Fee
| Component | Value |
|---|---|
| Provider fee | $12.65 |
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 performed outside hospital, to G378 or G552 .. add 12.65
- when performed outside hospital, to G370 ................ add 12.65
- when performed outside hospital, to G328 ................ add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital .............................. add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital, to Z080, Z081, Z082, Z083, Z084 or Z085 ................................................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside of hospital ........................... add 12.65
- when performed outside of hospital ........................... add 12.65
- when performed outside of hospital ........................... add 12.65
- when performed outside of hospital ........................... add 12.65
- when performed outside of hospital ........................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital, to Z590, Z591 or Z763 ................................................................................... add 12.65
- when performed outside of hospital ........................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside of hospital, to Z722............. add 12.65
- when performed outside hospital ............................... add 12.65
- when performed outside hospital ............................... add 12.65
Passages mentioning E542
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) ......................................................... 95.10DIAGNOSTIC AND THERAPEUTIC PROCEDURES
GYNAECOLOGY
Fee
G363 Cervical mucous penetration test ........................................... 22.00
G378 Insertion of intrauterine contraceptive device ......................... 47.50
G552 Removal of intrauterine contraceptive device......................... 23.80
E542 - when performed outside hospital, to G378 or G552 .. add 12.65
Payment rules:
G552 is not eligible for payment on the same day as G378.+ G369 B.C.G. inoculation, following tuberculin tests.......................... 5.30
+ G370 Injection of bursa, or injection and/or aspiration of joint,
ganglion or tendon sheath ................................................. 20.25
G371 - each additional bursa, joint, ganglion or tendon sheath, to a
maximum of 5 .................................................................... 19.90
E542 - when performed outside hospital, to G370 ................ add 12.65
G328 Aspiration of bursa or complex joint, with or without injection 39.80
G329 - each additional bursa or complex joint, to a maximum of 2
20.25
E542 - when performed outside hospital, to G328 ................ add 12.65
E446 - peripheral joint injection using image guidance following a
failed blind attempt, to G370 or G371 ........................ add 30.00
Note:
1.For the purpose of G328 and G329, a joint is defined as complex only if it is:
a.a joint other than the knee; or
b.a knee joint in which the anatomy is distorted by disseminated lupus erythaematosus,
dermatomyositis, rheumatoid arthritis, Still's disease, ankylosing spondylitis or other
seronegative spondyloarthropathies.
2.E446 is only eligible for payment when injection of the joint must be repeated using any
method of image guidance following a failed blind attempt(s) by the same or different
physician. Professional and/or technical fees for obtaining and interpreting the images
required for the purpose of guidance of the injection are not eligible for payment to any
physician.
Payment rules:
1. G370, G371, G328 or G329 are not eligible for payment when rendered in conjunction with a
surgical procedure involving the same site or area.
2. Only one of G370, G371, G328 and G329 is eligible for payment for the same bursa, joint or
complex joint.
3. Aspiration and/or injection of the olecranon bursa is only eligible for payment as G370/G371.
4. G328/G329 are not eligible for payment solely for injection of complex joint.
5. G370, G371, G328, G329 are uninsured services for injection of intra-articular
viscosupplementation agents.
[Commentary:
1.Use of intra-articular viscosupplementation agent for treatment of osteoarthritis is not
supported by evidence. An example of a viscosupplementation agent is hyaluronic acid. See
https://www.hqontario.ca/Portals/0/Documents/evidence/reports/rev_hylan_061705.pdf
2.For percutaneous provocation vertebral discography, refer to J006 Discogram page E4.]
G396 Injections of extensive keloids ................................................ 24.90
# Z455 - under general anaesthesia................................................. 44.70 6Biopsy(ies)
Z116 - any method, when sutures are used .................................. 32.45
E542 - when performed outside hospital ............................... add 12.65
Z113 - any method, when sutures are not used ............................ 32.45
Note:
Z116 may be allowed more than once on an IC basis if medically necessary (in order to make a
diagnosis or to plan treatment) to biopsy more than one lesion or to obtain a second biopsy
from an extensive lesion. If claimed, may be allowed with chemical treatment of lesion (code
Z117).Group 1 - e.g. keratosis, pyogenic granuloma
(see Appendix D Surface Pathology)
Removal by excision and suture
Z156 - single lesion........................................................................ 21.90 6
Z157 - two lesions.......................................................................... 29.05 6
Z158 - three or more lesions.......................................................... 48.50 6
E542 - when performed outside hospital ............................... add 12.65
Removal by electrocoagulation and/or curetting
Z159 - single lesion........................................................................ 11.55 6
Z160 - two lesions.......................................................................... 17.35 6
Z161 - three or more lesions.......................................................... 28.70 6
Note:
1.Paring of a lesion by any method, including curetting, and/or electrocoagulation, without
complete removal of the lesion does not constitute Z159, Z160 or Z161 and is not eligible for
payment.
