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Billing code

E542A — Office Premium (Tray Fee)

Office procedure premium

Add to certain procedures, such as laceration repair, skin excisions, joint injections or IUD insertion, when done outside hospital.

Watch for: Payable only with a procedure it is printed under, done outside hospital, and not with E432.

Code

E542A

Description

Office Premium (Tray Fee)

FHO+ basket

Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Add-on for certain office procedures (laceration repair, skin excisions, joint injections, IUD insertion and others) done outside hospital.

What it covers

E542 is an add-on printed under specific procedures in the Schedule with the words 'when performed outside hospital'. It is payable only with the procedures it is listed under, when you do them in the office or another non-hospital setting (J46, J53, M15).

The same E542 appears under 14 headings, from gynaecology and joint injections to skin, anal, vulvar and eyelid procedures.

Billing rules

• Payable only when the procedure is performed outside hospital (J46, M15).
• Payable only with a procedure E542 is printed under. Examples: G378 IUD insertion and G552 removal (J46); G370 joint, bursa, ganglion or tendon-sheath injection/aspiration and G328 complex joint aspiration (J53); laceration repair Z154, Z175–Z177, Z179, Z190–Z192 (M15); abscess drainage Z101, Z103, Z104, Z106, Z173, Z174, foreign body removal Z114 and biopsy with sutures Z116 (M1); benign lesion excision Z156–Z158 and Z162–Z164 (M3); cyst or lipoma excision Z122–Z127 and Z096 (M4); excision of pre-malignant or malignant lesions R160–R165 (M5) and R048–R050, R094, R040, R041 (M6); debridement Z080–Z085 (M10); nail excision Z128–Z131 (M23); chalazion Z874 (Y10); endometrial sampling Z770 (V7).
• Not payable with E432, the speculum pelvic exam add-on to A001/A007 (A4).

Often billed with

• Z176 or Z154 laceration repair in the office (M15).
• G370 joint injection outside hospital (J53).
• G378 IUD insertion (J46).
• FHO: E542 is an in-basket core service and one of the Schedule 2B codes with 50% total shadow billing (FHO Agreement p.76 and p.88, §4.4).

Common rejections

• EQ6: The referring provider number on the claim isn't registered with the Ministry; check or remove the referring number before resubmitting.
• VJ7: The claim reached OHIP more than three months after the service date; resubmit as stale-dated only if it was first sent on time (VJ7 guide; GP9).
• EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide).

Related codes: Z176, Z154, G370, G328, G378, G552, Z101, Z116

Source: Schedule of Benefits (July 1, 2026), listed under 14 headings; first listing Diagnostic and Therapeutic Procedures, Gynaecology, page J46; also J53, M1–M25, P14, S1–S34, U1, V2–V7, Y10.

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