Paediatrics OHIP Billing Cheat Sheet

Updated October 10, 2026

OHIP specialty 26. Well baby or child check · Developmental or behavioural care · Newborn or delivery.

Download the Paediatrics cheat sheet (PDF)

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

Office consultation

  • A265A Consultation ($190.35): Written referral from a physician or NP; written report back (GP16).
  • A260A Long consultation, 75+ min ($342.25): All of A265A plus 75+ minutes face to face. Start and stop times in the chart or it pays $0 (A168).
  • A662A Extended consultation, 90+ min ($442.40): All of A265A plus 90+ minutes face to face. Start and stop times in the chart (A168).
  • A667A Neurodevelopmental consultation, 90+ min ($456.80): Complex neurodevelopmental condition (autism, global delay). 90+ min with child and caregiver. ADHD alone pays a lesser fee (A168–A169). Limit: 1 per patient per 12 months.
  • A266A Repeat consultation ($104.70): Same problem, new written referral, after another doctor cared for the child in between (GP19).
  • A665A Prenatal consultation ($105.50): Fetus over 20 weeks at risk; asked by the obstetrician, family doctor or NP. You can still bill a consult on the baby after birth (A170).

Tips

  • Spent 75 minutes? A260A pays $342.25, 80% more than A265A ($190.35). At 90 minutes A662A pays $442.40. Write start and stop times or it pays $0 (A168).
  • Time for A260A, A662A and A667A counts only face-to-face time, not chart review, and not time spent on other billable procedures (A169).
  • OHIP adds the age premium to consults on the remittance: +30% under 30 days, +25% to 1 year, +20% to 2, +15% to 5, +10% to 16 (GP64).
  • One consult per patient per diagnosis every 2 years; a second for the same problem pays as an assessment (GP17). Use A263A for a later full work-up.
  • Patients 18+ only when you saw them in the year before they turned 18, they have a chronic condition, and they're under 22; or with MOH prior approval (A168).

Office follow-up

  • A263A Full specialist assessment ($95.75): Full history of the problem and detailed exam of the affected systems (GP23). Limit: 1 per 12 months (2 if a new, unrelated diagnosis).
  • A661A Complex re-assessment ($86.35): Complex, obscure or serious problem. Send a written report to the family doctor or it pays a lesser fee (GP24). Limit: 4 per 12 months, A263A included.
  • A264A Re-assessment ($70.75): Full relevant history and exam of one or more systems (GP23). Limit: 2 per 12 months.
  • A262A History and exam of the problem ($50.20): Level 2: history and exam enough to make a diagnosis (GP27).
  • A261A Quick look or advice ($24.85): Level 1: brief history and exam of one area, or brief advice (GP27).

Tips

  • Chronic diagnosis on the GP26 list (asthma 493, diabetes 250, autism 299, behaviour disorder 313, specific developmental delay 315, prematurity 765, epilepsy 345)? Tick E078A: +50% on A262A, A263A, A264A or A661A in the office or clinic (GP25). ADHD (314) and global developmental delay or intellectual disability (319) aren't on the list: E078A with either is rejected.
  • A661A pays $86.35 vs A264A $70.75 when the case is complex and you write to the family doctor. Up to 4 a year (GP24).
  • A263A pays almost double A262A. Use it for the full work-up once a year; A264A or A661A after that.
  • Phone or video follow-up: A261A–A264A can be billed by phone or video with K301A / K300A (Appendix J). Video pays 100%, phone 85%.
  • You asked another specialist for advice about the child, 10+ min by phone (K730A, $37.05) or by e-consult (K738A, $16.45)? Both are paid on top of today's visit (A42, A48).

