Knowing which fee codes are available within your specialty is an important aspect of billing correctly.
If you’re an anesthesiologist then submitting claims can be a bit more complicated than other specialties since fee codes don’t always have a set price, as they differ depending on time units or your patient’s BMI.
Thus, it’s really important to make sure you calculate time units correctly in order to avoid rejections.
In an attempt to make things easier, we’ve created a cheat sheet that lists all of the OHIP fee codes available for Anaesthesia. Go ahead and bookmark this page for a quick referencing, or for a downloadable PDF scroll to the bottom.
Here’s what you’ll find in the cheat sheet:
- Anaesthesia OHIP Billing Guidelines for Consultations & Assessments
- In Patient Anaesthesia OHIP Billing Codes
- In Patient: Special Visit Premium
- Emergency Department: Special Visit Premium
- Out Patient Anaesthesia OHIP Billing Codes
- Subsequent Visits
- Subsequent Visits by the MRP
- Subsequent Visits by MRP following transfer from and ICU
- Anaesthesia During a Procedure or Surgery
- Anaesthesia Premiums (after hours & Special visits)
- Anaesthesia Extra Units
- Anaesthesia for Nerve Block Procedures
- Downloadable PDF file
- OHIP billing codes Searchable Database
Anaesthesia OHIP Billing Guidelines for Consultations & Assessments
Consultations are allowed 1 per 12-month period.
- Requirements: written request from a referring physician or nurse practitioner.***2nd Consultation is payable in a 12-month period if the diagnosis is completely different than the first.
Repeat Consultations are allowed 1 per 12-month period, following a consultation pertaining to the same diagnosis.
- Requirements: written request from a referring physician or nurse practitioner.
Limited Consultations are allowed 1 per 12-month period.
- Requirements: written request from a referring physician or nurse practitioner.
General Assessments are allowed 1 per 12-month period.
- Requirements: less time spent with the patient than a consultation.
General Re-assessments are allowed 2 per 12-month period.
- Partial Assessments are unlimited.
In Patient Anaesthesia OHIP Billing Codes
C215 Limited Consultation
C016 Repeat Consultation
C013 Medical Specific Assessment
C014 Medical Specific Re-Assessment
In Patient: Special Visit Premium
When using a premium for time and travel make sure you always use the ‘A’ prefix.
The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).
|Weekdays||Mon. – Fri. “Sacrifice of Office hours”||Evenings Mon. – Fri.||Weekends & Holidays||Nights|
|Travel Premium||C960 : $36.40 Max. 2||C961 : $36.40 Max. 2||C962 : $36.40 Max. 2||C963 : $36.40 Max. 6||C964 : $36.40 Unlimited|
|First Person Seen||C990 : $20.00 Max. 1||C992 : $40.00 Max. 1||C994 : $60.00 Max. 1||C986 : $75.00 Max. 1||C996 : $100.00 Unlimited|
|Additonal Person(s) Seen||C991: $20.00 Max. 9||C993: $40.00 Max. 9||C995: $60.00 Max. 9||C987: $75.00 Max. 19||U997: $100.00 Unlimited|
Emergency Department: Special Visit Premium
Use the ‘A’ prefix and add a premium for time and travel if you were outside the hospital when called.
|Weekdays||Mon. – Fri. “Sacrifice of Office hours”||Evenings M-F||Weekends & Holidays||Nights|
|Travel Premium||K960 : $36.40 Max. 2||K961 : $36.40 Max. 2||K962 : $36.40 Max. 2||K963 : $36.40 Max. 6||K964 : $36.40 Unlimited|
|First Person Seen||K990 : $20.00 Max. 1||K992 : $40.00 Max. 1||K994 : $60.00 Max. 1||K998 : $75.00 Max. 1||K996 : $100.00 Unlimited|
|Additonal Person(s) Seen||K991: $20.00 Max. 9||K993: $40.00 Max. 9||K995: $60.00 Max. 9||K999: $75.00 Max. 19||K997: $100.00 Unlimited|
Out Patient Anaesthesia OHIP Billing Codes
A215 Limited Consultation
A016 Repeat Consultation
A013 Medical Specific Assessment
A014 Medical Specific Re-Assessment
Subsequent Visits by the MRP
Subsequent Visits by MRP following transfer from and ICU
C121 Intercurrent illness – diagnosis must be totally different than admission diagnosis.
C018 Concurrent Care (allowed 4 the first week then 2 every week after).
Anaesthesia During a Procedure or Surgery
Calculation of Fee Payable = Basic and Time Units.
