A967 – Care of the elderly 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 care of the elderly (age 65 or older). The assessment must satisfy, at a minimum, all of the requirements of an intermediate assessment.
When to Use
- Billing for a comprehensive geriatric assessment for a patient aged 65+ with multiple chronic conditions, requiring detailed history, physical exam, and management plan, exceeding the scope of a general intermediate assessment (A007).
- When a physician with documented geriatric care expertise provides an in-depth assessment of a frail elderly patient presenting with functional decline, including cognitive and psychosocial evaluation, which goes beyond a standard intermediate assessment.
- To bill for a focused assessment of a patient 65 or older with a specific geriatric syndrome (e.g., falls, incontinence) where the assessment requires specialized knowledge and a more extensive workup than a general intermediate assessment.
Common Pitfalls
- Billing A967 when the assessment does not meet the minimum requirements of an intermediate assessment (e.g., insufficient history, incomplete physical exam, lack of management plan).
- Using A967 for a patient under the age of 65, as this code is strictly limited to patients 65 years and older.
- Submitting A967 for a routine follow-up visit or a simple problem-focused assessment that could be billed with a general intermediate (A007) or intermediate (A005) assessment code.
Billing Tips
- Ensure the patient's chart clearly documents the specialized geriatric knowledge and experience applied during the A967 assessment, distinguishing it from a standard intermediate assessment.
- A967 is eligible for the 15% Age Premium (AGE_PREMIUM_65) for patients 65 and older, provided all other criteria are met.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Assessment
Must satisfy all requirements of an 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.
Patient must be age 65 or older
FPA is specifically for physicians with focused practice training/experience.
The service includes the provision of premises, equipment, supplies, and personnel unless performed in a hospital or nursing home.
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