Otolaryngology OHIP Billing Cheat Sheet

Updated October 10, 2026

OHIP specialty 24. Procedure-only visit · Urgent call to a ward patient · In-patient consult (non-urgent).

Download the Otolaryngology cheat sheet (PDF)

Pick the visit, tick what you did, bill the codes at the bottom. Ontario fees effective July 1, 2026.

Office consultation

  • A245A Consultation ($92.70): Written referral from a physician or NP in the chart; report back to them (GP16).
  • A935A Long consultation, 50+ minutes ($194.65): Special surgical consultation: 50+ minutes face to face, not counting scopes, procedures or chart review. Chart start and stop times (GP19–GP20).
  • A246A Repeat consultation ($53.65): Same problem again after another doctor treated it in between. Needs a new written referral (GP19).
  • A243A No written referral ($44.75): Paid as a specific assessment: full history of the complaint and detailed exam (GP16, GP23). Limit: 1 per 12 months (2 if a clearly different diagnosis).

Tips

  • Scoped the nose, nasopharynx or larynx? Add Z296A ($33.25) on top of the consult, as long as it was the only operative procedure that day (P1).
  • Did a nasal biopsy, polypectomy, foreign body removal, cautery or packing through the flexible scope? Bill that code plus E839A ($35.25) instead of Z296A (P1, P4).
  • A935A pays $194.65, more than double A245A, when you spend 50+ minutes with the patient. Time spent scoping doesn't count (GP19–GP20).
  • One consult per patient per diagnosis every 2 years; a clearly unrelated diagnosis allows 1 per 12 months (GP17).
  • Booking a procedure for a later visit? On that day only a partial assessment (A244A) is paid with a Z procedure (SP4).

Follow-up visit

  • A244A Follow-up check ($30.45): Partial assessment: history of the complaint, the exam needed, advice (GP25).
  • A243A Full work-up of a new or different problem ($44.75): Specific assessment: full history of the complaint and detailed exam (GP23). Limit: 1 per 12 months (2 if a clearly different diagnosis).

Tips

  • Debrided an ear with real outer or middle ear pathology under the microscope? Z907A ($27.40) pays double G420A. Not for wax, and not with loupes or a headlight (Y16).
  • G420A is only insured for impacted wax causing hearing loss after drops failed, or wax that has to come out to see the drum (J97).
  • A scope or procedure you planned at an earlier visit allows only A244A with it, not A243A (SP4).
  • Specific assessments are capped at 1 per patient per 12 months (2 for a clearly different diagnosis); extras are paid as A244A (GP23).
  • E078A (chronic disease premium) isn't payable to otolaryngology (24): GP25 limits it to geriatrics, endocrinology, neurology, paediatrics, pathology, physical medicine, radiation oncology, medical oncology, infectious disease, respirology, rheumatology, haematology and clinical immunology, so OHIP won't pay it.

Procedure-only visit

Tips

  • Microscopic debridement: Z907A one ear $27.40; the other ear at 85% (Y16). G420A can't be added (J97).
  • Z915A (simple foreign body) for wax alone pays $0 (Y14).
  • Z912A or Z914A in an otherwise healthy child needs chronic effusion lasting 3+ months or recurrent acute otitis with effusion (Y16).
  • Epley (G403A) and ear syringing (G420A) take G700A ($8.80) when they were the only reason for the visit; not in hospital (J3, J97).
  • ENT office procedures carry no E542A tray fee.

Called to the ED

  • A245A Consultation ($92.70): A request on the hospital's common record counts as the written referral (GP16).
  • A935A Consultation, 50+ minutes ($194.65): Start and stop times charted (GP19–GP20).
  • A243A Specific assessment ($44.75): Your own patient, or no consult request.

Tips

  • Use the A-codes here, not C-codes, with the ED special visit premiums. Chart the time you saw the patient (GP69).
  • Nosebleed: cautery Z314A and anterior packing Z315A are per side; posterior packing Z316A covers both. Done through the flexible scope: add E839A ($35.25) (P4).
  • Non-elective procedure started 17:00–24:00 weekdays or any time on a weekend or holiday: E409A adds 50% to the procedure fee; nights 00–07: E410A adds 75% (SP2, GP104).
  • Already at the hospital? Evenings, weekends and nights still earn the first person seen premium without travel (GP66).

Urgent call to a ward patient

  • A245A Consultation ($92.70): Another physician's in-patient, non-elective request.
  • A935A Consultation, 50+ minutes ($194.65): Start and stop times charted (GP19–GP20).
  • A243A Specific assessment ($44.75): Another physician's patient seen urgently.