Well baby or child check

  • A262A Well baby visit (under 2) ($50.20): Full exam, weight and measurements, advice to parents (GP27, GP34).
  • A268A Enhanced 18-month visit ($74.25): Age 17–24 months: well baby care plus an 18-month developmental screen (Rourke) and a parent questionnaire such as NDDS, concerns charted (GP34).
  • K267A Check-up, age 2 to 11 ($48.05): No acute illness. History, exam, screening and advice for age (GP21). Limit: 1 per 12 months; extra ones are uninsured.
  • K269A Check-up, age 12 to 17 ($89.15): No acute illness (GP21). Limit: 1 per 12 months; extra ones are uninsured.

Tips

  • Bill each vaccine with its own code from the procedure list (G841A, G846A, G845A and others). They're paid on top of the visit (J3).
  • A268A pays $74.25 vs $50.20 for a regular well baby visit. Chart the screen result and the questionnaire concerns or it's paid as A262A (GP34).
  • K269A for a teen pays $89.15, almost double K267A. Both are once a year per patient (GP21).
  • Child under 6 at developmental risk you follow? Once you've done the screening tool 3 times in 12 months, add K119A ($142.50) (A170).

Developmental or behavioural care

  • K122A Developmental or behavioural care, child ($102.35): ADHD, autism, anxiety, behaviour. You must meet the A172 criteria (35% of billings, or extra training).
  • K123A Same, with the family in the room ($116.15): Family developmental or behavioural care (A172).
  • K005A Mental health care (no A172 criteria) ($80.00): Use this if you don't qualify for K122A (A172 commentary).
  • K008A Interview or counselling with child and/or parent ($80.00): Psychological problem or learning disability. Booked separately; billed on the child's number (A28).
  • K002A Interview with relatives or substitute decision-maker ($80.00): About the child's care, not only for consent. Booked, 20+ min (A28).

Tips

  • Count face-to-face time in one stretch: 20 min = 1 unit, 46 = 2, 76 = 3, 106 = 4. Under 20 minutes it's an assessment (GP55).
  • If you qualify, K122A pays $102.35 per unit vs $80 for K005A; K123A with family pays $116.15 (A172).
  • Same day as a consult or assessment only for a clearly different diagnosis (GP55).
  • Counselling only (K013A) pays $80 for the first 3 units a year, then K033A $56.30 (GP58); no other visit that day.
  • K122A and K123A can be billed by video or phone with K300A / K301A (Appendix J).

Newborn or delivery

  • H261A Routine newborn care ($82.90): Well baby, first 10 days, in hospital or home. 1 per baby (2 if moved to another hospital) (GP32–GP33).
  • H267A Called to attend a delivery ($63.45): Constant attendance at the delivery of an at-risk baby; includes the newborn exam (A174).
  • C263A Sick newborn assessment ($95.75): Medical specific assessment of a sick newborn in hospital (A173).

Tips

  • H261A pays $82.90 vs $71.15 for the family doctor's H001A.
  • An extra trip outside your usual rounds only to discharge the newborn earns a special visit premium (GP33). Otherwise leave 'Called in' at No.
  • At a delivery, H267A isn't paid if you bill another service then, except C263A for a sick baby (A174).

NICU day

  • G600A Level A, first day ($376.05): Ventilated: full life support, monitoring, parenteral nutrition (J33).
  • G601A Level A, day 2 onward ($187.95): Per day.
  • G610A Level B, first day ($258.05): Intensive care with monitoring, oxygen and IV therapy, no ventilation (J33).
  • G611A Level B, day 2 onward ($129.00): Per day.
  • G620A Level C, first day ($162.95): Intermediate: oxygen, non-invasive monitoring or gavage feeds (J33).
  • G621A Level C, day 2 onward ($81.50): Per day.

Tips

  • The day fee includes your consult and all assessments, lines, catheters, intubation, blood gases and ventilation. Don't bill them separately (J33).
  • Sole newborn in a low-volume unit: G603A ($564.00) instead of G600A, up to 25 a year. Under 750 g or 26 weeks: G604A ($536.95) (J33).
  • Moved up or down a level? Second-day fees apply (J33).
  • Taking over as MRP after NICU transfer: C142A and C143A ($71.80 each), but not if you gave the NICU care (GP46).

