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Billing code

A033A — Specific Assessment

General surgery specific assessment

A general surgeon bills A033 for a full history of the complaint and detailed exam of the affected area, outside the patient's home.

Watch for: One per patient per physician per 12 months; if your pre-operative visit was within 12 months, only A034 is payable before a same-day Z-code procedure.

Code

A033A

Description

Specific Assessment

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

General Surgery (03) specific assessment: full history of the complaint and detailed exam of the affected area. One per patient per 12 months.

What it covers

A033 is the specific assessment in the General Surgery (03) listing (A107). A specific assessment is a specialist service, rendered somewhere other than the patient's home, with a full history of the presenting complaint and a detailed examination of the affected parts, regions or systems needed to make a diagnosis, exclude disease or assess function (GP23).

A consultation that lacks a proper written request, or is over the consultation limits, is paid at a lesser assessment fee: for a surgeon, the specific assessment (GP16, GP17, GP18).

Billing rules

• One per patient per physician per 12 months; a second only for a clearly different, unrelated diagnosis. Extras are paid at a lesser assessment fee (GP23).
• Not payable in the patient's home (GP23).
• Z-prefix procedures (IOPs) are payable in addition to the assessment. But if the major pre-operative visit was in the previous 12 months, only a partial assessment (A034) is payable the same day before the IOP, and if the major pre-operative visit is that same day, no other assessment before the IOP is payable (GP4, SP4).
• A hospital or day care admission assessment can't be claimed by the surgeon unless it is the major pre-operative visit, where the decision to operate is made (GP4, SP2).
• Detention (K001) can only start after 60 minutes (GP30).
• Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; telephone pays 85% (A70, AJ1).

Often billed with

• Z543 anoscopy or Z546 Barron ligation the same visit, independent operative procedures payable in addition to the assessment (GP4, S27, S28).
• U990 or U991 special visit premiums on a non-elective call to a hospital out-patient department; the A-prefix General Listings assessment goes with the premium (GP69, GP71, SP2).
• K300A or K301A when the assessment is done by video or telephone (A70).

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.
• A3F: OHIP's description is 'no fee for this code on service date': OHIP had no payable fee for the code on that date. Check the service date and the fee code on the claim.
• ERF: OHIP's description is 'referring physician not currently eligible to refer'. A specific assessment doesn't need a referral, but OHIP checks any referring number on the claim; make sure it is correct.

Related codes: A034, A035, A036, A935, C033, Z543

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, General Surgery (03), page A107; General Preamble GP4 and GP23 (specific assessment); Surgical Preamble SP2 and SP4

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