What is OHIP billing code A051?

A051 is "Complex Medical Specific Re-Assessment", an OHIP General Listings code from the Ontario Schedule of Benefits (Physician Services).

How much does A051 pay?

The current OHIP fee for A051 is $0.00, effective 2025-06-01, per the Ontario Schedule of Benefits.

How do I bill A051 to OHIP?

A051 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A051 claims against the Schedule of Benefits rules before submission.

What codes are related to A051?

Codes related to A051 in the Schedule of Benefits include A053, A054, C051.

All codes

A051

A051 – Complex Medical Specific Re-Assessment

OHIP General Listings Code — Community Medicine (05) · Schedule of Benefits

Ask AI Bill This Code — Sign Up Free

A service rendered by a specialist in Community Medicine (05) requiring a full, relevant history and physical examination of one or more systems.

When to Use

Bill A051 when a specialist in Community Medicine performs a detailed history and physical examination of a patient with a new, complex condition requiring specialist input, distinct from a routine follow-up.
Use A051 for a specialist re-assessment of a patient with a chronic condition that has significantly worsened or changed, necessitating a comprehensive review of multiple systems beyond a standard re-assessment (A054).
Consider A051 when a patient presents with multiple, interconnected symptoms that require a thorough, system-specific examination to differentiate between potential complex diagnoses.

Common Pitfalls

Billing A051 more than twice per patient per physician within a 12-month period, unless it's for a hospital admission, will lead to rejection.
Submitting A051 claims that exceed the combined limit of 4 per patient per physician per 12 months when combined with A053 claims, even if the individual A051 limit is not reached.
Failing to document a 'full, relevant history' and a 'physical examination of one or more systems' can result in an audit or claim rejection for A051.

Billing Tips

When billing A051 for virtual care, remember to append the 'A' suffix to the code.
If A051 is performed during a time eligible for special visit premiums (e.g., evenings, weekends), ensure the appropriate premium codes are submitted alongside A051 and that the time of service is documented.

Have a specific question? Ask our billing assistant

Provider Fee$0.00

Specialist Fee$70.90

Effective: June 1, 2025

Ready to bill this code?

SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.

Get Started Free Already have an account? Sign in