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E423
E423 – Partial assessment
OHIP Surgical Assists Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Manual cycloplegic refraction is the service rendered personally by an ophthalmologist for evaluation of patients up to and including 15 years of age for the evaluation of strabismus and/or amblyopia requiring glasses or contact lenses. It is payable as an add-on to a specific assessment (A233) or partial assessment (A234).
When to Use
- Use E423 when performing a cycloplegic refraction on a patient aged 15 or younger during an A233 or A234 visit specifically to address strabismus or amblyopia.
- Apply this code when the clinical necessity for glasses or contact lenses is directly linked to the management of strabismus or amblyopia in pediatric patients.
Common Pitfalls
- Billing E423 for routine refractive errors in children without a documented diagnosis of strabismus or amblyopia will result in rejection.
- Exceeding the limit of two services per 12-month period per patient per physician will lead to automatic claim denials.
- Failing to link the service to diagnostic code 368 will cause the claim to fail validation.
Billing Tips
- Always append E423 to the primary assessment code (A233 or A234) on the same claim to ensure the add-on logic is processed correctly.
Provider Fee$0.00
Specialist Fee$25.00
Effective: April 1, 2025
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Procedure
Code Classes
Assessments, Diagnostic and Therapeutic Procedures
E423 is limited to a maximum of two services per 12 month period per patient per physician.
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