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Billing code

A007A — Intermediate Assessment

Regular office visit

Bill A007 for a visit needing a history and exam of the affected parts or systems, and for well-baby care under age 2.

Watch for: Billed by video or telephone with K300A or K301A only when an existing patient relationship exists; otherwise bill A101 or A102.

Code

A007A

Description

Intermediate Assessment

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 intermediate assessment: history and exam of the affected parts or systems. Also the code for well-baby care under age 2.

What it covers

A007 is the Family Practice intermediate assessment: a primary care service that needs a more extensive exam than a minor assessment. It requires a history of the presenting complaint, and inquiry into and examination of the affected parts, regions, systems, or mental or emotional disorder as needed to make a diagnosis, exclude disease or assess function (GP27).

A007 is also the code for well-baby care: a periodic assessment of a well newborn or infant in the first two years of life, with a complete exam, weight and measurements, and instructions to the parents (A4, GP34).

Billing rules

• Patients aged 65 or older: paid with a 15% age premium (GP64).
• In the patient's home, travel is part of A007, and Table VI home special visit premiums are not payable with it (A4).
• Detention (K001) can only start after 30 minutes of an intermediate assessment (GP30).
• Can be billed by video or telephone as comprehensive virtual care when an existing patient-physician relationship exists, with K300A or K301A; telephone pays 85% (A70, AJ1).

Often billed with

• E432 for a pelvic exam with speculum outside a hospital or ICHSC; once per day, not with E430, E431 or E542 (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: Q015A newborn episodic fee on up to eight A007 well-baby visits to enrolled infants in the first year, same service date (Agreement p.73; OMA Q-codes p.8).
• 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

• AT3: Billed by video or phone (K300A/K301A), but OHIP found no existing relationship: no in-person service in 24 months and no enrolment to you or your group (A66). Otherwise bill A101/A102.
• 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.
• VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
• EQE: The physician wasn't registered in the group on the claim on the service date. A registration issue, not a coding one.

Related codes: A001, A003, A004, A002, A008, K300, K301

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A4; General Preamble GP27 (intermediate assessment) and GP34 (well baby care)

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