A063 – Specific Assessment
OHIP General Listings Code — Orthopaedic Surgery (06) · Schedule of Benefits
A specific assessment is a service rendered by a specialist (Orthopaedic Surgery) in a place other than a patient’s home. It requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
When to Use
- Bill A063 for an initial, comprehensive assessment of a new complaint like chronic knee pain, requiring a full history and targeted physical exam to establish a diagnosis.
- Use A063 when assessing a patient for a new fracture or dislocation, even if a reduction procedure is performed the same day, provided it's the major pre-operative assessment.
- Claim A063 for a specialist assessment of a patient presenting with a distinct, unrelated second problem within 12 months of a previous A063 service for a different diagnosis.
Common Pitfalls
- Billing A063 for a routine follow-up of a previously assessed condition; use A064 (Partial Assessment) or other appropriate follow-up codes instead.
- Submitting A063 for a service that meets the criteria for a formal consultation (A065), which requires a written request from a referring physician or NP.
- Claiming A063 for an in-patient assessment; use C063 for hospital in-patients instead.
Billing Tips
- If the 12-month usage limit for A063 is exceeded for the same diagnosis, the claim will be adjusted to the fee of A064.
- A063A can be submitted for virtual care assessments, provided all requirements for the code are met remotely.
Effective: June 1, 2025
Consultations and Visits
Orthopaedic Surgery (06)
Consultations and Visits
Assessment
A063 is the 'General Listing' code for Orthopaedic Surgery assessments in office or out-patient settings.
Special visit premiums (travel and sacrifice of office hours) are eligible when A063 is rendered as a non-elective service in the Emergency Department, Out-patient Department, or Hospital In-patient setting.
Not eligible for Age-Based Fee Premiums () or Chronic Disease Assessment Premiums ().
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