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A815
A815 – Midwife or Aboriginal Midwife-Requested Special Assessment
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) is an assessment of a mother or newborn provided by a physician upon the written request of a midwife or Aboriginal midwife because of the complex, obscure, or serious nature of the patient’s problem. It must include the constituent elements of A813 (MAMRA) and is payable in any setting.
When to Use
- Bill A815 when a midwife requests a physician assessment for a mother with a complex postpartum hemorrhage that requires a detailed physical exam and management plan, exceeding the scope of a routine assessment.
- Use A815 for a newborn with suspected congenital anomaly identified by a midwife, necessitating a comprehensive physician evaluation beyond a standard neonatal check.
- A815 is appropriate when a midwife requests a physician's assessment for a mother experiencing severe, unexplained antepartum pain requiring a minimum 50-minute dedicated assessment and consultation.
Common Pitfalls
- Failure to document the written request from the midwife in the patient's chart is a common reason for claim rejection.
- Claims for A815 are frequently downgraded to A813 if the required 50 minutes of direct patient contact is not clearly documented with start and stop times.
- Billing A815 when the assessment is for a condition that could be managed by the midwife without physician consultation risks an audit.
Billing Tips
- Ensure the written request from the midwife specifies the complex, obscure, or serious nature of the patient's problem to justify the A815 assessment.
- Meticulously record the start and end times of the patient encounter to substantiate the 50-minute minimum duration required for A815.
Provider Fee$186.95
Effective: June 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
A813Midwife or Aboriginal Midwife-Requested Assessment (MAMRA)A817Midwife or Aboriginal Midwife-Requested Special Assessment (MAMRSA) by VideoC815Midwife or Aboriginal Midwife-Requested Special Assessment (Hospital In-Patient)A816Midwife or Aboriginal Midwife-Requested Anaesthesia Assessment (MAMRAA)
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