A007 – Intermediate assessment or well baby care
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An intermediate assessment is a primary care general practice service that requires a more extensive examination than a minor assessment. It requires a history of the presenting complaint(s), inquiry concerning, and examination of the affected part(s), region(s), system(s), or mental or emotional disorder as needed to make a diagnosis, exclude disease, and/or assess function. Well baby care is a periodic assessment of a well newborn / infant during the first two years of life including complete examination with weight and measurements, and instructions to the parent(s) or patient’s representative regarding health care.
When to Use
- Bill A007 for a 15-month-old infant's routine check-up, including a complete physical exam, weight, and measurements, as this falls within the first two years of life and is not the specific 18-month visit (A002).
- Use A007 for an intermediate assessment of a 40-year-old patient presenting with a persistent cough and fever, requiring a detailed history, physical examination of the respiratory system, and diagnostic workup.
- Bill A007 for a follow-up visit for a patient with a new diagnosis of hypertension, where a comprehensive history, physical exam, and discussion of management plan are performed.
Common Pitfalls
- Billing A007 for a simple follow-up of a stable chronic condition without a documented change in status or need for a more extensive assessment than a minor assessment (A001).
- Submitting A007 for a well baby visit after the child's second birthday; K017 (Periodic health visit - child) is the appropriate code for routine check-ups beyond 24 months.
- Claiming A007 on the same day as A008 (Mini assessment), as these codes are mutually exclusive for same-day billing.
Billing Tips
- When performing a well baby visit for a patient aged 0-24 months, ensure documentation includes weight, measurements, and parental counselling to support the A007 claim.
- If a patient 65 years or older requires an intermediate assessment, remember to add the 15% Age-Based Fee Premium (GP64) to the A007 fee.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Primary Care / Family Practice
Assessment
For Intermediate Assessment: Requires history of presenting complaint, inquiry, and examination of affected parts/regions/systems/mental disorder as needed to make a diagnosis, exclude disease, and/or assess function.
For Well Baby Care: Requires complete examination with weight and measurements, and instructions to the parent(s) or representative regarding health care.
Must include a direct physical encounter (unless billed as virtual care A007A).
Must include all specific elements of assessments as defined in (history, physical exam, inquiry, arrangements for follow-up, etc.).
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