What are the billing rules for E420A?

Service must be on the day of the trauma or within 24 hours (GP109). Only payable for services where the medical record lists the ISS score (GP109). Submit the premium on the same claim record as the services it applies to (GP109).

What is E420A often billed with?

ED assessments and consultations, e.g. H102, H122, H055, H065 (GP109). Critical care codes G521, G523, G522 (GP109). Surgical procedures such as Z341 chest tube or fracture reductions (GP109).

Why is E420A rejected?

AD9: Premium not allowed alone: E420 must be on the same claim as the services it increases (GP109).

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Billing code

E420A — Trauma Premium - Add 50%

Q: What is OHIP billing code E420A?

Trauma premium: adds 50% to eligible services for a patient with an Injury Severity Score above 15 (age 16+) or above 12 (under 16).

Trauma premium

Adds 50% to eligible services within 24 hours of trauma when the Injury Severity Score is above 15, or above 12 under 16.

Watch for: The ISS must be in the medical record, and the premium must be on the same claim as the services it applies to.

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

Code: E420A
Description: Trauma Premium - Add 50%
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Jul 1, 2013
Termination date: No end date

Explanation

Updated October 26, 2026

Trauma premium: adds 50% to eligible services for a patient with an Injury Severity Score above 15 (age 16+) or above 12 (under 16).

What it covers

E420 adds 50% to eligible services rendered on the day of the trauma or within 24 hours, for patients 16 or older with an Injury Severity Score (ISS) above 15, or under 16 with an ISS above 12 (GP109).

Eligible services are those in Consultations and Visits (Section A, including ED H-codes), Obstetrics (Section K), Surgical Procedures (Sections M to Z), the resuscitation codes G395, G391, G521, G522 and G523, and surgical assistant and anaesthesia basic and time units (GP109).

Billing rules

Service must be on the day of the trauma or within 24 hours (GP109).
Only payable for services where the medical record lists the ISS score (GP109).
Submit the premium on the same claim record as the services it applies to (GP109).
Not applied to special visit or after-hours premiums, but those premiums are still payable with the trauma services (GP109).
For trauma with these ISS thresholds, two surgeons doing components of the same procedure may each claim the full fee (SP3).

Often billed with

ED assessments and consultations, e.g. H102, H122, H055, H065 (GP109).
Critical care codes G521, G523, G522 (GP109).
Surgical procedures such as Z341 chest tube or fracture reductions (GP109).

Common rejections

AD9: Premium not allowed alone: E420 must be on the same claim as the services it increases (GP109).

Related codes: G521, G523, G522, G395, G391, H102

Source: Schedule of Benefits (July 1, 2026), General Preamble, Other Premiums (Trauma Premium), page GP109.

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