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Billing code

P005A — Antenatal Preventative Assessment

Antenatal risk review

Bill P005 once per pregnancy when the most responsible physician completes and documents the initial review of psychosocial, genetic and medical antenatal risk.

Watch for: With any other visit or consultation by you the same day, except P003 or P004, P005 is paid at nil.

Code

P005A

Description

Antenatal Preventative 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

Antenatal preventative health assessment: the MRP's documented initial review of antenatal risk, once per pregnancy.

What it covers

P005 is the antenatal preventative health assessment, rendered by the most responsible physician to do the initial review of antenatal risk (K4).

The review must cover all current psychosocial, genetic and medical issues that affect antenatal risk, and must be documented in writing in the patient's permanent medical record (K4).

Billing rules

• Maximum once per pregnancy (K4).
• Billed by the most responsible physician (K4).
• Same patient, same day, same physician as any other consultation or visit except P003 and P004: P005 is insured but paid at nil (K4).
• The written review of psychosocial, genetic and medical risk must be in the chart (K4).
• P005A is on the Appendix J list of services payable by video or telephone (AJ1); bill it with the K300A (video) or K301A (telephone) modality indicator (A70).
• Comprehensive virtual care needs an existing patient-physician relationship, for example an in-person insured service by you in the past 24 months or the patient being enrolled to you or your group (A66).
• E079 (initial smoking cessation discussion) may be added when its conditions are met (A56).

Often billed with

• P003 at the first major prenatal visit (K4).
• P004 at a routine prenatal visit (K4).
• E079 for an initial smoking cessation discussion (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.
• AT3: P005 billed as video or phone care was rejected because OHIP found no existing patient-physician relationship on the service date (A66); without one, only limited virtual care applies.
• VH8: The date of birth on the claim doesn't match OHIP's record for that health number; correct it and resubmit.

Related codes: P003, P004, P002, K300, K301, E079

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

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