OHIP explanatory code 49

What 49 means

The Ministry of Health’s official wording for 49 is: “Paid according to the average fee for this service. Independent consideration will be given if clinical records/operative reports presented..”

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 49

Paid at the average fee for this service - if you believe a higher amount is warranted, submit the clinical records/operative report to the Ministry for independent consideration (via a Remittance Advice Inquiry or your claims office).

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

• 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
• 50Paid in accordance with the Schedule of Benefits
• 51Fee Schedule Code changed in accordance with Schedule of Benefits
• 52Fee-for-service assessed by medical consultant
• 53Fee allowed according to appropriate item in a previous Schedule of Benefits