What is OHIP billing code A165?

A165 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A165 pay?

The current OHIP fee for A165 is $180.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A165 to OHIP?

A165 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A165 claims against the Schedule of Benefits rules before submission.

What codes are related to A165?

Codes related to A165 in the Schedule of Benefits include A160, A865, A166, E082, A160, A865, A166.

All codes

A165

A165 – Consultation

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
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(this code)
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 consultation rendered by a specialist in nephrology following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary assessment (general, specific, or medical specific) and a written report back to the referring provider.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.

The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.

The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.

Usage limits

Limited to one service per patient per two consecutive 12-month periods for the same diagnosis by the same physician. For a clearly defined unrelated diagnosis, limited to one service every 12 months.

A160Comprehensive nephrology consultation (minimum 75 minutes)A865Limited consultation A166Repeat consultation E082Admission Assessment Premium (MRP)A160 A865 A166

If the consultation requirements (written request/report) are not met, the fee will be adjusted to a lesser assessment fee.

Preoperative consultations for low-risk elective procedures (e.g., cataracts, colonoscopy) are only eligible if medically necessary and documented as such.

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