What is OHIP billing code A260?

A260 is "Special paediatric consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A260 pay?

The current OHIP fee for A260 is $342.25, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A260 to OHIP?

A260 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A260 claims against the Schedule of Benefits rules before submission.

What codes are related to A260?

Codes related to A260 in the Schedule of Benefits include A265, A662, A667, C260, W260.

All codes

A260

A260 – Special paediatric consultation

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

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Levels of this visit

The A26x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A261 Level 1 - Paediatric assessment
A Level 1 paediatric assessment includes one or both of the following: a brief history and examination of the affected part or region or related to a mental or emotional disorder…
$24.85
A262 Level 2 - Paediatric assessment
A Level 2 paediatric assessment is a paediatric service that requires a more extensive examination than a level 1 paediatric assessment.
$50.20
A264 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist in Paediatrics (26) that requires a full, relevant history and physical examination of one or more systems.
$70.75
A263 Medical specific assessment
A service rendered by a specialist in Paediatrics requiring a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s)…
$95.75

Consultations

A266 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…
$104.70
A265 Consultation
A consultation rendered by a Paediatrician following a written request from a referring physician, nurse practitioner, or dental surgeon, requiring a comprehensive assessment and…
$190.35
A260 Special paediatric consultation(this code)
A special paediatric consultation is a consultation in which the physician provides all the elements of a consultation (A265) and spends a minimum of 75 minutes in direct contact…
$342.25

A special paediatric consultation is a consultation in which the physician provides all the elements of a consultation (A265) and spends a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A written report must be provided to the referring practitioner.

Minimum of 75 minutes of direct patient contact is required.

Start and stop times of the service must be recorded in the patient's permanent medical record.

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.

The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.

The written request sets out the information relevant to the referral and specifies the service(s) required.

Age

Paediatrics general listings (A167): adult patient eligible only if seen by the paediatrician in the 12 months before age 18 with ongoing chronic condition management and less than 22 years of age - older patients need written MOH prior approval

Usage limits

Limited to one service per two consecutive 12-month periods for the same diagnosis by the same physician (general consultation limits apply).

A265Paediatric Consultation A662Extended special paediatric consultation (90 min)A667Neurodevelopmental consultation (90 min)C260Special paediatric consultation - Hospital Inpatient W260Special paediatric consultation - Long-term care

Calculation of time excludes non-patient-facing time such as reviewing charts, imaging, or documentation.

Calculation of time excludes time devoted to any other separately billable service or procedure.

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