Emergency Medicine Billing in Ontario

Emergency department billing in Ontario runs on its own set of codes. A physician on duty in a hospital emergency department does not bill A007 or A003. They bill the H prefix listings in the Emergency Department Physician section of the Schedule of Benefits, and the code changes with the time of day: the same comprehensive assessment is H102 at 10:00 on a Tuesday, H132 at 19:00 that evening, H152 at 19:00 on Friday and H122 at 03:00.

This guide covers every ED assessment code and fee, the time tiers, the ED holiday calendar, procedures and premiums, critical care, consultations, call-in premiums and ED groups. If you are new to OHIP billing, start with our step-by-step guide to billing OHIP. Fees are from the Schedule of Benefits effective April 1, 2026, and every code links to its page.

Who bills the H-codes

The General Preamble (GP50) defines an Emergency Department Physician as a physician working in a hospital emergency department, or a Hospital Urgent Care Clinic, specifically to provide services to unscheduled patients who attend for physician services. A Hospital Urgent Care Clinic is a hospital-run clinic that provides some or all ED services but is open to the public for less than 24 hours a day.

Two points from GP50 settle most questions:

• Specialty does not matter. Apart from the consultation fee, any physician on duty in the emergency department, of any specialty, must submit using the H prefix listings.
• The listings apply when a full- or part-time Emergency Department Physician is working a pre-arranged shift or designated period, and to an on-call physician whose service does not qualify for a special visit premium.

A physician who is in the hospital but not on duty in the ED, and sees a patient there, uses the General Listings instead (Consultations and Visits, page A19). A community walk-in or urgent care centre is not a hospital ED. On Saturdays, Sundays and holidays it is an "emergency department equivalent", where the only assessment code payable is A888 ($44.55), with no premiums (page A5).

The ED assessment codes and time tiers

The Schedule (pages A15 and A16) lists four assessment levels:

• Minor assessment.
• Multiple systems assessment: a detailed history and examination of more than one system, part or region.
• Comprehensive assessment and care: a full history and physical examination, concomitant treatment, and intermittent attendance over many hours as the patient's condition warrants, including interpretation of investigations and liaison with the family physician, family and agencies.
• Re-assessment: an assessment at least two hours after the original assessment or a previous re-assessment, showing that further care or investigation is needed and is performed.

Each level has four codes, one per time period:

The numbering is regular. The third character gives the period (0 weekday daytime, 3 evening, 5 weekend and holiday, 2 night) and the last digit gives the level (1 minor, 2 comprehensive, 3 multiple systems, 4 re-assessment).

Three features of the ED schedule differ from the special visit and after-hours premium schedules:

1. The day starts at 08:00, not 07:00. Nights run 00:00 to 08:00. A patient seen at 07:30 on a Wednesday is a night code.
2. Friday evening is billed on the weekend tier. From 17:00 to 24:00 on Friday, use H151 to H154, not H131 to H134.
3. Nights apply every day. A patient seen at 03:00 on a Sunday or a holiday is H121 to H124, not the weekend tier, because the weekend and holiday tier covers 08:00 to 24:00 only.

Re-assessment limits

H104 and its tier equivalents have firm payment rules (page A15). A re-assessment is not payable for a discharge assessment, when the Emergency Department Physician admits the patient, or when the re-assessment leads directly to a referral for consultation. It is limited to three per patient per day and two per physician per patient per day. Re-assessments are payable in addition to comprehensive assessment and care when these criteria are met.

The 65-and-over premium

The age-based premiums in the General Preamble (GP64) increase the amount payable by 15% for patients aged 65 or older for comprehensive assessment and care (H102, H122, H132, H152) and multiple systems assessments (H103, H123, H133, H153). Minor assessments and re-assessments are not on the list.

ED holidays: a different calendar

The Schedule has two definitions of "holiday" (GP3). One applies to almost every code. The other applies only to H prefix emergency department listings and to A888. For H-codes, the holidays are:

• Family Day, Good Friday, Victoria Day, Canada Day, Civic Holiday, Labour Day, Thanksgiving and New Year's Day;
• every day from December 25 to December 31, inclusive;
• the Friday before Christmas, if Christmas falls on a Saturday or Sunday;
• the Monday after New Year's Day, if New Year's Day falls on a Saturday or Sunday;
• the Friday before or the Monday after Canada Day, at the physician's choice, if Canada Day falls on a Saturday or Sunday.

