A261 – Level 1 - Paediatric assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Level 1 paediatric assessment includes one or both of the following: a. a brief history and examination of the affected part or region or related to a mental or emotional disorder; or b. brief advice or information regarding health maintenance, diagnosis, treatment and/or prognosis.
When to Use
- Use A261 for a brief assessment of a specific pediatric condition, such as a rash or minor injury, where only a focused history and exam are performed.
- Bill A261 when providing brief anticipatory guidance on a common childhood issue like teething or sleep habits, without a comprehensive review of systems.
- A261 is appropriate for a quick follow-up on a stable pediatric condition with minimal changes, focusing on the affected area or a specific concern.
Common Pitfalls
- Billing A261 when a more comprehensive assessment (e.g., A262) or a specific medical assessment (A263) is warranted based on the complexity and duration of the visit.
- Submitting A261 on the same day as another assessment or consultation code (e.g., A001, A263) by the same physician for the same patient, unless distinct diagnoses are clearly documented.
- Attempting to bill the E078 Chronic disease assessment premium with A261; only Level 2 paediatric assessments (A262) and certain other medical assessments (GP25) are eligible.
Billing Tips
- A261 is the paediatric equivalent of a Minor Assessment (A001) and should be used for similar levels of complexity in pediatric patients.
- Ensure the documentation clearly reflects either a brief history/exam of the affected part or region, or brief advice/information regarding health maintenance, diagnosis, treatment, and/or prognosis to support the A261 claim.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Paediatrics
Assessment
A Level 1 paediatric assessment includes one or both of the following: a. a brief history and examination of the affected part or region or related to a mental or emotional disorder; or b. brief advice or information regarding health maintenance, diagnosis, treatment and/or prognosis.
Paediatric patient
A261 is the paediatric specialty equivalent of a Minor Assessment (A001).
If a specialist renders A261 in the Emergency Department or Out-Patient Department and subsequently admits the patient to hospital, an admission assessment (e.g., C263) is eligible for payment in addition to A261 if each service is rendered separately.
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