What is OHIP billing code A265?

A265 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A265 pay?

The current OHIP fee for A265 is $190.35, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A265 to OHIP?

A265 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A265 claims against the Schedule of Benefits rules before submission.

What codes are related to A265?

Codes related to A265 in the Schedule of Benefits include A260, A662, A667, A266, A565, C265, W265.

All codes

A265

A265 – 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(this code)
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 consultation rendered by a Paediatrician following a written request from a referring physician, nurse practitioner, or dental surgeon, requiring a comprehensive assessment and a written report with findings and recommendations.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

Written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures).

Written report (including findings, opinions, and recommendations) must be sent to the referring provider.

The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.

A copy of the signed written request must be kept in the consultant's 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.

Usage limits

Limited to one service per two consecutive 12-month periods for the same diagnosis by the same physician (except for hospital inpatients or ED visits between 12-24 months). Limited to one service every 12 months for a clearly defined unrelated diagnosis.

A260Special paediatric consultation (minimum 75 minutes)A662Extended special paediatric consultation (minimum 90 minutes)A667Neurodevelopmental consultation A266Paediatric repeat consultation A565Paediatric limited consultation C265Paediatric consultation (Hospital Inpatient)W265Paediatric consultation (Long-Term Care)

Neurodevelopmental consultations for less complex conditions (e.g., attention deficit disorder) are payable at a lesser fee (A265) compared to the complex neurodevelopmental code (A667).

A265 is the standard paediatric consultation code; for services exceeding 75 minutes of direct contact, see A260.

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