What is OHIP billing code A053?

A053 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A053 pay?

The current OHIP fee for A053 is $83.85, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A053 to OHIP?

A053 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A053 claims against the Schedule of Benefits rules before submission.

What codes are related to A053?

Codes related to A053 in the Schedule of Benefits include A054, A051, C053, A058.

All codes

A053

A053 – Medical specific assessment

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

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Levels of this visit

The A05x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A058 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…
$39.95
A054 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist in community medicine that requires a full, relevant history and physical examination of one or more systems.
$64.30
A051 Complex medical specific re-assessment
A service rendered by a specialist in Community Medicine (05) requiring a full, relevant history and physical examination of one or more systems.
$74.45
A053 Medical specific assessment(this code)
A service rendered by a specialist in Community Medicine in a place other than a patient’s home, requiring a full history of the presenting complaint and detailed examination of…
$83.85

Consultations

A056 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…
$94.75
A055 Consultation
A consultation rendered by a specialist in community medicine following a written request from a referring physician, nurse practitioner, or dental surgeon.
$152.80
A050 Special community medicine consultation
A consultation rendered by a specialist in community medicine who provides all the appropriate elements of a consultation and spends a minimum of 50 minutes in direct contact with…
$176.10

A service rendered by a specialist in Community Medicine in a place other than a patient’s home, requiring a full history of the presenting complaint and 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.

Documentation of findings, diagnosis, and follow-up plan in the medical record.

Usage limits

Limited to one per patient per physician per 12 month period. May be increased to two if a second unrelated diagnosis is made or if 90 days have elapsed and the second service is a hospital admission assessment.

A054Medical specific re-assessment A051Complex medical specific re-assessment C053Medical specific assessment (Hospital In-patient)A058Partial assessment

Used for 'special visits' to long-term care in-patients when applicable.

Excessive claims beyond the 12-month limit will be adjusted to a lesser assessment fee (e.g., partial assessment).

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