1 Unit fee = $15.01.
Assisting at Surgery and Anaesthesia Time Units Table
|Time in Minutes [Hours]||Assistant Time Units for Billing||Anaesthesia Time Units for Billing|
|60-75 (1h – 1h 15m)||6||6|
|75-90 (1h 15m – 1h 30m)||8||8|
|90-105 (1h 30m – 1h 45m)||10||11|
|105-120 (1h 45m – 2h)||12||14|
|120-135 (2h – 2h 15m)||14||17|
|135-150 (2h 15m – 2h 30m)||16||20|
|150-165 (2h 30m – 2h 45m)||19||23|
|165-180 (2h 45m – 3h)||22||26|
|180-195 (3h – 3h 15m)||25||29|
|195-210 (3h 15m – 3h 30m)||28||32|
|210-225 (3h 30m – 3h 45m)||31||35|
|225-240 (3h 45m – 4h)||34||38|
|240-255 (4h – 4h 15m)||37||41|
|255-270 (4h 15m – 4h 30m)||40||44|
|270-285 (4h 30m – 4h 45m)||43||47|
|285-300 (4h 45m – 5h)||46||50|
|300-315 (5h – 5h 15m)||49||53|
|315-330 (5h 15m – 5h 30m)||52||56|
|330-345 (5h 30m – 5h 45m)||55||59|
|345-360 (5h 45m – 6h)||58||62|
|360-375 (6h – 6h 15m)||61||65|
|375-390 (6h 15m – 6h 30m)||64||68|
|390-405 (6h 30m – 6h 45m)||67||71|
|405-420 (6h 45m – 7h)||70||74|
|420-435 (7h – 7h 15m)||73||77|
|435-450 (7h 15m – 7h 30m)||76||80|
|450-465 (7h 30m – 7h 45m)||79||83|
|465-480 (7h 45m – 8h)||82||86|
|480-495 (8h – 8h 15m)||85||89|
|495-510 (8h 15m – 8h 30m)||88||92|
E400C Evening Premium
- 1700-2400hrs Mon to Fri, daytime or evenings on Sat Sun and Holidays.
- Adds 50% to each fee code.
E401C Night Premium
- Adds 75% to each fee code.
Special Visit Premiums
C998C Evening Premium
- 1700-2400 Mon-Fri or for non-elective surgery with sacrifice of office hours weekday.
- Maximum of 2 per shift.
C985C Sat, Sun or holidays Daytime and Evenings
- Maximum of 6 per shift.
- Maximum: Unlimited.
Check out our article for more on how special visit premiums work and how to claim them.
Anaesthesia Extra Units
|E021C||Premature newborn less than 37 weeks gestational age.||9 units|
|E014C||Newborn to 28 days.||5 units|
|E009C||Infant from 29 days to 1 year of age.||4 units|
|E019C||Infant from 1 year to 8 years of age.||2 units|
|E007C||70-79 year old adult.||1 unit|
|E018C||80 plus years old.||3 units|
|E010C||Patient with body mass index (BMI)>40.||2 units|
|E011C||Patient in prone position during surgery.||4 units|
|E024C||Patient in sitting position during surgery great than 60 degrees.||4 units|
|E025C||Unanticipated massive transfusion (at least one blood volume of red blood cells).||10 units|
|E012C||Patient who is known to have malignant hyperthermia.||5 units|
|E022C||ASA III Patient with severe systemic disease limiting activity but not incapacitating.||2 units|
|E017C||ASA IV Patient with incapacitating systemic disease that is a constant threat to life.||10 units|
|E016C||ASA V Moribund patient not expected to live 24hrs with or without operation.||20 units|
|E020C||ASA E Patient undergoing anesthesia for emergency surgery which commences
within 24 hours of operating room booking to E022C, E017C or E016C.
**E016C, E017C, E020C are not eligible for payment when anesthesia is rendered to a brain dead patient for organ donations**
Anaesthesia for Nerve Block Procedures
|E030C||Procedural sedation.||4 units|
|E031C||General anesthesia or deep sedation.||4 units|
E030C and E031C are not payable with the above list of “Extra Units.”
Replacement of Listed Basic Units
|E650C||When a pump is used in conjunction with an anesthetic.||28 units|
|E645C||Off pump coronary artery bypass grafting, to R742 or R743.||40 units|
|E002C||When hypothermia is used by the anesthesiologist in procedures not specifically identified as required hypothermia.||25 units|
|E013C||When anesthetic management is required for emergency relief of acute upper airway obstruction.||10 units|
Z432C is not payable for an anesthesia service in support of a nerve block.
Downloadable PDF file
If you’re interested in other OHIP fee codes, make sure to save a link to our OHIP searchable database below. You can search by speciality, billing code or keyword.
Remember you have the option of ” starring” your most commonly used billing codes. That way, they’ll appear at the top for searching.
Contact us if you have any questions regarding Anaesthesia Billing codes.
Looking to maximize your billing?
Check out The Ultimate OHIP Billing Guide for more tips, tricks and automated features!
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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