What is OHIP billing code A604?

A604 is "Medical specific re-assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A604 pay?

The current OHIP fee for A604 is $72.65, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A604 to OHIP?

A604 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A604 claims against the Schedule of Benefits rules before submission.

All codes

A604

A604 – Medical specific re-assessment

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

Ask a question

Levels of this visit

The A60x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A608 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…
$49.80
A604 Medical specific re-assessment(this code)
A medical specific re-assessment is a service rendered by a specialist and requires a full, relevant history and physical examination of one or more systems.
$72.65
A601 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.
$84.10
A603 Medical specific assessment
A medical specific assessment is a specialist service requiring a full history of the presenting complaint and a detailed examination of the affected systems to make a diagnosis…
$96.70

Consultations

A606 Repeat consultation
A repeat consultation is an additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another…
$105.25
A605 Consultation
A consultation rendered by a specialist in cardiology following a written request from a referring physician, nurse practitioner, or dental surgeon.
$188.45
A600 Comprehensive cardiology consultation
This service is a consultation rendered by a specialist in cardiology who provides all the appropriate elements of a consultation and spends a minimum of 75 minutes in direct…
$342.25

A medical specific re-assessment is a service rendered by a specialist and requires a full, relevant history and physical examination of one or more systems. 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 (as described in : 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 of related procedures. 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.

All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.

For services not listed, refer to Internal Medicine section

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