Education and Prevention Committee Billing Briefs

Education and Prevention Committee (EPC) Billing Briefs are prepared jointly by the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide general advice and guidance to physicians on billing matters.

Category: Ophthalmology (23); Anaesthesiology (01)     
Date Issued: February 13, 2025

Strabismus procedure fee code changes

Claims Tip: A new payment structure has been introduced for strabismus procedures effective April 1, 2023.

Five new fee codes for strabismus surgical repair procedures were introduced into the Schedule of Benefits – Physician Services (Schedule) effective April 1, 2023.

  1. E185 – Horizontal or vertical rectus muscle
  2. E184 – Inferior oblique muscle

  3. E183 – Superior oblique muscle

    Note: The fee codes above specify different anatomic sites (extraocular muscles) and may be claimed based on the muscle that is surgically corrected.

  4. E182 – Transposition of extraocular muscle to treat a paretic, lost, or damaged eye muscle
  5. E877 – Repeat strabismus procedure(s), which adds a 30% premium to fee codes E185, E184, E183 and E182

A maximum of 4 of any combination of E185, E184, E183 and E182 are eligible for payment per patient per day (see page Y7 of the Schedule).

These new fee codes replace E158, E159, E162 and E952, which have been removed from the Schedule.

There has been no change to fee code E949, which continues to be eligible for payment for use of an adjustable suture.

Examples

Example 1 – Strabismus surgery involving 1 to 4 extra-ocular muscles

Dr. Anwar performs a strabismus repair procedure by correcting the right medial rectus and right superior rectus muscles as well as the right superior oblique muscle. An adjustable suture is used for the superior oblique.

What fee codes are eligible for payment to Dr. Anwar?

Explanation:

  • E185 x 2 (for repair of the medial and superior rectus muscles, since two different muscles are being repaired) and E183 (for repair of the superior oblique muscle) are eligible for payment.
  • E949 is also eligible for payment as an adjustable suture was used for the superior oblique muscle repair.

Example 2 – Strabismus surgery involving more than 4 muscles

Dr. Phillips performs a bilateral strabismus repair procedure by correcting the medial and inferior rectus muscles bilaterally as well as the left superior oblique muscle (a total of 5 muscles).

What fee codes are eligible for payment to Dr. Phillips?

Explanation:

  • E183 (for repair of the superior oblique muscle) and E185 x 3 (for repair of medial and inferior rectus muscles) are eligible for payment.
  • Recall that a maximum of 4 of any combination of E185, E184, E183 and E182 are eligible for payment per patient per day.

Example 3 – Repeat strabismus surgery

Dr. Charbonneau performs a strabismus surgery. The procedure involves repeat repair of the left superior oblique muscle (previously corrected several years ago) as well as repair of the left lateral rectus muscle (no prior procedure).

What fee codes are eligible for payment to Dr. Charbonneau?

Explanation:

  • E183 (for repair of the superior oblique muscle) and E185 (for repair of the lateral rectus muscle) are eligible for payment.
  • E877 is also eligible for payment with E183, as this was a repeat procedure. 

Keywords/Tags

OHIP Claims; OHIP Payment; Strabismus; Eye Surgery; Ophthalmology

Claims contact information

For additional information, please visit the Resources for Physicians and the How to Get Help with Billing Questions pages on the ministry website.

If you have any billing or claims submission inquiries, please contact the Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

To provide feedback on EPC Billing Briefs, or to suggest topics for future EPC Billing Briefs, send an email to the attention of the joint Ministry of Health/OMA Education and Prevention Committee.

The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly prepared this educational resource to provide general advice and guidance to physicians on specific billing matters.

The Ministry of Health and the Ontario Medical Association logos

The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly established the Education and Prevention Committee (EPC). The EPC’s primary goal is to educate physicians about submitting OHIP claims for payment for the insured service provided.

EPC Billing Briefs are prepared jointly by the MOH and the OMA to provide general advice and guidance to physicians on billing matters. EPC Billing Briefs are provided for education and information purposes only. The information provided in this EPC Billing Brief is based on the April 2024 Schedule of Benefits - Physician Services (Schedule).

While the OMA and MOH make every effort to ensure that this EPC Billing Brief is accurate, the Health Insurance Act (HIA) and its Regulations prevail over anything stated in this EPC Billing Brief. Changes in applicable statutes, regulations, or case law may affect the accuracy or currency of the information provided in this EPC Billing Brief. In the event of a discrepancy between this EPC Billing Brief and the HIA or its Regulations and/or Schedule under the regulations, the text of the HIA, Regulations and/or Schedule prevail.

Note: This document is technical in nature and is available in English only due to its limited targeted audience. This publication has been exempted from translation under the French Language Services Act. For questions or support regarding this document, please contact the Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

Remarque : Ce document est de nature technique et est disponible en anglais uniquement en raison de son public cible limité. Ce document a été exempté de la traduction en vertu de la Loi sur les services en français. Pour toute question ou de l’aide concernant ce document, veuillez contacter Les Services de renseignements, Centre de contact pour le soutien des services par courriel ou en téléphonant le 1-800-262-6524.