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Billing code

J896C — Level 1 sleep study – initial diagnostic

First diagnostic overnight sleep study

Bill J896 for a patient's first overnight Level 1 sleep study in Ontario to diagnose a sleep disorder, including split-night studies.

Watch for: Once per patient per lifetime; later overnight studies are J897 (repeat diagnostic) or J895 (therapeutic).

Code

J896C

Description

Level 1 sleep study – initial diagnostic

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

First overnight Level 1 sleep study (polysomnography) to diagnose a sleep disorder; once per patient per lifetime.

What it covers

A Level 1 study is an overnight sleep study with continuous monitoring of oxygen saturation, ECG and ventilation (airflow and respiratory effort), plus EEG, EOG and sub-mental EMG to stage sleep (J109).

The initial diagnostic study is the first overnight sleep study paid in Ontario to diagnose a sleep disorder, including a split-night study (J109).

Billing rules

• Maximum one initial diagnostic study per patient per lifetime; all later overnight studies are repeat diagnostic (J897) or therapeutic (J895) studies (J109).
• A therapeutic study (J895) in the same 12-hour period is not payable (J112).
• Bill the technical component (H) with suffix B and the professional component (P) with suffix C, as separate claims (J107).
• Outside a hospital or a hospital's off-site premises, only the professional component is payable (J107).
• The professional component requires an interpreting physician who meets the CPSO sleep medicine standards, and a qualified physician must be reachable throughout the study (J108).
• The technical component needs a technician in constant attendance and staff and equipment that meet the CPSO standards (J108).
• Special visit premiums are not payable with sleep studies (J108).
• If the recording isn't sufficient for a diagnostic interpretation, no professional fee is paid and the study is billed as J898, J899 or J990 by time in bed (J109).

Common rejections

• AM1: OHIP's message is 'Service Limit Exceeded': an initial diagnostic study has already been paid for this patient; bill J897 or J895 if the criteria are met (J109).

Related codes: J897, J895, J898, J899, J990

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Sleep Studies, page J109. Sleep study rules J107–J108.

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