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A441
A441 – Additional subsequent visits
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient necessitated by the complexity, obscurity, or seriousness of the patient’s condition. It requires a full history of the presenting complaint and a physical examination of one or more systems.
When to Use
- Bill A441 when a Medical Oncology patient requires a comprehensive re-evaluation due to a significant change in their condition, such as new metastatic disease or a severe treatment complication, necessitating a full history and system examination.
- Use A441 for a patient with a complex cancer diagnosis who presents for a scheduled re-assessment where the physician needs to delve deeply into new symptoms, review extensive recent investigations, and formulate a revised treatment plan.
- A441 is appropriate when a patient's cancer treatment response is ambiguous, requiring a detailed assessment of multiple organ systems to determine efficacy and potential toxicity, beyond what is covered by A444 (Medical specific re-assessment).
Common Pitfalls
- Claims for A441 may be reduced to a lesser assessment fee if the physician does not submit written findings, opinions, or recommendations to the patient's primary care physician.
- Exceeding the limit of 4 A441 services per patient per physician per 12-month period will result in the claim being adjusted to a lesser assessment fee.
- Billing A441 for an in-patient requires using C441 instead; failure to do so will lead to claim rejection or adjustment.
Billing Tips
- Ensure the diagnostic code submitted with A441 is appropriate for the complexity and seriousness of the patient's condition being reassessed.
- A441 can be billed with E078 (Chronic disease assessment premium) if the patient has an established chronic disease diagnosis, the service is rendered in an office/out-patient clinic, and all other E078 criteria are met.
Provider Fee$0.00
Specialist Fee$70.90
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Medical Oncology
Code Classes
Assessment
The physician must report his/her findings, opinions, or recommendations in writing to the patient’s primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee.
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