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Physical Medicine & Rehabilitation OHIP billing codes
Physiatry consultations and complex assessments, rehabilitation unit team management, electrodiagnostics, chemodenervation and injections.
54 codes in 8 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 31 is in the full Physical Medicine listing.
Consultations & assessments — office
- A315Consultation - Physical Medicine & Rehabilitation—
- A425Comprehensive Physical Medicine and Rehabilitation ConsultationComprehensive physical medicine and rehabilitation consultation—
- A515Limited consultation—
- A316Repeat consultationRepeat consultation - Physical Medicine & Rehabilitation—
- A313Medical specific assessmentA medical specific assessment rendered by a specialist in Physical Medicine & Rehabilitation. This service requires a comprehensive history of the presenting complaint and a detailed examination of the affected body parts or systems.—
- A310Medical specific re-assessmentMedical specific re-assessment for Physical Medicine & Rehabilitation (31).—
- A311Complex medical specific re-assessment—
- A318Partial Assessment—
- A510Complex neuromuscular assessment—
- A511Complex physiatry assessmentComplex physiatry assessment for ongoing management of TBI, stroke, or spinal cord injury.—
Hospital in-patient
- C315Physical Medicine & Rehabilitation Consultation - Non-Emergency Hospital In-PatientA consultation by a specialist in Physical Medicine & Rehabilitation for a non-emergency hospital in-patient, following a written request from a referring practitioner.—
- C425Comprehensive physical medicine and rehabilitation consultationA comprehensive physical medicine and rehabilitation consultation for a non-emergency hospital in-patient. This service is subject to the same conditions as <billingCode>A425</billingCode>.—
- C515Limited consultationA limited consultation provided by a Physical Medicine & Rehabilitation specialist to a non-emergency hospital in-patient. This service is less demanding than a full consultation but must meet all standard consultation requirements, including a written referral.—
- C316Repeat consultationA repeat consultation performed by a specialist in Physical Medicine & Rehabilitation for a non-emergency hospital in-patient. This service is requested when the consultant's opinion is sought again for the same problem after the patient has received interval care from another physician.—
- C314Medical specific re-assessmentA medical specific re-assessment for a non-emergency hospital in-patient by a specialist in Physical Medicine & Rehabilitation. This service involves a full, relevant history and physical examination of one or more systems.—
- C311Complex medical specific re-assessmentA complex medical specific re-assessment for a non-emergency hospital in-patient, rendered by a specialist in Physical Medicine & Rehabilitation due to the complexity, obscurity, or seriousness of the patient's condition.—
- C312Subsequent visit - first five weeksA subsequent visit by a Physical Medicine & Rehabilitation specialist for a non-emergency hospital in-patient during the first five weeks of admission.—
- C317Subsequent visit - sixth to thirteenth week inclusiveA subsequent visit for a hospital in-patient rendered by a specialist in Physical Medicine & Rehabilitation during the sixth to thirteenth week of admission, limited to a maximum of three visits per week.—
- C319Subsequent visit - after thirteenth weekA subsequent visit for a non-emergency hospital in-patient provided by a Physical Medicine & Rehabilitation specialist. This service is applicable after the 13th week of admission and is limited to a maximum of six per patient per month.—
- C318Concurrent care - per visitA routine assessment rendered in a hospital by a consultant providing continued directive care at the request of the patient's Most Responsible Physician (MRP). This service is subject to weekly limits.—
- C510Complex neuromuscular assessmentA complex neuromuscular assessment for a non-emergency hospital in-patient, rendered by a specialist in Physical Medicine & Rehabilitation. This service is subject to the same conditions as billing code <billingCode>A510</billingCode>.—
- C511Complex physiatry assessmentA complex physiatry assessment for a non-emergency hospital in-patient. This service is subject to the same conditions as <billingCode>A511</billingCode>.—
Rehabilitation unit & management
- H312Team management in a Rehabilitation Unit - first twelve weeksA subsequent visit fee for team management by a physiatrist of an active in-patient during the first twelve weeks of rehabilitation care.—
- H317Team management in a Rehabilitation Unit - from thirteenth to twenty-sixth weekA per-visit fee for team management by a physiatrist for an active in-patient in a Rehabilitation Unit, applicable from the thirteenth to the twenty-sixth week of care.—
- H319Team management in a Rehabilitation Unit - twenty-seventh week onwardsA subsequent visit for the team management of an active in-patient in a Rehabilitation Unit, applicable from the twenty-seventh week of care onwards, with a maximum of six visits per month.—
- H313Rehabilitation counsellingA time-based service for rehabilitation counselling provided to one or more individuals in a rehabilitation unit, billed in half-hour units.—
- K313Physiatric managementPhysiatric management is a service rendered by physiatrists for the regulation, management, and supervision of a patient's active and ongoing rehabilitation treatment. This service is only payable on days when rehabilitation services are provided and cannot be billed with any other service on the same day.—
Electrodiagnostics
- G456Professional component of complete needle electromyography and nerve conduction studiesProfessional component for a comprehensive electromyography (EMG) and nerve conduction study (NCS), involving two or more nerves and associated muscles.$120.00
- G455Technical component of complete EMG/NCS procedureTechnical component for a complete electromyography (EMG) and nerve conduction study (NCS) on two or more nerves, also known as a Schedule A procedure. This service is related to its professional component counterpart, <billingCode>G456</billingCode>.$31.80
- G458Single fibre electromyographyPerforms a single fibre electromyography, a diagnostic procedure to assess neuromuscular function.$275.00
- G473Complex neuromuscular electrodiagnostic testing - professional componentThe professional component for a comprehensive ('Schedule C') nerve conduction study (NCS) and electromyography (EMG) for complex neuromuscular disorders. Requires a minimum of 60 minutes of procedure time.$275.00
Chemodenervation & botulinum toxin