Tips

  • Non-elective calls to a ward use A-codes with the in-patient premiums; routine ward consults are C245A with no premium (GP43, GP65).
  • No premiums for patients seen on rounds or for elective admission assessments (GP65).
  • The travel premium needs a trip from another location; not between buildings on the same hospital campus (GP66).

Hospital rounds

  • C242A Routine visit, weeks 1 to 5 ($31.00): 1 per day. Weeks 6 to 13: C247A (max 3 per week); after week 13: C249A (max 6 per month) (GP43).
  • C122A You're the MRP: day after admission ($71.80): Once per admission; not the same day as C124A or C126A (GP44).
  • C123A You're the MRP: second day after admission ($71.80): Once per admission (GP44).
  • C142A You're the MRP: first visit after transfer out of the ICU ($71.80): Patient got critical care, ventilatory or comprehensive care just before transfer (not monitoring only), and you didn't give it. Instead of C122A: one of C122A/C142A per admission (GP46).
  • C143A You're the MRP: second visit after transfer out of the ICU ($71.80): Instead of C123A: one of C123A/C143A per admission. Not the same day as C124A or C126A (GP46).
  • C124A You're the MRP: discharge day ($71.80): Stay of 48 h+; discharge summary within 48 h with reason, procedures, diagnosis, discharge meds (GP45).
  • C126A You're the MRP: discharge day, medically complex ($95.10): Stay of 7+ consecutive days, 3+ diagnoses that lengthened it, 45+ minutes of your own time; otherwise paid as a lesser fee. One of C124A/C126A per admission (A13, GP45).
  • C248A Concurrent care ($31.00): Another doctor is the MRP and asked you to keep following (GP48).

Tips

  • As MRP, the two days after admission and discharge day pay $71.80 each instead of $31.00 (GP44–GP45). Came from the ICU? C142A/C143A take the place of C122A/C123A (GP46).
  • A long, complex stay (7+ days, 3+ contributing diagnoses, 45+ min on discharge day) pays C126A $95.10 instead of C124A $71.80 (A13).
  • E083A adds 30% to your MRP subsequent visits, C121A, C122A–C126A, C142A, C143A and C982A, when the hospital doesn't pay you for in-patient care (GP47).
  • After week 5, an acute intercurrent illness is C121A ($40.05), outside the weekly visit limits (GP43). Palliative care visits as MRP: C982A $40.05 (GP50).
  • Visit limits count from admission, or from the referral date if the patient was referred to you in hospital (SP2). The surgeon can't bill the admission assessment unless it was the decision-to-operate visit (SP2).

In-patient consult (non-urgent)

  • C245A Consultation ($92.70): Written request in the hospital chart (GP16).
  • C935A Consultation, 50+ minutes ($194.65): Start and stop times charted (GP19–GP20).
  • C246A Repeat consultation ($53.65): Same problem after another doctor treated it in between (GP19).
  • C243A Specific assessment ($44.75): Full history of the complaint and detailed exam (GP23).
  • C244A Specific re-assessment ($31.00): 2 per 12 months, except admissions (GP23).

Tips

  • Called urgently instead of on rounds? Pick "Urgent call to a ward patient": the A-code plus premiums pays more.
  • Bedside scope: add Z296A when it's the only operative procedure (P1).

Booked surgery (OR)

Tips

  • Bilateral tubes: Z914A is a Z (independent) procedure, so each ear is claimed in full (SP4).
  • Other procedures under the same anaesthetic: the main one at 100%, the others at 85%, unless the Schedule says otherwise (SP2).
  • Tonsillectomy S063A already includes adenoidectomy; don't add S065A (S2).
  • The surgical fee covers care until the first post-op visit; the decision-to-operate consult is billed separately (SP1, SP2).

Phone or video

  • A245A + K300A Consultation by video ($92.70): Consults are video only, on an Ontario Health verified platform (A67–A68, Appendix J).
  • A244A + K300A Follow-up by video ($30.45): Full fee.
  • A244A + K301A Follow-up by phone ($30.45): Phone pays 85% of the in-person fee (A70).
  • A243A + K301A Specific assessment by phone ($44.75): 85% of $44.75 (A70).
  • A101A Video, no relationship with the patient ($20.00): No in-person visit or video consult with you in the last 24 months (A66, A73).
  • A102A Phone, no relationship with the patient ($15.00)

Tips

  • The patient has to ask for the visit, or it follows up one they asked for. Check-in calls and normal results aren't billable (A68).
  • If you find you need to look in the ears or scope, only the in-person visit is paid (A67).
  • A video consult counts as a relationship: follow-ups for 24 months can be by phone at 85% (A66).
  • Write in the chart whether it was phone or video.

