What are the billing rules for E078A?

Only for physicians registered with OHIP in specialty 07 Geriatrics, 15 Endocrinology & Metabolism, 18 Neurology, 26 Paediatrics, 28 Pathology, 31 Physical Medicine, 34 Therapeutic Radiology, 44 Medical Oncology, 46 Infectious Disease, 47 Respiratory Disease, 48 Rheumatology, 61 Haematology or 62 Clinical Immunology (GP25). Only in an office or a hospital out-patient clinic; not for hospital in-patients, long-term care patients or emergency department patients (GP25). The claim must carry one of the GP26 diagnostic codes, for example 250 diabetes, 345 epilepsy, 493 asthma, 585 chronic renal failure or 714 rheumatoid arthritis (GP26).

What is E078A often billed with?

A263 and A264 paediatric medical specific assessment and re-assessment, and A262 level 2 paediatric assessment (A170, GP25). A623, A624 and A628 clinical immunology assessments (A83). A151 complex medical specific re-assessment in endocrinology (A98).

Why is E078A rejected?

V30: OHIP's description is 'fee code and diagnostic code combination not covered'. E078 needs one of the GP26 chronic disease diagnostic codes on the claim; any other diagnostic code rejects (GP26). EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. E078 is paid only to the 13 specialties named in GP25, so correct the specialty or the registration, then resubmit. EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.

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Billing code

E078A — Chronic disease assessment premium

Q: What is OHIP billing code E078A?

Adds 50% to an eligible specialist assessment for an established chronic disease on the GP26 diagnostic list. Office or hospital clinic only.

Chronic disease assessment premium

Adds 50% to an eligible specialist's office or clinic assessment of a patient with an established chronic disease on the GP26 list.

Watch for: Use one of the GP26 chronic disease diagnostic codes; not payable with a consultation or for in-patients.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$0.01	$0.00	$0.00	$0.00

Code: E078A
Description: Chronic disease assessment premium
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Jan 1, 2023
Termination date: No end date

Explanation

Updated October 26, 2026

Adds 50% to an eligible specialist assessment for an established chronic disease on the GP26 diagnostic list. Office or hospital clinic only.

What it covers

E078 is the chronic disease assessment premium, an add-on of 50% printed under 13 specialty listings, starting with Clinical Immunology (62) (A83) and including Endocrinology (A98) and Paediatrics (A170).

It is paid on top of a medical specific assessment, medical specific re-assessment, complex medical specific re-assessment, partial assessment or level 2 paediatric assessment, when the patient has an established chronic disease documented in the medical record (GP25).

Billing rules

Only for physicians registered with OHIP in specialty 07 Geriatrics, 15 Endocrinology & Metabolism, 18 Neurology, 26 Paediatrics, 28 Pathology, 31 Physical Medicine, 34 Therapeutic Radiology, 44 Medical Oncology, 46 Infectious Disease, 47 Respiratory Disease, 48 Rheumatology, 61 Haematology or 62 Clinical Immunology (GP25).
Only in an office or a hospital out-patient clinic; not for hospital in-patients, long-term care patients or emergency department patients (GP25).
The claim must carry one of the GP26 diagnostic codes, for example 250 diabetes, 345 epilepsy, 493 asthma, 585 chronic renal failure or 714 rheumatoid arthritis (GP26).
Not payable when the diagnosis hasn't been established (GP26).
Not payable with a consultation, which isn't on the GP25 list. The listings also exclude it with A760 (A98), A510 and A511 (A176), A113 (A142) and A480 (A200), and for the same patient on the same day as A570 (A198).
On comprehensive virtual care it pays 50% of the fee for the virtual service (A74).

Often billed with

A263 and A264 paediatric medical specific assessment and re-assessment, and A262 level 2 paediatric assessment (A170, GP25).
A623, A624 and A628 clinical immunology assessments (A83).
A151 complex medical specific re-assessment in endocrinology (A98).
K301A when the base assessment is done by telephone; the premium is then 50% of the virtual fee paid (A70, A74).

Common rejections

V30: OHIP's description is 'fee code and diagnostic code combination not covered'. E078 needs one of the GP26 chronic disease diagnostic codes on the claim; any other diagnostic code rejects (GP26).
EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. E078 is paid only to the 13 specialties named in GP25, so correct the specialty or the registration, then resubmit.
EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.
A3F: OHIP's description is 'no fee for this code on service date'. E078 carries a fee only as an add-on in the 13 specialty listings that print it (GP25); check the specialty on the claim, the base assessment and the service date.
A36: OHIP describes this as 'Claimed by Other Practitioner': OHIP matched the service to another physician's claim for the patient. Check the base assessment and billing number before resubmitting.

Related codes: A623, A263, A153, A624, A628, A262, A151

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, listed under 13 specialties (first at Clinical Immunology (62), page A83); General Preamble GP25-GP26 (chronic disease assessment premium); Virtual Care premiums, page A74

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