Error code
T1 — Paid based on the surgery claim
Paid per surgeon's claim
OHIP set this line's payment from the surgeon's claim for the same patient and date, not exactly as you billed.
What to do: Compare your procedure codes and count with the surgeon's claim; if theirs is wrong, ask their office to correct it.
- Code
- T1
- Description
- Paid based on the surgery claim
Explanation
Updated October 26, 2026
OHIP set this line's payment to match the surgeon's claim for the same operation. Compare your claim with the surgical claim before querying it.
What it means
The Ministry's wording for T1 is "Fee allowed according to surgery claim". OHIP paid this line based on what the surgical claim for the same patient and date shows, rather than exactly as you billed it.
This usually affects claims whose value depends on the operation itself. Surgical assistant fees are built from the assistant units of the procedure (GP85) and anaesthesia fees from the anaesthesia units of the procedure (GP92), so a difference between your claim and the surgeon's can change what you are paid.
Common causes
- The procedure code on your claim differs from the one the surgeon billed
- The surgeon billed a different number of procedures, or a different service date
- The surgeon's claim was itself corrected or reduced
How to fix it
- Compare your claim with the surgeon's: patient, service date, procedure codes and number of procedures.
- If the surgeon's claim is wrong, ask the surgeon's office to correct it.
- If both claims are right and the payment still looks wrong, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with the operative details.
Don't resubmit if
- The claim is already on the RA. Use an RAI, not a new claim, if you disagree with the payment.
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