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A443
A443 – First 2 subsequent visits per patient per month
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A service rendered by a specialist in Medical Oncology requiring a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.
When to Use
- Bill A443 for an initial comprehensive assessment of a new oncology patient presenting with a new cancer diagnosis requiring a full history and detailed physical exam.
- Use A443 when a patient with a previously diagnosed cancer requires a new, distinct assessment for a new primary cancer or a significant progression of their existing disease, necessitating a full history and detailed examination.
- A443 is appropriate for an initial assessment of a patient referred for a second opinion on their cancer diagnosis or treatment plan, provided a full history and detailed examination are performed.
Common Pitfalls
- Billing A443 for routine follow-up visits; these should be billed as A444 (Medical specific re-assessment) or A441 (Complex medical specific re-assessment) depending on complexity.
- Submitting A443 for an in-patient assessment; use C443 for in-patients, as A443 is strictly for out-patient services.
- Claim rejections may occur if the documentation does not clearly support a 'full history' and 'detailed examination' for diagnosis, exclusion, or functional assessment, rather than a brief update.
Billing Tips
- Ensure your documentation clearly delineates the 'full history' and 'detailed examination' performed, distinguishing it from a re-assessment (A444/A441).
- A443 is limited to one per 12-month period, with exceptions for different diagnoses or a 90-day gap plus hospital admission; be mindful of these usage limits to avoid adjustments.
Provider Fee$0.00
Specialist Fee$79.85
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Medical Oncology (44)
Code Classes
Assessment
Full history of the presenting complaint
Detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.
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