Diagnostic code
428 — Ischaemic and Other Forms of Heart Disease: Congestive heart failure
428 is an OHIP diagnostic code used on Ontario Health Insurance Plan claims. Ischaemic and Other Forms of Heart Disease: Congestive heart failure.
- Code
- 428
- Description
- Ischaemic and Other Forms of Heart Disease: Congestive heart failure
Updated October 26, 2026
428 is the OHIP diagnostic code for congestive heart failure.
Conditions billed under this code
- Heart failure
What it covers
The Ministry lists 428 as 'Congestive heart failure' under Ischaemic and Other Forms of Heart Disease, in the Diseases of the Circulatory System chapter.
Use it for heart failure, including follow-up visits for a patient with known heart failure.
Close neighbours: 402 hypertensive heart disease, 410 acute heart attack, 412 old heart attack or chronic coronary artery disease without symptoms, 413 angina, 427 atrial fibrillation and other arrhythmias, 429 other forms of heart disease. Swelling or shortness of breath not yet diagnosed is 785 or 786.
Billing notes
- 428 is on the GP26 list for E078, the chronic disease assessment premium (+50%) that specialists in the listed specialties add to an office or out-patient clinic assessment (GP25–GP26).
- Cardiology's congestive heart failure premium, E088 (+50%), is for office or out-patient clinic assessments of a patient with established heart failure, and claims must be submitted with 428 (A79–A80).
- Congestive heart failure is one of six diseases eligible for chronic disease shared appointments, K140 to K144 (A22).
- Q050A, the heart failure management incentive ($125 a year), is an annual payment in eligible primary care models for documenting the required elements of heart failure care for an enrolled patient (AQ2; FHO Agreement §11.4).
Related codes: 402, 410, 412, 413, 427, 429
Sources
- OHIP Diagnostic Codes (Ministry of Health, February 2026)
- Schedule of Benefits: Physician Services (effective July 1, 2026)
- OMA Primary Care Q-Codes Quick Reference Guide (November 2020)
APEX flags claims whose diagnostic code does not fit the service billed before they come back rejected. See how APEX works · Pricing