What is OHIP billing code A204?

A204 is "Partial assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A204 pay?

The current OHIP fee for A204 is $40.50, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A204 to OHIP?

A204 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A204 claims against the Schedule of Benefits rules before submission.

What codes are related to A204?

Codes related to A204 in the Schedule of Benefits include A203, A205, A206, C204.

All codes

A204

A204 – Partial assessment

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

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Levels of this visit

The A20x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A204 Partial assessment(this code)
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…
$40.50
A203 Specific assessment
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)…
$62.65

Consultations

A206 Repeat consultation
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…
$71.45
A205 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon.
$134.25

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 creation of an appropriate medical record.

History of the presenting complaint.

Necessary physical examination.

Advice to the patient.

Appropriate medical record.

Direct physical encounter with the patient (unless provided via virtual care).

A203Specific assessment A205Consultation A206Repeat consultation C204Specific re-assessment (In-patient equivalent)

Used for office or Out-Patient Department (OPD) visits.

Physicians in hospital but not on duty in the Emergency Department use this code when seeing patients in the Emergency or OPD.

Special visit premiums (Travel and First Person Seen) may be applicable if rendered in an OPD or Emergency Department, subject to general preamble restrictions.

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