What is OHIP billing code A313?

A313 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A313 pay?

The current OHIP fee for A313 is $86.40, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A313 to OHIP?

A313 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A313 claims against the Schedule of Benefits rules before submission.

What codes are related to A313?

Codes related to A313 in the Schedule of Benefits include E078, A310, A311.

All codes

A313

A313 – Medical specific assessment

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

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Levels of this visit

The A31x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A318 Partial assessment
A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate…
$44.45
A310 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist (specifically Physical Medicine & Rehabilitation) that requires a full, relevant history and physical…
$75.90
A311 Complex medical specific re-assessment
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition and includes all the…
$82.75
A313 Medical specific assessment(this code)
A medical specific assessment is a service rendered by a specialist in a place other than a patient's home.
$86.40

Consultations

A316 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…
$106.60
A315 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based insured dental…
$220.80

A medical specific assessment is a service rendered by a specialist in a place other than a patient's home. It requires 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. In addition to the common elements, all services described as assessments, or as including assessments (e.g. consultations), include the following specific elements as per : • A. A direct physical encounter with the patient including taking a patient history and performing a physical examination. • B. Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. • C. Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. • D. Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. • E. Making arrangements for follow-up care. • F. Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service and results. • G. When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. • H. Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.

Requires a full history of the presenting complaint and 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.

E078 A310 A311

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