What is OHIP billing code A055?

A055 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A055 pay?

The current OHIP fee for A055 is $152.80, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A055 to OHIP?

A055 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A055 claims against the Schedule of Benefits rules before submission.

What codes are related to A055?

Codes related to A055 in the Schedule of Benefits include A050, A400, A405, A056, C055, W055.

All codes

A055

A055 – Consultation

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
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(this code)
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 consultation rendered by a specialist in community medicine following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary assessment and the preparation of a written report (including findings, opinions, and recommendations) to the referring provider.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.

The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.

The written request sets out the information relevant to the referral and specifies the service(s) required.

The request would ordinarily also include appropriate clinical information, such as the reason for the referral for consultation, present and past history, physical findings and relevant test results and reports.

A written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.

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

Usage limits

Limited to one service per two consecutive 12-month periods for the same diagnosis by the same physician. Exceptions apply if the second service is rendered to a hospital inpatient or in an Emergency Department more than 12 months (but less than 24 months) after the first. Limited to one service every 12 months for a clearly defined unrelated diagnosis.

A050Special community medicine consultation A400Comprehensive community medicine consultation A405Limited consultation A056Repeat consultation C055In-patient consultation W055Long-term care consultation

Preoperative consultations for low-risk elective procedures (e.g., cataracts, colonoscopy) are only eligible if medically necessary and documented as such.

If the consultant has been paid for a consultation and then receives a referral for ongoing management, subsequent services are not payable as consultations.

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