What are the billing rules for H055A?

Only for specialists in emergency medicine (FRCP); other physicians use H065 (GP19). Needs a written, signed request from the referring physician or nurse practitioner naming the referrer and billing number and the patient's health number; otherwise it is paid as a lesser assessment (GP16). Paid as an assessment if the patient was referred by another ED physician in the same hospital, or if done outside the ED or other hospital critical care area (GP19).

What is H055A often billed with?

H105 interim admission orders when another physician will admit the patient (A16). E420 trauma premium for qualifying trauma patients (GP109).

Why is H055A rejected?

A4D: Invalid specialty for this service code: H055 is only for specialists in emergency medicine; other physicians bill H065 (GP19). ESD: The hospital ED is part of an alternative funding agreement, so H-prefix services there aren't paid fee-for-service unless billed under the AFA's second on-call or GP Expert group number (GP110).

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Billing code

H055A — Emergency medicine specialist consultation in the ED

Q: What is OHIP billing code H055A?

Consultation in the emergency department by an emergency medicine specialist (FRCP) on duty, following a written request from a physician or NP.

ED specialist consultation

Bill H055 for an ED consultation by an on-duty emergency medicine specialist (FRCP), after a written request from a physician or nurse practitioner.

Watch for: Only emergency medicine specialists can bill H055; other ED physicians bill H065.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$125.65	$0.00	$0.00	$0.00

Code: H055A
Description: Emergency medicine specialist consultation in the ED
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

Consultation in the emergency department by an emergency medicine specialist (FRCP) on duty, following a written request from a physician or NP.

What it covers

H055 is the consultation by an ED physician on duty who is a specialist in emergency medicine (FRCP). All other ED physicians bill H065 (GP19, A97).

A consultation is an assessment done after a written request from a physician or nurse practitioner who wants your opinion because of the complexity, seriousness or obscurity of the case, and includes a written report back to them (GP16).

Billing rules

Only for specialists in emergency medicine (FRCP); other physicians use H065 (GP19).
Needs a written, signed request from the referring physician or nurse practitioner naming the referrer and billing number and the patient's health number; otherwise it is paid as a lesser assessment (GP16).
Paid as an assessment if the patient was referred by another ED physician in the same hospital, or if done outside the ED or other hospital critical care area (GP19).
The ED report counts as the written consultation report, but a copy must go to the referring physician or NP or it is paid as an assessment (GP19).
Same patient, same physician, same diagnosis: 1 per two consecutive 12-month periods; a second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first (GP17).
Special visit premiums are not payable with H-prefix ED codes (GP65).
Not payable fee-for-service in an ED covered by an alternative funding agreement, except under the AFA's second on-call or GP Expert group numbers (GP110).
Specialist consultation: age premiums apply for patients under 16 (GP64).

Often billed with

H105 interim admission orders when another physician will admit the patient (A16).
E420 trauma premium for qualifying trauma patients (GP109).

Common rejections

A4D: Invalid specialty for this service code: H055 is only for specialists in emergency medicine; other physicians bill H065 (GP19).
ESD: The hospital ED is part of an alternative funding agreement, so H-prefix services there aren't paid fee-for-service unless billed under the AFA's second on-call or GP Expert group number (GP110).

Related codes: H065, H105, H102, H103, H104, E420

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Emergency Medicine (12), page A97; rules GP19, GP50.

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