What is OHIP billing code A263?

A263 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A263 pay?

The current OHIP fee for A263 is $95.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A263 to OHIP?

A263 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A263 claims against the Schedule of Benefits rules before submission.

What codes are related to A263?

Codes related to A263 in the Schedule of Benefits include A264, A661, K119.

All codes

A263

A263 – Medical specific assessment

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(this code)
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
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 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) needed to make a diagnosis, and/or exclude disease, and/or assess function.

Full history of the presenting complaint

Detailed examination of the affected part(s), region(s), or system(s)

Direct physical encounter (unless virtual suffix A is used)

Discussion and advice to the patient or representative

Usage limits

Limited to one per patient per physician per 12 month period. May be increased to two if a second unrelated diagnosis is made or if 90 days have elapsed and it is a hospital admission assessment. Combined limit of 4 per 12 months with A661.

A264Medical specific re-assessment A661Complex medical specific re-assessment K119Paediatric developmental assessment incentive

A263 is not eligible for the age-based percentage premiums (which apply to consultations, not assessments).

Excess services beyond the 12-month limit are adjusted to a lesser assessment fee.

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