OHIP Billing Codes for Radiation Oncology

Consultation 

A345 Consultation 

A765 Consultation patient 16 years and under 

A346 Repeat Consultation 

A745 Limited Consultation 

E082 MRP Premium – Add this to Admission consultation or admission assessment *Please refer to the SoB page GP 16-19 for the detailed Consultation payment rules. 

Special Visit Premiums (Emergency Department) 

*When billing Special Visit Premiums, use A-prefix consultation or assessment.

Not eligible for payment to Emergency Department Physicians (see definition GP67)

 * Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

Assessment / Follow-up – Automatic Codes (A34XA/A34VA) 

The MDBilling.ca automated codes allow a physician to bill a single code (A34XA/ A34VA) for a “follow up”, and our software will automatically choose the highest paying assessment based on existing assessment codes previously billed in our database. The algorithm will choose the highest paying assessment code first, and subsequently bill assessment codes in decreasing fee value per the rules from the OHIP Schedule of Benefits (section GP23-25). 

In-Patient Services 

C345 Consultation 
C765 Consultation, patient 16 years of age and under 

C745 Limited Consultation 

C346 Repeat Consultation 

C343 Medical Specific Assessment

C344 Medical Specific Re-Assessment 

C341 Complex Medical Specific Re-Assessment 

C777 Intermediate assessment - Pronouncement of death 

C771 Certification of death 

Special Visit Premiums (In-Patient) 

*When billing Special Visit Premiums, use A-prefix consultation or assessment.

 The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).

 * Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

Hospital Rounding – Automatic Codes (IPTMA, IPTXA) 

Service codes for rounding will differ depending on the number of days the patient has been admitted. The MDBilling.ca automatic codes allow a physician to enter one code for rounding. Our software system will automatically choose the correct (and highest paying) inpatient subsequent visit service allowed based on the admission date entered.

HOW TO USE: 

IPTMA (MRP Rounding): Our system will choose the correct inpatient subsequent visit code and add the MRP premium (E083/E084) for you. 

IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you. 

MRP Subsequent Visit Premium E083/E084 

  *For more information please refer to SOB page GP47 

E083 Weekday 

E084 Saturday, Sunday or Holiday 

Other Subsequent Visits by MRP 

C142 + E083/E084 1st day following transfer from ICU 

C143 + E083/E084 2nd day following transfer from ICU 

C124 + E083/E084 Day of discharge (patient must be in hospital for at least 48 hours)

Other Visits

C121 Additional visit due to intercurrent illness 

C348 Concurrent Care 

C982 Palliative Care

Counselling & Interview 

Automatic Codes (K01XA / K04XA) 

When billing counselling codes, there are limits on the number of units billable before the need to select a different service code (refer to OHIP Schedule of Benefits section A19). 

• Individual Counselling (K01XA): K013 for the first three units of K013 and K040 combined per patient per provider per 12 month period; K033 thereafter.
• Group Counselling (K04XA): K040 for the first three units of K013 and K040 combined per patient per provider per 12 month period; K041 thereafter.

HOW TO USE: 

Simply bill K01XA (Individual Counselling) or K04XA (Group Counselling), and the system will search for existing counselling codes in our database and choose the appropriate counselling code for you. 

Note: 

• Per unit fee calculated in ½ hour increment 

• With the exception of the codes listed below, no other services are eligible for payment when rendered by the same physician the same day as any type of counselling service: E080, G010, G039, G040, G041, G042, G043, G202, G205, G365, G372, G384, G385, G394, G462, G480, G489, G482, G538, G590, G840, G841, G842, G843, G844, G845, G846, G847, G848, H313, K002, K003, K008, K014, K015, K031, K035, K036, K038, K682, K683, K684, K730

Detention 

Detention (K001) time may be payable following a consultation or assessment when a physician is required to spend considerable extra time in treatment or monitoring of the patient. See OHIP Schedule of Benefits page GP29 for further information. 

K005 Primary mental health care 

K014 Counselling for transplant recipients, donors or families of recipients and donors

K015 Counselling of relatives - on behalf of catastrophically or terminally ill patient

K002 Interview with relatives 

Hospital in-patient case conference 

K121 Hospital in-patient case conference 

*Please see OHIP Schedule of Benefits pages A29-A30 for further information.

Unit calculation chart:

MDBilling.ca Billing Resource 

To know more about how to bill virtual services, please refer to Virtual Care Billing Guide during COVID-19