What is OHIP billing code A043?

A043 is "Specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A043 pay?

The current OHIP fee for A043 is $64.90, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A043 to OHIP?

A043 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A043 claims against the Schedule of Benefits rules before submission.

What codes are related to A043?

Codes related to A043 in the Schedule of Benefits include A044, A045, C043.

All codes

A043

A043 – Specific assessment

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

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Levels of this visit

The A04x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A044 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…
$33.40
A043 Specific assessment(this code)
A specific assessment is a service rendered by a specialist in Neurosurgery (04) in a place other than a patient’s home.
$64.90

Consultations

A046 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…
$64.85
A045 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures).
$145.60

A specific assessment is a service rendered by a specialist in Neurosurgery (04) in a place other than a patient’s home. It requires 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, and/or exclude disease, and/or assess function.

Full history of the presenting complaint.

Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.

Must be rendered in a place other than the patient's home (e.g., office or outpatient department).

Usage limits

Limited to one per patient per physician per 12-month period. This limit is increased to two per 12-month period if the patient presents a second time with a complaint for which a clearly different and unrelated diagnosis is made.

A044Partial assessment (Neurosurgery)A045Consultation (Neurosurgery)C043Specific assessment (Hospital In-patient)

A043 is not eligible for Age-based fee premiums (percentage increases) under .

Neurosurgery (04) is not an eligible specialty for the Chronic Disease Assessment Premium.

If the physician is in the hospital but not on duty in the Emergency Department, A043 should be used for assessments in the Emergency or OPD.

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