All codes
A400
A400 – Comprehensive Community Medicine Consultation
OHIP General Listings Code — Community Medicine (05) · Schedule of Benefits
A consultation rendered by a specialist in community medicine who provides all the appropriate elements of a consultation 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.
When to Use
- When a patient requires an in-depth assessment of complex social determinants of health impacting their chronic disease management, exceeding the scope of a standard A055.
- For a patient presenting with multiple, interconnected health issues requiring a holistic community-based care plan, justifying the 75-minute direct contact requirement.
- When a specialist in community medicine is consulted for a patient with significant barriers to accessing primary care, necessitating a comprehensive evaluation and care coordination strategy.
Common Pitfalls
- Billing A400 when the direct patient contact time is less than 75 minutes, leading to a reduced fee or rejection.
- Failing to document the start and stop times of the patient encounter in the medical record, which can result in a payment adjustment.
- Not obtaining a written request from the referring provider or not sending a written report back, which can reduce the payable amount to a lesser assessment fee.
Billing Tips
- Ensure that any time spent on separately billable procedures or non-patient-facing tasks (e.g., chart review, documentation) is strictly excluded from the 75-minute minimum.
- Verify that the patient's diagnosis for which A400 is billed has not been seen within the last 24 months, or clearly document that the current consultation is for a distinct, unrelated diagnosis if within the 12-month period.
Provider Fee$0.00
Specialist Fee$240.55
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Community Medicine (05)
Service Type
Consultations and Visits
Code Classes
Consultation
A050Special community medicine consultation (minimum 50 minutes)A055Community medicine consultation (standard)A405Limited community medicine consultationA056Repeat community medicine consultationC400Comprehensive community medicine consultation - Hospital In-patientW400Comprehensive community medicine consultation - Long-Term Care
The calculation of time excludes non-patient-facing time such as time spent reviewing charts, imaging, or documentation.
The fee for A400 is $270.60 (as of the current Schedule).
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