2.Excision or removal by electrocoagulation and/or curetting of plantar verrucae is not an
insured service.EXCISION OF PRE-MALIGNANT LESIONS INCLUDING BIOPSY OF EACH LESION –
SINGLE OR MULTIPLE SITES
The amount payable for excision of a pre-malignant lesion will be adjusted to a lesser fee if the
pathologist’s report is not retained in the patient’s record.
Face or Neck
Simple excision
R160 - single lesion........................................................................ 6 58.30 6
R161 - two lesions.......................................................................... 6 95.75 6
R162 - three or more lesions.......................................................... 6 191.45 6
E542 - when performed outside hospital .............................. add 12.65
Other Areas
Simple excision
R163 - single lesion........................................................................ 6 47.75 6
R164 - two lesions.......................................................................... 6 78.65 6
R165 - three or more lesions.......................................................... 6 157.35 6
E542 - when performed outside hospital ............................... add 12.65
Note:
Excision of a pre-malignant lesion is only payable for the following lesions:
1.Dysplastic Nevus (nevus with dysplastic features, atypical melanocytic hyperplasia, atypical
melanocytic proliferation, atypical lentiginous melanocytic proliferation or premalignant
melanosis)
2.Actinic/Solar Keratosis
3.Chemical and other pre-malignant keratoses
4.Large Cell Acanthoma
5.Erythroplasia of Queryrat
6.Leukoplakia
[Commentary:
In-situ lesions such as Lentigo Maligna (melanoma-in-situ) and Bowen's Disease (squamous
cell carcinoma-in-situ) are considered malignant lesions.]
Z119 Cryotherapy treatment of at least 5 pre-malignant actinic
keratosis lesions on the same day, not to include freeze-
thaw cycles......................................................................... 31.80
Note:
Z119 is only eligible for payment when liquid nitrogen is used.
[Commentary:
For fewer than five lesions see Z117.]
Claims submission instructions:
Submit claims with diagnostic code 232.Face or neck
Simple excision
R048 - single lesion........................................................................ 6 100.95 6
R049 - two lesions.......................................................................... 6 152.50 7
R050 - three or more lesions.......................................................... 6 255.25 7
E542 - when performed outside hospital ............................... add 12.65
Other areas
Simple excision
R094 - single lesion........................................................................ 6 63.70 7
R040 - two lesions.......................................................................... 6 104.85 6
R041 - three or more lesions.......................................................... 6 209.70 7
E542 - when performed outside hospital ............................... add 12.65
Malignant melanoma
R010 - wide excision in any area and must include > 1 cm margins
and layered closure ............................................................ 6 135.95 7
# E540 - if excision is performed in hospital for tumour free margin
with frozen section, to excision or repair fees .... add 25%
[Commentary:
For sentinel node biopsy refer to Z427 p R2.]
Note:
1.When excision of benign, pre-malignant or malignant skin lesions are corrected by
a.Advancement flap including undermining of more than 2.5 cm per side, or
b.Rotation, transposition, Z-plasty, or
c.Other flap or graft
claim the appropriate benefit listed under Skin Flaps and Grafts Section instead of foregoing
excision benefits.
2.Excision by S-plasty technique is considered a form of simple excision rather than a
reconstructive flap.
Face or neck
Curettage, electrodesiccation or cryosurgery
R018 - single lesion........................................................................ 6 75.10 6
R019 - two lesions.......................................................................... 6 123.70 7
R020 - three or more lesions.......................................................... 6 247.30 6INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
SKIN AND SUBCUTANEOUS TISSUE
Asst Surg Anae
Wound and ulcer debridement
Debridement of wound(s) and/or ulcer(s) extending into subcutaneous tissue
Z080 - one ..................................................................................... 21.90
Z081 - two...................................................................................... 32.90
Z082 - three ................................................................................... 49.30
Z083 - four or more........................................................................ 65.75
Debridement of wound(s) and/or ulcer(s) extending into any of the following structures: tendon,
ligament, bursa and/or bone
Z084 - one ..................................................................................... 65.75
Z085 - two or more ........................................................................ 98.65
E542 - when performed outside hospital, to Z080, Z081, Z082,
Z083, Z084 or Z085 ................................................... add 12.65
Payment rules:
1.Wound and ulcer debridement services are only eligible for payment where:
a.the physician performs a minimum of 10 minutes of debridement; and
b.the service is rendered personally by the physician.
2.Suture of laceration (Z154, Z175, Z176, Z177, Z179, Z190, Z191, Z192), and complex
laceration repair (Z187, Z188, Z189) services are not eligible for payment with wound and
ulcer debridement services.
