What is OHIP billing code A163?

A163 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A163 pay?

The current OHIP fee for A163 is $95.95, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A163 to OHIP?

A163 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A163 claims against the Schedule of Benefits rules before submission.

What codes are related to A163?

Codes related to A163 in the Schedule of Benefits include A165, A160, A865, A166, A164, A161, A168, C163.

All codes

A163

A163 – Medical specific assessment

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The A16x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A168 Partial assessment
A partial assessment is a limited medical service that includes a history of the patient's presenting complaint, the necessary physical examination, advice to the patient, and the…
$44.75
A164 Medical specific re-assessment
A medical specific re-assessment rendered by a specialist in Nephrology.
$72.00
A161 Complex medical specific re-assessment
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition and includes all the…
$83.40
A163 Medical specific assessment(this code)
A medical specific assessment is a service rendered by a specialist in Nephrology (16) in a place other than a patient’s home.
$95.95

Consultations

A166 Repeat consultation
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…
$116.75
A165 Consultation
A consultation rendered by a specialist in nephrology following a written request from a referring physician, nurse practitioner, or dental surgeon.
$180.75
A160 Comprehensive nephrology consultation
A consultation rendered by a specialist in nephrology who provides all the appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of direct…
$342.25

A medical specific assessment is a service rendered by a specialist in Nephrology (16) in a place other than a patient’s home. It requires a full history of the presenting complaint and a 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.

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.

Rendered in a place other than the patient's home.

Usage limits

Limited to one per patient per physician per 12 month period. This limit is increased to two per 12 month period if: (1) the patient presents a second time with a clearly different and unrelated diagnosis, or (2) at least 90 days have elapsed and the second assessment is a hospital admission assessment.

A165Consultation A160Comprehensive nephrology consultation A865Limited consultation A166Repeat consultation A164Medical specific re-assessment A161Complex medical specific re-assessment A168Partial assessment C163Medical specific assessment (In-patient)

The amount payable for assessments in excess of the 12-month limits will be adjusted to a lesser assessment fee.

A163 is not eligible for the Chronic Disease Assessment Premium as Nephrology (16) is not an eligible specialty for that premium.

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