A957 – Addiction medicine FPA
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A focused practice assessment (FPA) rendered by a GP/FP physician, or a specialist, with additional training and/or experience in addiction medicine (including methadone). The assessment must satisfy, at a minimum, all of the requirements of an intermediate assessment.
When to Use
- Bill A957 for a comprehensive addiction medicine assessment, including a detailed history of substance use, mental health comorbidities, and a physical exam, when initiating treatment for opioid use disorder with methadone.
- Use A957 when a patient presents with a new or worsening alcohol use disorder requiring a formal assessment to determine the appropriate treatment plan, including potential detoxification and ongoing support.
- A957 is appropriate for assessing a patient with a complex history of stimulant abuse and associated psychiatric symptoms, necessitating a focused evaluation beyond a standard intermediate assessment.
Common Pitfalls
- Billing A957 when the service provided is a brief follow-up or management of an established addiction issue; K039 (Smoking cessation follow-up) or other appropriate visit codes should be used instead.
- Submitting A957 for a general intermediate assessment (e.g., I007) without the specific addiction medicine focus and required additional training/experience.
- Billing A957 on the same day as another consultation, assessment, or visit code (e.g., A007, A001) to the same patient by the same physician, which is explicitly prohibited.
Billing Tips
- Ensure your documentation clearly supports the addiction medicine focus and meets all requirements of an intermediate assessment, as the Ministry may request proof of specialized training or experience.
- Consider billing K001 (Detention) in addition to A957 if the assessment extends beyond 30 minutes and involves significant physician time for complex cases.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Primary care general practice service
Assessment
Must satisfy, at a minimum, all of the requirements of an intermediate assessment.
Intermediate assessment requires a history of the presenting complaint(s), inquiry concerning, and examination of the affected part(s), region(s), system(s), or mental or emotional disorder as needed to make a diagnosis, exclude disease, and/or assess function.
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