A115 – Major eye examination
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A major eye examination is a complete evaluation of the eye and vision system for patients aged 20 to 64 inclusive. The examination must include: relevant history (ocular, past medical, family); a comprehensive examination (visual acuity, gross visual field testing by confrontation, ocular mobility, slit lamp examination, ophthalmoscopy and, where indicated, ophthalmoscopy through dilated pupils and tonometry); visual field testing by the same physician where indicated; refraction, and if needed, provision of a refractive prescription; advice and instruction to the patient; submission of the findings of the assessment in writing to the patient's primary care physician or nurse practitioner; and any other medically necessary components of the examination (including eye-related procedures) not specifically listed above.
When to Use
- Bill A115 for a 45-year-old patient presenting with new floaters and flashes, requiring a dilated fundus exam and visual field testing due to suspected retinal tear.
- Use A115 for a 30-year-old patient with a history of uveitis who requires a comprehensive eye exam including slit lamp and tonometry to monitor for complications.
- Bill A115 for a 55-year-old patient referred via E077 for a major eye examination due to a suspected optic nerve anomaly, even if they don't have one of the listed chronic conditions.
Common Pitfalls
- Billing A115 for a routine screening eye exam in a patient without a qualifying medical condition or an E077 referral; use A110/A112 or A237/A239 for age-appropriate periodic assessments.
- Failing to document the submission of findings in writing to the patient's primary care physician or nurse practitioner, which is a mandatory component of A115.
- Billing A115 on the same day as an E077 service by the same physician; E077 is for identifying the need for A115, not for performing the A115 itself.
Billing Tips
- Ensure the patient is between 20 and 64 years inclusive; patients outside this age range require different codes (e.g., A110, A112, A237, A239).
- If the patient does not have a listed medical condition (diabetes, glaucoma, etc.) but requires a major eye exam, ensure they have a valid E077 referral to justify the A115 claim.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Ophthalmology / Primary Care
Assessment
Must include relevant history (ocular medical history, relevant past medical history, relevant family history); a comprehensive examination (visual acuity, gross visual field testing by confrontation, ocular mobility, slit lamp examination, ophthalmoscopy and, where indicated, ophthalmoscopy through dilated pupils and tonometry); visual field testing by the same physician where indicated; refraction, and if needed, provision of a refractive prescription; advice and instruction to the patient; submission of the findings of the assessment in writing to the patient's primary care physician or nurse practitioner; and any other medically necessary components of the examination (including eye-related procedures) not specifically listed above.
Aged 20 to 64 inclusive
A115 is the insured major eye exam for the 20-64 age group with medical necessity.
Not eligible for virtual care (video or telephone).
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