What is OHIP billing code A004?

A004 is "General re-assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A004 pay?

The current OHIP fee for A004 is $39.35, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A004 to OHIP?

A004 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A004 claims against the Schedule of Benefits rules before submission.

What codes are related to A004?

Codes related to A004 in the Schedule of Benefits include A003, C004, W004.

All codes

A004

A004 – General re-assessment

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The A00x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A008 Mini assessment
A mini assessment is rendered when an assessment of a patient for an unrelated non-WSIB problem is performed during the same visit as an assessment of a WSIB related problem for…
$13.40
A001 Minor assessment
A minor assessment includes one or both of the following: a brief history and examination of the affected part or region or related to a mental or emotional disorder…
$26.80
A004 General re-assessment(this code)
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…
$39.35
A007 Intermediate assessment or well baby care
An intermediate assessment is a primary care general practice service that requires a more extensive examination than a minor assessment.
$44.55
A003 General assessment
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…
$95.60

Consultations

A006 Repeat consultation
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval…
$47.10
A005 Consultation
A consultation is an assessment rendered following a written request from a referring: physician 2.
$95.60

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.

Requires a full history (presenting complaint, family medical history, past medical history, social history, and functional inquiry into all body parts and systems), though history elements already obtained in the original assessment need not be repeated.

Requires an examination of all body parts and systems, except for breast, genital, or rectal examination where not medically indicated or refused.

May include a detailed examination of one or more parts or systems.

Usage limits

Limited to two per 12 month period, per patient per physician. General re-assessments rendered for hospital admissions are exempt from this limit. Excess services are adjusted to a lesser assessment fee.

A003General assessment C004In-patient general re-assessment W004Long-Term Care general re-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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