Introduction to OHIP Billing


The purpose of this resource is to introduce physicians to foundational concepts related to OHIP billing, organized as four modules: Understanding the Schedule of Benefits; Assessments and Consultations; Time-based services; and Special Visit Premiums.

OHIP fee codes referred to in the modules can be located via the numeric index of the current OHIP Schedule of Benefits for Physician Services (the “Schedule”): OHIP Schedule of Benefits

For additional information on OHIP billing, refer Resources for Physicians

Disclaimer: This educational resource has been provided for education and information purposes only and expresses the MOH’s and OMA’s guidance at the time of publication. The information provided in this educational resource is based on the April 1, 2020 Schedule of Benefits for Physician Services (Schedule). While the MOH and the OMA make every effort to ensure that this educational resource accurately reflects the law, the Health Insurance Act (HIA) and Regulations are the definitive authority in this regard and must be relied upon by physicians. Changes in statutes, regulations or other laws may affect the accuracy or currency of the guidance provided for in this educational resource. In the event of a discrepancy between this educational resource and the HIA, its Regulations and/or Schedule, the text of the HIA, Regulations and/or Schedule prevail.

The OMA assumes no responsibility for any discrepancies or differences of interpretation of the Schedule, any applicable law, or regulation with the Government of Ontario including but not limited to the Ministry of Health and the College of Physicians and Surgeons of Ontario. Members are advised to contact the ministry’s Service Support Contact Centre by calling 1-800-262-6524 for any billing related questions.

This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 4 Mainpro+ credits.

This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the University of Ottawa’s Office of Continuing Professional Development. You may claim a maximum of 4.0 hours (credits are automatically calculated).

Faculty Disclosures

The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly prepared this educational resource to provide general advice and guidance to physicians on specific billing matters.

To obtain your CME Certificate, you will need to complete ALL four modules.


If you are having any issues with downloading your CME Certificate, please contact info@oma.org and it will be sent to you. Sorry for the inconvenience.


  • Module 1 – Understanding the Schedule of Benefits (SOB): This module introduces the Schedule of Benefits for Physician Services (the Schedule) and provides an overview of how to determine the most appropriate fee codes to claim for specific services.
  • Module 2 – Assessments and Consultations: This module will assist you in identifying the specific elements of assessments and consultations, recognize when limits apply, and create awareness of common billing errors. It will help you determine if a consultation is eligible for payment and to select the most appropriate fee code for specific patient assessment scenarios.
  • Module 3 – Time-based Services: This module will assist you in understanding time-based insured services, requirements when claiming services which have specific time requirements, determining the time period that may be claimed and identifying common concerns leading to incorrect submissions.
  • Module 4 – Special Visit Premiums: This module will assist you in understanding the three components of Special Visit Premiums listed in the Schedule of Benefits for Physician Services, including when a patient visit is eligible for a special visit premium.
Start Now!
Module 1 Understanding the Schedule of Benefits  
Unit 1 Understanding the Schedule of Benefits
Unit 2 Glossary of Select Terms used in the Module
Unit 3 Legal and Regulatory Framework
Unit 4 Uninsured Services
Unit 5 Medical Records
Unit 6 Organization of the Schedule
Unit 7 Organization of the Schedule (Cont.)
Unit 8 Fee Schedule Codes and Naming Conventions
Unit 9 Suffixes
Unit 10 How the Schedule Works
Unit 11 Example: Understanding the differences between different types of assessment
Unit 12 Check Your Understanding
Module 2 Assessments and Consultations  
Unit 1 Assessments and Consultations
Unit 2 Common Billing Errors Related to Assessments and Consultations
Unit 3 Family Practice and Practice in General Versus Specialist Assessment and Consultation Codes
Unit 4 Family Practice and Practice in General Versus Specialist Assessment and Consultation Codes (Cont.)
Unit 5 Consultations
Unit 6 Examples of patient visits that do not meet payment criteria as consultation:
Unit 7 Key Features of Specific Types of Assessments
Unit 8 Key Features of Specific Types of Assessments (Cont.)
Unit 9 Additional Features of Consultation
Unit 10 Limits for Consultations
Unit 11 Case Examples
Unit 12 Case Examples (Cont.)
Unit 13 May Counselling or Primary Mental Health Care Be Claimed in Addition to a Consultation or Assessment?
Unit 14 Case Examples (Cont.)
Unit 15 Case Examples (Cont.)
Unit 16 Check Your Understanding
Module 3 Requirements for Time-Based Services  
Unit 1 Requirements for Time-Based Services
Unit 2 Common Concerns
Unit 3 Services with Time Requirements
Unit 4 Time-Unit-Based Services
Unit 5 Time Based Units
Unit 6 Anesthesia and Surgical Assistant’s Services
Unit 7 Key Points for Services with Time Requirements
Unit 8 Case Examples
Unit 9 Case Examples (Cont.)
Unit 10 Check Your Understanding
Module 4 Special Visit Premiums  
Unit 1 Special Visit Premiums
Unit 2 Introduction
Unit 3 Common Billing Errors
Unit 4 When Is a Visit Eligible for a Special Visit Premium?
Unit 5 Special Visit Premiums to a Patient’s Home
Unit 6 Definitions (A900)
Unit 7 How to Determine Which Special Visit Premium Fee Code(s) to Claim
Unit 8 Additional Rules for Specific Categories of Physicians
Unit 9 Case Examples
Unit 10 Check Your Understanding
Unit 11 More Information