Hospital in-patient consult

  • C265A Consultation ($190.35): Written request on the hospital chart; report back (GP16).
  • C260A Long consultation, 75+ min ($342.25): Same rules as A260A. Start and stop times (A173).
  • C662A Extended consultation, 90+ min ($442.40): Same rules as A662A (A173).
  • C667A Neurodevelopmental consultation, 90+ min ($456.80): Same rules as A667A (A173).
  • C263A Full specialist assessment ($95.75): Detailed exam of affected systems; also used as an admission assessment (GP40).
  • C264A Re-assessment ($70.75): Admitted within 90 days of your last visit for the same illness (GP40).

Tips

  • You admitted the child and are MRP? E082A adds 30% to the admission consult or assessment, once per admission (GP42).
  • Urgent call from outside the hospital? Use 'Called to the ED' or bill the A-code with premiums; C-codes take no special visit premiums (A173).
  • C661A complex re-assessment pays $86.35 and C266A repeat consult $104.70 (A173).
  • Child in a chronic care or convalescent hospital, or a designated chronic or convalescent bed? Bill the W codes at the same fees: W265A, W260A (75+ min), W662A (90+ min), W667A neurodevelopmental, W565A limited, W266A repeat (A174).

Hospital rounds

  • C262A Daily visit ($40.05): Paediatric subsequent visit, 1 a day for the whole stay (GP43).
  • C122A MRP, day after admission ($71.80): Once per admission. Second day: C123A, same fee (GP44).
  • C123A MRP, second day after admission ($71.80): Once per admission (GP44).
  • C124A MRP, discharge day ($71.80): Discharge summary within 48 h; stay over 48 h; not for well newborns (GP45).
  • C126A MRP, complex discharge ($95.10): Stay 7+ days, 3+ diagnoses, 45+ min on discharge (A13).
  • C268A Concurrent care ($40.05): You direct care, another doctor is MRP. 4 the first week, then 2 a week (GP48).
  • C142A MRP, 1st visit after NICU or PICU transfer ($71.80): Child was getting critical, ventilatory, comprehensive or neonatal intensive care there, not just monitoring. Instead of C122A; not if you gave that care (GP46).
  • C143A MRP, 2nd visit after NICU or PICU transfer ($71.80): Instead of C123A; same conditions as C142A (GP46).

Tips

  • As MRP, C122A and C123A pay $71.80 vs $40.05 for C262A. Always bill them on days 1 and 2 after admission (GP44).
  • E083A adds 30% to every MRP visit; E084A adds 45% on weekends and holidays. Only one a day (GP47).
  • Not for admissions for delivery or well newborn care (GP44, GP45).
  • After a NICU or PICU transfer to you as MRP: C142A / C143A in place of C122A / C123A (GP46).

Called to the ED

  • A265A Consultation ($190.35): Requested by the ED doctor; report back (GP16).
  • A260A Long consultation, 75+ min ($342.25): 75+ min face to face, start and stop times (A168).
  • A263A Full specialist assessment ($95.75): Your own patient, or no consult request (GP23).
  • A264A Re-assessment ($70.75): Full relevant history and exam (GP23).
  • A262A History and exam of the problem ($50.20): Level 2 paediatric assessment (GP27).

Tips

  • Called in from outside the hospital? Set 'Called in' and 'I travelled there': travel + first-patient premiums can add $58 to $140 (GP70).
  • Already in the hospital, not on ED duty? Still A-codes; the first-person premium applies in the evening, weekend or night even without travel (GP66).
  • Admitting the child as MRP? Your ED consult is the admission assessment: tick E082A (+30%) (GP41–GP42).
  • Called urgently to a ward patient who isn't yours? Same A-codes, with the in-patient (C9xx) premiums of Table III (GP43, GP72).

