All codes
A661
A661 – Complex Medical Specific Re-Assessment
OHIP General Listings Code — Paediatrics (26) · 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. 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.
When to Use
- Use A661 for a pediatric patient with a rare genetic disorder requiring complex management and a detailed written opinion to the referring pediatrician.
- Bill A661 when a child presents with a severe, undiagnosed neurological condition necessitating extensive investigation and a comprehensive report to the primary care physician.
- Consider A661 for a pediatric patient with a serious congenital anomaly that requires a specialized re-assessment and a detailed written plan for ongoing care to the family physician.
Common Pitfalls
- Submitting A661 without a clear, written report to the primary care physician will result in payment adjustment to a lesser fee, often A264.
- Billing A661 more than 4 times per patient per physician within a 12-month period, even if combined with A263, will lead to claim rejection.
- Using A661 for conditions that do not meet the criteria for complexity, obscurity, or seriousness will result in an audit or claim denial.
Billing Tips
- Ensure the written report accompanying A661 clearly outlines the complexity, obscurity, or seriousness of the pediatric condition and provides specific recommendations.
- Verify that the patient's condition warrants the 'complex' designation; if not, consider billing A264 (Medical specific re-assessment) instead.
Provider Fee$0.00
Specialist Fee$74.75
Effective: June 1, 2025
Category
Consultations and Visits
Subcategory
Paediatrics (26)
Service Type
Consultations and Visits
Code Classes
Assessment
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