A721 – Complex medical specific re-assessment
OHIP General Listings Code · 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. It includes all the requirements of a medical specific re-assessment, which requires a full, relevant history and physical examination of one or more systems.
When to Use
- Billing A721 for a patient with a newly diagnosed, severe autoimmune condition requiring extensive investigation and management planning, beyond a standard re-assessment.
- Using A721 when a patient presents with a rare neurological disorder with ambiguous symptoms that necessitate a deep dive into history, multiple system examinations, and specialized opinion.
- Appropriate for a patient with a complex, multi-system failure following a major trauma, where a thorough re-evaluation of all affected systems is critical for ongoing care.
Common Pitfalls
- Submitting A721 without a written report to the patient's primary care physician will result in the fee being adjusted to a lesser assessment code.
- Billing A721 for a condition that is not demonstrably complex, obscure, or serious, leading to claims being downgraded to A723 or A724.
- Exceeding the limit of 4 combined A721 and A723 claims per patient per physician within a 12-month period, causing subsequent claims to be rejected.
Billing Tips
- Ensure the written report to the primary care physician clearly outlines the complexity, findings, and specific recommendations justifying the A721 designation.
- Document the 'complex, obscure, or serious' nature of the patient's condition in the patient's chart to support the use of A721 over A723 or A724.
Effective: April 1, 2026
Occupational Medicine
Assessment
The physician must report findings, opinions, or recommendations in writing to the patient’s primary care physician.
Failure to provide the written report will result in the fee being adjusted to a lesser assessment fee.
If the requirements for a complex medical specific re-assessment are not met, the amount payable will be adjusted to a lesser assessment fee (typically a medical specific re-assessment or partial assessment).
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