What is OHIP billing code A483?

A483 is "Complex rheumatology assessment", an OHIP General Listings code from the Ontario Schedule of Benefits (Physician Services).

How much does A483 pay?

The current OHIP fee for A483 is $0.00, effective 2025-06-01, per the Ontario Schedule of Benefits.

How do I bill A483 to OHIP?

A483 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A483 claims against the Schedule of Benefits rules before submission.

All codes

A483

A483 – Complex rheumatology assessment

OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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A medical specific assessment is a service rendered by a specialist in Rheumatology in a place other than a patient's home. According to the Schedule of Benefits, this service requires 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, and/or exclude disease, and/or assess function. In addition to the common elements, all services which are described as assessments, or as including assessments (e.g. consultations), include the following specific elements: A. A direct physical encounter with the patient including taking a patient history and performing a physical examination. B. Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. C. Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. D. Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. E. Making arrangements for follow-up care. F. Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service and results. G. When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. H. Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.

When to Use

Use A483 for a new patient presenting with undiagnosed inflammatory arthritis requiring a comprehensive history, detailed joint examination, and initial diagnostic workup planning.
Bill A483 when a patient with established lupus requires a reassessment due to new organ involvement (e.g., renal or neurological) necessitating a detailed systemic review and examination.
A483 is appropriate for a patient referred for evaluation of suspected systemic vasculitis, involving a thorough history of systemic symptoms and a focused physical examination of affected organ systems.

Common Pitfalls

Billing A483 when a simpler assessment code, like A007 (General assessment), would suffice for a less complex rheumatological issue.
Submitting A483 for a follow-up visit that does not involve a significant change in diagnosis or management, which might be better billed as a follow-up visit code.
Claiming A483 when the documentation lacks a detailed examination of affected parts or systems, failing to meet the 'complex' assessment criteria.

Billing Tips

Ensure documentation clearly outlines the complexity of the rheumatological condition, differentiating it from a standard assessment (e.g., A007) by detailing multiple affected systems or complex diagnostic considerations.
A483 can be billed with the E078 chronic disease assessment premium if the patient has a documented chronic disease from the OHIP list and the service is provided in an office or hospital outpatient clinic setting.

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Provider Fee$0.00

Specialist Fee$83.10

Effective: June 1, 2025

Category

A. Consultations and Visits

Subcategory

CONSULTATIONS AND VISITS

Service Type

Assessment

Code Classes

Assessments

As with all insured services, the medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.

Documentation must include 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, and/or exclude disease, and/or assess function.

Limit: x per 12_months (per_patient_per_physician) — Limited to one per patient per physician per 12 month period unless either of the following circumstances are met in which case the limit is increased to two per patient per physician per 12 month period: 1. the patient presents a second time with a complaint for which a clearly different diagnosis is made, unrelated to the diagnosis made at the time of the first specific assessment in that 12 month period; or 2. in the case of a medical specific assessment, at least 90 days have elapsed since the date of the last specific assessment and the second assessment is a hospital admission assessment. The amount payable for specific or medical specific assessments in excess of this limit will be adjusted to a lesser assessment fee.

Limit: x per 12_months (per_patient_per_physician) — Any combination of medical specific assessments and complex medical specific re-assessments are limited to 4 per patient per physician per 12 month period. The amount payable for these services in excess of this limit will be adjusted to a lesser assessment fee.

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