What are the billing rules for F055A?

Open reduction means treating the fracture or dislocation by closed intramedullary fixation or by an operation that exposes it; the fee includes fixation by internal or external devices (N1). The major pre-operative visit (the consultation or assessment where you decide to treat) may be billed in addition to the fracture or dislocation fee (N1, SP2). Multiple fractures or dislocations: the major one is paid at 100% and each other one at 85% (N1).

< Billing codes

Billing code

F055A — Humeral neck fracture (no head dislocation) – open reduction

Q: What is OHIP billing code F055A?

Open reduction of a humeral neck fracture without dislocation of the head.

Humeral neck fracture, open

Bill F055 for open reduction of a humeral neck fracture without dislocation of the head; with head dislocation, open reduction is F052.

Watch for: Use F052 when the head is dislocated; if after-care is transferred, the operating surgeon claims 80% of the fee.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$775.95	$0.00	$77.46	$95.76	$95.76

Code: F055A
Description: Humeral neck fracture (no head dislocation) – open reduction
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Apr 1, 2026
Termination date: No end date

Explanation

Updated October 26, 2026

Open reduction of a humeral neck fracture without dislocation of the head.

What it covers

F055 is open reduction of a neck fracture without dislocation of the head, in the Shoulder, Arm and Chest section (N26). With dislocation of the head, open reduction is F052 (N26).

Billing rules

Open reduction means treating the fracture or dislocation by closed intramedullary fixation or by an operation that exposes it; the fee includes fixation by internal or external devices (N1).
The major pre-operative visit (the consultation or assessment where you decide to treat) may be billed in addition to the fracture or dislocation fee (N1, SP2).
Multiple fractures or dislocations: the major one is paid at 100% and each other one at 85% (N1).
If after-care is transferred to another physician, the surgeon who did the open reduction claims 80% of the fee (N2).
Non-elective and started after hours: add E409 (+50%, weekday evenings and weekend/holiday days and evenings) or E410 (+75%, nights 00:00–07:00) (GP103–GP104, SP2).
Repeat reductions of the same fracture or dislocation: claim the full fee for the final reduction and after-care; earlier reductions by the same surgeon are claimed at 85% (N2).
Age premiums of 10% to 30% apply for patients under 16 (GP64).

Related codes: F053, F054, F052, F049, F044

Source: Schedule of Benefits (July 1, 2026), Musculoskeletal System Surgical Procedures, Shoulder, Arm and Chest, page N26. Fracture and dislocation rules N1–N2.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing