All codes
A937
A937 – Pain management FPA
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A focused practice assessment (FPA) rendered by a GP/FP physician with additional training and/or experience in pain management. The assessment must satisfy, at a minimum, all of the requirements of an intermediate assessment.
When to Use
- Bill A937 for a comprehensive pain management assessment by a GP/FP with documented specialized training, exceeding the scope of a standard intermediate assessment (e.g., K005).
- Use A937 when a patient requires an in-depth evaluation of chronic pain conditions, including a detailed history, physical examination, and formulation of a multi-modal treatment plan.
- A937 is appropriate for initial consultations focused on complex pain syndromes that may involve multiple contributing factors and require specialized management strategies beyond general practice.
Common Pitfalls
- Billing A937 when the assessment does not meet the minimum requirements of an intermediate assessment (e.g., K005), leading to claim rejection.
- Failure to have documentation readily available to support specialized training or experience in pain management upon ministry request can result in audits and clawbacks.
- Billing A937 on the same day as another consultation, assessment, visit, or counselling service (e.g., K005, K013) to the same patient by the same physician is prohibited and will be denied.
Billing Tips
- Ensure the patient's chart clearly reflects the specialized nature of the pain management assessment, detailing the advanced history, examination, and treatment planning.
- While not explicitly required for billing, be prepared to demonstrate your pain management training or experience to the ministry if requested, to justify the use of A937 over a general assessment code.
Provider Fee$44.55
Effective: April 1, 2026
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Consultations and Visits
Code Classes
Assessment
Physicians should be prepared to provide to the ministry documentation demonstrating training and/or experience on request.
FPA stands for Focused Practice Assessment.
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