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Paediatrics OHIP billing codes
Paediatric consultations and assessments, periodic health visits, newborn care, neonatal intensive care and in-patient visits.
46 codes in 7 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 26 is in the full Paediatrics listing.
Consultations & assessments — office
- A265Paediatric consultation—
- A260Special paediatric consultationSpecial paediatric consultation (minimum 75 minutes)—
- A662Extended Special Paediatric ConsultationExtended Special Paediatric Consultation (minimum 90 minutes)—
- A565Limited consultationLimited consultation - Paediatrics—
- A266Repeat consultationRepeat consultation - Paediatrics—
- A261Level 1 - Paediatric assessment—
- A262Level 2 - Paediatric assessment—
- A263Medical specific assessmentMedical specific assessment - Paediatrics—
- A264Medical specific re-assessmentMedical specific re-assessment - Paediatrics—
- A661Complex Medical Specific Re-AssessmentComplex medical specific re-assessment—
- A665Prenatal Consultation—
- A667Neurodevelopmental ConsultationNeurodevelopmental consultation (minimum 90 minutes)—
- A268Enhanced 18 month well baby visit—
Periodic health visits & screening
- K267Periodic health visit - 2 - 11 years of ageA periodic health visit for a child from 2 to 11 years of age who reveals no apparent acute physical or mental illness. This service includes an age and gender-appropriate history, physical examination, health screening, and relevant counselling.—
- K269Periodic health visit - 12 - 17 years of ageA periodic health visit by a Paediatrician for an adolescent patient aged 12 to 17 years. This service is for patients who present without any apparent acute physical or mental illness and is limited to one per patient, per physician, per 12-month period.—
- K119Paediatric developmental screeningAn incentive for a paediatrician providing ongoing management of a paediatric patient under age six at developmental risk, requiring documentation of three developmental surveillances over a 12-month period.—
Hospital in-patient
- C265Paediatric Non-Emergency Hospital In-Patient ConsultationA consultation for a paediatric patient rendered in a non-emergency hospital in-patient setting.—
- C260Special paediatric consultationA special paediatric consultation for a non-emergency hospital in-patient, subject to the same conditions as service `<billingCode>A260</billingCode>`. This service typically requires a significant amount of time due to the complexity of the case.—
- C662Extended Special Paediatric ConsultationAn extended special paediatric consultation rendered for a non-emergency hospital in-patient, subject to the same conditions as <billingCode>A662</billingCode>.—
- C565Limited paediatric consultationA limited consultation for a paediatric patient in a non-emergency hospital in-patient setting. This service is less demanding than a full consultation but must meet the same requirements, including a written request from a referring practitioner.—
- C266Paediatric repeat consultationA repeat consultation provided by a paediatrician to a hospital in-patient for the same presenting problem, following care rendered by another physician in the interim.—
- C263Medical specific assessmentA medical specific assessment for a non-emergency hospital in-patient, rendered by a Paediatrician. It involves a detailed history and examination of the affected part(s) or system(s) to diagnose or assess function.—
- C264Medical specific re-assessment - PaediatricsA medical specific re-assessment provided by a Paediatrics specialist to a non-emergency hospital in-patient, requiring a focused history and examination of one or more systems.—
- C661Complex Medical Specific Re-AssessmentA complex re-assessment for a hospital in-patient by a paediatrician (<specialtyCode>26</specialtyCode>) due to the complexity, obscurity, or seriousness of the patient's condition. This service has specific usage limits and requires a written report to the primary care physician.—
- C262Subsequent paediatric visit - per visitA routine assessment for pediatric in-patients in a hospital, limited to one per patient per day for the duration of the admission.—
- C268Paediatric concurrent careA routine in-hospital assessment by a Paediatric specialist providing ongoing care at the request of the Most Responsible Physician (MRP), limited to 4 visits in the first week and 2 per week thereafter.—
- K122Subsequent visit by the Most Responsible Physician - day following the hospital admission assessmentA time-based service for individual developmental or behavioural care provided by a qualified paediatrician for patients with mental illness, behavioural maladaptations, or developmental disorders. The service is payable in units of ½ hour (or major part thereof).—
- K123Second day following the hospital assessmentA time-based service for family developmental and/or behavioural care provided by a qualified paediatrician, encompassing assessment and treatment for various developmental or emotional issues. This service is calculated in 30-minute units.—
- C665Prenatal ConsultationA prenatal consultation provided by a paediatrician to a hospital in-patient, subject to the same conditions as `<billingCode>A665</billingCode>`. This service is rendered following a written request from a referring practitioner.—