Also bill, if it's true

  • G441A + G526A Audiogram: pure tone plus speech ($37.25): You interpret it personally; testing by you, your trained employee or a hospital audiologist; keep qualification records or it pays $0. Pure tone only: G440A + G525A, $17.80 (J98–J99).
  • G442A + G529A Tympanometry (impedance) ($5.66): Advanced hearing test: by you, or an audiologist employed by you or a public hospital (J98–J99).
  • G700A The procedure was the only reason for the visit ($8.80): For G420A or G403A. Once per visit, not in hospital, not with a consult or assessment (J3).
  • E409A Non-elective procedure started 17:00–24:00 weekdays, or daytime or evening on a weekend or holiday (+50%): Adds 50% of the ticked procedure fees. Fractures and dislocations count; not for ED physicians on shift (GP103–GP104).
  • E410A Non-elective procedure started at night, 00:00–07:00 (+75%): Adds 75% of the ticked procedure fees (GP104).
  • E083A You're the most responsible physician (+30%): Adds 30% to MRP subsequent visits, C121A, C122A–C126A, C142A, C143A and C982A, if the hospital doesn't pay you for in-patient care (GP47).
  • K036A Filled in the Northern Health Travel Grant form ($10.25): Specialist's part of the form; payable to the referring doctor and the specialist (A60).
  • K730A Phoned another specialist for advice about this patient ($37.05): You're the referring doctor; 10+ minutes, start and stop times charted. Not to arrange a referral, a transfer or to discuss test results. Paid on top of today's visit; 1 per patient per day (A42–A44).
  • K738A Sent an e-consult to another specialist ($16.45): You're the referring doctor; secure e-consult, answered within 30 days. Paid on top of today's visit; 1 a day, 6 per patient per 12 months (A48–A49).
  • K121A In-patient case conference ($37.05): Per 10-minute unit (10, 16, 26, 36 min…). Pre-scheduled, with the MRP plus 2+ other physicians or regulated professionals; chart start/stop, participants and outcome. Paid with today's visit, as long as the visit was done outside the conference. Max 4 per patient per 12 months, 8 units a day (A31–A33).

Did a procedure?

  • Z296A Flexible nasopharyngolaryngoscopy ($33.25): Only when it's the only operative procedure that day (P1).
  • G454A Stroboscopy ($16.80)
  • Z907A Microscopic ear debridement, one ear ($27.40): Real outer or middle ear pathology or a mastoid cavity; not wax (Y16).
  • Z907A Microscopic ear debridement, other ear ($23.29): Contralateral side at 85% (Y16).
  • G420A Ear syringing or curetting (wax), one or both ears ($13.15): Impacted wax with hearing loss after drops, or to see the drum (J97).
  • Z913A Small perforation repair under local ($39.00): Other ear at 85% (Y17).
  • Z912A Myringotomy, per ear ($42.15)
  • Z916A Intratympanic injection, per ear ($75.90): Includes any myringotomy (Y16).
  • Z915A Foreign body out of the ear, simple ($10.55): $0 if it was only wax (Y14).
  • Z909A Ear canal biopsy ($25.85)
  • Z904A Ear polyp removal, office ($25.85)
  • G403A Epley (particle repositioning) for BPPV ($21.70)
  • Z314A Nosebleed cautery, per side ($11.50)
  • Z315A Anterior nasal packing, per side ($15.35)
  • Z316A Posterior nasal packing ($35.50): One or both sides.
  • E839A Done through the flexible scope ($35.25): Add to cautery, packing, nasal biopsy, single polyp or foreign body (Z314A, Z315A, Z316A, Z309A, Z304A, Z311A) (P1, P4).
  • Z309A Nasal biopsy, single ($18.30)
  • Z304A Nasal polyp removal, single ($21.00)
  • Z311A Foreign body out of the nose, local ($10.55)
  • F136A Nasal fracture, closed reduction ($102.35): Includes septal manipulation (N34).
  • Z301A Drain septal abscess or haematoma ($55.60)
  • Z510A Drain peritonsillar or pharyngeal abscess ($91.10)
  • Z324A Indirect laryngoscopy with biopsy or foreign body removal ($44.70)
  • Z111A Frenotomy, no general anaesthetic ($20.00)
  • Z914A Myringotomy with tube, per ear (OR) ($78.60): Both ears paid in full (SP4).
  • S063A Tonsillectomy, with or without adenoidectomy ($214.50)
  • S065A Adenoidectomy alone ($101.25)
  • M012A Septoplasty ($293.95)
  • Z302A Turbinate reduction, one or both sides ($55.60)
  • M083A Endoscopic ethmoidectomy, per side ($350.00): Bilateral: add E844A $200 (P6).

Can I bill these together?

