All codes
A064
A064 – Partial Assessment
OHIP General Listings Code — Orthopaedic Surgery (06) · Schedule of Benefits
Partial assessment rendered by an Orthopaedic Surgeon (Specialty 06).
When to Use
- Bill A064 for an orthopaedic surgeon's follow-up visit focused on a specific post-operative issue, such as checking a wound or cast, where a full assessment (A063) is not required.
- Use A064 when an orthopaedic surgeon sees a patient in the office for a brief review of imaging results and provides initial management advice, without a comprehensive history and physical.
- A064 is appropriate for an orthopaedic surgeon's initial assessment of a minor, isolated musculoskeletal complaint that does not warrant a full consultation (A065).
Common Pitfalls
- Billing A064 for a routine follow-up after a major surgical procedure; these typically require a more comprehensive assessment code or are bundled into post-operative care.
- Submitting A064 on the same day as another assessment (e.g., A063) for the same patient unless there is a distinctly separate and unrelated diagnosis documented.
- Claiming A064 for a service that meets the criteria for a full consultation (A065) or a specific assessment (A063), leading to potential downcoding or rejection.
Billing Tips
- A064 is not eligible for the Chronic Disease Assessment Premium (E078) because Orthopaedic Surgery is not a listed specialty for this premium.
- While A064 has no specific frequency limit, ensure each claim represents a distinct, medically necessary partial assessment and not simply a brief check-in.
Provider Fee$0.00
Specialist Fee$24.25
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Orthopaedic Surgery (06)
Service Type
Consultations and Visits
Code Classes
Assessment
A history of the presenting complaint.
The necessary physical examination.
Advice to the patient.
An appropriate record of the service.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.