Claims Submission Ontario Health Insurance Program
Resource Manual for Physicians
 
4.13   Explanatory Codes (Continued)

Consultations

C1 Allowed as repeat/limited consultation.
C2 Allowed at re-assessment fee.
C3 Allowed at minor assessment fee.
C4 Consultation not allowed with this service - paid as assessment.
C5 Allowed as multiple systems assessment.
C6 Allowed as Type 2 admission assessment.
C7 An admission assessment (C003A) or general re-assessment (C004A) may not be claimed by any physician within 30 days following a pre-dental / pre-operative assessment.

Diagnostic and Therapeutic

D1 Allowed as repeat procedure - initial procedure previously claimed.
D2 Additional procedures allowed at 50%.
D3 Not allowed in addition to visit fee.
D4 Procedure allowed at 50% with visit.
D5 Procedure already allowed - visit fee adjusted.
D6 Limit of payment for this procedure reached.
D7 Not allowed in addition to other procedure.
D8 Allowed with specific procedures only.
D9 Not allowed to a hospital department.
DA Maximum for this procedure reached - paid as repeat / chronic procedure.
DC Procedure paid previously not allowed in addition to this procedure - fee adjusted to pay the difference.
DE Lab tests already paid - visit fee adjusted.
DH Ventilatory support allowed with Haemodialysis.
DG Diagnostic services for hospital in-patients are not payable on a fee-for-service basis - included in the hospital global budget.

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