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Billing code

E500A — Third and each later delivery in a multiple birth (add-on)

Third and later baby

Add for each baby from the third onward in a multiple birth, billed with P006, P018, P020, P041 or P042.

Watch for: Not payable for caesarean multiples between 20 and 23 weeks, and only live deliveries count.

Code

E500A

Description

Third and each later 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 each baby from the third onward in a multiple birth, billed with P006, P018, P020, P041 or P042.

What it covers

E500 is an add-on for the third and each later baby delivered in a multiple birth. It is billed with the delivery code: P006 (vaginal), P020 (operative vaginal), or P018, P041 or P042 (caesarean) (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

• Vaginal multiples: P006 or P020 for the first baby, 85% of P006 or P020 for the second, and E500 for the third and each later baby (K6, rule 1).
• First baby vaginal, then caesarean: one of P018, P041 or P042, plus 85% of P006 or P020, plus E500 from the third baby (K6, rule 2).
• Caesarean only: 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: spontaneous vaginal deliveries pay only P006, whatever the number of fetuses (K6, rule 4). Caesarean multiples pay no E500 (K6, rule 5).
• Stillbirths: only live deliveries count. If all fetuses are known stillborn, only one delivery code is payable (K6, rule 6).
• E500 is on the list of codes that can take the E676 morbid obesity premium (SP6).
• FHO: physicians in Income Stabilization may bill E500A at full fee-for-service (Agreement App. J §3.6, p.99).

Often billed with

• P006 or P020 for vaginal births, or P018, P041 or P042 for caesarean births (K6).
• E499 when the second baby is also delivered by caesarean section (K6).

Common rejections

• ADF: The base procedure was missing, invalid or paid at zero. This add-on is only payable with P006, P018, P020, P041 or P042 (K6).

Related codes: P006, P020, P018, P041, P042, E499, E502, E414

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

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