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Billing code

P018A — Caesarean Section

Caesarean section

Bill P018 for a caesarean section: the surgeon uses suffix A, the surgical assistant suffix B, and the anaesthesiologist suffix C.

Watch for: For each additional baby, add E499 (second) or E500 (third and later) rather than billing a second P018.

Code

P018A

Description

Caesarean Section

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

Caesarean section, billed by the surgeon (A), surgical assistant (B) and anaesthetist (C). Each further baby is added with E499/E500, not a second P018.

What it covers

P018 is caesarean section, listed under Labour - Delivery in the Obstetrics section (K6). Labour-delivery services carry the specific elements of independent operative surgical procedures marked with prefix #, so the fee does not include the premises, equipment and staff used in the operating room (K1, SP1). The section is subject to the Surgical Preamble where applicable (K2).

The surgeon bills P018 with suffix A, the surgical assistant with suffix B and the anaesthesiologist with suffix C (K3). The assistant's fee is 6 basic units and the anaesthesia fee 7 basic units, plus time units (K6, GP85-GP86, GP92-GP93). Ordinary immediate care of the newborn is included in the labour-delivery fee, or in the anaesthetic fee when the anaesthesiologist provides it (K3).

Billing rules

• Multiple births by caesarean only: one P018 (or P041/P042), plus E499 for the second baby and E500 for the third and each later baby. If the first baby is born vaginally and the next by caesarean, P018 is paid with 85% of P006 or P020, plus E500 from the third baby (K6).
• Between 20 and 23 weeks' gestation, multiple caesarean deliveries pay one P018 plus E499 for the second baby; E500 is not payable. Babies known to be stillborn are not counted when live babies are also delivered (K6).
• A life-threatening newborn emergency needing active resuscitation is billed separately as G521, G522 or G523; endotracheal intubation and tracheo-bronchial toilet go under G211 (K3).
• Surgeon: E411 sole delivery premium (+100%) is payable with P018A when it is the only delivery that calendar day, to a maximum of 25 per physician per fiscal year (K7).
• Surgeon: C989 is payable with the first obstetrical delivery of the calendar day when weekday office hours are sacrificed, maximum one per physician per calendar day (K7, GP78). Non-elective deliveries starting evenings, nights, weekends or holidays take the E409/E410 procedure premiums (GP103-GP104).
• Assistant: E400B (evenings and weekend/holiday daytime, +50%) or E401B (nights, +75%) when the case starts after hours (GP87). A physician who claims P009 for the same patient cannot also claim assistant or anaesthesia units (K7).
• E676 morbid obesity premium is payable with P018 when the BMI is over 40 and recorded in the chart and the surgery is done under general anaesthesia, which in the Schedule means any anaesthesia other than topical or local infiltration, so a spinal or epidural qualifies (GP3); once per patient per physician (SP6-SP7).
• FHO: P018A counts toward the labour and delivery special payment (5 or more qualifying services in a fiscal year) (Agreement p.66 §8.4).

Often billed with

• E400B or E401B, the surgical assistant's after-hours premiums, when the case starts after 17:00 on a weekday, on a weekend or holiday, or at night (GP87).
• E676 (E676A surgeon +25%, E676B assistant +6 units) for a patient with BMI over 40 under general anaesthesia; P018 is on the eligible code list (SP6).
• C998B assistant special visit premium, evenings, for the first patient seen when the assistant travels in; payable on top of E400B/E401B (GP88).
• E499 and E500 for the second and later babies of a multiple birth (K6).
• E411 sole delivery premium and C989 sacrifice of office hours premium for the surgeon, when their conditions are met (K7).

Common rejections

• V66: OHIP's description is 'missing admission date'. A caesarean is a hospital in-patient service, so put the patient's admission date on the claim and resubmit.

Related codes: P041, P042, P006, P020, E499, E500, E411, E676

Source: Schedule of Benefits (July 1, 2026), Obstetrics, Labour - Delivery, page K6 (preamble K1-K3, K7); General Preamble GP3, GP78, GP85-GP87, GP92-GP93, GP103-GP104; Surgical Preamble SP6-SP7; FHO Physician Payment Agreement 2026-04 p.66

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