What is OHIP billing code A463?

A463 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A463 pay?

The current OHIP fee for A463 is $107.00, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A463 to OHIP?

A463 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A463 claims against the Schedule of Benefits rules before submission.

What codes are related to A463?

Codes related to A463 in the Schedule of Benefits include A465, A460, A275, A466, A464, A461, A468, A270.

All codes

A463

A463 – Medical specific 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
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(this code)
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 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 the affected part(s), region(s), or system(s) needed to make a diagnosis, exclude disease, and/or assess function.

Full history of the presenting complaint

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

Usage limits

Limited to 1 per patient per physician per 12-month period. May be increased to 2 if the patient presents with a clearly different and unrelated diagnosis, or if 90 days have elapsed and the second assessment is a hospital admission assessment. Additionally, any combination of medical specific assessments (A463) and complex medical specific re-assessments (A461) is limited to 4 per patient per physician per 12-month period.

A465Consultation A460Comprehensive infectious disease consultation A275Limited consultation A466Repeat consultation A464Medical specific re-assessment A461Complex medical specific re-assessment A468Partial assessment A270Complex infectious disease assessment E078Chronic disease assessment premium

Assessments in excess of the 12-month limits will be adjusted to a lesser assessment fee (e.g., partial assessment).

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