{
  "resourceType": "CodeSystem",
  "status": "draft",
  "content": "not-present",
  "name": "OnOhipScheduleOfBenefitsCS",
  "id": "on-ohip-schedule-of-benefits",
  "title": "OHIP Schedule of Benefits (Ontario fee codes)",
  "description": "The Ontario Health Insurance Plan (OHIP) Schedule of Benefits fee codes -- the service codes\ncarried on Ontario physician claims, and what `Invoice.lineItem.chargeItem[x].coding[ohip]`\nidentifies.\n\n**This artifact enumerates no codes, and the sample below is not a substitute for the schedule.**\nThe artifact declares the system so that a fee code pinned to it is recognisable as an OHIP fee\ncode and the system URI resolves to a definition; the page then shows a sample so a reader can see\nwhat these codes look like. Neither is the code system. Obtain that from the Ontario Ministry of\nHealth: the Schedule of Benefits for Physician Services, and also the Laboratory, Dental and\nOptometry schedules, which carry codes the physician schedule does not (`T` codes are dental and\n`V` codes are optometry -- reading only the physician schedule silently loses several hundred\ncodes).\n\n**A fee code is only correct relative to a dated edition.** The Schedule of Benefits is\n**incorporated by reference into R.R.O. 1990, Reg. 552** under Ontario's *Health Insurance Act*\nand is amended only by regulation change, twice yearly and by interim update. Reg. 552 defines\nthe schedule as the Ministry's published document of that name and excludes its commentary and\ncertain appendices, so the fee codes and the conditions on claiming them are the part with\nregulatory force. Read a code against the edition in force on the **date of service**, not the\ndate you are reading: codes are added, amended and delisted, and a code that was billable is not\nnecessarily billable now.\n\nCodes are the schedule's own alphanumeric service codes in their BASE four-character form (for\nexample `A007`). Case-sensitive. A trailing `A`, `B` or `C` seen in billing software is a\nsuffix naming which component of the service is being claimed, not part of the code: it is\ncarried beside the code, never appended to it.\n\n**No canonical is published upstream.** Ontario does not publish a FHIR canonical for the\nschedule, so this specification names one. The URI is stable: it is pinned in stored `Coding.system`\nvalues and will not be changed.\n\n### The OHIP diagnostic codes are a different code set, and the trap is that they look like ICD-9\n\nAn OHIP claim carries two codes: a **fee code** from this system, and a **diagnostic code** from\nOntario's own three-digit diagnostic set, which has\n[its own system URI](CodeSystem-on-ohip-diagnostic-codes.md) and is not this one. The\ndiagnostic set is where implementers lose data, so the warning belongs beside the system they will\nreach for first.\n\n**Ontario's diagnostic codes are ICD-9-LIKE in shape and share many of its codes, but the set is\nNOT a subset of ICD-9. Do not derive an OHIP diagnostic code by truncating an ICD-9 code.** The\nrange 895-971 is a parallel Ontario space laid over ICD-9 numbers that are already occupied by\nsomething unrelated:\n\n| code | means, in Ontario | means, in ICD-9 |\n|---|---|---|\n| `970` | Other Acceptable Diagnosis: Prenatal Care | poisoning by CNS stimulants |\n| `967` | Immunization: Influenza | poisoning by sedative |\n\nMeasured against the Provincial Health Care Vocabulary Standard, a SNOMED CT -> ICD-9 -> truncate\nroute reaches only **69.4%** of cases, and **124** of them land inside 895-971 and come out **valid\nand wrong** -- \"Poisoning caused by opioid receptor agonist\" becomes `970` Prenatal Care, \"Pica\"\nbecomes `307` Sleep-Wake disorders. Nothing downstream rejects those. They go on a claim, they\nadjudicate, and the diagnosis on the record is not the diagnosis the clinician made.\n\nA code alone does not even determine a concept within the Ontario set: **eighteen codes carry two\nunrelated meanings** (`072` is both \"Mumps\" and \"Gait Training\").\n\n**Map to the Ontario diagnostic set explicitly, from its own concept list. Never compute it from\nICD-9.**",
  "url": "https://fhir.apps.health/CodeSystem/on-ohip-schedule-of-benefits",
  "experimental": false,
  "caseSensitive": true,
  "date": "2026-08-22",
  "publisher": "WELLSTAR Technologies Corp.",
  "jurisdiction": [
    {
      "coding": [
        {
          "code": "CA-ON",
          "system": "urn:iso:std:iso:3166:-2"
        }
      ]
    }
  ],
  "copyright": "The system URI is defined by this specification. The Schedule of Benefits itself is published by the Ontario Ministry of Health and is Crown copyright of the King's Printer for Ontario. It is incorporated by reference into R.R.O. 1990, Reg. 552 under the Health Insurance Act, and the King's Printer permits any person to reproduce the text contained in Ontario's regulations without seeking permission and without charge, provided the reproduction is accurate and is not represented as an official version. Fee codes shown on this specification's rendered page are reproduced on that basis and are NOT AN OFFICIAL VERSION: they are a sample, they are not maintained against the Ministry's amendment cycle, and the edition in force at ontario.ca governs. This artifact itself enumerates no codes."
}