OHIP billing code for chronic disease premium

E078A adds 50% to an eligible specialist assessment for a chronic disease on the GP26 diagnostic list.

Code	What it is	Fee
E078A	Chronic disease assessment premium	50% premium

E078A: Chronic disease assessment premium

Adds 50% to an eligible specialist assessment for an established chronic disease on the GP26 diagnostic list. Office or hospital clinic only.

Only for physicians registered with OHIP in specialty 07 Geriatrics, 15 Endocrinology & Metabolism, 18 Neurology, 26 Paediatrics, 28 Pathology, 31 Physical Medicine, 34 Therapeutic Radiology, 44 Medical Oncology, 46 Infectious Disease, 47 Respiratory Disease, 48 Rheumatology, 61 Haematology or 62 Clinical Immunology (GP25).
Only in an office or a hospital out-patient clinic; not for hospital in-patients, long-term care patients or emergency department patients (GP25).
The claim must carry one of the GP26 diagnostic codes, for example 250 diabetes, 345 epilepsy, 493 asthma, 585 chronic renal failure or 714 rheumatoid arthritis (GP26).
Not payable when the diagnosis hasn't been established (GP26).
Not payable with a consultation, which isn't on the GP25 list. The listings also exclude it with A760 (A98), A510 and A511 (A176), A113 (A142) and A480 (A200), and for the same patient on the same day as A570 (A198).

V30: OHIP's description is 'fee code and diagnostic code combination not covered'. E078 needs one of the GP26 chronic disease diagnostic codes on the claim; any other diagnostic code rejects (GP26).
EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. E078 is paid only to the 13 specialties named in GP25, so correct the specialty or the registration, then resubmit.
EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.
A3F: OHIP's description is 'no fee for this code on service date'. E078 carries a fee only as an add-on in the 13 specialty listings that print it (GP25); check the specialty on the claim, the base assessment and the service date.
A36: OHIP describes this as 'Claimed by Other Practitioner': OHIP matched the service to another physician's claim for the patient. Check the base assessment and billing number before resubmitting.

E078A adds 50% to an eligible specialist assessment for a chronic disease on the GP26 diagnostic list.

Updated October 26, 2026.