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Error code

O4 — Pregnancy office visits before delivery are included in the obstetric fee

Included in obstetric fee

Pregnancy-related office visits before the delivery are included in the obstetric fee, so they weren't paid separately.

What to do: Check whether the refused visits were pregnancy-related; a visit for an unrelated condition may be claimed as an ordinary assessment.

Code
O4
Description
Pregnancy office visits before delivery are included in the obstetric fee

Explanation

Updated October 26, 2026

O4 means pregnancy-related office visits before delivery were treated as included in the obstetric fee.

What it means

O4 means office visits related to the pregnancy, claimed before the delivery, are included in the obstetric fee and are not paid separately.

How to fix it

  1. Check which visits were refused and whether they were pregnancy-related.
  2. A visit for a condition unrelated to the pregnancy, apart from routine prenatal visits, may be claimed as an ordinary assessment (Schedule K2, note 4).
  3. If you believe the decision is wrong, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details.

Don't resubmit if

  • The line is already on your RA. Question it with 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: O5, O2

Sources