What is OHIP billing code A613?

A613 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does A613 pay?

The current OHIP fee for A613 is $95.95, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill A613 to OHIP?

A613 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates A613 claims against the Schedule of Benefits rules before submission.

What codes are related to A613?

Codes related to A613 in the Schedule of Benefits include A611, A614, A615, A618, C613.

All codes

A613

A613 – Medical specific assessment

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

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Levels of this visit

The A61x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

A618 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…
$44.75
A614 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist in Haematology (61) that requires a full, relevant history and physical examination of one or more systems.
$72.00
A611 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 and includes all the…
$83.40
A613 Medical specific assessment(this code)
A service rendered by a specialist in Haematology, in a place other than a patient’s home, requiring a full history of the presenting complaint and detailed examination of the…
$95.95

Consultations

A616 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…
$118.05
A615 Consultation
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner or dental surgeon who requests the opinion of a haematology…
$192.90

A service rendered by a specialist in Haematology, in a place other than a patient’s home, requiring a full history of the presenting complaint and 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.

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.

Service must be rendered in a place other than the patient’s home.

Usage limits

Limited to one per patient per physician per 12 month period. The limit is increased to two per 12 month period if: 1) the patient presents with a clearly different and unrelated diagnosis, or 2) at least 90 days have elapsed since the last specific assessment and the second is a hospital admission assessment. Claims in excess of these limits are adjusted to a lesser assessment fee.

A611Complex medical specific re-assessment A614Medical specific re-assessment A615Consultation A618Partial assessment C613Medical specific assessment (Hospital In-patient)

For services not listed under Haematology, refer to the Internal Medicine section.

Physicians in hospital but not on duty in the Emergency Department seeing patients in the Emergency or OPD should use General Listings (A613).

The fee for A613 is $95.95.

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