< Billing codes

Billing code

P004A — Minor Prenatal Assessment

Routine prenatal visit

Bill P004 for each routine follow-up prenatal visit after the first major prenatal visit (P003).

Watch for: For a condition unrelated to the pregnancy, bill the appropriate assessment instead; P004 isn't payable as a video or phone visit.

Code

P004A

Description

Minor Prenatal Assessment

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

Minor prenatal assessment: the routine follow-up prenatal visits after the first major prenatal visit (P003).

What it covers

P004 is the minor prenatal assessment (K4). After the major prenatal visit (P003), routine prenatal visits are billed as P004. Each prenatal visit includes the necessary history, examination, record and advice, including pregnancy-related counselling (K2). Prenatal visits are assessments under the Schedule (K1).

Normal prenatal care is a general assessment visit, then monthly visits to 28 weeks, every 2nd week to 36 weeks, then weekly until delivery. Complicated pregnancies may need more visits (K2).

Billing rules

• For a condition unrelated to the pregnancy, seen apart from the routine prenatal visits, bill the appropriate assessment instead (K2).
• Illness from or associated with the pregnancy, or false labour, needing extra home or hospital visits is claimed per visit (K2).
• If an uncomplicated patient transfers to you for obstetrical care, bill the appropriate assessment, then prenatal visits; this doesn't apply to physicians substituting for each other or when you first see the patient in labour (K2).
• P005 (antenatal preventative assessment) is payable on the same day as P004 (K4).
• E079 (initial smoking cessation discussion) and E080 (first visit after hospital discharge) may be added to P004 when their own conditions are met (A56, GP28).
• P004 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 for prenatal care 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

• P003 at the first major prenatal visit, then P004 for routine visits (K2, K4).
• P005 once per pregnancy (K4).
• E079 when a smoking cessation discussion is held (A56).

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.
• 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.
• A3H: The line billed more services of this code than OHIP's fee schedule master allows; check the number of services and resubmit.

Related codes: P003, P005, P002, P008, E079

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

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing