< Billing codes

Billing code

A025A — Dermatology consultation

Dermatology consultation

A dermatologist bills A025 for a consultation at the written request of a physician or nurse practitioner, with a written report back.

Watch for: Put the referrer's billing number on the claim and keep the signed request in the chart, or OHIP pays a lesser assessment.

Code

A025A

Description

Dermatology consultation

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

A dermatologist's consultation at the written request of a physician or nurse practitioner, with a written report back to the referrer.

What it covers

A consultation is an assessment requested in writing by a physician, nurse practitioner or (for in-hospital dental procedures) a dental surgeon, because of the complexity, seriousness or obscurity of the case, or because another opinion is requested (GP16).

It includes the consultant's assessment, a review of all relevant data, and a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (GP16). A025 is the dermatology office consultation (A91).

Billing rules

• Keep the referrer's written, signed request in the chart. It must name you or the specialty, the referrer and their billing number, and the patient and health number; otherwise OHIP pays a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods. A second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first (GP17).
• A clearly unrelated diagnosis allows one consultation per 12 months. Consultations over the limits, or requested by a medical trainee, are paid as an assessment (GP17, GP18).
• If you ask for the referral after seeing the patient, it is not a consultation; bill the visit you provided (GP16).
• Detention (K001) starts only after 60 minutes of the consultation (GP29, GP30).
• Age premiums apply to specialist consultations and repeat consultations: +30% under 30 days down to +10% for ages 5 to 15 (GP64).
• Virtual care: video only (Appendix J AJ2), with an existing patient relationship and the K300A video indicator; not payable by phone (A66, A70).
• A consultation, other assessment or visit you give within 60 days after an e-assessment request for the same diagnosis pays only as a specific or partial assessment (GP35).

Often billed with

• Diagnostic and therapeutic procedures, such as G375/G377 intralesional infiltration, are payable in addition to a consultation or assessment (J3).
• K001 detention after the first 60 minutes (GP30).

Common rejections

• ARF: The claim is missing the referring provider's number. A consultation follows a written request that names the referrer and their billing number (GP16).
• AT2: This code is video only in Appendix J; billing it with the phone indicator K301A is not allowed (AJ2, A70).

Related codes: A026, A021, A027, C025, A023, A024, U025, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Dermatology (02), page A91; rules GP16–GP18.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing