a full consultation.—
- W150Comprehensive Endocrinology ConsultationA comprehensive endocrinology consultation for a patient in a long-term care institution, rendered following a written request. This service is subject to the same conditions as <billingCode>A150</billingCode>.—
- W252Admission assessment - Type 1A Type 1 admission assessment, which is a comprehensive general assessment, rendered by a specialist in Endocrinology & Metabolism to a patient upon non-emergency admission to a long-term care facility such as a chronic care hospital or nursing home.—
- W254Admission assessment - Type 2An initial visit to assess a newly admitted long-term care patient, where the admitting physician has previously performed a consultation, general assessment, or general re-assessment for the same condition.—
- W257Admission assessment - Type 3A general re-assessment of a patient being re-admitted to a long-term care institution after a minimum 3-day stay in another institution.—
- W259Periodic health visitA routine health check-up for a patient in a long-term care institution, performed by a specialist in Endocrinology & Metabolism. As per <SectionPages>GP21</SectionPages>, this service is for patients with no acute illness and is limited to one per 12-month period per physician.—
- W760Complex endocrine neoplastic disease assessmentA complex assessment for endocrine neoplastic disease provided to non-emergency in-patients in a long-term care setting. Billing is subject to the same conditions as <billingCode>A760</billingCode>.—
How to use this endocrinology code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to endocrinology (specialty 15) — 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 endocrinology 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 endocrinology & metabolism bill?
The consultations & assessments — office section of this set starts with A155 (Consultation - Endocrinology). 9 codes are listed in that section.
What is in the Endocrinology & Metabolism code set?
51 OHIP billing codes across 7 sections: Consultations & assessments — office; Hospital in-patient; Diabetes management; Premiums; Dynamic endocrine tests; Thyroid procedures; Long-term care. Endocrinology consultations, diabetes management and insulin initiation, dynamic endocrine testing and thyroid 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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