< Billing codes

Billing code

A035A — Consultation

General surgery consultation

A general surgeon bills A035 for an assessment at the written request of a referring physician or nurse practitioner, with a report back.

Watch for: Put the referrer's billing number on the claim and keep the signed request; over-limit consultations pay only as A033 or A034.

Code

A035A

Description

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

General Surgery (03) consultation: a surgeon's assessment at the written request of a referring physician or nurse practitioner, with a report back.

What it covers

A035 is the General Surgery (03) consultation (A107): an assessment after a written request from a referring physician, nurse practitioner or dental surgeon, because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

It includes the written report and, unless stated otherwise, a general, specific or medical specific assessment with review of all relevant data (GP16).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for in-hospital dental care) naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart. The consultant sends a written report back. Otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16).
• Same patient, physician and diagnosis: one consultation per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later). Unrelated diagnosis: one per 12 months. Extras are paid as an assessment (GP17, GP18).
• Use A935 special surgical consultation when the surgeon spends at least 50 minutes in direct contact (GP19, A107).
• Pre-operative consultations before colonoscopy, cystoscopy, carpal tunnel or arthroscopy under local or IV sedation need documented medical necessity (GP18).
• The major pre-operative visit is billed separately from the surgery; a surgeon's admission assessment is payable only if it is that visit (SP2).
• Patients under 16: specialist consultation age premium of 10% to 30% (GP64).
• Video only (with K300A), never telephone (AJ2).

Common rejections

• AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the request.
• AC1: A limit was reached. Consultations over the GP17 limits are payable only as an assessment, such as A033 or A034, so resubmit with that code.
• 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.
• ERF: OHIP's description is 'referring physician not currently eligible to refer'. Check the referring provider number on the claim matches the provider who signed the written request.

Related codes: A935, A036, A033, A034, C035

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, General Surgery (03), page A107; General Preamble GP16 to GP19; Surgical Preamble SP2

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