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A621
A621 – Complex Medical Specific Re-Assessment
OHIP General Listings Code — Clinical Immunology (62) · 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.
When to Use
- Billing for a patient with a newly diagnosed, complex autoimmune condition requiring detailed investigation and management planning, beyond a standard A624.
- Assessing a patient with a severe, poorly understood allergic reaction that has failed to respond to initial treatments, necessitating a comprehensive re-evaluation.
- Re-assessing a patient with a rare or obscure immunological disorder where the diagnosis is still evolving and requires extensive review of prior investigations and specialist consultations.
Common Pitfalls
- Failure to submit a written report of findings to the patient's primary care physician will result in the fee being adjusted to a lesser assessment fee.
- Billing A621 more than 4 times per patient per 12-month period, as this limit is shared with A623 and claims exceeding it are adjusted.
- Using A621 for a condition that does not meet the 'complex, obscure, or serious' criteria, when a less complex code like A624 would be more appropriate.
Billing Tips
- For virtual care, remember to append the 'A' suffix to A621 (i.e., A621A) to indicate a video or telephone consultation.
- Ensure the patient has an established diagnosis of a chronic disease documented in their chart to be eligible for the E078 Chronic Disease Assessment Premium when billing A621.
Provider Fee$0.00
Specialist Fee$71.80
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Clinical Immunology (62)
Service Type
Consultations and Visits
Code Classes
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.
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