3.All wound and ulcer debridement services include the application of any necessary dressing
if rendered.
[Commentary:
Debridement of wound(s) or ulcer(s) must be performed personally by the physician. Wound
dressings may be performed by the physician or by others delegated to perform wound
dressings where such delegation is authorized in accordance with the Schedule requirements
for delegated services. See page GP62 of the General Preamble of this Schedule.]
Note:
Wound dressing and wound and debridement services are not payable in addition to any
surgical procedure unless complications require such care in excess of the usual post-
operative care.
Medical record requirements:
Wound or ulcer debridement services are only eligible for payment where:
1.the minimum time requirements involved in the debridement of the wound(s) or ulcer(s) are
documented in the patient's permanent medical record; and
2.Documentation supporting the debridement of each separate lesion for which a claim is
made is found in the medical record.INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
SKIN AND SUBCUTANEOUS TISSUE
Asst Surg Anae
Repair of lacerations
Note:
Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the
appropriate fee.
Z176 - up to 5 cm........................................................................... 21.90 6
Z154 - up to 5 cm if on face and/or requires tying of bleeders and/
or closure in layers ............................................................. 39.35 6
Z175 - 5.1 to 10 cm........................................................................ 39.35 6
Z177 - 5.1 to 10 cm if on face and/or requires tying of bleeders and/
or closure in layers ............................................................. 78.15 6
Z179 - 10.1 to 15 cm...................................................................... 55.20 6
Z190 - 10.1 to 15 cm if on face and/or requires tying of bleeders
and/or closure in layers ..................................................... 111.20 6
Z191 - more than 15.1 cm - other than face .................................. 84.70 6
Z192 - more than 15.1 cm - on face .............................................. 169.75 7
E530 - if inhalation general anaesthesia (other than 50% N2O/O2
mixture) is used, when suture of laceration is sole
procedure................................................................... add 55.20
E531 - if extensive debridement is required (see General
Preamble GP12) ........................................................ add I.C
E542 - when performed outside hospital ............................... add 12.65
R024 - Acute laceration earlobe, unilateral .................................... 110.25
UVC - Removal of sutures only..................................................... visit.fee
Complex laceration repair
Face
A complex laceration repair of the face is a repair that requires a minimum of 20 minutes of
time to perform the repair procedure and at least one of the following:
a.anatomical alignment of the vermilion border, eyebrow, eyelid or pinna;
b.closure of three or more layers (muscle sheath, subcutaneous tissue, skin etc.); or
c.ligation of multiple bleeding vessels.
Z187 Complex laceration repair, face .............................................. 101.15
Anatomical area other than face (except zone 1 repair of digit)
A complex laceration repair of an anatomical area other than face is a repair that requires a
minimum of 20 minutes of time to perform the repair procedure and at least one of the
following:
a.closure of three or more layers (muscle sheath, subcutaneous tissue, skin etc.); or
b.ligation of multiple bleeding vessels.
Z188 Complex laceration repair, anatomical area other than face,
(except digit, zone 1 repair)................................................ 101.15OPERATIONS OF THE BREAST
Asst Surg Anae
INCISION
Needle biopsy
Z141 - one or more ........................................................................ nil 37.20
E542 - when performed outside hospital ............................... add 12.65
Z143 - large core breast biopsy - (14 gauge or larger bore needle) 144.85
Aspiration of cyst
Z139 - one or more ........................................................................ nil 37.20
Drainage of intramammary abscess or haematoma
# Z140 Single or multiloculated - local anaesthetic............................. 33.00
# Z740 Single or multiloculated - general anaesthetic ........................ 133.80 6
EXCISION
# R107 Tumour or tissue for diagnostic biopsy and/or treatment, e.g.
carcinoma, fibroadenoma or fibrocystic disease (single or
multiple - same breast) ...................................................... 6 169.95 6
# E525 - after localization with mammographic wire or radioactive
seeds, to R107........................................................... add 48.05
# R111 Partial mastectomy or wedge resection for treatment of breast
disease, with or without biopsy, e.g. carcinoma or extensive
fibrocystic disease .............................................................. 6 306.75 7
# E525 - after localization with mammographic wire or radioactive
seeds to R111 ............................................................ add 48.05
# E546 - with axillary node dissection up to the level of the axillary
vein, to R111 .............................................................. add 388.75
# E505 - with limited axillary node sampling, to R111............... add 178.05
Payment rules:
1.E505 is not eligible for payment in addition to Z427.
2.Z427 is only eligible for payment in addition to E546 when a frozen section report
demonstrates micrometastases.
