Two distinct billing patterns under one specialty. Obstetrics is a small number of high-value codes — P006A vaginal delivery at $512.65, P018A caesarean at $579.80 — plus associated services and the after-hours premiums that deliveries so often qualify for. Gynaecology is office assessments and procedures, where the imaging and the catheter introduction are separate codes and billing one without the other is the common loss.
IntelAGENT bills the delivery from the phone when it happens, which is the only time the attendance and the small codes around it are still accurate. See how →
Obstetric and gynaecological claims are not complicated; what makes the specialty leak revenue is that the highest-value work arrives unscheduled, at night, and gets billed days later from a labour record rather than at the time.
The codes and what they pay
| Code | Description | Fee |
|---|---|---|
| P018A | Caesarean section | $579.80 |
| P020A | Operative delivery — mid-cavity extraction or assisted breech | $535.60 |
| P006A | Vaginal delivery | $512.65 |
| A205A | Consultation | $134.25 |
| P023A | Repair of laceration / oxytocin infusion | $67.75 |
| P007A | Postnatal care in hospital and/or home | $65.55 |
| A203A | Specific assessment | $62.65 |
| P030A | Cervical ripening | $58.60 |
| G399A | Transvaginal sonohysterography — catheter introduction | $44.15 |
| A204A | Partial assessment | $40.50 |
| J165C | Transvaginal sonohysterography — professional component | $33.15 |
| P025A | Non stress test | $9.65 |
Fees are from the OHIP Schedule of Benefits and are the ministry's, not ours. Associated-service rules, what each delivery code includes, and the conditions attached to antenatal and postnatal codes are all in the current Schedule. Surgical procedures carry their own codes and rules and are not listed here. These fees are from the Schedule effective July 1, 2026 (PDF).
Deliveries and what travels with them
A delivery is rarely one code. The delivery itself is the largest line, and around it sit services that are separately payable but are not prompted by it:
- Repair and oxytocin. P023A at $67.75, for repair of a laceration or an oxytocin infusion. Routine enough that it is assumed to be part of the delivery fee, which it is not.
- Postnatal care. P007A at $65.55 for care in hospital or at home.
- Cervical ripening. P030A at $58.60, where it was done.
- Non-stress testing. P025A at $9.65, small and high volume.
- After-hours premiums. Covered below, and the biggest number in this list.
The Schedule states for each delivery code what is included in the fee and what may be billed alongside it. That is worth reading once properly rather than inferring from what has been paid before, because a service wrongly assumed to be included is never billed and so never corrected.
The after-hours premiums are the specialty's biggest loss
No other specialty has this much high-value work landing outside normal hours as a matter of course. Labour does not schedule itself, and a delivery at 02:40 on a Sunday is an ordinary week for an obstetrician.
The premium codes for after-hours and weekend work are billed alongside the service, not instead of it, and the eligibility turns on the time the service was rendered and the circumstances in which you attended. Two things cause them to be missed:
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The claim is built later, from the chart
The chart has the delivery time. The person entering the claim a week later is reading for the procedure, not for the clock. By the time the claim is built, the premium has to be remembered rather than observed.
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The time bands are not intuitive
Which band a service falls into, and whether being called in rather than being present matters, are specific rules. A premium billed under the wrong band is refused, and a few refusals are usually enough to stop someone billing them at all — which is a far more expensive outcome than the occasional refusal. How the premiums work sets out the structure.
The habit that fixes it. Record the delivery time on the claim at the time of the delivery, not from the chart afterwards. Everything the premium depends on is known at that moment and is progressively harder to recover from then on.
The gynaecology side
Office and day-surgery work, with a different failure pattern: not omission of premiums but omission of the companion code.
Transvaginal sonohysterography is the clearest example. The catheter introduction is G399A at $44.15 and the imaging is J165C at $33.15 — two codes for one procedure, and billing one without the other is a routine loss of roughly the other's value. The same shape recurs wherever a procedure and its imaging are separately listed.
Mind the suffix on a diagnostic code. Where a diagnostic service has both a technical and a professional component, the Schedule requires the technical component to be claimed with suffix B and the professional component with suffix C. J165 is listed at $99.95 in total and $33.15 for the professional component, so J165C and J165B are not interchangeable and neither is the same as the total.
Assessments follow the ordinary consultation and assessment ladder: A205A consultation at $134.25, A203A specific assessment at $62.65, A204A partial assessment at $40.50. The judgement about which applies is clinical; what a billing system can do is make sure the one you chose is the one that goes out, and that a consultation carries the referring physician it requires. A missing referring physician is one of the most common rejections on consultation codes — see claim rejections.
On surgical fees. Hysterectomy, myomectomy, oophorectomy and laparotomy have their own codes in the Schedule, and the surgical-assistant codes for the same procedures look superficially similar while paying a unit value rather than the procedure fee. If you are checking a surgical fee, check the exact code suffix against the Schedule rather than a near match.
What gets missed
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After-hours and weekend premiums on deliveries
The largest loss in the specialty by a wide margin, and the most consistent.
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Associated delivery services
P023A and P007A assumed to be inside the delivery fee.
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The companion code on office procedures
Catheter introduction billed without the imaging, or the reverse.
-
Deliveries never entered
A night of on-call reconstructed from memory several days later. The high-value code is remembered; the three small ones around it are not.
Billing obstetrics and gynaecology in IntelAGENT
A delivery is remembered. The attendance, the assessments and the premiums around it are the ones reconstructed days later, if at all.
- Billing from the phone, at the time. A delivery entered on the mobile app when it happens carries the actual time, which is what the premiums depend on.
- Premium prompting. Eligible premiums for the time and circumstances are offered rather than remembered.
- Companion codes offered together. Procedures with a separately payable second code are presented as the pair they are.
- Referring physician enforced on consultations. The rejection family that consultations produce is caught before submission rather than after.
- Rejections surfaced with the reason. So a refused premium is corrected rather than abandoned.
Three months free, then 0.25% of paid claims, capped at $39.99 a month. IntelAGENT has submitted OHIP claims since 2016 for more than 2,000 Ontario physicians.
Frequently asked questions
How is a vaginal delivery billed under OHIP?
P006A is the vaginal delivery code, $512.65 effective July 1, 2026. Associated services are separate codes — P023A for repair of a laceration or oxytocin infusion at $67.75, P007A for postnatal care in hospital or at home at $65.55 — and after-hours premiums apply on top where the delivery met the criteria.
What is the OHIP code for a caesarean section?
P018A, $579.80 effective July 1, 2026. P020A covers an operative delivery by mid-cavity extraction or assisted breech at $535.60. Both are in the Schedule of Benefits with their own associated-service rules.
Can obstetricians bill after-hours premiums for deliveries?
Yes, where the delivery meets the criteria for the premium. Deliveries fall outside normal hours more often than almost any other scheduled service, and a premium claimed days later from a labour record is easy to leave off altogether.
What office procedures do gynaecologists bill most?
Transvaginal sonohysterography is the clearest example — G399A for catheter introduction at $44.15 with J165C, the professional component of the imaging, at $33.15 — along with non-stress testing at P025A, and assessments from the A20xA series.