Fee Schedule Master — April 2026 — Paediatric Billing Codes

OHIP Billing Codes for Paediatrics

Browse paediatric OHIP fee codes from the April 1, 2026 Fee Schedule Master. Includes well-baby visits, developmental assessments, immunizations, age-based premiums, and pairing rules. Clear the search to browse all 6,347 codes.

Regulatory Currency

This guide reflects the following MOH INFOBulletins:

  • 260312 — New and Updated Explanatory Codes (Apr 8, 2026)
  • 260304 — PSA Fee Schedule Adjustments (Apr 1, 2026)

Last verified: April 16, 2026

Paediatric OHIP Billing Codes

Paediatric billing in Ontario uses standard OHIP fee codes from the General/Family Practice section of the Schedule of Benefits. The most-used paediatric codes are A002 (enhanced 18-month well baby visit, $73.95), A007 (intermediate assessment or well baby care, $44.55), A001 (minor assessment, $26.80), and A003 (general assessment, $95.60). Most assessment codes require a diagnostic code on the claim. Age-based premiums of 15% apply for patients under age 2 on eligible assessment codes.

Well-Baby Visit Billing (A002, A007)

A007 ($44.55) is the standard well-baby care code for routine paediatric check-ups. A002 ($73.95) is the enhanced 18-month well baby visit — a more comprehensive developmental screening visit. A003 ($95.60) may be used for a full general assessment at a first paediatric visit. General assessments (A003) are limited to once per patient per physician per 12-month period under the Schedule of Benefits. Search for “paediatric” below to see all relevant codes, or expand any code row to see its full billing rules.

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Data sourced from the Ontario Ministry of Health Fee Schedule Master (effective April 1, 2026) and the Schedule of Benefits for Physician Services. Updated April 10, 2026. OpsMed updates this database within 48 hours of every FSM release.

The April 2026 Fee Schedule Master contains 7,522 entries. This tool searches the 6,347 active codes; 1,175 inactive and deleted codes are excluded from search results.

Need a diagnostic code? → OHIP Diagnostic Code Lookup  |  Claim rejected? → OHIP Rejection Code Lookup  |  Billing FHO+ time codes? → FHO+ Billing Guide

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Paediatric OHIP Billing — FAQ

What OHIP billing codes are used for paediatric visits?

Common paediatric OHIP billing codes include A002 (18-month well baby visit, $73.95), A007 (intermediate assessment or well baby care, $44.55), A003 (general assessment, $95.60), and A001 (minor assessment, $26.80). Well-baby visits use A007 for routine checks. Developmental assessments may use A003 or specialist assessment codes. Immunization administration codes are also used frequently in paediatric practice.

What is the OHIP code for a well-baby visit?

Well-baby visits in Ontario are billed using A007 (intermediate assessment or well baby care, $44.55 as of April 2026) for routine well-child check-ups. The enhanced 18-month well baby visit uses A002 ($73.95), which includes developmental screening. A003 (general assessment, $95.60) may be used when a comprehensive new-patient assessment is performed.

Are there age-based fee premiums for paediatric OHIP billing?

Yes. The OHIP Schedule of Benefits includes age-based fee premiums for services to patients under 2 years of age and over 65 years. Certain assessment codes (A003, A007, A004, and others) are eligible for a 15% premium when billed for patients in the qualifying age group. The premium is applied automatically by OHIP when the patient age on the health card matches the criteria. Expand any eligible code in the lookup tool to see premium eligibility details.