A101 – Limited Virtual Care by Video
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Limited Virtual Care Service is an assessment which includes at a minimum, history-taking and medically appropriate exam to arrive at a diagnosis and provide an appropriate management plan and/or management, and when provided, the other specific elements of assessments.
When to Use
- Use A101 when a patient requires a virtual assessment for a new, acute issue (e.g., rash, minor infection) and a video consultation is medically appropriate and sufficient for diagnosis and management.
- Bill A101 for follow-up virtual care of a chronic condition where a video assessment is necessary to review symptoms or treatment efficacy, provided it's a medically necessary follow-up to a patient-initiated visit.
- A101 is appropriate for a physician not acting as MRP in a facility, assessing a patient via video when local expertise is lacking and a preceding in-person assessment occurred within 30 days.
Common Pitfalls
- Billing A101 when the service could not be completed virtually and required an in-person encounter; only the in-person service is then payable, and A101 should not be claimed for the same clinical issue on the same day.
- Failure to document the video modality in the patient's medical record can lead to claim rejection or audit issues.
- Submitting A101 for physician-initiated 'check-ins' or administrative calls, which are not eligible for payment under this code.
Billing Tips
- When providing A101 to a patient with whom you do not have an existing/ongoing relationship, append the suffix 'A' to the A101 code.
- Ensure the patient and physician are both located in Ontario at the time of the virtual service to meet OHIP eligibility requirements.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Virtual Care
Assessment
Must be initiated by the patient or the patient’s representative, or represent a medically necessary follow-up to a preceding visit initiated by the patient.
The delivery modality (Video) must be documented on the patient's medical record.
The physician must personally perform the service or rendered in accordance with the payment rules regarding supervision of a Medical Trainee.
If it becomes apparent that the service cannot be appropriately completed without a direct physical encounter, the virtual service is not eligible for payment; only the in-person service is eligible.
An 'Existing/Ongoing Patient-Physician Relationship' is defined as: 1) At least one in-person insured service in the preceding 24 months; 2) Patient is enrolled to the physician or their group; 3) A video consultation was provided in the preceding 24 months; or 4) Specific services (e.g., A920, A945) were provided in the preceding 24 months.
If the modality changes during the service (e.g., phone to video), only the modality representing more than 50% of the time is payable.
Physician-initiated 'check-ins' or administrative calls are not eligible for payment.
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