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Error code

49 — Paid at the average fee. Send clinical/operative records for reconsideration

Paid at average fee

OHIP paid this service at its average fee instead of pricing it from your clinical or operative records.

What to do: Compare the amount paid with what you claimed; send the records with an inquiry if the difference is worth pursuing.

Code
49
Description
Paid at the average fee. Send clinical/operative records for reconsideration

Explanation

Updated October 26, 2026

OHIP paid this service at its average fee instead of pricing it from your records. Send the clinical or operative records if you want it reconsidered.

What it means

Code 49 is an explanatory code on the Remittance Advice (RA). The Ministry's wording is that the service was paid according to the average fee for the service, and that independent consideration will be given if clinical records or operative reports are presented. The claim was paid, but at a standard amount, not an amount set from the details of your case.

It fits services that don't have one fixed fee. The Schedule of Benefits marks these 'IC' (independent consideration). A medical consultant sets the fee for each IC claim, and the claim must come with a supporting letter explaining the fee claimed, an operative or consultation report, and a comparison of the procedure's scope and difficulty with procedures listed in the Schedule (GP12). Unlisted surgical procedures are claimed under R990 and unlisted tumours under R993 (SP4).

If the average fee is fair for what you did, there is nothing to do. If the case took more time or skill than usual, the records are how you ask for a higher amount.

Common causes

  • An IC service, such as R990 or R993, billed without the supporting letter and operative report
  • Supporting documents that didn't reach the Ministry with the claim
  • Documents that didn't explain why the case justified more than the usual amount

How to fix it

  1. Compare the amount paid with the amount you claimed and decide whether the difference is worth pursuing.
  2. Gather the operative report or clinical notes, and write a short letter explaining the fee claimed and comparing the procedure's scope and difficulty with similar listed procedures.
  3. To ask for reconsideration, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the date of the RA the claim appears on. Attach the records and letter, and ask for the claim to be given independent consideration.
  4. The Ministry answers on the RAI: paid correctly, adjustment required, or final decision. If the answer isn't marked final, keep the same inquiry going by sending new information. Don't open a second RAI for the same claim.
  5. For future IC claims, set the manual review indicator and send the letter and report through eSubmit, or by fax, when you submit the claim.

Don't resubmit if

  • The claim is on the RA. Billing it again would be a duplicate; ask for reconsideration through an RAI.
  • You have no records that support a higher fee. The Ministry reconsiders on the strength of the documents.

How APEX handles it

APEX shows 49 on the claim line and has no correction rule for it. A line that was paid something is not added to the Correction Centre. If nothing on the visit was paid, the visit is listed under Outstanding for you to review; APEX never sends it on its own. If you are handling it through an RAI instead, use Ignore on it so it isn't sent again as a new claim. APEX doesn't write the inquiry or send records for you. See how APEX works · Pricing

Related codes: 48, 50, 52, 46, 47

Sources