How do I fix OHIP error code 65?

Check where the service was done, and whether the patient was an in-patient or was admitted within 24 hours for the same condition. If the hospital's funding covers it, there is nothing to bill. Bill only the professional component (suffix C) where one is listed. Check that the claim's location and in-patient details are right. If the service wasn't part of a hospital stay and you believe it is payable, 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. Include the dates and where the service was done.

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Error code

65 — Covered by the hospital payment

Q: What does OHIP error code 65 mean?

Code 65 means OHIP didn't pay this fee because hospital funding covers the service. Check where it was done and whether the patient was admitted.

Q: When shouldn't I resubmit a 65 claim?

The patient was an in-patient, or was admitted to the same hospital within 24 hours for the same condition. The claim is on the RA. Use an RAI, not a new claim.

Covered by hospital funding

OHIP treats this service, or the part you claimed, as already paid through the hospital's funding.

What to do: Check where it was done and whether the patient was admitted; bill only the professional component where one is listed.

Code: 65
Description: Covered by the hospital payment

Explanation

Updated October 26, 2026

Code 65 means OHIP didn't pay this fee because hospital funding covers the service. Check where it was done and whether the patient was admitted.

What it means

Code 65 is an explanatory code on the Remittance Advice (RA). The Ministry's wording is 'Service included in approved hospital payment'. OHIP treats the service, or the part of it you claimed, as already paid for through the hospital, so it doesn't pay it again on a physician claim.

The Schedule of Benefits has rules that work this way. The technical component of a diagnostic service (the 'H' or 'T' column, billed with suffix B) is not payable for a hospital in-patient, or for a patient who is admitted to the same hospital within 24 hours for the same condition (GP11). For services marked '#' and done in a hospital, the premises, equipment, supplies and staff are funded by the hospital's global budget (GP13).

These rules apply to the technical side of a service. They don't stop the physician who interpreted a test from billing the professional component (suffix C). Code 80 is a different code, used when a hospital technical fee is paid at an adjusted amount.

Common causes

A technical component (suffix B) billed for a hospital in-patient (GP11)
A technical component billed for an outpatient admitted to the same hospital within 24 hours for the same condition (GP11)
Wrong location or admission details on the claim

How to fix it

Check where the service was done, and whether the patient was an in-patient or was admitted within 24 hours for the same condition.
If the hospital's funding covers it, there is nothing to bill. Bill only the professional component (suffix C) where one is listed.
Check that the claim's location and in-patient details are right.
If the service wasn't part of a hospital stay and you believe it is payable, 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. Include the dates and where the service was done.

Don't resubmit if

The patient was an in-patient, or was admitted to the same hospital within 24 hours for the same condition.
The claim is on the RA. Use an RAI, not a new claim.

How APEX handles it

APEX shows 65 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. See how APEX works · Pricing

Related codes: 80, 30, 42