Limits and claims

Daily and monthly caps

Check the shared daily maximum and the prorated monthly maximum before submitting a large day or month.

Quick answer: All four hourly codes share a 56-unit, 14-hour daily maximum. The monthly maximum is 240 hours for 28 days and is prorated for longer months using the published unit limits.

Last reviewed September 9, 2026

Daily maximum

  • Add Q310A, Q311A, Q312A, and Q313A together for the service date.
  • The combined maximum is 56 units, or 14 hours.
  • A single claim item above 56 units rejects with A3H.
  • An incoming claim that exceeds the combined daily limit may be approved at $0 with explanatory code MD.

Published monthly limits

Month lengthUnitsPublished hour equivalent
28 days960240 hours
29 days995248.6 hours
30 days1,029257.1 hours
31 days1,063265.7 hours

How Year 1 claims are handled

For service dates from April 1, 2026 through March 31, 2027, OMA guidance says the Ministry billing system applies the daily and prorated monthly maximums. A submission that takes the physician over a limit may be rejected. Review the available room before submitting a large claim and resubmit within the limit when necessary.

The 25% support-pool and 5% clinical-administration ratios are reconciled separately in Year 1. See Monthly ratio limits for that process.

Important notes

  • These caps apply across all four hourly codes, not separately to each category.

Sources