A254 – Ophthalmology consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A follow-up vision rehabilitation assessment by an ophthalmologist of a patient with either low visual acuity, visual field defect, or significant oculomotor dysfunction. Definitions The following phrases have the following meanings for the purpose of fee schedule code A254: - Low visual acuity: best corrected visual acuity of 20/50 (6/15) or less in the better eye and not amenable to further medical and/or surgical treatment. - Significant oculomotor dysfunction: nerve palsy or nystagmus resulting in low visual acuity or visual field defects as defined and not amenable to further medical and/or surgical treatment. - Visual field defect: splitting of fixation, scotomata, quadranopic or hemianopic field defects not amenable to further medical and/or surgical treatment. This service is only payable when a minimum of three (3) of the following eight (8) listed components are rendered during the same visit: 1. Cognitive assessment to determine capacity to cooperate with assessment and treatment. 2. Assessment of residual visual function to include at least two of the following tests: visual acuity tested with ETDRS charts, macular perimetry, contrast sensitivity tested at 5 spatial frequencies and fixation instability. 3. Assessment of eccentric preferred retinal loci. 4. Assessment of near functional visual acuity with ETDRS charts. 5. Assessment of reading skills. (Commentary: For example, using MNRead or Colenbrander charts.) 6. Prescribing of low vision devices aimed to improve residual visual function. 7. Preparation of a vision rehabilitation plan and/or discussion of the plan with the patient. 8. Supervised training of the patient, in accordance with recognized programs, for use of low vision devices and/or training for rehabilitation of skills dependent on vision. This service includes the common and specific elements of an assessment as outlined in the General Preamble on pages -.
When to Use
- Bill A254 for a follow-up assessment of a patient with established low vision (e.g., best corrected acuity 20/50 or worse) who is not a surgical candidate and requires a structured plan for vision rehabilitation.
- Use A254 when assessing a patient with a significant visual field defect (e.g., hemianopia) that impacts daily function and is not amenable to further medical treatment, provided at least three of the required components are met.
- A254 is appropriate for patients with oculomotor dysfunction like nystagmus or nerve palsy causing visual impairment, where the focus is on maximizing residual function and rehabilitation, not on treating the underlying cause.
Common Pitfalls
- Billing A254 without documenting at least three of the eight specified components (e.g., cognitive assessment, residual visual function tests, low vision device prescription) will lead to rejection.
- Do not bill A254 if the patient's condition (low acuity, visual field defect, oculomotor dysfunction) is amenable to further medical or surgical treatment; this code is for rehabilitation of non-improvable conditions.
- Avoid billing A254 on the same day as A252 (Ophthalmology consultation) by the same physician, as only one assessment or consultation is payable per patient per day.
Billing Tips
- Ensure your documentation clearly lists which three (or more) of the eight required components were performed and specifies the patient's condition (low visual acuity, visual field defect, or oculomotor dysfunction) meeting the definition.
- A254 is a follow-up service; confirm the patient has had a prior A252 service by the same physician for the same condition before submitting A254.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
The medical record must document that a minimum of three (3) of the eight (8) required components were rendered during the same visit.
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