All codes
B604
B604 – B604
OHIP Paediatrics Code · Schedule of Benefits
When to Use
- B604 is appropriate for a comprehensive assessment and management plan for a patient with a new diagnosis of a complex neurological condition requiring specialist input.
- Use B604 when a specialist performs a detailed neurological examination, reviews extensive prior investigations, and formulates a multi-faceted treatment strategy for a patient with a rare or poorly understood neurological disorder.
- This code is indicated for the initial consultation and management of a patient presenting with symptoms suggestive of a rapidly progressive neurodegenerative disease, where urgent specialist intervention is critical.
Common Pitfalls
- Billing B604 for routine follow-up visits or for conditions that do not meet the complexity threshold for specialist consultation.
- Submitting B604 when the patient's condition has been previously managed by another specialist, as it is intended for new diagnoses requiring initial specialist assessment.
- Failing to adequately document the complexity of the neurological assessment, the review of investigations, and the rationale for the specialist management plan, which can lead to claim rejection or audit issues.
Billing Tips
- Ensure the patient's medical record clearly outlines the specific neurological condition, the extent of the examination performed, and the detailed management plan to support the B604 claim.
- Verify that the patient has not been seen by another specialist for the same condition within a relevant timeframe, as B604 is typically for initial specialist consultations.
Provider Fee$0.00
Specialist Fee$2,728.25
Effective: April 1, 2026
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