Key takeaways
- Friday evenings now follow weekend and holiday billing rules: Effective April 1, 2026, emergency department services from 17:00 to 24:00 on Fridays moved into the H151A–H154A assessment family and H113A after-hours premium period.
- Monday–Thursday evenings have a clearer billing window: H131A–H134A now apply from 17:00 to 24:00 Monday through Thursday, while the new H114A provides an after-hours premium for eligible non-assessment services during the same period.
- Review claims dating back to April: Ontario implemented updated processing rules August 1, 2026, but the changes apply to services from April 1. The Ministry plans to adjust eligible claims submitted under the previous processing rules.
Ontario changed how emergency physicians bill several after-hours OHIP services in 2026. The biggest shift involves Friday evenings. After 5 p.m. on Fridays, eligible emergency department assessments now use the same H15x fee schedule codes as weekends and holidays rather than the weekday-evening H13x family.
Ontario also introduced H114A, a new after-hours fee for eligible services provided Monday through Thursday evenings. The changes took effect April 1, 2026, with updated OHIP processing rules implemented August 1.
For emergency physicians, the practical takeaway is straightforward: the correct after-hours code now depends more precisely on both the service performed and when it occurred.
What changed for Ontario emergency medicine billing in 2026?
Changes and updates are a hallmark of Ontario medical billing and 2026 is seeing a number of important shifts in codes. The Ministry of Health revised nine emergency medicine fee schedule codes and introduced two new codes as part of the 2024 Physician Services Agreement.
For after-hours billing, the most important changes involve three groups:
Time of service | 2026 Assessment codes | What changed |
Monday–Thursday, 17:00–24:00 | H131A–H134A | Now specifically limited to Monday–Thursday evenings |
Friday, 17:00–24:00 | H151A–H154A | Friday evenings moved into the weekend/holiday family |
Saturday, Sunday or holiday, 08:00–24:00 | H151A–H154A | Remains the applicable assessment family |
Monday–Thursday, 17:00–24:00, eligible non-assessment service | H114A | New after-hours premium |
Friday, 17:00–24:00, or weekends/holidays 08:00–24:00, eligible non-assessment service | H113A | Friday evenings newly added |
The April 2026 Schedule of Benefits lists H131A–H134A at $30.05, $75.40, $61.50, and $30.05, respectively, and H151A–H154A at $34.15, $85.70, $69.60, and $34.15. H113A is listed at $32.20 and the new H114A at $23.65.
What you need to know: Don’t treat “weekday evening” as one billing period anymore. Friday after 17:00 now sits in a different OHIP category than Monday through Thursday. It’s an important change with those Friday evening hours increasing to a premium rate.
Friday evening emergency billing now uses H151A–H154A
One of the most significant changes affects services delivered between 17:00 and midnight on Fridays.
Previously, Friday evening assessments fell within the weekday-evening structure. Effective April 1, 2026, Friday evenings joined Saturdays, Sundays, and holidays under H151A–H154A:
- H151A: Minor assessment
- H152A: Comprehensive assessment and care
- H153A: Multiple systems assessment
- H154A: Reassessment
For Friday services from April 1 onward, the Ministry updated its claims system August 1 to pay these codes at the applicable Friday evening/weekend/holiday rate. Before that processing update, Friday claims submitted under H151A–H154A could convert to their weekday daytime H101A–H104A equivalents.
What you need to know: If you worked a Friday evening ED shift between April 1 and July 31, review those claims and subsequent remittance activity. The service may have been processed differently before Ontario implemented the new rules.
H131A–H134A now apply to Monday–Thursday evenings
The H13x code family has also been tightened.
Effective April 1, H131A, H132A, H133A, and H134A apply specifically from 17:00 to 24:00 Monday through Thursday. Friday evening has been removed from that window.
The coding pattern remains familiar:
- H131A: minor assessment
- H132A: comprehensive assessment and care
- H133A: multiple systems assessment
- H134A: reassessment
The change therefore affects timing rather than the underlying assessment categories.
What you need to know: For an assessment at 7 p.m. Thursday, look to the H13x family. For the equivalent assessment at 7 p.m. Friday, look to H15x. Recording the service date and time accurately now has an even greater impact on code selection.
