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Error code

D6 — Payment limit reached for this procedure

Procedure limit reached

The payment limit for this procedure was reached for the patient, so it wasn't paid or was paid less.

What to do: Look up the procedure's limit and check the patient's history for that period.

Code
D6
Description
Payment limit reached for this procedure

Explanation

Updated October 26, 2026

OHIP didn't pay this procedure, or paid less, because the payment limit for it was reached. Check the limit in the Schedule.

What it means

Code D6 means the limit of payment for this procedure has been reached.

When a maximum has no time period, it means per patient per day. When it names a period, services are counted per patient in date order and those over the limit are not eligible for payment (GP7). For example, ultraviolet light therapy (G470) is limited to one per patient per day (J36), and cardioversion (Z437) to three sessions per patient per day (J9).

Common causes

  • More of the procedure than the daily or period limit
  • A wrong service date or number of services

How to fix it

  1. Look up the limit for the procedure.
  2. Check the patient's history for the procedure in that period.
  3. If the date or number of services was wrong, 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.
  4. Otherwise, the limit applies.

Don't resubmit if

  • The procedure really is over its limit.
  • 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

Related codes: AM1, M1, MY, DA

Sources