The December rule is the one that matters. In 2026, Christmas is a Friday. A patient seen at 14:00 on Tuesday, December 29 is H152 ($85.70), not H102 ($56.70), because December 29 is a holiday for H-codes. Under the general definition, Boxing Day falls on a Saturday this year and moves to Monday, December 28; December 29 to 31 are ordinary weekdays for every other code. That includes the ED procedure premium, which is an E code and follows the general calendar.

Days the Schedule does not list are not OHIP holidays, even if they are public holidays elsewhere: Remembrance Day and the National Day for Truth and Reconciliation (September 30) are billed as ordinary days. Our OHIP holiday billing page covers both definitions in full.

Premiums for other services: H112, H113, H114

When an Emergency Department Physician renders another service in premium hours and an assessment may not be claimed, the Schedule (page A16) pays one flat premium per patient visit:

There is no weekday daytime premium, and these are not added to an H-code assessment.

Procedures and procedure premiums

E412 and E413

The after-hours procedure premiums in the General Preamble (GP103 and GP104) have a separate pair for Emergency Department Physicians:

• E412: 20% increase to the procedural fee, evenings 17:00–24:00 Monday to Friday, or daytime and evenings on Saturdays, Sundays and holidays.
• E413: 40% increase, nights 00:00–07:00.

They apply to the non-elective procedures listed there, including surgical procedures (fractures and dislocations included) and a defined list of major invasive procedures. They are only payable to an Emergency Department Physician who is required to submit H prefix claims at the time of the service. The general premiums, E409 (50%) and E410 (75%), are not payable for a procedure by an Emergency Department Physician.

These premiums use a 07:00 boundary, not 08:00: a procedure at 07:30 on a weekday is in the night assessment tier but outside E413. And because E412 is not an H prefix listing, it follows the general holiday calendar, so there is no E412 on the daytime of December 29, 2026.

Common ED procedures

The rules worth knowing (pages A16 to A18 and M15):

• Tissue adhesive closures are paid at 50% of the laceration fee. A complex repair needs at least 20 minutes plus a listed criterion, such as three or more layers or ligation of multiple bleeding vessels.
• H100 must be performed personally by a trained Emergency Department Physician when no radiologist is available for an urgent interpretation, for suspected tamponade, cardiac standstill, traumatic intraperitoneal hemorrhage, ruptured AAA or ruptured ectopic pregnancy; two per patient per day. Other than H100 and ultrasound guidance (J149), ultrasound by an Emergency Department Physician is not payable.
• H264 is one per patient per day, personally rendered, and payable in addition to the assessment.
• H105 is for interim orders for a non-elective patient pending admission by a different most responsible physician. It is payable with the initial assessment or consultation, and at nil when the admission assessment is payable to the Emergency Department Physician.

Critical care and resuscitation

Life threatening critical care (pages J26 and J27) is for a patient whose illness or injury acutely impairs one or more vital organ systems, so that imminent life-threatening deterioration is highly probable. Per physician per patient, for the first three physicians:

• G521: first quarter hour (or part), $125.10
• G523: second quarter hour (or part), $64.50
• G522: each quarter hour (or part) after the first half hour, $42.50
• G391: fourth and subsequent physicians, per quarter hour, $34.35

Other critical care (page J28) is resuscitation for a potential threat to life or limb: G395, first quarter hour, $64.70, then G391 for each further quarter hour, $34.35. G395 is not payable with G521, G522 or G523 for the same patient by the same physician on the same day.

Time counts only when fully devoted to the patient, at the bedside or on the patient's floor, excluding separately billable procedures, and you cannot see other patients during it. For the same patient, physician and day, the fee includes assessment and ongoing monitoring, IV, arterial and central lines, intubation, blood gases and catheters (and, for life threatening critical care, defibrillation and cardioversion). A consultation or assessment rendered before or after the critical care may still be payable; the assessment that is part of the resuscitation is not.

The trauma premium, E420, adds 50% to Section A services (including the H-codes) and to G395, G391, G521, G522 and G523 within 24 hours of the trauma, for patients 16 or older with an Injury Severity Score over 15, or under 16 with a score over 12 (GP109). Submit it on the same claim record as those services.

