What is OHIP billing code A415?

A415 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A415 pay?

The current OHIP fee for A415 is $159.45, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A415 to OHIP?

A415 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A415 claims against the Schedule of Benefits rules before submission.

What codes are related to A415?

Codes related to A415 in the Schedule of Benefits include C415, A545, A416, A120, C545, C416.

All codes

A415

A415 – Consultation

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
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(this code)
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 consultation is an assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon who requests the opinion of a gastroenterologist because of the complexity, seriousness, or obscurity of the case.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

Written request from a referring physician, nurse practitioner, or dental surgeon.

Written report back to the referring provider including findings, opinions, and recommendations.

Must include a general, specific, or medical specific assessment.

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common 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.

OHIP diagnostic codes: 263, 555, 556, 571, 579

Usage limits

One per two consecutive 12 month periods for the same diagnosis; one every 12 months for an unrelated diagnosis.

C415 A545 A416 A120 C545 C416

Virtual care (A415A) is restricted to Video Only (Appendix J).

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