Error code
D4 — Procedure allowed at 50% with visit
Procedure at 50% with visit
The procedure was paid at 50% because a visit was billed for the same patient.
What to do: Read the Schedule notes for the procedure and visit before sending a remittance advice inquiry.
- Code
- D4
- Description
- Procedure allowed at 50% with visit
Explanation
Updated October 26, 2026
OHIP paid this procedure at 50% because a visit was billed with it. Check the procedure's notes before sending an RAI.
What it means
Code D4 means a procedure was paid at 50% because a visit was billed for the same patient.
The Ministry doesn't say which procedures this applies to. Check the notes under the procedure code in the Schedule for how it is paid with a visit.
Common causes
- A procedure and a visit billed together
How to fix it
- Read the Schedule notes for the procedure and the visit.
- If the visit and procedure were separate and the rule doesn't apply, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details such as your chart notes.
- Otherwise, the payment is correct.
Don't resubmit if
- The claim is already on the RA and you only disagree with the decision. Use an RAI, not a new claim.
How APEX handles it
APEX reads your error reports and remittance advice from MCEDT and lists claims rejected with this code in its Correction Centre for you to correct and resubmit. See how APEX works · Pricing