What is OHIP billing code A035?

A035 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A035 pay?

The current OHIP fee for A035 is $114.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A035 to OHIP?

A035 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A035 claims against the Schedule of Benefits rules before submission.

What codes are related to A035?

Codes related to A035 in the Schedule of Benefits include A935, A036, C035.

All codes

A035

A035 – Consultation

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

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Levels of this visit

The A03x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A034 Partial assessment
A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate…
$34.10
A033 Specific assessment
A specialist service requiring a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis…
$56.40

Consultations

A036 Repeat consultation
A repeat consultation is an additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another…
$76.45
A035 Consultation(this code)
A consultation rendered by a specialist in General Surgery (03) following a written request from a referring physician, nurse practitioner, or dental surgeon.
$114.75

A consultation rendered by a specialist in General Surgery (03) following a written request from a referring physician, nurse practitioner, or dental surgeon.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A written report (including findings, opinions, and recommendations) must be sent to the referring provider.

The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.

The medical record must contain a copy of the signed written request (except in common-record environments like hospitals).

The request must identify the consultant, the referrer (name and billing number), and the patient (name and health number).

Usage limits

Limited to one service per two consecutive 12-month periods for the same patient by the same physician for the same diagnosis (except for repeat consultations or specific hospital/ED scenarios). Limited to one service every 12 months for a clearly defined unrelated diagnosis.

A935Special surgical consultation A036Repeat consultation C035Consultation (Hospital In-patient)

Pre-operative consultations for low-risk elective procedures (cataract surgery, colonoscopy, cystoscopy, carpal tunnel surgery, arthroscopic surgery) are only eligible if the medical record demonstrates the consultation is medically necessary.

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