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Medical specialties
Rheumatology OHIP billing codes
Rheumatology consultations and complex assessments, rheumatoid arthritis management, joint injections and infusions.
30 codes in 5 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 48 is in the full Rheumatology listing.
Consultations & assessments — office
- A485Complex rheumatology assessmentConsultation (Rheumatology)—
- A590Comprehensive rheumatology consultation—
- A595Limited consultationLimited consultation - Rheumatology—
- A480Complex rheumatology assessmentComplex rheumatology assessment for ongoing management of specific complex musculoskeletal disorders.—
- A483Complex rheumatology assessmentA medical specific assessment rendered by a Rheumatologist. It requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s), and is performed in a location other than the patient's home.—
- A484Complex rheumatology assessmentMedical specific re-assessment - Rheumatology—
- A486Complex rheumatology assessment—
- A481Complex medical specific re-assessment—
- A488Partial assessmentPartial assessment - Rheumatology—
Hospital in-patient
- C485Rheumatology ConsultationA consultation service provided by a Rheumatology specialist to a non-emergency hospital in-patient, following a written request from a referring practitioner.—
- C590Comprehensive rheumatology consultationA comprehensive rheumatology consultation for a hospital in-patient, subject to the same conditions as <billingCode>A590</billingCode>.—
- C595Limited consultationA limited consultation for a non-emergency hospital in-patient requested by a referring practitioner. This service is less demanding than a full consultation but shares the same general requirements.—
- C486Repeat consultationA repeat consultation rendered by a Rheumatology specialist to a hospital in-patient for the same problem, following care by another physician since the initial consultation. This service requires a new written referral.—
- C483Medical specific assessmentA medical specific assessment performed by a rheumatologist for a non-emergency hospital in-patient. This service requires a detailed history of the presenting complaint and a thorough examination of the affected body part(s) or system(s).—
- C484Medical specific re-assessmentA medical specific re-assessment for a hospital in-patient provided by a rheumatologist, requiring a full, relevant history and physical examination of one or more systems, typically following a previous assessment for the same condition.—
- C481Complex medical specific re-assessmentA complex medical specific re-assessment for a non-emergency hospital in-patient rendered by a Rheumatologist, used for cases involving significant complexity, obscurity, or seriousness.—
- C482Subsequent visit - first five weeksA routine assessment of a hospital in-patient by a Rheumatologist during the first five weeks of admission. This service is limited to one per patient, per day.—
- C487Subsequent visit - sixth to thirteenth week inclusive (maximum 3 per patient per week)A routine subsequent visit by a Rheumatologist to a non-emergency hospital in-patient, rendered during the sixth to thirteenth week of admission. This service is limited to a maximum of three visits per week.—
- C489Subsequent visit - after thirteenth weekA subsequent visit by a Rheumatologist for an acute care hospital in-patient, rendered after the thirteenth week of admission. This service is limited to a maximum of six visits per patient per month.—
- C488Concurrent careA routine assessment by a consultant for a hospital in-patient, requested by the Most Responsible Physician (MRP) who retains primary care responsibility. Limited to four visits in the first week and two per week thereafter.—
- C480Complex rheumatology assessmentA complex rheumatology assessment for a hospital in-patient, subject to the same conditions as billing code `<billingCode>A480</billingCode>`. This service is performed by a specialist in Rheumatology.—
Joint injections & aspirations
- G370Injection of bursa, or injection and/or aspiration of joint, ganglion or tendon sheath$20.25
- G371Injection or aspiration of additional bursa, joint, ganglion or tendon sheathEach additional bursa, joint, ganglion or tendon sheath injection or aspiration, to a maximum of 5.$19.90
- G328Aspiration of bursa or complex jointThis code represents a diagnostic or therapeutic procedure. Specific details for this service are not available in the provided context.$39.80
- G329Aspiration of bursa or complex joint - each additionalAspiration of bursa or complex joint - each additional, to a maximum of 2$20.25
Infusions
- G381Standard chemotherapyStandard chemotherapy service for malignant or autoimmune diseases using agents with minor toxicity. This service includes physician supervision, the infusion itself, and all patient assessments for a 24-hour period post-treatment.$54.50
- G390Supervision of chemotherapy, biologic agent, or bispecific antibody infusionSupervision of chemotherapy for induction phase of acute leukemia or myeloablative therapy prior to bone marrow transplantation (maximum of 1 per induction phase or myeloablative therapy); and/or supervision of biologic agent(s) such as Chimeric Antigen Receptor T-Cell Therapy (CAR-T) infusion (maximum of 1 per infusion); and/or supervision of bispecific antibody infusion, during initial dosing phase, where there is a high risk of cytokine release syndrome (maximum of 3 per initial dosing phase)$262.40
How to use this rheumatology code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to rheumatology (specialty 48) — 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 rheumatology 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 rheumatology bill?
The consultations & assessments — office section of this set starts with A485 (Complex rheumatology assessment). 9 codes are listed in that section.
What is in the Rheumatology code set?
30 OHIP billing codes across 5 sections: Consultations & assessments — office; Hospital in-patient; Management & premiums; Joint injections & aspirations; Infusions. Rheumatology consultations and complex assessments, rheumatoid arthritis management, joint injections and infusions.
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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