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Billing code

E098A — Gastroenterology Chronic Disease Assessment Premium - Add 50% For Virutal Services

Gastroenterology chronic disease premium

Adds 28% to a gastroenterologist's office assessment of a patient with Crohn's, colitis, malnutrition, celiac disease or chronic cirrhosis.

Watch for: Bill with A413, A414, A411 or A418 and diagnostic code 263, 555, 556, 571 or 579.

Code

E098A

Description

Gastroenterology Chronic Disease Assessment Premium - Add 50% For Virutal Services

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2023

Termination date

No end date

Explanation

Updated October 26, 2026

A 28% premium on certain gastroenterologist office assessments for patients with Crohn's, colitis, malnutrition, celiac disease or chronic cirrhosis.

What it covers

E098 is added to an assessment by a gastroenterology specialist (41) when the assessment is a medical specific assessment, medical specific re-assessment, complex medical specific re-assessment or partial assessment (A104).

It applies in an office or a hospital out-patient clinic (not the ED), for a patient with an established, charted diagnosis of Crohn's disease, ulcerative colitis, malnutrition, celiac disease or chronic liver cirrhosis (A104).

Billing rules

• Payable only to gastroenterology specialists (41) (A104).
• Only with A413, A414, A411 or A418 (A104).
• Office or hospital out-patient clinic only; not for in-patients, LTC patients or ED patients (A104).
• The diagnosis must already be established and documented in the chart (A104).
• Submit with diagnostic code 263, 555, 556, 571 or 579 (A105).
• Payable on comprehensive virtual care services at 28% of the virtual fee (A74).

Often billed with

• A413 medical specific assessment (A104).
• A414 medical specific re-assessment (A104).
• A411 complex medical specific re-assessment (A104).
• A418 partial assessment (A104).

Common rejections

• AD9: OHIP describes this as 'Premium not allowed alone': E098 must be on the same claim as an eligible assessment (A413, A414, A411 or A418) (A104).
• A4D: OHIP describes this as 'Invalid specialty for this service code': E098 is only payable to gastroenterology specialists (41) (A104).
• V30: OHIP describes this as 'FSC/Diagnostic Code Combination Not A Benefit': submit E098 with diagnostic code 263, 555, 556, 571 or 579 (A105).

Related codes: A413, A414, A411, A418, E078

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Gastroenterology (41), page A104; claims instructions page A105.

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