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Billing code

E499A — Second caesarean delivery in a multiple birth (add-on)

Second baby by caesarean

Add for the second baby delivered by caesarean section in a multiple birth, billed with P018, P041 or P042.

Watch for: Only payable with P018, P041 or P042; not part of the combination when the first baby was born vaginally.

Code

E499A

Description

Second caesarean delivery in a multiple birth (add-on)

FHO+ basket

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

Effective date

Apr 1, 2025

Termination date

No end date

Explanation

Updated October 26, 2026

Add-on for delivering the second baby by caesarean section in a multiple birth, billed with P018, P041 or P042.

What it covers

E499 is an add-on for the second baby delivered by caesarean section in a multiple birth. Bill it with the caesarean code used: P018 (caesarean section), P041 (with tubal interruption) or P042 (with hysterectomy) (K6).

Labour and delivery services carry the specific elements of independent operative procedures marked #, so the fee does not include the premises, equipment, supplies and staff funded by the hospital (K1). The Surgical Preamble applies to obstetric codes (K2, rule 5).

Billing rules

• Caesarean-only multiple births (with or without a trial of labour): bill one of P018, P041 or P042, plus E499 for the second baby and E500 for the third and each later baby (K6, rule 3).
• Between 20 and 23 weeks' gestation: one of P018, P041 or P042 plus E499 for the second baby. E500 is not payable for the third or later babies (K6, rule 5).
• If the first baby is born vaginally and the next by caesarean, the Schedule pays the caesarean code plus 85% of P006 or P020, and E500 from the third baby. E499 is not part of that combination (K6, rule 2).
• Stillbirths: when some fetuses are known to be stillborn, only the live deliveries count under these rules. If all are known stillborn, only one of P006, P018, P020, P041 or P042 is payable (K6, rule 6).
• The delivering physician bills with suffix A (K3, note 16).
• E499 is on the list of codes that can take the E676 morbid obesity premium (BMI over 40, general anaesthesia, BMI charted) (SP6, SP7).

Often billed with

• P018, P041 or P042, the caesarean section itself (K6).
• E500 for the third and each later baby (K6).
• E414 high-risk obstetrical premium when one of its listed conditions is present (K8).

Common rejections

• ADF: The base procedure was missing, invalid or paid at zero. This add-on is only payable with P018, P041 or P042 (K6).

Related codes: P018, P041, P042, E500, P006, P020, E414, E676

Source: Schedule of Benefits (July 1, 2026), Obstetrics, Labour - Delivery, page K6.

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