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Billing code

H264A

ED pelvic exam with speculum

Bill H264 when the ED physician personally does a pelvic exam with speculum in the emergency department, on top of the assessment.

Watch for: Maximum one per patient per day; a second claim rejects as service limit exceeded.

Code

H264A

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

Pelvic exam with speculum personally done by the ED physician in the emergency department. Payable on top of the assessment.

What it covers

H264 is a pelvic examination with speculum in the emergency department, personally rendered by an Emergency Department Physician (A17, A18).

Billing rules

• Maximum 1 per patient per day (A18).
• Must be personally rendered by an ED physician (A18).
• Payable in addition to the assessment (A18).
• 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

• ED assessments such as H102, H103 or H101 and their after-hours equivalents (A18).

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).
• AM1: Service limit exceeded: H264 is limited to one per patient per day (A18).

Related codes: H103, H102, H101, H100

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00) – Emergency Department Physician, pages A17–A18.

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