A004 – General re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A general re-assessment is a comprehensive assessment service that includes all the elements of a general assessment (A003), with the exception that the patient's history does not need to include all the details already obtained in the original assessment.
When to Use
- Bill A004 when a patient requires a comprehensive reassessment of their health status, including a full history and physical examination, after an initial general assessment (A003) within the past 12 months.
- Use A004 for an admission assessment if a physician has seen the patient for the same presenting illness within 90 days prior to hospital admission.
- A004 is appropriate for a follow-up comprehensive assessment following a significant change in a patient's condition or management plan, provided it meets the criteria for a full re-assessment.
Common Pitfalls
- Billing A004 more than twice per patient per physician within a 12-month period without meeting the hospital admission exception will result in payment adjustment to a lesser assessment fee.
- Submitting A004 for a patient encounter that does not include a full history and examination of all body parts and systems (unless medically indicated or refused) risks claim rejection.
- Using A004 when the patient's history elements have not been updated or when only a focused problem-oriented visit has occurred, instead of a comprehensive re-assessment.
Billing Tips
- A004 is eligible for Special Visit Premiums (e.g., E080 for first post-operative visit) when applicable, provided all other criteria are met.
- When billing A004 for a patient aged 75 or older, ensure the 15% Age Premium is applied to the fee.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
A004 is eligible for Special Visit Premiums (Travel and First/Additional Person Seen) in Emergency, Out-patient, In-patient, LTC, and Home settings.
If a physician has assessed the patient for the same presenting illness within 90 days of a hospital admission, the admission assessment constitutes a general re-assessment (A004).
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