What are the billing rules for G604A?

Bill instead of G600 or G603 when the newborn is under 750 grams or 26 weeks gestational age; only one of G600, G603 and G604 applies (J33). These are team fees for neonatologists, paediatricians and anaesthesiologists giving complete care; the physician-in-charge is the physician(s) providing the care each day (J33). While billing neonatal intensive care, no other critical care codes are paid to the same physician(s) (J30).

What is G604A often billed with?

G556 night-time ICU/NICU admission assessment premium (J35). Separately billable interventions done that day (J33).

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Billing code

G604A — Neonatal Low Birth Weight Intensive Care - Payable In Lieu Of G600 Or G603 For Newborn Less Than 750 Grams In Weight Or 26 Weeks Gestational Age

Q: What is OHIP billing code G604A?

Level A neonatal intensive care for a newborn under 750 grams or 26 weeks gestational age, billed in place of G600 or G603.

NICU Level A, tiny newborn

Bill G604 instead of G600 or G603 for Level A neonatal intensive care of a newborn under 750 grams or 26 weeks.

Watch for: Only one of G600, G603 or G604 applies; no other critical care codes are paid to you that day.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$536.95	$0.00	$0.00	$0.00	$0.00

Code: G604A
Description: Neonatal Low Birth Weight Intensive Care - Payable In Lieu Of G600 Or G603 For Newborn Less Than 750 Grams In Weight Or 26 Weeks Gestational Age
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

Level A neonatal intensive care for a newborn under 750 grams or 26 weeks gestational age, billed in place of G600 or G603.

What it covers

Neonatal intensive care is a team fee for being in constant or periodic attendance over a one-day period to provide all aspects of care to Intensive Care Area patients. It includes the initial consultation or assessment, later assessments, ongoing monitoring, and procedures such as arterial, venous, C.V.P. or urinary catheters, IV lines, blood gas interpretation, nasogastric and endotracheal intubation, tracheal toilet and ventilation (J33).

G604 sits under Level A: full life support including monitoring, ventilatory support and parenteral alimentation (J33). It is payable in lieu of G600 or G603 for a newborn less than 750 grams in weight or 26 weeks gestational age (J33).

Billing rules

Bill instead of G600 or G603 when the newborn is under 750 grams or 26 weeks gestational age; only one of G600, G603 and G604 applies (J33).
These are team fees for neonatologists, paediatricians and anaesthesiologists giving complete care; the physician-in-charge is the physician(s) providing the care each day (J33).
While billing neonatal intensive care, no other critical care codes are paid to the same physician(s) (J30).
Life-threatening or other critical care (G521–G523, G395, G391) is not paid to the same physician on the same day as this per diem (J27, J28).
C101 ICU visit premium and special visit premiums are not payable with NICU team fees (GP103, GP65).
Add G556 when the initial NICU admission visit is at night (00:00–07:00); once per patient per admission (J35).

Often billed with

G556 night-time ICU/NICU admission assessment premium (J35).
Separately billable interventions done that day (J33).

Related codes: G600, G601, G603, G610, G620, G556

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Critical Care (Neonatal Intensive Care, Level A), page J33.

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