OHIP explanatory code 42

What 42 means

The Ministry of Health’s official wording for 42 is: “FSC Billed Included in Other Procedure.”

This code appears as an explanatory code on your monthly Remittance Advice (RA). It means the claim was adjudicated — paid, reduced, or refused — for the reason below. A claim already on your RA generally shouldn't be blindly resubmitted; follow the suggested action.

How to fix 42

The fee was reduced or capped under this rule. If you believe the full amount was payable, file a Remittance Advice Inquiry with supporting detail.

Payment-time codes appear on the monthly Remittance Advice after adjudication. Some are informational, some explain a reduced or refused payment. Where you disagree with the outcome, the usual route is a Remittance Advice Inquiry or written inquiry — not resubmitting the same claim, which can create a duplicate.

Related codes

• 36OHIP records show service has been rendered by another Practitioner, Group, Lab
• 37Effective April 1, 1993 the listed benefit for this code is 0 Laboratory Medicine Services (LMS) units
• 40Service or related service allowed only once for same patient
• 41Fee Schedule Code (FSC) Billed - No Evidence in Supporting Documentation Provided
• 45Specialty code restriction on Fee Schedule Code
• 46Paid Per 2nd Review by Medical Advisor (MA)
• 47Not Paid Per 2nd Review by Medical Advisor (MA)
• 48Paid as submitted - clinical records may be requested for verification purposes