Fee
| Component | Value |
|---|---|
| Provider fee | $11.95 |
Schedule and sources
- Fee edition
- October 1, 2026
- Record effective
- 2026-04-01
- Schedule edition
- July 22, 2026; effective July 1, 2026
- Official files
- Fee masterSchedule PDFOntario source page
- when cervical cancer screening specimen(s) are collected outside of hospital or ICHSC, to G365....................... add 11.95
Passages mentioning E430
Definition/Required Elements of Service:
Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most
responsible physician (MRP) of routine medical care, management and supervision of a patient in a
nursing home or home for the aged for one calendar month. The service requires a minimum of two
assessments of the patient each month, where these assessments constitute services described as
"W" prefix assessments.
The requirements above are subject to the exceptions as described in payment rule #8.
[Commentary:
As with all services described as assessments, direct physical encounter with the patient is
required.]
In addition to the common elements, this service includes the provision of the following services by
any physician to the same patient during the month.
A. Services described by subsequent visits (e.g. W003, W008).
B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions
described in Payment rule #7 are satisfied.
C. Services described by palliative care subsequent visits (e.g. W872).
D. Services described by admission assessments (e.g. W102, W104, W107).
E. Services described by periodic health visit or general re-assessments (e.g. W109, W004).
F. Services described by visit for pronouncement of death (W777) or certification of death (W771)
except if the services are performed in conjunction with a special visit.
G. Service described by anticoagulation supervision (G271).
H. Completion of home care referral form and home care supervision (K070, K071, K072).
I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489),
injection (G372, G373), immunization (G538, G590, G849), collection of cervical cancer screening
specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001,
G002, G481, G004, G005, G009, G010, G011, G012, G014).
J. All medication reviews.
K. All discussions with the staff of the institution related to the patient’s care.
L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s
representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday
to Friday (excluding holidays).
M.Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act
requests.A003 General assessment............................................................... 95.60
Note:
A003 is not eligible for payment for an assessment provided in the patient’s home.
A004 General re-assessment .......................................................... 39.35
Note:
The collection of cervical cancer screening specimen(s) is included in the consultation, repeat
consultation, general or specific assessment (or re-assessment), or routine postnatal visit when
pelvic examination is normal part of the foregoing services. However, the add-on codes E430
or E431 can be billed in addition to these services when collection of cervical cancer screening
specimen(s) is performed outside of a hospital or ICHSC.
A001 Minor assessment................................................................... 26.80
A007 Intermediate assessment or well baby care ........................... 44.55
E432 - when pelvic exam including speculum is performed
outside of hospital or ICHSC, to A001 and A007 ....... add 5.00
A002 Enhanced 18 month well baby visit (see General Preamble
GP34) ................................................................................. 73.95
Payment rules:
1.Special visit premiums listed in Table VI on page GP75 of this Schedule are not eligible for
payment with A007 or A001 when rendered in a patient’s home.
2.For A007 or A001 rendered in a patient’s home, travelling to and from the home is included
as a common element of the insured service. See page GP13 of this Schedule.
3.See the Definitions section of this Schedule for the definition of home.
4.E432 is limited to one service per patient per day.
5.E432 is only eligible for payment when the procedure is personally rendered by the
physician.
6.E432 is not eligible for payment with E430, E431, or E542.
Mini assessment
A mini assessment is rendered when an assessment of a patient for an unrelated non-WSIB
problem is performed during the same visit as an assessment of a WSIB related problem for
which only a minor assessment was rendered.
A008 Mini assessment ..................................................................... 13.40
[Commentary:
A008 is only payable when the WSIB component of the visit is the service described as A001.
In circumstances where a different service or a higher level of assessment is claimed, A008 is
not payable in addition.]CONSULTATIONS AND VISITS
OBSTETRICS AND GYNAECOLOGY (20)
GENERAL LISTINGS
A205 Consultation* .......................................................................... 134.25
A935 Special surgical consultation (see General Preamble GP19). 194.65
A206 Repeat consultation* .............................................................. 71.45
A203 Specific assessment*.............................................................. 62.65
A204 Partial assessment ................................................................. 40.50
E432 - when pelvic exam including speculum is performed
outside of hospital or ICHSC, to A203, A204, A205 and
A206.......................................................................... add 5.00
Payment rules:
1.The collection of cervical cancer screening specimen(s) is included in the consultation,
repeat consultation, general or specific assessment (or re-assessment), or routine post-natal
visit when pelvic examination is normal part of the foregoing services. However, the add-on
codes E430 or E431 can be billed in addition to these services when collection of cervical
cancer screening specimen(s) is performed outside of a hospital or ICHSC.
2.E432 is limited to one service per patient per day.
3.E432 is only eligible for payment when the procedure is personally rendered by the
physician.
4.E432 is not eligible for payment with E430, E431, or E542.
EMERGENCY OR OUT-PATIENT DEPARTMENT (OPD)
Physician in hospital but not on duty in the Emergency Department when seeing patients in the
Emergency or OPD - use General Listings.
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
See General Preamble GP40 to GP48. For emergency calls and other special visits to in-
patients, use General Listings and Premiums when applicable - see General Preamble GP65 to
GP78.