Consultations in the ED

Two codes cover consultations by an Emergency Department Physician (GP19):

• H055, $125.65: specialist in emergency medicine (FRCP).
• H065, $95.60: all other physicians.

Either is paid as a lesser assessment if the patient was referred by another ED physician in the same hospital, or if the service is rendered somewhere other than the emergency department or another critical care area of the hospital. It is also paid as an assessment if a copy of the ED report does not go to the referring physician or nurse practitioner. Specialists called to consult in the ED bill their own specialty's consultation codes.

Called in to the ED: special visit premiums

Special visit premiums are not payable with H prefix codes (GP65). They apply when a physician is called in, and which table you use depends on whether you are an Emergency Department Physician for that purpose (GP67 and GP68).

Table V (H960 to H989) is for an Emergency Department Physician who is not at the hospital when the ED asks them to attend, either on a scheduled ED day at a time they are not scheduled, or while on scheduled ED call. The patient-seen premiums are payable only when the physician travels to the ED; if you are already at the hospital, the H-code may be payable instead. Bill an A-prefix assessment from the General Listings with the premium, not an H-code.

Patient-seen maximums are totals of first and additional persons per period: 5 on weekdays and evenings, 10 on weekends and holidays, and no maximum at night. Table V has no sacrifice of office hours column.

Table I (K960 to K999) is for physicians who are not Emergency Department Physicians, such as a family physician or specialist called in to the ED. First person seen codes are K990 $20.55 (weekday daytime), K992 $41.10 (weekday daytime with sacrifice of office hours), K994 $61.70 (evenings), K998 $77.10 (Saturdays, Sundays and holidays) and K996 $102.80 (nights), with travel at $37.40. Beyond the table's limits, later patients on that visit are billed with the H prefix listings.

An Emergency Department Physician called to a ward on a non-elective basis uses the General Listings and the C-prefix inpatient premiums. For travel rules and exclusions, see our special visit premiums guide.

ED groups and alternate funding agreements

Emergency Department Physicians may be funded through an Emergency Department Alternate Funding Arrangement (ED AFA) or fee-for-service (GP67 commentary). An ED AFA group bills under its group number, and its claims are shadow billed: ordinary H-code claims, paid at a portion of the fee that the agreement sets and that differs between sites. The Ministry pays the group one monthly Group Remittance Advice, and the group pays its physicians. The coding rules in this guide do not change; a shadow-billed claim at the wrong tier is paid on the wrong fee. SnapBill's group billing covers the group side: sheets reviewed by the clerk, the Group RA split by physician, and pay statements.

Deadlines and common ED rejections

The three-month deadline. For services on or after April 1, 2023, OHIP must receive the claim within three months of the service date. Later claims are stale-dated and rejected with VJ7 unless the Ministry approves them for stale-dated processing.

The rejections and non-payments that come up most often on ED claims:

• Wrong tier for the date or time. A weekday code on a December 29 shift, a weekday evening code on a Friday evening, or a daytime code for a 07:30 patient.
• Re-assessments over the limits or billed with a discharge, an admission by the ED physician, or a referral.
• Duplicates across a shift change. When two physicians bill the same patient on the same date, OHIP may reject the second claim as already paid to another practitioner (A36).
• Assessments billed with critical care for the same patient and physician on the same day, when the assessment was part of the resuscitation.
• Health card problems. ED patients often present with an old card; a version code that does not match produces EH2.
• Consultations without a referring provider, or consults billed as H055 by a physician who is not a specialist in emergency medicine.

Each error code is explained in our guide to OHIP rejection codes.

Where SnapBill fits

SnapBill is built by physicians. Take one photo of the whole shift list or a stack of ED stickers and SnapBill turns it into claims, each with its health number, codes, OHIP diagnostic code and, where it is written on the sheet, the time the patient was seen. Every claim is checked against the Schedule of Benefits before it goes out: each H-code against the days and hours of its tier on the ED holiday calendar, including December 25 to 31, and each special visit premium against its period, the day of the week and the service location. These checks are warnings you can act on or override, never holds. Claim review on Premium follows up on rejected claims, and group billing covers ED AFA departments. Essentials is 0.2% of paid claims, capped at $34.99 a month plus HST; Premium is 1.5% of paid claims.

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Fees and rules verified against the OHIP Schedule of Benefits, effective April 1, 2026. Browse any code on our billing code pages, or create a free account and have your ED claims checked automatically.