A680 – Initial Assessment – Substance Abuse
OHIP General Listings Code — Family Practice & Practice in General (00) · Schedule of Benefits
Initial assessment - substance abuse is an assessment where the physician spends a minimum of 50 minutes in direct contact with the patient assessing a patient related to substance abuse with or without the patient's relative(s) or patient’s representative, exclusive of time spent rendering any other service that is separately eligible for payment to the patient.
When to Use
- Bill A680 for a comprehensive 50-minute assessment of a patient presenting with new concerns regarding opioid dependence, including detailed history, psychosocial evaluation, and initial treatment plan formulation.
- Use A680 when a patient requires a dedicated 50-minute assessment for alcohol use disorder, including a review of systems, physical exam if indicated, and DSM diagnosis, separate from a routine follow-up visit.
- A680 is appropriate for a new patient referred specifically for an in-depth assessment of stimulant abuse, provided the physician spends at least 50 minutes in direct contact and documents a DSM diagnosis for the substance abuse.
Common Pitfalls
- Billing A680 when the patient encounter is primarily for smoking cessation, as this is explicitly excluded and should be billed using codes like A957 or K039.
- Failure to record the exact start and stop times of the 50-minute assessment in the patient's chart will lead to a reduced payment, as per submission instructions.
- Not documenting a specific DSM diagnosis for each problematic substance identified during the assessment will result in a payment adjustment, even if the time requirement is met.
Billing Tips
- Ensure the 50-minute direct patient contact time excludes any time spent on other separately billable services or non-patient-facing administrative tasks.
- When billing A680, confirm that a DSM diagnosis is recorded for each substance of abuse identified, not just a general statement of substance use disorder.
Effective: April 1, 2026
Consultations and Visits
Family Practice & Practice in General (00)
Consultations and Visits
Assessment
Start and stop times of the service must be recorded in the patient’s permanent medical record.
A DSM diagnosis must be recorded in relation to each problematic substance in the patient’s permanent medical record.
Relevant information obtained in the provision of all elements of the service must be recorded in the medical record.
Practice group is defined as those physicians who are part of the same billing group or are co-located and have shared access to the patient’s medical record.
Time calculation excludes non-patient-facing time such as reviewing charts, imaging, or documentation.
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