What is OHIP billing code A063?

A063 is "Specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A063 pay?

The current OHIP fee for A063 is $45.55, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A063 to OHIP?

A063 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A063 claims against the Schedule of Benefits rules before submission.

What codes are related to A063?

Codes related to A063 in the Schedule of Benefits include A065, A066, A064, C063.

All codes

A063

A063 – Specific assessment

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

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Levels of this visit

The A06x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A064 Partial assessment
Partial assessment rendered by an Orthopaedic Surgeon (Specialty 06).
$25.95
A063 Specific assessment(this code)
A specific assessment is a service rendered by a specialist (Orthopaedic Surgery) in a place other than a patient’s home.
$45.55

Consultations

A066 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…
$55.35
A065 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures).
$89.80

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.

Full history of the presenting complaint.

Detailed examination of the affected part(s), region(s), or system(s) to make a diagnosis, exclude disease, or assess function.

Usage limits

Limited to one per patient per physician per 12-month period. A second assessment is allowed within the same 12-month period only if the patient presents with a clearly different and unrelated diagnosis.

A065Consultation A066Repeat consultation A064Partial assessment C063Specific assessment (In-patient)

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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