  • E078A with A243A, A244A: No. E078A is only paid to the specialties listed in GP25; Otolaryngology (24) isn't one of them (GP25).
  • A245A with A243A, A244A, A246A, A935A: No. Only one assessment is paid per visit (GP10).
  • A243A with A244A: No. Only one assessment is paid per visit (GP10).
  • A243A with Z296A, Z907A, Z913A, Z912A, Z916A, Z909A, Z904A, Z915A, Z309A, Z304A, Z311A, Z314A, Z315A, Z324A: Sometimes. Z codes are independent procedures. If you planned it at an earlier visit in the last 12 months, only a partial assessment (A244A) is paid before it that day (SP4).
  • A244A with Z296A, Z907A, Z913A, Z912A, Z916A, Z909A, Z904A, Z915A, Z309A, Z304A, Z311A, Z314A, Z315A, Z316A, Z324A, Z301A, Z510A, Z111A: Yes. A partial assessment is the visit allowed with a planned Z procedure (SP4).
  • A245A,A935A,C245A,C935A with Z296A, Z907A, Z913A, Z912A, Z916A, Z909A, Z904A, Z915A, Z309A, Z304A, Z311A, Z314A, Z315A, Z316A, Z324A, Z301A, Z510A, Z111A, Z914A: Yes. The consult where you decide on the procedure is the major pre-op visit, and it is paid with a Z procedure done the same day. No second assessment before it that day (SP4 §13, GP4).
  • K731A,K739A with A245A, A935A, A246A, A243A, A244A, C245A, C935A, C246A, C243A, C244A: No. The consultant side of a phone or e-consult isn't paid if you also see the patient (consult, assessment or visit) that day or the next (A43, A49).
  • Z296A with Z314A, Z315A, Z316A, Z309A, Z304A, Z311A, Z324A, Z301A, Z510A, F136A, Z907A, Z913A, Z912A, Z916A, Z909A, Z904A, Z915A, E839A: No. Z296A is paid only when it's the only operative procedure; through the scope, add E839A to cautery, packing, biopsy, polyp or foreign body instead (P1, P4).
  • Z296A with Z292A, Z293A, Z322A, Z323A: No. Z296A isn't paid with direct laryngoscopy the same day, and only when it's the only operative procedure (P1, P7).
  • G420A with Z906A, Z907A, Z908A, Z913A: No. G420A isn't paid with Z906A, Z907A, Z908A or Z913A (J97, Y16).
  • Z913A with Z908A, E323A: No. Z913A isn't paid with Z908A or E323A (Y17).
  • Z912A with Z916A: No. Intratympanic injection includes the myringotomy (Y16).
  • S063A with S065A: No. S063A already includes adenoidectomy (S2).
  • S063A with Z914A, Z912A, Z302A, M012A: Sometimes. Same anaesthetic: the main procedure at 100%, others at 85% (SP2); several Z procedures done together are each paid in full (SP4).
  • G700A with A245A, A935A, A246A, A243A, A244A, C245A, C243A: No. G700A is only for a visit where the procedure was the sole reason, and not in hospital (J3).
  • C122A,C123A with C124A, C126A: No. C122A and C123A aren't paid the same day as C124A or C126A (GP44).
  • C142A,C143A with C124A, C126A: No. C142A and C143A aren't paid the same day as C124A or C126A (GP46).
  • C122A with C142A: No. Only one of C122A or C142A per hospital admission (GP44, GP46).
  • C123A with C143A: No. Only one of C123A or C143A per hospital admission (GP44, GP46).
  • C124A with C126A: No. Only one of C124A or C126A per hospital admission (A13).
  • M083A with M054A: No. M083A isn't paid with M054A: the ethmoidectomy may already include the maxillary antrostomy (P6).
  • E600A with E643A: No. The operating microscope add-on E600A isn't paid with laser microlaryngoscopy E643A (P7).
  • E083A with C248A: No. E083A is for the MRP; concurrent care means another doctor is the MRP (GP47–GP48).
  • E409A with E410A: No. One after-hours rate per procedure, by its start time (GP104).

Sources: Schedule of Benefits (July 1, 2026): General Preamble GP10–GP69 and GP104, Surgical Preamble SP1–SP4, Aural Y14–Y18, Respiratory P1–P11, Digestive S1–S4, Endocrine W1–W2, Lymphatic R2, Diagnostic and Therapeutic J3 and J97–J100, Otolaryngology A166–A167, Practice in General A31–A60 (case conferences, phone and e-consults, forms), Virtual Care A66–A75. Surgeon fees shown; assistant and anaesthesia units are billed by those physicians. Totals leave out age premiums (OHIP adds 10–30% for children on consults and procedures) and the 85% rate on second procedures under one anaesthetic (OHIP applies it on the remittance). Screening audiometry and tests requested by schools, employers or WSIB are uninsured (J98).

Other disciplines

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