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Gastroenterology OHIP billing codes
GI consultations, the chronic disease premium, upper and lower endoscopy with add-ons, ERCP, motility studies and tubes.
73 codes in 8 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 41 is in the full Gastroenterology listing.
Consultations & assessments — office
- A415Consultation - Gastroenterology—
- A545Limited consultationLimited consultation - Gastroenterology—
- A416Repeat ConsultationRepeat consultation for Gastroenterology (41).—
- A413Medical Specific AssessmentMedical Specific Assessment - Gastroenterology—
- A414Medical Specific Re-AssessmentMedical Specific Re-Assessment (Gastroenterology)—
- A411Complex Medical Specific Re-AssessmentComplex Medical Specific Re-Assessment (Gastroenterology)—
- A418Partial AssessmentPartial Assessment - Gastroenterology—
- A120Colonoscopy assessment, same day as colonoscopy—
Hospital in-patient
- C415Gastroenterology ConsultationA consultation rendered in an acute care hospital for a non-emergency in-patient, provided by a specialist in Gastroenterology. This service requires a written request from a referring practitioner.—
- C545Limited consultationA consultation in gastroenterology for an acute care hospital in-patient, rendered following a written request from a referring physician, nurse practitioner, or dental surgeon.—
- C416Repeat consultationA medical specific re-assessment for a hospital in-patient, rendered by a specialist in Gastroenterology (41). This service requires a full, relevant history and physical examination of one or more systems.—
- C413Medical specific assessmentA medical specific assessment rendered by a specialist in Gastroenterology for a non-emergency hospital in-patient. This service involves a comprehensive history and examination of the presenting complaint to establish a diagnosis or assess function, as per rules on <SectionPages>GP23</SectionPages>.—
- C414Medical specific re-assessmentA medical specific re-assessment for a hospital in-patient provided by a specialist in Gastroenterology. This service involves a full, relevant history and physical examination of one or more systems.—
- C411Complex medical specific re-assessmentAn additional hospital visit by a Gastroenterologist for an inpatient who develops an acute intercurrent illness after the 5th week of hospitalization, exceeding the standard subsequent visit limits.—
- C412Subsequent visit - first five weeksSubsequent visit by a gastroenterologist for an acute care hospital in-patient during the first five weeks of admission.—
- C417Subsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week)A subsequent visit by a gastroenterologist for a hospital in-patient during the sixth to thirteenth week of admission. This service is limited to a maximum of three visits per week as specified on <SectionPages>A105</SectionPages> and <SectionPages>GP43</SectionPages>.—
- C419Subsequent visit - after thirteenth weekA routine in-hospital subsequent visit by a Gastroenterologist for a patient who has been hospitalized for more than thirteen weeks.—
- C418Concurrent careA routine assessment for concurrent care in a hospital setting, rendered by a consultant at the request of the Most Responsible Physician (MRP).—
Upper endoscopy
- Z527GastroscopyA diagnostic endoscopic procedure of the upper gastrointestinal tract, which may include taking biopsies, photographs, and removing small polyps (≤ 1 cm).$82.90
- Z528Gastroscopy - subsequentGastroscopy - subsequent (within three months following previous gastroscopy)$67.85
- Z547Gastroscopy - with removal of foreign bodyThis service is a gastroscopy procedure performed for the removal of a foreign body from the stomach. It may be billed with add-on codes for the removal of large polyps.$99.75
- E674Gastroscopy - with snare polypectomy - 1st polyp > 1 cmPayable for the snare polypectomy of the first polyp greater than 1 cm encountered during a gastroscopy. This code is an add-on to the primary gastroscopy procedure and is limited to one per procedure.$142.40
- E675Gastroscopy - with snare polypectomy - additional polyp > 1 cmAn add-on fee for the snare polypectomy of each additional large polyp (> 1 cm) during a primary gastroscopy procedure. This is limited to a maximum of two additional polyps.$73.50
- Z515OesophagoscopyA diagnostic procedure involving the visual examination of the oesophagus using an endoscope, which may include taking tissue samples (biopsies).$68.25
- Z399Oesophagoscopy - electiveAn elective endoscopic examination of the oesophagus, stomach, and optionally the duodenum, which may include biopsies. This procedure is not eligible for an assistant's fee.$92.50
- Z400Oesophagoscopy for active bleedingAn oesophagogastroduodenoscopy (EGD) performed for the diagnosis and management of active upper gastrointestinal bleeding.$125.10
- E696Oesophagoscopy with dilatation of oesophagusAdd-on fee for oesophageal dilatation performed during an oesophagoscopy-gastroscopy-duodenoscopy procedure.$30.65
