What is OHIP billing code A461?

A461 is "Complex medical specific re-assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A461 pay?

The current OHIP fee for A461 is $95.05, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A461 to OHIP?

A461 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A461 claims against the Schedule of Benefits rules before submission.

What codes are related to A461?

Codes related to A461 in the Schedule of Benefits include A463, A464, A460, C461, E078.

All codes

A461

A461 – Complex medical specific re-assessment

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

Ask a question

Levels of this visit

The A46x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A468 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…
$62.15
A464 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems.
$82.10
A461 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.
$95.05
A463 Medical specific assessment
A service rendered by an infectious disease specialist in a place other than a patient’s home, requiring a full history of the presenting complaint and a detailed examination of…
$107.00

Consultations

A466 Repeat consultation
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval…
$124.00
A465 Consultation
A consultation rendered by an infectious disease specialist following a written request from a referring physician, nurse practitioner, or dental surgeon.
$205.90
A460 Comprehensive infectious disease consultation
A comprehensive infectious disease consultation requiring a minimum of 75 minutes in direct contact with the patient, satisfying all elements of a consultation as defined in the…
$342.25

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

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

The start and stop times must be recorded in the patient’s permanent medical record.

Must include 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. This limit is shared with medical specific assessments (A463).

A463Medical specific assessment A464Medical specific re-assessment A460Comprehensive infectious disease consultation C461Complex medical specific re-assessment (In-patient)E078Chronic disease assessment premium

The requirement to record start and stop times is explicitly stated in the Infectious Disease section (A125).

The fee for A461 is $95.05 (as of the current Schedule).

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