- G485Chemodenervation injection - first major nerve and/or branchesProvides for the chemodenervation of a single major peripheral motor nerve or its branches using agents like phenol or alcohol to reduce focal spasticity, with optional EMG guidance.$45.45
- G486Chemodenervation injection - each additional major nerve and/or its branchesThis is an add-on code for the chemodenervation of each additional major nerve on the same day, following an initial injection (<billingCode>G485</billingCode>). This procedure uses non-anaesthetic chemical agents to reduce focal spasticity.$28.50
- G487Chemodenervation injection - first major nerve and/or its branches (repeat or additional procedure within 30 days)A repeat or additional chemodenervation injection of the first major nerve or its branches, using agents like phenol or alcohol, for focal spasticity. This procedure must be performed within 30 days of a prior chemodenervation injection.$28.50
- G488Chemodenervation injection - each additional major nerve and/or its branches same dayAn add-on for the chemodenervation of each additional major nerve (and/or its branches), when performed as a repeat or supplementary procedure within 30 days of a prior chemodenervation injection.$18.80
- G875Botulinum toxin injection - first injectionFirst botulinum toxin injection for the treatment of Oromandibular dystonia, limb dystonia, cervical dystonia, or spasticity.$40.00
- G876Botulinum toxin injection - each additional injectionFee for each additional botulinum toxin injection administered for conditions like dystonia or spasticity. This code is billed in conjunction with <billingCode>G875</billingCode> and is limited to a maximum of 11 units.$10.00
- G877EMG and/or ultrasound guidance for Botulinum toxin injection (one injection)An add-on service providing Electromyography (EMG) guidance for a single Botulinum toxin injection. This service is payable with `<billingCode>G870</billingCode>`, `<billingCode>G873</billingCode>`, `<billingCode>G874</billingCode>`, or `<billingCode>G875</billingCode>` when EMG is required to determine the injection site.$18.85
- G878EMG and/or ultrasound guidance for two or more injectionsProvides electromyography (EMG) guidance when required for two or more botulinum toxin injections. This is an add-on code that must be billed with a primary botulinum toxin injection procedure.$28.10
Injections & nerve blocks
- G370Injection of bursa, or injection and/or aspiration of joint, ganglion or tendon sheath$20.25
- G371Injection or aspiration of additional bursa, joint, ganglion or tendon sheathEach additional bursa, joint, ganglion or tendon sheath injection or aspiration, to a maximum of 5.$19.90
- G328Aspiration of bursa or complex jointThis code represents a diagnostic or therapeutic procedure. Specific details for this service are not available in the provided context.$39.80
- G329Aspiration of bursa or complex joint - each additionalAspiration of bursa or complex joint - each additional, to a maximum of 2$20.25
- G060Peripheral nerve block, majorA major peripheral nerve block for acute pain management, such as a block of the radial, median, ulnar, femoral, or sciatic nerve, a paravertebral block, an ankle block, or a fascia iliaca block.$55.00
- G061Peripheral nerve block, minorA minor peripheral nerve block for acute pain management, including specific nerve blocks like ilioinguinal, intercostal, or TAP block. This service is limited to a maximum of 4 services per patient, per physician, per day.$30.00
Long-term care
- W515Consultation - Non-Emergency Long-Term Care In-Patient ServicesA consultation rendered by a Physical Medicine & Rehabilitation specialist for a patient in a long-term care institution, provided upon written request from a referring practitioner and subject to specific frequency limits.—
- W516Repeat consultation - Non-Emergency Long-Term Care In-Patient ServicesA repeat consultation by a Physical Medicine & Rehabilitation specialist for a patient in a non-emergency long-term care setting, requiring a new referral for the same problem after intervening care by another physician.—
- W310Limited consultationA limited consultation by a Physical Medicine & Rehabilitation specialist for a non-emergency in-patient in a long-term care setting. This service requires a written referral and is less demanding than a full consultation.—
- W425Comprehensive physical medicine and rehabilitation consultationA comprehensive consultation provided by a specialist in Physical Medicine & Rehabilitation for a patient in a non-emergency long-term care institution. This service is subject to the same conditions as <billingCode>A425</billingCode> and requires a written referral.—
- W512Admission assessment - Type 1A Type 1 admission assessment is a general assessment rendered to a patient on admission to a non-emergency long-term care institution, such as a nursing home or chronic care hospital.—
- W514Admission assessment - Type 2A Type 2 admission assessment is an initial visit to assess a patient following admission to a long-term care institution, when the admitting physician has already performed a consultation, general assessment, or general re-assessment for the patient prior to admission.—
- W517Admission assessment - Type 3A general re-assessment for a patient who is re-admitted to a long-term care institution after a minimum three-day stay in another institution.—
- W419Periodic health visitA periodic health visit for a patient in a long-term care institution, performed by a Physical Medicine & Rehabilitation specialist. This service is intended for a patient who has no acute illness and focuses on age and gender-appropriate health screening and counselling.—
How to use this physiatry code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to physical medicine (specialty 31) — 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 physiatry 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 physical medicine & rehabilitation bill?
The consultations & assessments — office section of this set starts with A315 (Consultation - Physical Medicine & Rehabilitation). 10 codes are listed in that section.
What is in the Physical Medicine & Rehabilitation code set?
54 OHIP billing codes across 8 sections: Consultations & assessments — office; Hospital in-patient; Rehabilitation unit & management; Electrodiagnostics; Chemodenervation & botulinum toxin; Injections & nerve blocks; Premiums; Long-term care. Physiatry consultations and complex assessments, rehabilitation unit team management, electrodiagnostics, chemodenervation and injections.
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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