Looking for a way to not have to deal with billing code updates?
What is the new H114A after-hours code?
Ontario also introduced H114A, effective April 1, 2026.
H114A applies to eligible emergency department after-hours services delivered from 17:00 to 24:00 Monday through Thursday when another service is rendered during premium hours and an assessment isn’t claimed. The Schedule lists H114A at $23.65.
This distinction matters. H114A does not replace the H131A–H134A assessment codes. Instead, it extends the existing after-hours premium structure:
- H112A: nights, 00:00–08:00
- H113A: Friday evenings plus weekends and holidays
- H114A: Monday–Thursday evenings
Ontario also updated the processing rules, so H114A rejects with explanatory code ADJ when billed with diagnostic ultrasound services other than J149B/C.
What you need to know: Determine first whether you are billing an assessment or another eligible service. Then apply the corresponding after-hours assessment code or premium. Mixing the two concepts creates an avoidable source of billing errors.
H113A now includes Friday evenings
H113A previously covered eligible services from 08:00 to 24:00 on Saturdays, Sundays, and holidays.
As of April 1, it also covers Friday evenings from 17:00 to 24:00. Claims for eligible Friday H113A services began processing under the updated rules August 1.
Friday’s at 5:00p.m. is more than the unofficial start of the weekend. Think of the change alongside the H15x assessment update: both now treat Friday evening as part of the higher after-hours period associated with weekends and holidays.
What you need to know: Friday at 5 p.m. is now an important billing boundary. Billing workflows, templates or software rules created under the previous Schedule should reflect it.
What about claims submitted between April 1 and August 1?
Like all billing changes, these code updates come with their own additional complexity. The effective date and system implementation date are different.
The changes took effect April 1, 2026, while updated processing for several affected codes began August 1, 2026. The Ministry stated that a Medical Claims Adjustment will address eligible claims submitted during the intervening period, with further details to follow.
That makes reconciliation particularly important.
Review remittance statements rather than assuming an originally processed claim represents its final value. Our Ontario OHIP billing optimization checklist also outlines practical steps for reviewing rejected claims, payment adjustments and reconciliation workflows.
Build the 2026 changes into your billing workflow
Emergency medicine moves quickly. Billing rules do too.
For each after-hours ED encounter, confirm three things before submission: what service you provided, the exact day and time, and which OHIP period applies.
Then, monitor remittance statements for reductions, conversions, or adjustments.
- That broader workflow matters whenever provincial rules change. As we explain in our guide to how medical billing claims are reviewed, the right code still needs to align with the service, setting, and other required claim details.
Petal Medical Billing Ontario combines more than 20 years of OHIP expertise with billing support and specialty-specific guidance to help Ontario physicians keep pace with evolving billing requirements.
Connect with an ON billing expert to get more from your delivered care.
FAQs: Ontario emergency medicine billing changes for 2026
What changed for OHIP emergency medicine billing in 2026?
Ontario realigned several emergency department after-hours billing periods effective April 1, 2026. Friday evenings now fall under H151A–H154A for assessments and H113A for eligible non-assessment services, while H131A–H134A apply to Monday–Thursday evenings.
What is OHIP code H114A?
H114A is a new emergency department after-hours fee effective April 1, 2026. It applies to eligible services rendered from 17:00 to 24:00 Monday through Thursday when an assessment isn’t claimed. The listed fee is $23.65.
Which OHIP codes apply to Friday evening emergency department assessments?
From 17:00 to 24:00 on Fridays, eligible ED assessments fall under H151A for minor assessments, H152A for comprehensive assessment and care, H153A for multiple systems assessments, and H154A for reassessments.
When did Ontario’s new emergency medicine billing rules take effect?
The revised eligibility periods took effect April 1, 2026. Updated claims processing rules for the affected after-hours codes were implemented August 1, 2026.
Do Ontario emergency physicians need to review older 2026 claims?
Physicians should review relevant claims and remittance statements for services between April 1 and August 1, 2026. The Ministry has stated that eligible claims affected by the staged implementation will undergo a future Medical Claims Adjustment.
