A114 – Medical specific re-assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use A114 for a specialist follow-up visit where a detailed history and physical examination of a specific system (e.g., neurological exam for a patient with a new seizure) is performed, distinct from a general re-assessment.
- Bill A114 when a specialist re-evaluates a patient for a specific condition previously managed, requiring a focused history and exam, and the patient is not an inpatient.
- This code is appropriate for a specialist's assessment of a patient referred for a specific problem, where a comprehensive review of that system is necessary, and the patient has not been seen for this specific issue by the same specialist within the last 12 months.
Common Pitfalls
- Billing A114 when the patient has already been billed for a medical specific re-assessment (A114) by the same physician within the last 12 months, unless it's a hospital admission assessment.
- Submitting A114 for a patient who is an inpatient of any hospital, as C114 (Medical specific re-assessment - In-patient) or other inpatient codes would apply.
- Using A114 when the service provided was a partial assessment (A118) or a general re-assessment, as A114 requires a focus on one or more specific systems.
Billing Tips
- A114 is eligible for the Chronic Disease Assessment Premium (E078) if the patient has a documented chronic disease, the service is rendered in an office or hospital out-patient clinic, and the specialist has a qualifying designation (e.g., Geriatrics, Neurology).
- If A114 is billed in excess of the two per patient per physician per 12-month limit, OHIP will automatically adjust the fee to that of a partial assessment (A118).
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Requires a full, relevant history and physical examination of one or more systems.
If rendered as a hospital admission assessment, it is subject to the rules in (e.g., if the physician has previously assessed the patient for the same illness within 90 days).
Admission assessments are deemed to be a medical specific re-assessment if the admitting physician has previously assessed the patient for the same presenting illness within 90 days ().
A114 is specifically listed under Critical Care Medicine (11) in the Schedule.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.