[Commentary:
For sentinel node biopsy refer to Z427 p R2.]DIGESTIVE SYSTEM SURGICAL PROCEDURES
RECTUM
Asst Surg Anae
EXCISION
# S247 Haemorrhoidectomy, with or without sigmoidoscopy or repair
of fissure(s) and/or sphincterotomy and/or anal dilation..... 6 260.15 6
# Z565 Complete haemorrhoidectomy using cryotherapy and/or
Barron ligation(s) including rectal dilation........................... 99.60 6
# Z546 Barron ligation(s) (not to exceed 6 in any one year)............... nil 39.40
# Z566 Barron ligation(s) plus cryotherapy (not to exceed 6 in any one
year) ................................................................................... nil 39.10
# S249 Local excision for malignancy................................................. 6 331.40 7
Z757 Excision of benign anal lesion(s) ............................................ 6 47.15 6
E542 - when performed outside hospital ............................... add 12.65
# S251 Fistula-in-ano - exploration of fistula tract and insertion of
Seton drain and/or fistulotomy............................................ 6 234.45 6
# S250 Ligation of intersphincteric fistula tract (LIFT) and/or
endorectal advancement flap (ERAF) for definitive repair.. 6 339.50 6
E811 - for recurrent fistulae, to S250 or S251 ............... add 25%
Payment rules:
S247 and Z565 are only insured when the patient has:
a.failed a trial of non-surgical therapy;
b.Grade III or IV haemorrhoids; or
c.haemorrhoids with substantial concomitant skin tags.
INJECTION
Z575 Haemorrhoid injections (to a maximum of 6 per year)............ 27.05
Z576 Injections for anal fissure ........................................................ 35.90 6
REPAIR
# S253 Low imperforate anus repair ................................................... 7 1224.00 7
# S260 High imperforate anus repair (supra-levator).......................... 7 2050.75 7
# S256 Excision of scar, for stenosis .................................................. 6 162.15 6
# S257 Anoplasty, for stenosis............................................................ 6 313.20 6
# S258 Repair of anal sphincter.......................................................... 6 275.05 7
# S259 Repair of anal sphincter and ano-rectal ring........................... 6 405.95 6
DESTRUCTION
Z548 Cauterization of fissure ........................................................... 34.90 6
Fulguration of condylomata
Z549 - local anaesthetic................................................................. 30.95
# Z758 - general anaesthetic ............................................................ 6 97.65 6
MANIPULATION
Z550 Dilation of anal sphincter ........................................................ 13.70 6
# S248 Peter Lord procedure.............................................................. 49.65 6Z702 Biopsy ..................................................................................... 42.45 6
E542 - when performed outside of hospital ........................... add 12.65
Amputation
# S574 - partial.................................................................................. 6 304.65 7
# S575 - partial with inguinal glands 1 or 2 stages ........................... 6 468.70 7
# S576 - radical with inguinal and femoral glands 1 or 2 stages....... 6 771.15 7
Condylomata
Z701 - local anaesthetic................................................................. 34.95
# Z767 - general anaesthetic ............................................................ 84.25 6
# S599 Excision plaque for Peyronies disease ................................... 6 306.85 7
Note:
Where grafting is necessary, appropriate skin graft fee is payable with S599.INCISION OR EXCISION
# E861 - paracervical block - payable in addition to endometrial
sampling, ablation or curettage by same physician in an
office - unilateral or bilateral....................................... add 9.00
Z770 Endometrial sampling ............................................................. 38.85
E542 - when performed outside hospital ............................... add 12.65
# S772 Endometrial ablation by any method ...................................... 225.90 6
Note:
Hysteroscopy (Z582, Z583, Z587) is not eligible for payment when rendered with endometrial
ablation (S772).EXCISION
Chalazion
Single or multiple
Z874 - local anaesthetic................................................................. 70.00
E542 - when performed outside hospital ............................... add 12.65
# Z856 - general anaesthetic ............................................................ 150.00 6
Note:
See Appendix D Surface Pathology.
Epilation
Z857 - by hyfrecator, electrolysis or cryopexy .............................. 115.80 6
Note:
Verruca, keratosis, etc. - see Skin and Subcutaneous Tissue - Integumentary System also Lid
Tumours or Unlisted Plastic Procedures.Fee master record
Master, record 1238. Record Layout PDF, page 1.
E54220260401999999990000012650000000000000000000000000000000000000000000000
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 | 00000126500 / 12.65 |
| assistant | 00000000000 / 0 |
| specialist | 00000000000 / 0 |
| anaesthetist | 00000000000 / 0 |
| non anaesthetist | 00000000000 / 0 |
Explanation
AI-generated. Unreviewed.
This is an add-on for a procedure performed outside hospital. It is listed under several sections, including gynaecology, injections, skin, digestive, male and female genital, and ocular surgery.
Watch out for
Applies only when performed outside hospital. Some listings apply only to specified codes, such as G378 or G552.
Related codes
Report an issue
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Report an issue with E542. Do not include patient names, health details or other personal information.