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Error code

42 — Fee code billed is included in another procedure

Included in another procedure

OHIP paid the other procedure on the claim and treated this fee code as part of it, so it wasn't paid separately.

What to do: Read the main procedure's listing to see what it includes; send an inquiry only if this was a separate procedure.

Code
42
Description
Fee code billed is included in another procedure

Explanation

Updated October 26, 2026

Code 42 means the fee code billed is part of another procedure on the claim, so OHIP didn't pay it separately. Check what the main procedure includes.

What it means

Code 42 is a remittance advice explanatory code. The Ministry's wording is 'FSC Billed Included in Other Procedure'. OHIP paid the other procedure and treated this line as part of it.

The Schedule says a surgical fee includes the generally accepted surgical components of the procedure (SP2). Some sections also name procedures that can't be paid with others. For example, synovectomy codes other than E554 aren't payable with the joint procedures E554 is added to (N1). When a physician gives an anaesthetic or nerve block for their own procedure, it generally isn't payable (GP100).

D7 ('Not allowed in addition to other procedure') is a similar code.

Common causes

  • A step of a procedure billed as its own code
  • A related procedure on the same site at the same time billed separately
  • An anaesthetic or nerve block billed by the physician who did the procedure

How to fix it

  1. Read the main procedure's listing and its section preamble to see what it includes.
  2. If the second procedure was separate, for example at a different site or for a different condition, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with the operative report or chart notes.
  3. If it is included in the main procedure, there is nothing to fix.

Don't resubmit if

  • The procedure is a usual part of the main procedure.
  • You'd be sending the same code again on a new claim. It will get the same result.
  • The claim is on the RA. Use an RAI.

How APEX handles it

APEX has no correction rule for code 42 and doesn't send inquiries for it. If nothing on the visit was paid, the claim is listed under Outstanding for you to review. Usually the main procedure was paid, so the line stays in your claims with the billed and paid amounts. See how APEX works · Pricing

Related codes: D7, D2, 41, V3

Sources