What is OHIP billing code A065?

A065 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A065 pay?

The current OHIP fee for A065 is $89.80, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A065 to OHIP?

A065 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A065 claims against the Schedule of Benefits rules before submission.

What codes are related to A065?

Codes related to A065 in the Schedule of Benefits include A935, A066, A063, A064.

All codes

A065

A065 – Consultation

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
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(this code)
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 consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures). The consultant physician must be competent to give advice due to the complexity, seriousness, or obscurity of the case. The service includes necessary elements to prepare a written report back 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.

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.

Usage limits

Limited to one service per patient per two consecutive 12-month periods for the same diagnosis (with specific exceptions for hospital/ED settings). Limited to one service every 12 months for a clearly defined unrelated diagnosis.

A935Special surgical consultation A066Repeat consultation A063Specific assessment A064Partial assessment

Eligible for age-based fee premiums (): <30 days (30%), 30 days to <1 year (25%), 1 to <2 years (20%), 2 to <5 years (15%), 5 to <16 years (10%).

Eligible for Special Visit Premiums (-) if criteria for non-elective or travel are met.

If rendered in the Emergency Department by a physician not on duty, use General Listings (A065).

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