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A623
A623 – Medical Specific Assessment
OHIP General Listings Code — Clinical Immunology (62) · Schedule of Benefits
A medical specific assessment is a service rendered by a specialist in a place other than a patient’s home, requiring 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.
When to Use
- Use A623 for a specialist's initial, comprehensive evaluation of a patient presenting with a new, complex neurological complaint requiring detailed history and examination of the nervous system.
- Bill A623 when a cardiologist performs a thorough assessment of a patient's cardiac status, including a full history and focused cardiac examination, to diagnose a new arrhythmia.
- A623 is appropriate for an endocrinologist's detailed assessment of a patient with newly diagnosed, complex diabetes management issues, including a full history and examination of relevant systems.
Common Pitfalls
- Billing A623 more than once per patient per physician within 12 months without meeting the criteria for a second assessment (unrelated diagnosis or 90-day lapse for hospital admission assessment) will result in payment adjustment to A628.
- Submitting A623 for a patient already seen for the same condition within the 12-month period, without fulfilling the criteria for a re-assessment (A624 or A621), will lead to rejection or adjustment.
- Using A623 for a patient in a hospital bed (unless in the ED or OPD while not on duty) is incorrect; C623 should be used for hospital in-patients.
Billing Tips
- Ensure the documentation clearly reflects a full history and a detailed examination of the affected part(s), region(s), or system(s) to differentiate it from a limited consultation (A525) or a repeat consultation (A626).
- A623 can be billed with the E078 Chronic Disease Assessment Premium if the patient has a documented chronic disease and the assessment meets all E078 criteria, including being in an office or out-patient clinic setting.
Provider Fee$0.00
Specialist Fee$80.90
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Clinical Immunology (62)
Service Type
Consultations and Visits
Code Classes
Assessment
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