A002 – Enhanced 18 month well baby visit
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic assessment of a well infant between 17 and 24 months of age. The service includes a complete physical examination (including weight and measurements), instructions to the parent(s) or representative regarding health care, an age-appropriate developmental screen, and a review of a brief standardized tool (completed by the parent/caregiver) that aids in identifying children at risk of developmental disorders.
When to Use
- Bill A002 when a child between 17 and 24 months presents for their well-baby visit, and you have completed a physical exam, reviewed a parent-completed developmental screening tool (like the NDDS/Looksee), and provided age-appropriate counseling.
- Use A002 if the child is within the 17-24 month age range and the visit includes a documented developmental screen, such as the Rourke Baby Record, in addition to the standard physical assessment.
- A002 is appropriate when the physician spends time discussing the results of a standardized developmental tool completed by the caregiver and addresses any parental concerns identified by the tool.
Common Pitfalls
- Billing A007 instead of A002 because the physician did not review a parent-completed standardized developmental tool, even though the child was within the age range.
- Rejection due to the visit occurring outside the 17-24 month age window; ensure the patient's date of birth aligns with the service date for A002.
- Audit risk if the medical record does not clearly document the review of the standardized developmental tool and any identified concerns, or if the physical exam components (weight, measurements) are missing.
Billing Tips
- Ensure the standardized developmental tool (e.g., NDDS/Looksee) is completed by the parent/caregiver and documented in the chart to support the A002 billing.
- Confirm that no other assessment or consultation codes (excluding specific add-ons not applicable to A002) are billed on the same day by the same physician to avoid same-day restriction rejections.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Well baby care
Assessment
Child from 17 to 24 months of age
The standardized tool (e.g., NDDS/Looksee) must be completed by the parent/guardian, legal representative, or caregiver.
Medical record requirements: In addition to standard well baby care records, the physician must record the 18-month age-appropriate developmental screen and any concerns identified from the review of the standardized tool.
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