A624 – Medical Specific Re-Assessment
OHIP General Listings Code — Clinical Immunology (62) · Schedule of Benefits
A medical specific re-assessment is a service rendered by a specialist in Clinical Immunology (62) that requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use A624 for a specialist in Clinical Immunology (62) performing a detailed history and physical examination of one or more systems for a patient with a complex immunological condition, requiring at least 40 minutes.
- A624 is appropriate when a patient requires a follow-up assessment for an established immunological condition that necessitates a new, comprehensive history and physical, distinct from a routine follow-up (e.g., A625 Consultation or A626 Repeat Consultation).
- This code is suitable for reassessing patients admitted to hospital for an immunological condition, provided the specialist assessed them prior to admission for the same illness (refer to GP40 notes).
Common Pitfalls
- Billing A624 when the service provided was a less comprehensive encounter, such as a Limited Consultation (A525) or a Repeat Consultation (A626), will lead to claim rejection or adjustment.
- Exceeding the limit of two A624 services per patient per physician within a 12-month period, without meeting the hospital admission exception, will result in the fee being adjusted to that of a Partial Assessment (A628).
- Failure to document a minimum of 40 minutes for the service, including a full relevant history and physical examination of one or more systems, is a common reason for audit review and potential clawback.
Billing Tips
- When providing A624 via virtual care, ensure the 'A' suffix is appended to the code (A624A) to indicate a virtual service.
- A624 can be billed with the Chronic Disease Assessment Premium (E078) if the patient has a documented chronic disease and meets all other eligibility criteria for E078.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
Consultations and Visits
Assessment
As outlined on page , admission assessments are deemed to be a specific re-assessment or medical specific re-assessment under either of the following circumstances: 1. for those procedures prefixed with a “Z” or noted as an IOP, by a surgical specialist who has assessed the patient prior to admission in respect of the same illness; or 2. for those patients who have been assessed by a physician and subsequently admitted to the hospital for the same illness by the same physician.
For services not listed under Clinical Immunology, refer to the Internal Medicine section.
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