What is OHIP billing code A411?

A411 is "Complex medical specific re-assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A411 pay?

The current OHIP fee for A411 is $83.40, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A411 to OHIP?

A411 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A411 claims against the Schedule of Benefits rules before submission.

What codes are related to A411?

Codes related to A411 in the Schedule of Benefits include C411, A414, A413.

All codes

A411

A411 – Complex medical specific re-assessment

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

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Levels of this visit

The A41x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A418 Partial assessment
A partial assessment is the limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient and appropriate…
$44.75
A414 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist requiring a full, relevant history and physical examination of one or more systems.
$72.00
A411 Complex medical specific re-assessment(this code)
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.
$83.40
A413 Medical specific assessment
A medical specific assessment is a service rendered by a specialist in a place other than a patient’s home.
$95.95

Consultations

A416 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…
$106.90
A415 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon who requests the opinion of a…
$159.45

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. It includes all the requirements of a medical specific re-assessment (a full, relevant history and physical examination of one or more systems).

The patient's condition must be complex, obscure, or serious.

The physician must report findings, opinions, or recommendations in writing to the patient’s primary care physician.

Requires a full, relevant history and physical examination of one or more systems.

Usage limits

Limited to 4 per patient per physician per 12-month period (combined with medical specific assessments).

C411Complex Medical Specific Re-Assessment (In-patient)A414Medical Specific Re-Assessment A413Medical Specific Assessment

Physicians in hospital but not on duty in the emergency department when seeing patients in the emergency or OPD should use General Listings (A-prefix codes).

Gastroenterology (41) is NOT an eligible specialty for the Chronic Disease Assessment Premium (E078).

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