OHIP Billing Codes — Schedule of Benefits
Search the complete Ontario Schedule of Benefits for Physician Services. Look up any OHIP billing code — fee schedules, billing rules, and claim guidelines.
Browse by Category
Consultations & Assessments
Consultations, assessments and office visits by specialty
Special Visit Premiums
Special visit and travel premiums from the General Preamble
Hospital In-patient Visits
In-patient consultations, admission assessments and subsequent visits
Musculoskeletal Surgery (D)
Musculoskeletal surgical procedures
Procedural Add-ons & Premiums
Add-on and premium codes billed with a surgical or diagnostic procedure
Fracture & Musculoskeletal Procedures
Fracture care and musculoskeletal surgical procedures
Diagnostic & Therapeutic Procedures
Diagnostic and therapeutic procedures (section J)
Emergency Department Visits
Emergency department consultations, assessments and visits
Nuclear Medicine, Ultrasound & Pulmonary Function
Nuclear medicine, diagnostic ultrasound, pulmonary function and radiology-associated procedures
Counselling, Forms & Visit Premiums
Counselling, psychotherapy, forms, group care and visit-related premiums
Laboratory Medicine
Laboratory medicine and related diagnostic procedures
Respiratory Surgery
Respiratory system surgical procedures
Neurological & Spinal Surgery
Neurological and spinal surgical procedures
Obstetrics
Prenatal, delivery and postnatal care
Primary Care Premiums & Appendix Q
Primary care premiums, bonuses and Appendix Q codes
Surgical Procedures (R)
Musculoskeletal, cardiovascular and integumentary surgical procedures
Digestive, Urogenital & Genital Surgery
Digestive, urogenital, male and female genital and endocrine surgical procedures
T Codes
Schedule of Benefits codes beginning with T
U Codes
Schedule of Benefits codes beginning with U
V Codes
Schedule of Benefits codes beginning with V
Long-Term Care & Nursing Home Visits
Visits and assessments in long-term care and nursing homes
Diagnostic Radiology, MRI & Radiation Oncology
Diagnostic radiology, magnetic resonance imaging and radiation oncology
Y Codes
Schedule of Benefits codes beginning with Y
Surgical Procedures (Z)
Surgical procedures across every surgical section of the Schedule
Code sets: what each specialty actually bills
All 41 setsShift-sheet lists for emergency medicine, family practice, hospital and long-term care, and every specialty: consultation codes, premiums, diagnostics and procedures, with current fees.
Browse by Specialty
View all specialtiesUnderstanding the Ontario Schedule of Benefits
The Schedule of Benefits for Physician Services is the Ontario Ministry of Health document that defines every service OHIP insures, what each one pays, and the conditions under which it can be claimed. It is issued under the Health Insurance Act and it is the document OHIP adjudicates against — a service that isn't in the Schedule, or that doesn't meet the requirements printed beside it, doesn't get paid. In practice most physicians only ever work with a small slice of it, which is exactly how money gets left behind.
Every code here is drawn from the current Schedule, including the fee, the effective date, the specialties the code is restricted to, and the billing rules and premiums that attach to it. Search by code if you know it, or by plain-language description if you don't — “house call after hours” and A007 both get you to the same place.
The Schedule is organised into sections by the first letter of the code. A codes cover consultations and assessments — the bread-and-butter of office practice. G codes cover diagnostic and therapeutic procedures. K codes cover counselling, forms, and special services. E codes are add-ons that ride along with a base service rather than standing on their own. Browsing by section is a reliable way to find the codes you should be billing but aren't.
Common questions
What is the OHIP Schedule of Benefits?
The Schedule of Benefits for Physician Services is the Ontario Ministry of Health document, issued under the Health Insurance Act, that lists every insured physician service, its billing code, its fee, and the rules governing when it can be claimed. It is the authority OHIP pays from — if a service is not in the Schedule, OHIP does not pay it.
How are OHIP billing codes structured?
An OHIP billing code is five characters: a four-character base code plus a one-letter role suffix. The first letter of the base code identifies the section of the Schedule (A for consultations and visits, G for diagnostic and therapeutic procedures, K for counselling and special services, and so on). The suffix identifies your role in the service — A for the physician who rendered it, B for a surgical assistant, and C for an anaesthetist.
How often do OHIP fees change?
The Ministry updates the Schedule of Benefits periodically through amendments, usually alongside the Physician Services Agreement. Fee changes take effect on a stated date, and claims are paid at the fee in force on the service date — not the date you submit. Every code page here shows the current fee and its effective date, with fee history where we have it.
How long do I have to submit an OHIP claim?
OHIP claims must be submitted within six months of the service date. Past that, the claim is stale-dated and will be rejected. Within each month, claims received by the 18th are adjudicated in that cycle and paid on the 15th of the following month; anything after the 18th rolls into the next cycle.
What is the difference between a billing code and a diagnostic code?
The billing code says what service you performed and determines what you are paid. The OHIP diagnostic code — a three-digit code from the Ministry's own list — says why you performed it. Most claim items require both, and a mismatch between them is one of the more common causes of rejection.
Are these fees the same for every physician?
Not always. Some codes are restricted to particular specialties, and some pay a different amount depending on the specialty of the physician claiming them. Premiums layer on top: age-based premiums, after-hours and special visit premiums, and time-based units all change what a given service actually pays. Each code page lists the restrictions and eligible premiums we hold for that code.
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