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Medical specialties
Medical Genetics OHIP billing codes
Genetic consultations including extended and midwife-requested forms, in-patient visits, family counselling, genetic care and test interpretation.
25 codes in 3 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 22 is in the full Genetics listing.
Consultations & assessments — office
- A225Genetic consultation—
- A220Special genetic consultationSpecial genetic consultation (minimum 75 minutes)—
- A223Extended special genetic consultation—
- A325Limited Consultation—
- A226Repeat genetic consultation—
- A221Genetic minor assessment—
- A800Genetics ConsultationMidwife or Aboriginal Midwife-requested genetic assessment—
- A801Comprehensive midwife or aboriginal midwife-requested genetic assessment—
- A802Extended midwife or aboriginal midwife-requested genetic assessment—
Hospital in-patient
- C225Genetic consultation - non-emergency hospital in-patientA consultation by a specialist in Genetics for a non-emergency hospital in-patient. This service is subject to specific billing restrictions if a prior genetic assessment or care has been provided.—
- C220Special genetic consultation - non-emergency hospital in-patientA special genetic consultation for a non-emergency hospital in-patient, subject to the same conditions as <billingCode>A220</billingCode>.—
- C223Extended special genetic consultationAn extended special genetic consultation for a non-emergency hospital in-patient, subject to the same conditions as an A-prefix extended special genetic consultation (<billingCode>A223</billingCode>).—
- C325Limited consultationA limited consultation provided by a specialist in Genetics for a non-emergency hospital in-patient. This service is less demanding than a full consultation but follows the same general requirements, including a written referral.—
- C226Repeat consultation - geneticsA repeat consultation for a non-emergency hospital in-patient, requested for the same problem previously assessed by the same consultant, following an interval of care by another physician. This service requires a new written referral and must be rendered in an acute care hospital.—
- C222Subsequent visit - first five weeksA subsequent in-patient visit by a specialist in Genetics (22) rendered during the first five weeks of a patient's hospitalization. This service is limited to one per patient per day.—
- C227Subsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week)A subsequent visit by a Genetics specialist to a non-emergency hospital in-patient, rendered between the sixth and thirteenth week of admission. This service is limited to a maximum of three visits per patient per week.—
- C229Subsequent genetic visit - after thirteenth weekA routine assessment in hospital by a Genetics specialist for an in-patient after the thirteenth week of admission. This service is limited to a maximum of six visits per patient per month.—
- C800Midwife or Aboriginal Midwife-requested genetic assessmentA midwife or Aboriginal midwife-requested genetic assessment for a non-emergency hospital in-patient. This service is subject to the same conditions as <billingCode>A800</billingCode>.—
- C801Comprehensive midwife or aboriginal midwife-requested genetic assessmentA comprehensive genetic assessment for a non-emergency hospital in-patient, requested by a midwife or aboriginal midwife. This service is subject to the same conditions as the equivalent general listing assessment, <billingCode>A801</billingCode>.—
- C802Extended midwife or aboriginal midwife-requested genetic assessmentAn extended genetic assessment for a non-emergency acute care hospital in-patient, requested by a midwife or aboriginal midwife, and subject to the same conditions as <billingCode>A802</billingCode>.—
Genetic care, counselling & interpretation
- K222Genetic care, patient or familyA time-based genetic assessment service provided to a patient or their family, billed in 30-minute units.—
- K044Genetic family counsellingTime-based counselling for family members or guardians of a genetic patient to provide information regarding treatment options and prognosis.$62.75
- K223Clinical interpretation by a geneticistA service for the clinical interpretation by a Geneticist of pertinent pedigrees and/or genetic reports. This service requires a written request from a participating physician, and the geneticist must provide a written report back to the referring physician.—
- K224Clinical interpretation by a geneticist requested by a midwife or aboriginal midwifeA service for a geneticist to interpret pertinent pedigrees and/or genetic reports at the written request of a midwife or aboriginal midwife. The findings must be reported back in writing to the referrer and the patient's primary care physician.—
- K229Complex genetic test interpretationA time-based service, payable per half-hour unit, for the interpretation of complex genetic tests that is performed in conjunction with a consultation or genetic care service.—
How to use this genetics code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to genetics (specialty 22) — its own consultation and assessment codes, in-patient visits, premiums and the diagnostics or procedures that make up most of a day — sectioned the way a shift sheet reads. Codes open to every specialty that a genetics physician also bills (general assessments, forms, special visit premiums) live in the Family Practice and Special visit premiums sets.
Each code links to its full Schedule entry: fee history, restrictions, required diagnoses and the codes it can or cannot be billed with. Fees shown are the current provider or specialist fee; percentage premiums show the percentage they add to the base service.
Common questions
Which consultation or assessment code does medical genetics bill?
The consultations & assessments — office section of this set starts with A225 (Genetic consultation). 9 codes are listed in that section.
What is in the Medical Genetics code set?
25 OHIP billing codes across 3 sections: Consultations & assessments — office; Hospital in-patient; Genetic care, counselling & interpretation. Genetic consultations including extended and midwife-requested forms, in-patient visits, family counselling, genetic care and test interpretation.
Are these the current OHIP fees?
Fees are read from the current Ontario Schedule of Benefits for Physician Services and refreshed hourly. Claims are paid at the fee in force on the service date, so always confirm the effective date on the code page.
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