A611 – Not found
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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 and includes all the requirements of a medical specific re-assessment (a full, relevant history and physical examination of one or more systems).
When to Use
- Bill A611 when a patient with a newly diagnosed, aggressive hematological malignancy requires a comprehensive re-evaluation of their complex condition and treatment options.
- Use A611 for a patient with a severe, refractory autoimmune disorder that has significantly worsened, necessitating a detailed reassessment of multiple organ systems and treatment adjustments.
- A611 is appropriate for a patient with a rare, obscure neurological condition that has progressed, requiring an in-depth re-examination and review of specialized investigations.
Common Pitfalls
- Billing A611 when the patient's condition is not complex, obscure, or serious enough, leading to claims being adjusted to a lesser assessment fee.
- Failing to submit a written report of findings, opinions, or recommendations to the patient's primary care physician, resulting in a payment adjustment.
- Exceeding the limit of 4 combined A611 and A614 services per patient per physician within a 12-month period, causing subsequent claims to be paid at a reduced rate.
Billing Tips
- Ensure the written report to the primary care physician is comprehensive and clearly outlines the complexity of the patient's condition and the rationale for the re-assessment.
- If the patient has a documented chronic disease and meets all criteria, consider adding the E078 premium to the A611 claim for additional reimbursement.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Re-assessment
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 and includes all the requirements of a medical specific re-assessment.
The physician must report his/her findings, opinions, or recommendations in writing to the patient’s primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee.
Requires a full, relevant history and physical examination of one or more systems.
For services not listed under Haematology, refer to the Internal Medicine section.
Special visit premiums (-) may apply if the service is the first patient seen during a non-routine visit.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.