What is OHIP billing code A413?

A413 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A413 pay?

The current OHIP fee for A413 is $95.95, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A413 to OHIP?

A413 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A413 claims against the Schedule of Benefits rules before submission.

What codes are related to A413?

Codes related to A413 in the Schedule of Benefits include A414, A411, C413, E098.

All codes

A413

A413 – Medical specific assessment

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

Ask a question

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
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(this code)
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 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, exclude disease, and/or assess function.

Requires a full history of the presenting complaint.

Requires a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.

Must be rendered in a place other than a patient’s home.

Usage limits

Limited to one per patient per physician per 12-month period. This limit is increased to two if the patient presents with a clearly different and unrelated diagnosis, or if the second assessment is a hospital admission assessment occurring at least 90 days after the first.

A414Medical specific re-assessment A411Complex medical specific re-assessment C413Medical specific assessment (Inpatient)E098Gastroenterology chronic disease assessment premium

Claims in excess of the 12-month limits will be adjusted to a lesser assessment fee.

Eligible for Special Visit Premiums in the Emergency Department (Table I), Out-Patient Department (Table II), and Office (Table VIII) if criteria for non-elective travel/sacrifice of office hours are met.

Ready to bill this code?

SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.

Get Started Free Already have an account? Sign in