A801 – Comprehensive midwife or aboriginal midwife-requested genetic assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is an assessment provided by a geneticist upon the written request of a midwife or aboriginal midwife because of the complex, obscure or serious nature of the patient’s problem. This service includes the specific elements of an assessment and the physician must spend a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A801 when a midwife requests a genetic assessment for a patient with a complex family history of a rare genetic disorder, requiring a detailed 75-minute assessment.
- Use A801 for a patient referred by an aboriginal midwife due to concerns about potential teratogenic effects from maternal exposures during pregnancy, necessitating a comprehensive genetic evaluation.
- A801 is appropriate when a midwife refers a patient with a suspected chromosomal abnormality identified on prenatal screening, and a detailed genetic assessment exceeding 60 minutes is required.
Common Pitfalls
- Failure to document the start and end times of the 75-minute patient contact in the medical record will result in reduced payment.
- Submitting A801 without retaining the written request from the midwife in the patient's chart is a common reason for claim rejection or audit.
- Billing A801 when the patient was referred by a physician, rather than a midwife or aboriginal midwife, will lead to incorrect payment as this code is specific to midwife referrals.
Billing Tips
- Ensure the 75-minute direct patient contact time for A801 excludes any time spent on other separately billable services or procedures performed during the same encounter.
- Verify that the written report of findings, opinions, and recommendations is sent to both the referring midwife and the patient's primary care physician or nurse practitioner, if applicable, to meet documentation requirements.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Genetics
Consultation
The geneticist must submit his/her findings, opinions and recommendations in writing to both the midwife or aboriginal midwife and the patient’s primary care physician or nurse practitioner, if applicable.
The written request from the midwife or aboriginal midwife must be retained on the patient’s permanent medical record.
The service is eligible for payment only if start and stop times of the service are recorded in the patient's permanent medical record.
Calculation of time excludes time devoted to any other separately billable service or procedure.
Calculation of time excludes non-patient-facing time (e.g., chart review, imaging, documentation).
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