Case conference or doctor's call

  • K704A Out-patient case conference ($37.05): Pre-booked, MRP is a paediatrician or psychiatrist, 2+ others (school, CMHO agency, therapists). Patient under 18 (A34). Limit: 4 per 12 months, 8 units a day.
  • K121A In-patient case conference ($37.05): Pre-booked, MRP plus 2+ others (A33). Limit: 4 per 12 months, 8 units a day.
  • K731A Phone advice to another doctor or NP ($47.75): 10+ min. Not to arrange a visit or transfer (A42–A43).
  • K739A e-Consult answered ($20.50): Secure electronic request; answer within 30 days (A48).

Tips

  • Case conference units are 10 minutes: 10 min = 1, 16 = 2, 26 = 3, 36 = 4 (A31). Chart start/stop times, who attended and the decision (A32).
  • No phone consult or other case conference for that patient the same day as K704A (A34).
  • K731A or K739A pay $0 if you see the patient that day or the next (A43, A49).

Also bill, if it's true

  • K001A Detention: extra time past the consult (per 15 min) ($21.10): After 120 min for A260A, 180 min for A662A/A667A, 60 min for A265A. Paid case by case with a written explanation (GP30–GP31).
  • K119A Yearly developmental surveillance (PDAI) ($142.50): Under 6, at developmental risk, you manage them. Screening tool done 3 times and 3+ visits by you in the past 12 months. 1 per 12 months, 6 per lifetime (A170–A171).
  • K045A Yearly diabetes management ($80.25): 4+ visits with you in 12 months, you see 100+ diabetes patients a year, flow sheet kept. 1 per 12 months (A99).
  • E078A Chronic disease on the GP26 list (+50%): +50%. Office or clinic only, diagnosis established and coded (GP25–GP26).
  • E080A First visit within 14 days of a hospital discharge ($25.90): Only if you're the child's primary care doctor. Not after a well newborn stay unless NICU (GP28).
  • K730A Phoned another doctor for advice, 10+ min ($37.05): You keep caring for the child. Paid on top of your visit. Not to arrange a referral, transfer or test, or mainly to discuss results; not paid if the consultant sees the child that day or the next. 1 per patient per day (A42–A43).
  • K738A Sent an e-consult for advice ($16.45): Secure server, answer within 30 days. Paid on top of your visit. 1 per patient per day, 6 per 12 months (A48–A49).
  • K035A Reported a medical condition to the MTO ($36.25): Mandatory report under the Highway Traffic Act (licensed teen driver). More than 1 per 12 months for the same patient: manual review (A59).
  • K034A Phoned a listed reportable disease to the MOH ($36.00): You made the immediate phone report yourself, e.g. measles, invasive meningococcal disease, invasive Hib, acute bacterial meningitis. 1 per disease per 12 months (A60).
  • K070A Filled in a home care referral form ($34.75): You're the doctor giving the child ongoing care and completed it yourself. Paid on top of the visit. Once per Ontario Health atHome admission; not if already receiving home care (A58–A59).
  • K036A Northern Health Travel Grant form ($10.25): Paid to both the referring doctor and the specialist (A60).
  • H267A Also attended the delivery ($63.45): Called to the delivery of an at-risk baby. With a sick newborn, C263A is the one service paid on top of H267A (A174).
  • C263A Baby was sick: also assessed ($95.75): The only service paid on top of H267A at a delivery (A174).
  • E082A I admitted the patient and I'm the MRP (+30%): +30% on the admission consult or assessment. Once per admission; not for well newborns or transfers within the hospital (GP42).
  • E083A I'm the MRP, weekday (+30%): +30% on MRP visits (GP47).
  • E084A I'm the MRP, Saturday, Sunday or holiday (+45%): +45% in place of E083A (GP47).
  • C101A Patient is in the ICU or CCU ($9.10): Not with critical care, ventilatory or NICU team fees (GP103).

Did a procedure or shot?

