A007 Billing Code Explained: The OHIP Intermediate Assessment Deep Dive

If you bill OHIP in family practice, A007 is almost certainly your highest-volume code. It's the default fee for the standard office visit — and because it's billed dozens of times a day, small mistakes around it (wrong level, missed add-ons, same-day conflicts) compound faster than on any other code.

This is the first in our series of billing code deep dives. Every fee and rule below is verified against the current Schedule of Benefits, effective April 1, 2026.

What A007 is

A007 — Intermediate assessment or well baby care: $44.55. It's restricted to Family Practice & Practice in General (specialty 00), and it actually covers two distinct services:

1. Intermediate assessment — a history of the presenting complaint, plus inquiry into and examination of the affected part, region, system, or mental/emotional disorder, as needed to make a diagnosis, exclude disease, and/or assess function. In plain terms: a focused-but-substantive visit. More than a quick question, less than a full physical.
2. Well baby care — a complete examination with weight and measurements, plus instructions to the parent(s) regarding health care. This use is restricted to the first two years of life (0–24 months). Two adjacent codes matter here: the enhanced 18-month visit is A002 ($73.95), and once the child turns two, routine check-ups move to K017 — Periodic health visit, child ($49.55).

A007 is also eligible for comprehensive virtual care — billed with the A suffix (A007A) for video or telephone visits.

Full details, current fee, and related codes are on our A007 code page.

The assessment ladder: A001 vs A008 vs A007 vs A004 vs A003

Family practice assessments form a ladder, and picking the right rung is where most of the money is won or lost:

| Code | Service | Fee | |------|---------|-----| | A008 | Mini assessment | $13.40 | | A001 | Minor assessment | $26.80 | | A004 | General re-assessment | $39.35 | | A007 | Intermediate assessment / well baby care | $44.55 | | A003 | General assessment | $95.60 |

How to choose:

• A001 (minor) covers a brief history and examination of the affected part, or brief advice regarding health maintenance, diagnosis, treatment and/or prognosis. If the visit was a quick, single-issue check, this is the honest code.
• A007 (intermediate) is the step up: you took a history of the presenting complaint and examined the relevant system(s) to reach a diagnosis or assess function. Most bread-and-butter family practice visits land here.
• A003 (general) requires the full workup — and it's rationed: limited to one per patient, per physician, per 12-month period. A second A003 is only payable if the patient presents with a clearly different and unrelated diagnosis, or if at least 90 days have passed and the second assessment is a hospital admission assessment. Exceed the limit without meeting those criteria and the claim is adjusted down to a lesser assessment fee.
• A004 (general re-assessment) is limited to two per patient, per physician, per 12-month period (general re-assessments for hospital admissions are exempt). Excess services are adjusted to a lesser assessment fee.

The A007-vs-A003 decision trips people in both directions. Billing A003 for what was really a focused visit invites an adjustment; defaulting to A007 for a genuine complete history and physical leaves $51.05 behind — legitimately earned.

Same-day rules and common mistakes

A007 and A008 are not payable on the same day. A008 (mini assessment) exists mainly for WSIB scenarios — it's only payable when the WSIB component of the visit is the service described by A001. If you're claiming a higher-level assessment like A007 for the visit, A008 doesn't get added on top.

Home visits change the math. When A007 is rendered in the patient's home, travel to and from the home is included in the fee — and the special visit premiums (the B960–B996 series) are not payable with A007 in that setting. Don't stack B-codes onto a home-visit A007.

A007 vs the chronic disease K-codes. If the visit met the requirements of K030 — Diabetic Management Assessment ($45.75), billing it as a plain A007 costs you both the fee difference and the tracking value of the chronic disease code.

Stable follow-ups. An intermediate assessment requires an actual assessment. A brief recheck of a stable chronic condition with no change in status is A001 territory, not A007.

Add-ons worth checking on every A007

These are verified as payable in addition to A007:

• Age-based fee premium (65+): +15%. Automatic eligibility for patients 65 and older — $44.55 becomes ~$51.23. Easy to forget, applies constantly in a practice with older patients.
• Q012 after-hours premium: +30% for enrolled patients seen during designated after-hours blocks in patient enrolment models.
• E430 / E431 — cervical cancer screening specimen collection: $11.95, payable in addition to A007 when performed outside a hospital or ICHSC. Note the flip side: if a pelvic exam is a normal part of the service and E430/E431 doesn't apply, specimen collection is included in the A007 fee.
• E432 — pelvic exam including speculum: $5.00, an add-on to A001 and A007 outside hospital/ICHSC. Limited to one per patient per day, and only when personally rendered by the physician.

None of these change what happens in the room. They only change whether the claim reflects it.

The takeaway

A007 itself is simple — $44.55, focused assessment, family practice. The complexity lives at its edges: the ladder above and below it, the 12-month limits on A003/A004, the same-day exclusions, and the premiums that should ride along. Because A007 is billed at such volume, getting those edges right is one of the highest-leverage habits in family practice billing.

SnapBill runs an automated pre-submission review on every claim — flagging level-of-assessment issues, same-day conflicts, and eligible premiums like the 65+ age premium before the claim goes out. Try it free.

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Fees verified against the OHIP Schedule of Benefits, effective April 1, 2026. Browse the full details on our billing code pages, starting with A007.