A241 – Optometrist-requested assessment for neuro-ophthalmic disorders
OHIP General Listings Code · Schedule of Benefits
An assessment in which the ophthalmologist provides all the elements of an Optometrist-Requested Assessment (A253) for a patient with a neuro-ophthalmic disorder.
When to Use
- Bill A241 when an optometrist refers a patient specifically for a neuro-ophthalmic disorder assessment, requiring a detailed examination of neurological and ocular findings.
- Use A241 instead of A253 when the referral from the optometrist explicitly states a suspected neuro-ophthalmic condition, such as optic neuritis or cranial nerve palsies affecting vision.
- A241 is appropriate when the assessment includes a neurological examination component (at least four elements documented, including a neurological exam) in addition to ocular findings for a neuro-ophthalmic disorder.
Common Pitfalls
- Submitting A241 without retaining the written request from the optometrist can lead to reduced payment, as this is a mandatory documentation requirement.
- Failure to document at least four specific elements (e.g., pupillary exam, neurological exam, visual fields, fundus exam) will result in rejection or require billing a general assessment code.
- Billing A241 for a general neuro-ophthalmology consultation requested by a physician or NP; code A231 should be used in those instances.
Billing Tips
- Ensure the written report detailing findings, opinions, and recommendations is sent to both the referring optometrist and the patient's primary care physician (if applicable) to avoid payment issues.
- A241 cannot be billed for virtual care (telephone or video) as it is not listed in Appendix J.
Effective: April 1, 2026
Ophthalmology
Assessment
At least four of the following must be documented as part of the examination: (a) Detailed pupillary examination (includes pharmacological testing as applicable), (b) Detailed extraocular motility examination, (c) Ocular alignment testing, (d) Partial or complete neurological examination, (e) Detailed examination of the fundus, (f) Analysis of formal visual field test(s), (g) Analysis of pertinent diagnostic imaging studies.
The ophthalmologist must submit findings, opinions, and recommendations in writing to both the referring optometrist and the patient’s primary care physician or nurse practitioner (if applicable).
The written request from the optometrist must be retained in the patient’s permanent medical record.
Urgent or emergency requests may be initiated verbally but must be documented in writing.
A241 is not eligible for virtual care (video or telephone) as it is not listed in Appendix J (/).
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