All codes
A133
A133 – Medical specific assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A service rendered by a specialist in a place other than a patient’s home, requiring a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
When to Use
- Billing for a specialist's initial in-depth assessment of a new neurological condition like suspected Guillain-Barré syndrome, requiring a detailed history and neurological exam.
- Using A133 for a rheumatologist's comprehensive evaluation of a patient presenting with new-onset inflammatory arthritis, including joint examination and diagnostic workup planning.
- Billing for an endocrinologist's detailed assessment of a patient with newly diagnosed Cushing's disease, involving a thorough history of symptoms and physical examination of relevant systems.
Common Pitfalls
- Billing A133 for a follow-up visit that should be coded as A134 (Medical specific re-assessment) or A131 (Complex medical specific re-assessment).
- Submitting A133 for a patient's home visit; C133 is the appropriate code for in-patient assessments.
- Exceeding the one per patient per physician per 12-month limit without meeting the criteria for a second claim (different diagnosis or 90 days elapsed plus hospital admission).
Billing Tips
- A133 is eligible for the E078 Chronic Disease Assessment Premium if the patient has an established chronic disease and the assessment is performed by an eligible specialist in an office or hospital outpatient clinic setting.
- For virtual care, remember to append the 'A' suffix to A133 (i.e., A133A) to indicate a telemedicine service.
Provider Fee$0.00
Specialist Fee$81.55
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
Full history of the presenting complaint
Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.