A253 – Optometrist-Requested Assessment (ORA)
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Optometrist-requested assessment (ORA) is an assessment of a patient provided by an ophthalmologist upon the written request of an optometrist because of the complex, obscure or serious nature of the patient’s problem. Urgent or emergency requests may be initiated verbally but must also be documented in writing. The ORA includes the common and specific elements of a specific assessment.
When to Use
- Bill A253 when an optometrist refers a patient with a complex retinal detachment requiring surgical planning, and the ophthalmologist's assessment is crucial for determining the next steps.
- Use A253 for a patient with a suspected optic nerve tumor referred by an optometrist, where a detailed assessment beyond a standard eye exam is needed to guide further investigation.
- A253 is appropriate when an optometrist refers a patient with a rapidly progressing anterior uveitis that is not responding to initial treatment, necessitating a specialist ophthalmologist's evaluation.
Common Pitfalls
- Failure to retain the optometrist's written request in the patient's chart is a common reason for claim rejection or fee reduction.
- Submitting A253 when the assessment duration meets the criteria for A256 (minimum 50 minutes direct contact) will result in an incorrect claim.
- Billing A253 for a patient with uveitis or neuro-ophthalmic disorders when the ophthalmologist has the relevant fellowship training, as A931 or A241 would be the correct, more specific codes.
Billing Tips
- Ensure the written report of findings, opinions, and recommendations is sent to both the referring optometrist and the patient's primary care provider to avoid payment adjustments.
- Verify that the patient's condition is genuinely complex, obscure, or serious; routine eye exams referred by optometrists do not qualify for A253.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Urgent or emergency requests may be initiated verbally but must also be documented in writing.
The ophthalmologist must submit his/her findings, opinions and recommendations in writing to both the optometrist and the patient’s primary care physician or nurse practitioner, if applicable.
The written request from the optometrist must be retained on the patient’s permanent medical record.
The fee for A253 is $86.25 (as of April 1, 2026).
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