A003 – General assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general assessment is a service, rendered at a place other than in a patient’s home that requires a full history (the elements of which must include a history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems), and, except for breast, genital or rectal examination where not medically indicated or refused, an examination of all body parts and systems, and may include a detailed examination of one or more parts or systems.
When to Use
- Use A003 for a comprehensive annual physical or periodic health examination that requires a full systems review and complete physical exam, unlike the more focused A007 intermediate assessment.
- Use A003 for a new patient intake where a complete baseline medical history and full physical examination are required to establish the patient's health status.
Common Pitfalls
- Billing A003 more than once per 12-month period without a distinct, unrelated diagnosis or a qualifying hospital admission will result in an automatic downgrade to a lower-valued assessment code.
- Failing to document the functional inquiry for all body systems or omitting a physical exam of systems beyond the presenting complaint will lead to audit recovery, as A003 requires a 'full' assessment by definition.
Billing Tips
- Ensure you append the appropriate age premium for patients 65 and older, as A003 is eligible for a 15% increase under the AGE_PREMIUM_65 rule.
- If you perform a procedure during the same encounter, verify if it is separately billable; if it is not, the procedure is considered included in the A003 fee.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
In-person
Assessment
Full history (the elements of which must include a history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems).
Examination of all body parts and systems (except for breast, genital or rectal examination where not medically indicated or refused), and may include a detailed examination of one or more parts or systems.
A003 is not eligible for payment for an assessment provided in the patient’s home.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.