Ontario Health Insurance Plan

OHIP Schedule of Benefits and Fees

This information requires knowledgeable interpretation and is intended primarily for members of the professional health care community.

The OHIP Schedule of Benefits and Fees is not available in French.

Schedules Available

Physician Services – Schedule of Benefits

Physician Services Under the Health Insurance Act [PDF] - March 9, 2023 (effective April 1, 2023)

• Amendments regarding Emergency Department Diagnostics to the Schedule of Benefits under the Health Insurance Act [PDF] – April 1, 2005

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OHIP Fee Schedule Master – (For use with Billing Software)

The Fee Schedule Master below is effective December 1, 2022. If your Medical Billing Software has not been updated by your vendor, you are encouraged to do so at your earliest convenience.

Please direct technical inquiries to your Billing Package Developer / Vendor.

Resources

• OHIP Fee Schedule Master (April 1, 2023)
  Text format  |  ZIP File
• OHIP Fee Schedule Master Record Layout  [PDF]

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Independent Health Facilities

Schedule of Facility Fees under the Independent Health Facilities Act
March 9, 2023 (effective April 1, 2023)

• Schedule of Facility Fees for Independent Health Facilities [PDF]

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Services of Optometrists

• Schedule of Benefits [PDF] – April 1, 2023
• Schedule of Benefits [PDF] – Effective September 1, 2023. The Schedule reflecting changes that take effect on September 1, 2023 is available to facilitate the transition to the changes to coverage. The following changes are not applicable to optometry services rendered prior to September 1, 2023. Optometrists should continue to follow existing payment rules for any services rendered before September 1, 2023.

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OHIP Optometry Fee Schedule Master – (For use with Billing Software)

The Optometry Fee Schedule Master below has been updated effective April 1, 2023.

If your Medical Billing Software has not been updated by your vendor, you are encouraged to do so at your earliest convenience.

Please direct technical inquiries to your Billing Package Developer / Vendor.

Resources

• Text format  |  ZIP File
• OHIP Optometry Fee Schedule Master Record Layout [PDF]

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Laboratory Services

Schedule of Benefits for Laboratory Services – Effective July 1, 2020 (Updated July 1, 2020)

• Postal Code Classifications for L700, L777, L778, and L779

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Dental Services

Schedule of Benefits [PDF] – Effective October 1, 2021

• Master Numbering System (CIHI Institution Numbers)
  April 1, 2013

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