- E703Oesophagoscopy with snare polypectomy first polyp (> 1 cm)This is an add-on fee for the snare polypectomy of the first polyp greater than 1 cm, performed in conjunction with an oesophagoscopy-gastroscopy procedure.$50.50
- E795Endoscopic brushing of oesophagus, stomach, and/or duodenumAn add-on to an oesophagoscopy-gastroscopy procedure for the collection of tissue samples via brushing of the oesophagus, stomach, or duodenum.$46.30
- Z533Biopsy - incisional - by intubationThis service is for an incisional biopsy of the stomach performed via intubation.$36.80
Colonoscopy & lower endoscopy
- Z555Absence of signs or symptoms or risk factors, 50 years of age or older - sigmoid to descending colonColonoscopy from the sigmoid to descending colon for patients aged 50 or older who have no signs, symptoms, or risk factors. This service becomes uninsured if performed for the same patient within 10 years of a previous <billingCode>Z555</billingCode>.$51.95
- Z492Follow up of normal colonoscopyA follow-up sigmoidoscopy to the descending colon for an asymptomatic patient, five years after a normal screening colonoscopy (<billingCode>Z499</billingCode>). This service is uninsured if performed within the five-year period following the initial <billingCode>Z499</billingCode>.$51.95
- Z493Follow up of normal colonoscopy - sigmoid to descendingPerforms a follow-up colonoscopy (sigmoid to descending) 10 years after a previous normal colonoscopy for an asymptomatic patient.$51.95
- Z495Follow up of unsatisfactory colonoscopyA follow-up colonoscopy to the sigmoid or descending colon, performed when a previous colonoscopy was technically unsatisfactory due to issues such as poor preparation or failure to reach the cecum.$51.95
- Z497Confirmatory colonoscopy - sigmoid to descending colonA confirmatory colonoscopy procedure limited to the sigmoid and descending colon, performed as a follow-up to a positive preliminary test such as a FIT, sigmoidoscopy, barium enema, or CT scan.$51.95
- Z498Follow up of abnormal colonoscopy - sigmoid to descending colonA colonoscopy from the sigmoid to the descending colon performed as a follow-up for a patient with a previously identified abnormal colonoscopy, such as a prior malignancy or specific types of adenomatous polyps.$51.95
- Z499Colonoscopy for risk evaluation - sigmoid to descending colonA screening sigmoidoscopy to the descending colon for an asymptomatic patient with a family history indicating an increased risk of malignancy.$51.95
- Z494Colonoscopy for hereditary or other bowel disorders associated with increased risk of malignancyA colonoscopy for diagnosis or ongoing management in patients with hereditary or other bowel disorders (e.g., FAP, HNPCC, IBD) that carry an increased risk of malignancy.$51.95
- E705Colonoscopy into terminal ileumAn add-on procedure for extending a colonoscopy into the terminal ileum, payable in addition to a primary colonoscopy service.$30.30
- E740Colonoscopy to splenic flexureAn add-on to specified colonoscopy procedures (`Z491`-`Z499`, `Z555`) for extending the examination to the splenic flexure.$51.75
- E741Colonoscopy to hepatic flexureAn add-on fee for a colonoscopy procedure that extends to the hepatic flexure. This code is intended to be billed in addition to a primary colonoscopy service.$31.15
- E687Excision of obstructive tumour or stricture through colonoscopy - with laser debulkingAn add-on to the fee for excision of an obstructive tumour or stricture through a colonoscope (Z764, Z765), payable when laser debulking is performed.$69.80
- Z580Sigmoidoscopy (using 60 cm. flexible endoscope)Performance of a sigmoidoscopy, an endoscopic examination of the sigmoid colon, using a 60 cm flexible endoscope. This procedure is an endoscopic examination of the sigmoid colon.$57.70
- Z535Sigmoidoscopy with rigid scopeA sigmoidoscopy with or without anoscopy, performed using a rigid scope. This is a diagnostic endoscopic procedure of the rectum.$36.80
- Z536Sigmoidoscopy with biopsy(ies)An endoscopic procedure for the examination of the sigmoid colon using a rigid scope, which includes the taking of one or more biopsies.$44.55
- Z543Anoscopy (proctoscopy)Anoscopy (proctoscopy) is an endoscopic examination of the anus and rectum. This service is not separately payable when performed concurrently with certain other rectal procedures, such as haemorrhoid excision.$8.70
ERCP & biliary
- Z558Endoscopic retrograde cholangiopancreatography including sphincterotomy and removal of bile duct stonesAn Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure that includes sphincterotomy and may also involve the removal of one or more bile duct stones.$300.25
- Z561Endoscopic retrograde cholangiopancreatography with cannulation of common bile duct and/or pancreatic ductAn Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure involving the cannulation of the common bile duct and/or pancreatic duct. This surgical procedure is often performed for diagnostic or therapeutic purposes of the biliary system.$213.15
