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

Reciprocal Medical Billing

RD Duplicate, paid in RMBS.
60 Not a benefit of the Reciprocal Medical Billing Agreement.

Surgical Procedures

S1 Bilateral surgery, one stage, allowed at 85% higher than unilateral.
S2 Bilateral surgery, two stage, allowed at 85% higher than unilateral.
S3 Second surgical procedure allowed at 85%.
S4 Procedure fee reduced when paid with related surgery or anaesthetic.
S5 Not allowed in addition to major surgical fee.
S6 Allowed as subsequent procedure - initial procedure previously claimed.
S7 Normal pre-operative and post-operative care included in surgical fee.
SA Surgical procedure allowed at consultation fee.
SB Normal pre-operative visit included in surgical fee - visit fee previously paid - surgical fee adjusted.
SC Not allowed, major pre-operative visit already claimed.
SD Not allowed, Team / Assist Fee already claimed.
SE Major pre-operative visit previously paid and admission assessment previously paid - surgery reduced by the admission assessment.

Health Examinations

R1 Only one health exam allowed in a twelve-month period.

Maxima

M1 Maximum fee allowed for these services has been reached.
M2 Maximum allowance for radiographic examination(s) by one or more practitioners.
M3 Maximum fee allowed for prenatal care.
M4 Maximum fee allowed for these services by one or more practitioners has been reached.
M5 Monthly maximum has been reached.
M6 Maximum fee allowed for special visit premium - additional patient seen.

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