C205 Consultation* .......................................................................... 134.25
C935 Special surgical consultation (see General Preamble GP19). 194.65
C206 Repeat consultation* .............................................................. 71.45
C203 Specific assessment*.............................................................. 62.65
C204 Specific re-assessment* ......................................................... 44.30
Subsequent visits
C202 - first five weeks........................................................ per visit 31.00
C207 - sixth to thirteenth week inclusive (maximum 3 per patient
per week)................................................................ per visit 31.00
C209 - after thirteenth week (maximum 6 per patient per month)
............................................................................... per visit 31.00
Subsequent visits by the Most Responsible Physician (MRP)
See General Preamble GP44 to GP45 for terms and conditions.
C122 - day following the hospital admission assessment.............. 71.80
C123 - second day following the hospital assessment .................. 71.80
C124 - day of discharge ................................................................. 71.80
C126 - day of discharge, medically complex patient (see A13 for
terms and conditions) ......................................................... 95.10+ G362 Insertion of laminaria tent ....................................................... 6.25
E870 - when laminaria tent supplied by the physician........... add 8.35
G334 Telephone supervisory fee for ovulation induction with human
menopausal gonadotropins or gonadotropin-releasing
hormone (not eligible for payment same day as visit), to a
maximum of 10 per cycle ........................................per call 4.05
G399 Transvaginal sonohysterography, introduction of catheter, with
or without injection of contrast media ................................. 44.15
Note:
G399 is only eligible for payment when transvaginal sonohysterography professional and
technical services (J165 or J476) are rendered (either by the same or another physician).
[Commentary:
1.See Diagnostic Ultrasound section page G6.
2.G334 is not insured when rendered to support in-vitro fertilization services or artificial
insemination services. See Regulation 552 section 24(1) paragraph 23 and 29 under the
Act.]
Cervical cancer screening
+ G365 Collection of cervical cancer screening specimen(s).............. 12.00
E430 - when cervical cancer screening specimen(s) are collected
outside of hospital or ICHSC, to G365....................... add 11.95DIAGNOSTIC AND THERAPEUTIC PROCEDURES
GYNAECOLOGY
Fee
+ G394 Collection of additional cervical cancer screening specimen(s)
for any of the following purposes:
- Follow-up test once after low grade cytology results,
where the follow-up specimen(s) are collected between
March 3, 2025 and September 30, 2026; or
- Once every 3 years for patients who are
immunocompromised; or
- Follow-up test once, a minimum of 24 months after testing
human papillomavirus (HPV)-positive for other high risk
subtype as defined by Ontario cervical cancer screening
guidelines with normal/low grade cytology results; or
- Follow-up test once, a minimum of 24 months after
discharge from colposcopy when increased screening is
recommended by Ontario cervical cancer screening
guidelines; or
- Repeat after an invalid HPV test or an unsatisfactory
cytology test; or
- Post-hysterectomy vaginal vault testing for patients with
histologic evidence of dysplasia in the cervix at the time of
hysterectomy; or
- Where the physician is of the opinion that the patient is a
member of a vulnerable group that may have difficulty
accessing the services within the specified time period... 12.00
E431 - when cervical cancer screening specimen(s) are collected
outside of hospital or ICHSC, to G394....................... add 11.95
[Commentary:
E430 is payable when the requirements for G365 are met. E431 is payable when the
requirements for G394 are met.]
Payment rules:
1. For G365 services provided between March 3, 2025 and March 31, 2028, G365 is limited to
once per patient per 33 month period. For G365 services provided on or after April 1, 2028,
G365 is limited to one per patient per 54 month period.
2. G365 is uninsured for patients less than 25 years of age.
3. G394 is limited to once per patient per lifetime for vaginal vault testing post-hysterectomy for
patients with histologic evidence of dysplasia in the cervix at the time of hysterectomy.
4. G365 and G394 are not eligible for payment when performed in conjunction with a
consultation, repeat consultation, general or specific assessment or reassessment or routine
post-natal visit when a pelvic examination is a normal part of the foregoing services. One of
the add-on codes E430 or E431 is eligible for payment in addition to these services when an
insured collection of cervical cancer screening specimen(s) is performed outside of hospital
or ICHSC.
5. G365 and G394 are not eligible for payment when performed in conjunction with an insured
colposcopy service. One of the add-on codes E430 or E431 is eligible for payment in addition
to these services when an insured collection of cervical cancer screening specimen(s) is
performed outside of hospital or ICHSC.Fee master record
Master, record 1158. Record Layout PDF, page 1.
E43020260401999999990000011950000000000000000000000000000000000000000000000
Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.
| Field | Raw / scale 10,000 |
|---|---|
| provider | 00000119500 / 11.95 |
| assistant | 00000000000 / 0 |
| specialist | 00000000000 / 0 |
| anaesthetist | 00000000000 / 0 |
| non anaesthetist | 00000000000 / 0 |
Explanation
AI-generated. Unreviewed.
An add-on fee when cervical cancer screening specimens are collected outside of a hospital or ICHSC, to G365, listed under Diagnostic and Therapeutic Procedures and Gynaecology.
Watch out for
E432 is not eligible for payment with E430, E431, or E542.
Related codes
Report an issue
Something off?
Report an issue with E430. Do not include patient names, health details or other personal information.