  • G841A DTaP-IPV-Hib (2, 4, 6, 18 months) ($8.80)
  • G846A Pneumococcal conjugate ($8.80)
  • G462A Rotavirus (oral) ($8.80)
  • G845A MMR ($8.80)
  • G848A Varicella ($8.80)
  • G844A Meningococcal C ($8.80)
  • G840A DTaP-IPV (4 to 6 years) ($8.80)
  • G842A Hepatitis B ($8.80)
  • G843A HPV ($8.80)
  • G849A RSV ($8.80)
  • G590A Flu shot ($8.80)
  • G593A COVID-19 vaccine ($13.00)
  • G538A Other vaccine ($8.80): Only when there's no specific code.
  • G372A Other injection with a visit ($4.55): IM, SC or intradermal; each injection (J54).
  • G373A Injection was the only reason for the visit ($7.90): First injection; each more is G372A (J54).
  • G700A Shot or blood draw was the only reason for the visit ($8.80): Once per visit for (+) procedures such as vaccines and venipuncture; not in hospital, not with a consult or assessment that day (J3, J54).
  • G480A Blood draw, infant ($9.90): 29 days to under 2 years (GP2).
  • G482A Blood draw, child ($7.35): Age 2 to 15 (GP2).
  • G489A Blood draw, adolescent ($3.54): Age 16 or 17 (GP2).
  • G376A IV start, newborn or infant ($10.20)
  • Z804A Lumbar puncture ($150.00): Includes any injection and image guidance (J83).
  • G282A Umbilical vein catheter ($43.60): Included in NICU day fees (J33).
  • G309A Umbilical artery catheter ($45.55): Included in NICU day fees (J33).
  • G395A Resuscitation, first 15 min ($64.70): G391A for each further 15 min (J28).
  • G211A Intubation for resuscitation ($38.35): Included in NICU day fees (J33).
  • G275A Exchange transfusion ($205.45)
  • Z111A Tongue-tie release, no general anaesthetic ($20.00)
  • G310A + G313A ECG with your interpretation ($12.25)
  • J301 Spirometry ($18.70): Not with flow-volume loop J304 the same day (H4).
  • G420A Ear syringing or curetting ($13.15)
  • G014A Rapid strep test in your office ($6.80): Result, your reading and the treatment decision in the chart (J65, J68).
  • G010A Urine dipstick in your office, no microscopy ($2.64): Result, reading and treatment decision in the chart (J65, J68).
  • G009A Urinalysis with microscopy in your office ($4.90): Instead of G010A when you also do the microscopy (J68).

Can I bill these together?

