A116 – Repeat consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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 physician in the interval following the initial consultation but preceding the repeat consultation.
When to Use
- Bill A116 when you see a patient for a previously assessed problem, and another physician has provided care for that specific problem since your initial consultation.
- Use A116 if a patient returns for the same issue after seeing a different specialist, and you are providing a subsequent opinion or management plan.
- This code is appropriate when a referring physician requests your opinion again on a complex issue after the patient has undergone investigations or treatments with another provider.
Common Pitfalls
- Billing A116 when the patient has not seen another physician for the same problem in the interval; this scenario may be billable as A715 or a lesser assessment.
- Failing to obtain a new written request from the referring provider for each A116, which is a mandatory requirement.
- Submitting A116 for a new presenting problem, even if the patient has seen you previously; this requires a new consultation code (e.g., A715).
Billing Tips
- Ensure the interval care by another physician is clearly documented in your report to the referring provider to justify the A116.
- Remember to use C116 for hospital in-patients instead of A116, as A116 is for out-patient services.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
A116 is eligible for age-based fee premiums ().
If the requirements for a repeat consultation are not met (e.g., no interval care by another physician), the fee will be adjusted to a lesser assessment fee.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.