What are the billing rules for H065A?

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).

What is H065A 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 H065A rejected?

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

H065A — Consultation In Emergency Medicine

Q: What is OHIP billing code H065A?

Consultation in the emergency department by an ED physician on duty who is not an emergency medicine specialist (FRCP).

ED physician consultation

Bill H065 for an ED consultation by an on-duty ED physician who isn't an emergency medicine specialist, after a written request.

Watch for: Without a signed written request, or when referred by another ED physician in the same hospital, it pays as an assessment.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$95.60	$0.00	$0.00	$0.00	$0.00

Code: H065A
Description: Consultation In Emergency Medicine
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 ED physician on duty who is not an emergency medicine specialist (FRCP).

What it covers

H065 is the ED physician consultation for all physicians other than specialists in emergency medicine, who bill H055 instead (GP19, A16).

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

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).

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

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: H055, H105, H102, H103, H101, E420

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00) – Emergency Department Physician, page A16; rules GP16–GP19, GP50.

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