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Billing code

P020A — Operative Delivery

Assisted or operative delivery

Bill P020 for a forceps or vacuum-assisted delivery, a breech delivery, or shoulder dystocia needing advanced manoeuvres.

Watch for: Bill third- and fourth-degree tears separately as P045 or P046, and add E502 for a vaginal birth after caesarean.

Code

P020A

Description

Operative Delivery

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

Operative delivery: forceps or vacuum-assisted, breech, or shoulder dystocia using advanced manoeuvres.

What it covers

P020 is an operative delivery, defined as any of: forceps or vacuum-assisted delivery, breech delivery, or shoulder dystocia using advanced manoeuvres (K6).

It includes repair of a first or second degree tear or episiotomy extension. Assisted breech delivery is billed as P020 when it includes spontaneous delivery to the umbilicus with extraction of the shoulders, arms and head (K6, K3).

Billing rules

• Third and fourth degree tears are billed separately as P045 or P046 (K8).
• Two or more infants vaginally: P020 for the first, 85% of P006 or P020 as appropriate for the second, and E500 for the third and each later delivery (K6).
• Between 20 and 23 weeks, spontaneous vaginal deliveries pay only P006, whatever the number of fetuses. If all fetuses are known to be stillborn, only one delivery code is payable (K6).
• Add E502 for a vaginal birth after caesarean section (VBAC), successful or not (K6).
• Add E414 when at least one condition is present: fetal prematurity (<32 weeks), severe pregnancy-induced hypertension, IUGR below the 10th percentile, or significant placental insufficiency shown by absent umbilical flow or reversed S/D ratio (K8).
• E411 sole delivery premium (+100%) can be added to P020A when it is your only delivery that calendar day, up to 25 per physician per fiscal year (K7).
• Add E409 (+50%, weekday evenings and weekend/holiday days) or E410 (+75%, nights) when the delivery is non-elective, or elective but delayed into that period by an emergency (GP103–GP104).
• C989 can be added for the first obstetrical delivery of the calendar day when it required sacrifice of office hours (K7).

Often billed with

• E411 sole delivery premium (K7).
• E414 high risk obstetrical premium (K8).
• E502 VBAC (K6).
• E409/E410 after-hours premium (GP104).

Related codes: P006, P018, P045, P046, E411, E414, E502, C989

Source: Schedule of Benefits (July 1, 2026), Obstetrics, Labour - Delivery, page K6.

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