OHIP billing resources for Ontario physicians

This guide will assist physicians in identifying the specific elements of assessments and consultations, recognize when limits apply and create awareness of common billing errors.

This brief outlines when physicians can use the attendance at labour and delivery (P009) and sole delivery premium (E411).

This web page includes OHIP billing policies and procedures as well as claims contact information.

This guide covers the new fee codes (R102, R158 and R159) that were introduced to the Schedule as of April 1, 2023. These represent three levels of volume-displacement techniques, separated according to the complexity and level of skill and training required for each.

This guide to the Ministry of Health’s general process for audit of physician payments lets physicians know what to expect if their claims are reviewed and explains the general factors the ministry considers in the post-payment review process.

In this guide, physicians will find information on how they can get help with billing questions.

Physician Services (Schedule) includes changes to fee codes for excision of polyps during colonoscopy. This change introduces new fee codes that reflect the size of polyps that are removed.

This brief focuses on appropriate billing by the supervising physician. A subsequent publication will address the circumstances where a resident or clinical fellow with an OHIP billing number can submit claims for insured services.

This provides an introduction on the new fee codes for major nerve transfer (N291) and minor nerve transfer (N293) procedures. 

Details on claims submitted by a resident or clinical fellow with an OHIP billing number, which are only eligible for payment under certain specific circumstances.

Information in this guide includes understanding time-based insured services, requirements when claiming services that have specific time requirements, determining the time period that may be claimed and identifying common concerns leading to incorrect submissions.

This guide will assist physicians in understanding the three components of special visit premiums listed in the Schedule of Benefits, including when a patient visit is eligible for a special visit premium.

Information on common situations where a manual review of claims for surgical procedures is required.

This web page includes information on payment rules for the trauma premium, as well as common claims issues.

This educational module introduces the Schedule of Benefits and provides an overview of how to determine the most appropriate fee codes to claim for specific services.

This web page offers an introduction to OHIP comprehensive and limited virtual care services and fee codes.

This billing brief provides case-based examples to illustrate the application of many of the virtual care payment rules and conditions.

An overview of select new payment rules and processes relevant to virtual care services (effective Dec. 1, 2022).

A billing brief providing clarification of visits related to a surgical procedure on what to expect before and after with case-based examples.

This web page includes details on E013C, which is a fee code that is only eligible for payment for anesthesia services related to life-threatening emergencies where there is structural airway obstruction above the carina.

A web page with links to previous OHIP INFOBulletins, which inform payment, policy, program or software changes.

Access to the unified Ministry of Health and Ministry of Long-Term Care master numbering system.

Learn about the medical claims electronic data transfer, a secure method of transferring electronic files to and from an authorized user and the Ministry of Health.

Learning materials on the government of Ontario website that will help physicians bill OHIP.

A PDF of the physician services under the Health Insurance Act, effective July 24, 2023.