Error code
H5 — Monthly maximum fee applies after the 13th week
Over monthly visit limit
After the 13th week in hospital, subsequent visits are limited per month; visits over the limit weren't paid.
What to do: Count the month's visits and check the admission date; bill acute intercurrent illness visits as C121.
- Code
- H5
- Description
- Monthly maximum fee applies after the 13th week
Explanation
Updated October 26, 2026
H5: after the 13th week in hospital, subsequent visits are limited per month. Visits over the limit weren't paid. Use C121 for acute intercurrent illness.
What it means
H5 means the patient had been in hospital more than 13 weeks, and OHIP paid only up to the monthly maximum for subsequent visits.
In-hospital subsequent visits are limited to one per patient per day for the first 5 weeks after admission (C002), 3 per week from week 6 to 13 (C007), and 6 per month after 13 weeks (C009). Visits over the limit are not payable. Visits for an acute intercurrent illness after week 5 are billed as C121 and don't count toward the limits (Schedule GP43, A13). When a patient is referred within hospital, the weeks are counted from the date the second physician first saw them.
Common causes
- More than 6 subsequent visits in a month after week 13
- Visits for an acute intercurrent illness billed as regular subsequent visits instead of C121
How to fix it
- Count the subsequent visits billed for that month.
- Check the admission date on the claims.
- If extra visits were for an acute intercurrent illness, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with notes; bill such visits as C121 in future.
Don't resubmit if
- The claim is already on your RA. Use an RAI, not a new claim, if you disagree.
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