- Z760ERCP through gastrojejunostomy following previous Billroth IIEndoscopic retrograde cholangiopancreatography (ERCP) performed through a gastrojejunostomy, typically in a patient with a previous Billroth II gastrojejunostomy.$251.85
- E680Insertion of first endobiliary prosthesis and/or pancreatic stentAdd-on to Endoscopic Retrograde Cholangiopancreatography (ERCP) for the insertion of the first endobiliary prosthesis and/or pancreatic stent. Limited to a maximum of one instance per procedure.$82.35
- E681Insertion of additional endobiliary prosthesis and/or pancreatic stentAdd-on fee for inserting each additional endobiliary prosthesis or pancreatic stent during an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure. This is limited to a maximum of 3 additional stents and must be billed with Z561, Z558, or Z760.$43.60
- E816ERCP with electrohydraulic lithotripsy for choledocholithiasis$50.00
- E666Biliary tract manometryAn add-on procedure for performing biliary tract manometry during an Endoscopic Retrograde Cholangiopancreatography (ERCP). This code is payable in addition to Z561, Z558, or Z760.$52.30
- E668Cannulation of minor papillaAdd-on fee for cannulation of the minor papilla during an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure. Must be billed with a primary ERCP code.$93.80
- S237Linear or radial echo-endoscope - including biliary or pancreatic examinationEndoscopic ultrasound using a linear or radial echo-endoscope, including examination of the biliary and/or pancreatic systems. This procedure may also involve therapeutic interventions.$253.80
Motility & physiology
- G350Esophageal motility study with manometry and/or impedance planimetryA diagnostic procedure involving oesophageal motility studies with manometry to assess oesophageal function.$97.85
- G353Esophageal provocation testingEsophageal provocation testing is only eligible for payment when one or more of the following tests are performed: 1) acid perfusion testing; 2) provocative drug testing; 3) multiple rapid swallows; 4) rapid drink challenge; 5) solid bolus swallows.$35.00
- G354Anorectal manometry studyA diagnostic procedure that measures the pressures of the anal sphincter muscles, sensation in the rectum, and the neural reflexes that are needed for normal bowel movements.$61.80
- G166Hydrogen breath test - professional componentPays for the physician's interpretation and report (professional component) for a hydrogen breath test. This is billed with `<billingCode>G167</billingCode>` for the technical component.$10.45
- G167Hydrogen breath test - technical componentThe technical component of a hydrogen breath test, billed alongside the professional component `<billingCode>G166</billingCode>`. Payment is adjusted when rendered in a hospital.$7.70
Tubes, drains & haemorrhoids
- Z532Percutaneous endoscopic gastrostomyA surgical procedure for the percutaneous endoscopic placement of a gastrostomy tube.$172.95
- Z520Change of gastrostomy tubeA procedure for the replacement of a gastrostomy tube. The '#' prefix indicates that costs for premises, equipment, and supplies are funded through the facility and are not billable to the patient.$10.65
- Z539Dilation of gastrostomy, enterostomy, colostomy, etc.Dilation of an artificial intestinal or gastric opening (stoma), such as a gastrostomy, enterostomy, or colostomy.$25.25
- G349Oesophageal tamponade (Blakemore bag) - insertionInsertion of an oesophageal tamponade device, such as a Sengstaken-Blakemore tube, to control hemorrhage.$45.30
- Z590Paracentesis - for diagnostic sampleA surgical procedure involving the aspiration of peritoneal fluid for diagnostic sampling. An additional fee (<billingCode>E542</billingCode>) is payable when performed outside of a hospital.$31.30
- Z591Paracentesis with therapeutic drainageA surgical procedure for the aspiration of fluid from the peritoneal cavity (paracentesis) primarily for therapeutic drainage, which may also include obtaining a diagnostic sample.$57.65
- Z546Barron ligation(s)A surgical procedure for Barron ligation of hemorrhoids, limited to six services per patient in any one-year period.$39.40
- Z566Barron ligation(s) plus cryotherapy$39.10
- Z575Haemorrhoid injectionsInjection treatment for haemorrhoids, limited to a maximum of six services per patient per year.$27.05
How to use this gi code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to gastroenterology (specialty 41) — 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 gi 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 gastroenterology bill?
The consultations & assessments — office section of this set starts with A415 (Consultation - Gastroenterology). 8 codes are listed in that section.
What is in the Gastroenterology code set?
73 OHIP billing codes across 8 sections: Consultations & assessments — office; Hospital in-patient; Premiums; Upper endoscopy; Colonoscopy & lower endoscopy; ERCP & biliary; Motility & physiology; Tubes, drains & haemorrhoids. GI consultations, the chronic disease premium, upper and lower endoscopy with add-ons, ERCP, motility studies and tubes.
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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