Error code
R04 — Service Excluded from RMBS
Excluded from out-of-province billing
This service is excluded from Reciprocal Medical Billing, so it can't be billed to OHIP for an out-of-province patient.
What to do: Don't resubmit it as Reciprocal Medical Billing; bill the patient or their home province directly.
- Code
- R04
- Description
- Service Excluded from RMBS
Explanation
Updated October 26, 2026
R04 means the service can't be billed through Reciprocal Medical Billing. Bill the patient or their home province directly.
What it means
Error R04 means the service on this Reciprocal Medical Billing (RMB) claim is excluded from the RMB system.
Reciprocal Medical Billing (RMB) is how Ontario physicians bill OHIP for insured services to patients covered by another Canadian province's or territory's health plan, except Quebec. An RMB claim uses payment program RMB and carries the patient's out-of-province registration details instead of an Ontario health number. Some services are excluded and must be billed directly to the patient or to the home province.
Common causes
- Routine periodic health examinations, including routine eye examinations
- Telemedicine or virtual care services
- Services requested by a third party, or team conferences
- Services to people covered by another agency (for example the Armed Forces, WSIB, Veterans Affairs or federal penitentiaries)
- Other excluded services, such as cosmetic surgery, reversal of sterilization, genetic screening, acupuncture or experimental procedures
How to fix it
- Check the service against the Ministry's list of services excluded from RMB (Claims submission manual).
- If the service is excluded, don't resubmit it as RMB. Bill the patient or the patient's home province directly.
- If the claim also had services that RMB covers, resubmit those on their own RMB claim.
Don't resubmit if
- The service is on the RMB exclusion list. It will reject again.
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