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Billing code

P003A — Major Prenatal

First major prenatal visit

Bill P003 for the general assessment that starts antenatal care, with a full history and examination of all systems.

Watch for: Payable after another general assessment only if that earlier one wasn't about establishing antenatal care; not payable as a video or phone visit.

Code

P003A

Description

Major Prenatal

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

Major prenatal visit: the prenatal general assessment that starts antenatal care, with a full history and exam of all systems.

What it covers

P003 is the general assessment (major prenatal visit) (K4). It includes a full history, an examination of all parts or systems, an appropriate record and advice to the patient, including pregnancy-related counselling (K2).

Normal prenatal care is one prenatal general assessment, then monthly visits to 28 weeks, every 2nd week to 36 weeks, then weekly until delivery; the later routine visits are billed as P004 (K2, K4).

Billing rules

• A prenatal general assessment is payable after another general assessment only if the first assessment wasn't about establishing antenatal care (K2).
• If an uncomplicated patient transfers to you for obstetrical care, you may bill the appropriate assessment, then prenatal visits; not when physicians substitute for each other or when you first see the patient in labour (K2).
• A consultant referred an obstetrical patient because of complexity may bill a consultation in addition to the prenatal visits (K2).
• P005 is payable on the same day as P003 (K4).
• E079 (initial smoking cessation discussion) and E080 (first visit after hospital discharge) may be added when their conditions are met (A56, GP28).
• P003 is not on the Appendix J virtual care lists, so it isn't payable as a video or phone visit (AJ1).
• FHO: P003/P004 claims in the first 28 weeks for 5 or more enrolled patients in a fiscal year earn a prenatal special payment (Agreement p.67 §8.8).

Often billed with

• P005, the antenatal preventative health assessment, often done at the start of care (K4).
• E079 when a smoking cessation discussion is held (A56).
• P004 for the routine visits that follow (K4).

Common rejections

• VJ7: OHIP received the claim more than three months after the service date, so it was rejected as stale-dated (GP9).
• EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.
• A2B: OHIP flagged the prenatal code as not usual for the sex on the patient's OHIP record; check the health number and patient details on the claim.
• VH8: The date of birth on the claim doesn't match OHIP's record for that health number; correct it and resubmit.
• EH4: OHIP's record shows the patient's coverage ended before the service date; confirm the health number and service date, then the patient's coverage.

Related codes: P004, P005, P002, A003, E079

Source: Schedule of Benefits (July 1, 2026), Obstetrics, Prenatal Care, page K4 (preamble K1–K3)

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