Remittance Advice · Payment-time (remittance)
OHIP explanatory code 53
Fee allowed according to appropriate item in a previous Schedule of Benefits
What 53 means
The Ministry of Health’s official wording for 53 is: “Fee allowed according to appropriate item in a previous Schedule of Benefits.”
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 53
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
- 49Paid according to the average fee for this service. Independent consideration will be given if clinical records/operative reports presented.
- 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
- 54Interim payment - claim under review
- 55Deduction is an adjustment on an earlier account
- 56Claim under review
- 57This payment is an adjustment on an earlier account
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Code meaning per Ontario Ministry of Health — Remittance Advice Explanatory Codes / Messages (March 2026). The suggested action is general information for Ontario physicians, not billing, legal, or tax advice — codes and rules change, so verify against the current Ministry of Health documents before relying on a claim.