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Billing code

A003A — General Assessment with diagnosis other than 917, all ages

Full family practice checkup

Bill A003 for a general assessment: a full history and an exam of all body parts and systems, outside the patient's home.

Watch for: One per patient per physician per 12 months; extras pay a lesser fee, and it can't be billed by video or telephone.

Code

A003A

Description

General Assessment with diagnosis other than 917, all ages

FHO+ basket

Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Family practice general assessment: full history and exam of all body systems. Not payable in the home; one per patient per 12 months.

What it covers

A003 is the Family Practice general assessment. It needs a full history (presenting complaint, family, past medical and social history, and a functional inquiry into all body parts and systems) and an exam of all body parts and systems. Breast, genital or rectal exams may be left out when not indicated or refused (GP21).

It must be rendered somewhere other than the patient's home (GP21, A4).

Billing rules

• One per patient per physician per 12 months. A second is allowed for a clearly different, unrelated diagnosis, or if at least 90 days have passed and the second is a hospital admission assessment. Extras are paid at a lesser fee (GP21).
• Not payable in the patient's home (A4).
• Patients aged 65 or older: paid with a 15% age premium (GP64).
• Not on the Appendix J list, so it can't be billed by video or telephone (A68, AJ1, AJ2).
• A cervical screening specimen is included when the pelvic exam is part of the assessment (A4).
• Detention (K001) can only start after 60 minutes (GP30).
• A general assessment in the ED or out-patient department by the family physician who then admits the patient is the admission assessment (GP41).

Often billed with

• E430 or E431 when the cervical screening specimen is collected outside a hospital or ICHSC (A4).
• E080 for the primary care physician's first office or home visit within two weeks of an acute care discharge (GP28).
• E079 smoking cessation initial discussion, once per patient per 12 months (A56).
• FHO: Q012A after-hours premium for enrolled patients in evening and weekend hours or on holidays (Agreement p.68; OMA Q-codes p.8).

Common rejections

• EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
• VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.
• V16: OHIP couldn't accept the diagnostic code, usually because it isn't a plain numeric OHIP code. Use digits only, and check the fee code also suits the patient and the service.
• EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.
• VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.

Related codes: A004, A007, A001, K131, K132, C003

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A4; General Preamble GP21 (general assessment)

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