A054 – Medical Specific Re-Assessment
OHIP General Listings Code — Community Medicine (05) · Schedule of Benefits
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.
When to Use
- Bill A054 when a specialist in community medicine performs a relevant history and physical examination of one or more systems for a patient previously seen by the same physician for the same condition.
- Use A054 for a follow-up assessment of a specific medical condition by a community medicine specialist, distinct from a general assessment (A053) or a complex re-assessment (A051).
- A054 is appropriate when a specialist in community medicine re-evaluates a patient's condition post-hospitalization for the same illness, provided the physician also saw the patient prior to admission.
Common Pitfalls
- Billing A054 for a new patient or a patient not previously seen by the physician for the same condition will lead to rejection; use A053 instead.
- Submitting A054 for a patient already seen by the same physician for the same condition within the last 12 months, exceeding the two-visit limit, will result in payment adjustment to a lesser assessment fee.
- Claiming A054 for a service that is primarily a procedure, unless the assessment is for a clearly unrelated condition, may be considered included in the procedure fee.
Billing Tips
- Ensure the documentation clearly details the relevant history and physical examination of one or more systems to support the medical-specific nature of the re-assessment.
- A054 is eligible for the Chronic Disease Assessment Premium (E078) if the patient has a documented chronic disease and the service meets all E078 criteria, including being performed in an office or hospital out-patient clinic setting.
Effective: June 1, 2025
Consultations and Visits
Community Medicine (05)
Office/Out-patient
Assessment
Requires a full, relevant history and physical examination of one or more systems.
If rendered as a virtual care service (A054A), it must meet the requirements for comprehensive virtual care (video or telephone).
Admission assessments are deemed to be a medical specific re-assessment if the patient was assessed by the same physician prior to admission for the same illness.
A054 is specifically listed under the Community Medicine (05) specialty section.
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