< Error codes

Error code

V3 — Not allowed in addition to procedural fee

Visit included in procedure

OHIP paid the procedure but not the visit billed with it, because the procedure fee covers that visit.

What to do: Check what the visit was for; an unrelated significant problem or the major pre-operative visit can be paid separately.

Code
V3
Description
Not allowed in addition to procedural fee

Explanation

Updated October 26, 2026

V3 means OHIP didn't pay the visit on top of the procedure billed with it, because the procedure fee covers that visit. Check if the visit was separate.

What it means

V3 is a remittance advice explanatory code: 'Not allowed in addition to procedural fee'. OHIP paid the procedure and didn't pay the visit (assessment) line. It is the reverse of D3, where the procedure is the line not paid on top of the visit.

Most diagnostic and therapeutic procedures are payable in addition to a consultation or assessment unless the listing says the assessment is included (J3). Surgical fees are different: they include preparing the patient, the procedure and follow-up care until the first post-operative visit. The major pre-operative visit, where the decision to operate is made, is billed separately (SP1, SP2).

For independent operative procedures (Z codes), if the major pre-operative visit was in the previous 12 months, the only assessment payable before the procedure that day is a minor assessment for a family physician or a partial assessment for a specialist. If the major pre-operative visit is the same day, no other assessment before the procedure is payable (SP4).

Common causes

  • An assessment billed on the day of a surgical procedure when the visit wasn't the major pre-operative visit
  • An intermediate assessment billed before a Z-code procedure when the decision to operate was made at an earlier visit
  • A hospital or day surgery admission assessment billed by the surgeon (SP2, GP40)
  • A follow-up visit billed when the procedure fee already includes that care

How to fix it

  1. Read the procedure's listing and its section preamble to see what the fee includes.
  2. Check what the visit was for. A minor procedure plus an assessment for a completely unrelated, significant problem in another body system is payable as both (SP4). So is the major pre-operative visit.
  3. If the visit qualified, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with the chart notes showing the separate problem or the decision to operate.
  4. If the visit was part of the procedure, there is nothing to fix. If the rules allowed a lesser assessment, such as a minor assessment before a Z-code procedure, ask for it through the RAI.

Don't resubmit if

  • The visit was for the same problem as the procedure and wasn't the major pre-operative visit.
  • The claim is on the RA. Send an RAI instead of a new claim for the visit.
  • You'd be billing a visit in place of a listed procedure. The Schedule says a listed procedure should be billed as the procedure (SP4).

How APEX handles it

APEX has no correction rule for V3 and doesn't send inquiries for it. If nothing on the visit was paid, the claim is listed under Outstanding for you to review. Usually the procedure was paid, so the visit line stays in your claims with the billed and paid amounts. See how APEX works · Pricing

Related codes: D3, D4, D5, VA, D7

Sources