What is OHIP billing code A223?

A223 is "Extended special genetic consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A223 pay?

The current OHIP fee for A223 is $442.40, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A223 to OHIP?

A223 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A223 claims against the Schedule of Benefits rules before submission.

What codes are related to A223?

Codes related to A223 in the Schedule of Benefits include A225, A220, A226, A221, A325, C223.

All codes

A223

A223 – Extended special genetic consultation

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

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Levels of this visit

The A22x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A221 Genetic minor assessment
A minor assessment provided by a geneticist or a specialist with FCCMG designation, involving a brief history and examination or brief advice/information regarding health…
$38.05

Consultations

A226 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…
$119.40
A225 Consultation
A consultation rendered by a specialist in Genetics (22) or a specialist with FCCMG designation, following a written request from a referring physician, nurse practitioner, or…
$190.50
A220 Special genetic consultation
Special genetic consultation is a consultation in which the physician provides all the elements of a consultation (A225) and spends a minimum of 75 minutes in direct contact with…
$342.25
A223 Extended special genetic consultation(this code)
Extended special genetic consultation is a consultation in which the physician provides all the elements of a consultation (A225) and spends a minimum of 90 minutes in direct…
$442.40

Extended special genetic consultation is a consultation in which the physician provides all the elements of a consultation (A225) and spends a minimum of 90 minutes in direct contact with the patient with or without family, exclusive of time spent rendering any other separately billable intervention to the patient.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

Must be rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based insured dental procedures).

The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.

The physician must spend a minimum of 90 minutes in direct contact with the patient (with or without family).

Start and stop times of the service must be recorded in the patient's permanent medical record.

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 written request sets out the information relevant to the referral and specifies the service(s) required.

Usage limits

Consultations for the same patient by the same physician for the same diagnosis are limited to one service per two consecutive 12-month periods (except for repeat consultations or specific hospital/ED conditions). Consultations for a clearly defined unrelated diagnosis are limited to one service every 12 months.

A225Genetic Consultation A220Special genetic consultation (minimum 75 minutes)A226Genetic Repeat consultation A221Genetic minor assessment A325Genetic Limited consultation C223Extended special genetic consultation (In-patient)

If the requirements for a consultation (e.g., written request, report) are not met, the fee will be reduced to a lesser assessment fee.

Medically necessary consultations for low-risk elective surgeries (e.g., cataract, colonoscopy) are uncommon and must be clearly documented.

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