A056 – Repeat Consultation
OHIP General Listings Code — Community Medicine (05) · Schedule of Benefits
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 physician in the interval following the initial consultation but preceding the repeat consultation.
When to Use
- Bill A056 when a patient returns for follow-up on the same presenting problem after seeing another physician (e.g., their GP) for a new issue in the interim.
- Use A056 if a patient is referred back to you for the same issue after a hospital admission or a period of care by another specialist, provided the intervening care was for a different condition or problem.
- A056 is appropriate when a patient's condition has evolved, and their primary physician has managed a new aspect of their care before referring back for the original consultation's problem.
Common Pitfalls
- Billing A056 without a new, signed referral from the referring physician, nurse practitioner, or dental surgeon, even if the patient is returning for the same issue.
- Failing to document the intervening care by another physician in the medical record, which is the core requirement differentiating A056 from a standard consultation (A055).
- Submitting A056 when the patient has only seen the consultant again for the same problem without any intervening care by a different physician, which may result in the claim being adjusted to a lesser assessment fee.
Billing Tips
- Ensure the written report sent to the referring provider clearly outlines the intervening care and how it relates to the ongoing management of the original presenting problem.
- When billing virtually, always append the 'A' suffix to A056 and confirm the service was conducted via video, not audio-only.
Effective: June 1, 2025
Consultations and Visits
Community Medicine (05)
Consultations and Visits
Consultation
A new written request from the referring physician, nurse practitioner, or dental surgeon is required for each repeat consultation.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A written report (including findings, opinions, and recommendations) must be prepared and sent to the referring provider.
The medical record must contain a copy of the signed written request identifying the consultant, the referring provider (with billing number), and the patient.
The request must specify the clinical information relevant to the referral and the services required.
Special visit premiums (travel, emergency, etc.) may be billed in addition to A056 if the criteria in - are met.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.