What is OHIP billing code A243?

A243 is "Specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A243 pay?

The current OHIP fee for A243 is $44.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A243 to OHIP?

A243 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A243 claims against the Schedule of Benefits rules before submission.

What codes are related to A243?

Codes related to A243 in the Schedule of Benefits include A244, A245, C243.

All codes

A243

A243 – Specific assessment

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

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Levels of this visit

The A24x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A244 Partial assessment
A partial assessment is the limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient and appropriate…
$30.45
A243 Specific assessment(this code)
Specific assessment and medical specific assessment are services rendered by specialists, in a place other than a patient’s home, and require a full history of the presenting…
$44.75

Consultations

A246 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…
$53.65
A245 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental…
$92.70

Specific assessment and medical specific assessment are services rendered by specialists, in a place other than a patient’s home, and require a full history of the presenting complaint and 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.

Must be rendered in a place other than a 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 the patient presents a second time with a complaint for which a clearly different and unrelated diagnosis is made.

A244Partial assessment A245Consultation C243Specific assessment (Hospital In-patient)

A243 is the specific assessment code for Otolaryngology (24).

For hospital in-patients, use code C243.

For non-emergency long-term care in-patient services, A243 is used unless specific LTC codes apply.

Not eligible for age-based fee premiums ().

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