- C667Neurodevelopmental ConsultationA neurodevelopmental consultation for a non-emergency paediatric in-patient in an acute care hospital, subject to the same conditions as <billingCode>A667</billingCode>.—
Newborn care & delivery attendance
- H261Newborn care in hospital or homeProvides routine care for a well newborn for up to the first ten days of life in a hospital or home setting. This includes an initial general assessment, subsequent assessments as needed, and instructions to caregivers.—
- H267Attendance at maternal deliveryPayable to a paediatrician for constant attendance at the delivery of a baby expected to be at-risk. This service includes an assessment of the newborn.—
Neonatal intensive care
- G600Neonatal intensive care - 1st dayFirst day of Level A Neonatal Intensive Care, a per diem team fee for full life support including monitoring, ventilatory support, and parenteral alimentation for a newborn in an Intensive Care Area.$376.05
- G601Neonatal intensive care - 2nd day onwardsPer diem fee for the second and subsequent days of Level A Neonatal Intensive Care. This service involves providing full life support to an intensive care area newborn or infant, and is a team fee payable to the physician(s)-in-charge. Separately billable interventions may be claimed in addition.$187.95
- G603Neonatal low volume intensive carePayable for the first day of Level A neonatal intensive care for a sole newborn, in lieu of G600 or G604. This is a team fee limited to 25 services per physician per fiscal year.$564.00
- G604Neonatal low birth weight intensive careA team fee payable in lieu of <billingCode>G600</billingCode> or <billingCode>G603</billingCode> for the first day of Level A Neonatal Intensive Care for a newborn weighing less than 750 grams or with a gestational age of 26 weeks or less.$536.95
- G610Neonatal intensive care - Level B - 1st dayFirst day of Level B Neonatal Intensive Care, which is a team fee for the care of a newborn including monitoring, oxygen administration, and intravenous therapy, but without ventilatory support.$258.05
- G611Neonatal intensive care - Level B - 2nd day onwardsPer diem fee for the second day and onwards of Level B Neonatal Intensive Care. This service includes intensive monitoring, oxygen administration, and intravenous therapy, but does not include ventilatory support.$129.00
- G620Neonatal intensive care - Level C - 1st dayFirst day of intermediate neonatal intensive care (Level C) for an infant, which includes services such as oxygen administration, non-invasive monitoring, or gavage feeding.$162.95
- G621Neonatal intensive care - Level C - 2nd day onwardsPer diem team fee for providing Level C Neonatal Intensive Care from the second day onwards. This service is for intermediate care, including services like oxygen administration, non-invasive monitoring, or gavage feeding.$81.50
Diabetes & chronic disease
- 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.—
- E078Chronic Disease Assessment PremiumA premium payable in addition to an assessment when specific criteria for chronic disease management are met, including the type of assessment, physician specialty, setting, and established diagnosis.+50%
Long-term care
- W265Consultation - Non-Emergency Long-Term Care In-Patient ServicesA consultation service rendered by a paediatrician for a patient in a non-emergency, long-term care in-patient setting, following a written request from a referring practitioner.—
- W266Repeat consultation - Non-Emergency Long-Term Care In-Patient ServicesA non-emergency repeat consultation provided by a paediatrician for a patient in a long-term care institution. This service is for the same problem as an initial consultation and requires a new referral after the patient has received intervening care from another physician.—
- W565Limited consultationA limited consultation rendered by a paediatrician for a patient in a non-emergency, long-term care in-patient setting. This service is less demanding and time-consuming than a full consultation but has the same referral and documentation requirements.—
- W269Periodic health visitA periodic health visit for a paediatric patient in a long-term care institution, performed for a patient with no apparent acute illness to provide age and gender-appropriate health screening and counselling.—
How to use this paediatrics code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to paediatrics (specialty 26) — 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 paediatrics 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 paediatrics bill?
The consultations & assessments — office section of this set starts with A265 (Paediatric consultation). 13 codes are listed in that section.
What is in the Paediatrics code set?
46 OHIP billing codes across 7 sections: Consultations & assessments — office; Periodic health visits & screening; Hospital in-patient; Newborn care & delivery attendance; Neonatal intensive care; Diabetes & chronic disease; Long-term care. Paediatric consultations and assessments, periodic health visits, newborn care, neonatal intensive care and in-patient visits.
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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