  • A260A with A265A, A662A, A667A: No. A260A already includes all of A265A; bill the one that matches the time spent (A168).
  • A662A with A265A, A667A: No. A662A already includes all of A265A; bill one consultation (A168).
  • A667A with A265A: No. A667A already includes all of A265A (A168).
  • E078A with A265A, A260A, A662A, A667A, A266A, A665A, A261A, C263A, C264A, C661A, K122A, K123A: No. E078A only adds to A262A, A263A, A264A, A661A or a partial assessment, in the office or clinic, not in hospital (GP25).
  • E078A with A262A, A263A, A264A, A661A: Sometimes. Only for an established chronic diagnosis from the GP26 list, coded on the claim, in the office or out-patient clinic (GP25–GP26).
  • E080A with K122A, K123A, K002A, K003A: No. E080A only adds to the services listed in GP28 rule 5 (A261A–A264A, K004A–K008A, K013A, K033A and others); K122A, K123A and the K002A/K003A interviews aren't on it (GP28).
  • E080A with A265A, A260A, A662A, A667A, A266A, A665A, K267A, K269A, A268A: No. E080A only adds to the services listed in GP28 (A261A–A264A, K005A, K008A and others), not to consultations or check-ups.
  • E080A with A261A, A262A, A263A, A264A, K005A, K008A: Sometimes. Only for the child's primary care doctor, in the office or home, within 2 weeks of an acute in-patient discharge; K005A and K008A are on the GP28 list too (GP28).
  • A268A with A262A: No. A268A already includes the well baby visit (GP34).
  • K122A,K123A,K005A with A262A, A263A, A264A, A661A, A265A, A260A: Sometimes. Mental health or developmental time the same day as a consult or assessment is paid only for clearly different diagnoses (GP55, A172).
  • K008A,K002A with A262A, A263A, A264A, A265A: Sometimes. Only as a separately booked 20+ minute interview, not the history for the visit (A28, GP61).
  • H267A with C263A: Yes. When the newborn is sick, C263A is paid on top of attendance at delivery (A174).
  • H267A with G395A, G211A, C265A, H261A, G282A, G309A: No. H267A isn't paid when you bill another service at the delivery; only C263A for a sick newborn can go with it (A174).
  • G600A,G601A,G603A,G604A,G610A,G611A,G620A,G621A with G282A, G309A, G211A, G376A, C262A, C263A, C265A, C264A: No. The NICU day fee includes the consult, all assessments, lines, catheters and intubation (J33).
  • G600A,G601A,G603A,G604A,G610A,G611A,G620A,G621A with C101A: No. C101A isn't paid with NICU team fees (GP103).
  • G603A with G600A, G604A: No. G603A and G604A are paid in place of G600A, not with it (J33).
  • C122A,C123A,C142A,C143A with C124A, C126A: No. C122A, C123A, C142A and C143A aren't paid the same day as the discharge visit C124A or C126A (GP44, GP46).
  • C122A with C142A: No. Only one of C122A or C142A per admission (GP44).
  • C123A with C143A: No. Only one of C123A or C143A per admission (GP44).
  • C124A with C126A: No. One discharge-day MRP visit per admission (GP45, A13).
  • C262A with C122A, C123A, C124A, C126A, C142A, C143A: No. One subsequent visit a day; the MRP code replaces C262A on that day (GP43–GP45).
  • E083A with E084A: No. Only one of E083A or E084A per patient per day (GP47).
  • E083A,E084A with C268A, C265A, C263A: No. E083A/E084A only add to subsequent and MRP visits, not concurrent care or consults (GP47).
  • K731A,K739A with A265A, A263A, A264A, A262A, A261A, K122A, K123A: No. Phone or e-consult pays $0 if you see the patient the same or next day (A43, A49).
  • K704A with K731A, K730A, K121A: No. No other case conference or phone consult for the patient the same day as K704A (A34).
  • K730A,K738A with A265A, A260A, A662A, A667A, A266A, A665A, A263A, A264A, A661A, A262A, A261A, A268A, K267A, K269A, K122A, K123A, K005A, K008A: Yes. The referring doctor's phone or e-consult is paid in addition to visits the same day (A42, A48). 10+ min for K730A; not to arrange a referral, transfer or test (A43, A49).
  • K035A,K034A,K070A,K036A with A265A, A260A, A662A, A667A, A266A, A263A, A264A, A661A, A262A, A261A: Yes. Forms and reports are paid on top of the visit; K070A "in addition to the assessment fee" (A58–A60).
  • J301,J304 with A265A, A260A, A266A, A263A, A264A, A661A, A262A, A261A: Yes. Pulmonary function tests have no same-day rule against a consultation or assessment (H3–H6); bill both. J301 isn't paid with J304 the same day (H4).
  • J301 with J304: No. J301 isn't paid the same day as J304 (H4).
  • G700A with A265A, A260A, A266A, A263A, A264A, A661A, A262A, A261A, A268A, K267A, K269A: No. G700A is not paid when a consultation or assessment is paid to you the same day (J3).

Fees and rules from the Ontario Schedule of Benefits, July 1 2026 (page in brackets). Totals leave out the paediatric age premiums on consultations (+10% to +30% under 16, GP64), which OHIP adds on the remittance, and percentage premiums on per-unit services are shown per unit. Special visit premiums follow GP65–GP78. Phone pays 85% of the in-person fee; consultations are video only (Appendix J). Check the Schedule for anything not shown.

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