A250 – Retinopathy of prematurity assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Retinopathy of Prematurity (ROP) assessment is the service rendered by an ophthalmologist for initial assessment or follow-up assessment(s) of a patient with ROP who is either: a. 9 months of age or younger; or b. aged 10 months to 16 years with minimum stage 3 ROP disease.
When to Use
- Bill A250 for an initial ophthalmological examination of a premature infant under 9 months old to screen for retinopathy of prematurity.
- Bill A250 for follow-up assessments of a patient between 10 months and 16 years old who has been diagnosed with minimum stage 3 retinopathy of prematurity.
- Use A250 for ongoing monitoring of ROP progression in a patient who meets the age and disease stage criteria, even if no active treatment is currently being administered.
Common Pitfalls
- Claims for A250 will be rejected if submitted for patients older than 16 years, unless they have documented minimum stage 3 ROP.
- Do not bill A250 on the same day as any other assessment or consultation code (e.g., A007, A004) by the same physician, as per the same-day restriction.
- A250 is not eligible for virtual care billing; ensure the assessment is performed in person.
Billing Tips
- A250 is not eligible for the GP64 age-based fee premium, unlike ophthalmology assessment codes A233 and A234.
- While C250 is a related code for hospital in-patients, A250 is specifically for out-patient ROP assessments.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Ophthalmology
Assessment
The service is for the initial assessment or follow-up assessment(s) of a patient with Retinopathy of Prematurity (ROP).
Patient is 9 months of age or younger.; or Patient is aged 10 months to 16 years with minimum stage 3 ROP disease.
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