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Billing code

A036A — Repeat Consultation

General surgery repeat consultation

A general surgeon bills A036 for a second consultation on the same problem after another physician cared for the patient, on a new referral.

Watch for: Needs a new written, signed request naming the referrer and billing number; otherwise it pays as an assessment.

Code

A036A

Description

Repeat 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) repeat consultation: a second consultation for the same problem after another physician cared for the patient, on a new referral.

What it covers

A036 is the General Surgery (03) repeat consultation (A107). A repeat consultation is an additional consultation by the same consultant for the same presenting problem, after another physician has cared for the patient in the interval since the first consultation (GP19).

It has the same requirements as a consultation, including a new written request from the referring physician, nurse practitioner or dental surgeon and a written report back (GP16, GP19).

Billing rules

• Needs a new written, signed request naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart (GP16, GP19).
• If the repeat consultation requirements aren't met, it is paid as a general or specific assessment, depending on the specialty (GP17, GP18).
• Repeat consultations aren't counted in the consultation limits of one per two consecutive 12-month periods (GP18).
• A same-day Z-prefix procedure (IOP) is payable in addition to the consultation, but no other assessment before the IOP is payable if the major pre-operative visit is that day (GP4, SP4).
• Detention (K001) can only start after 60 minutes (GP30).
• Patients under 16: specialist consultation age premium of 10% to 30% (GP64).
• Video only (with K300A), never telephone (AJ2).

Often billed with

• U990 or U991 special visit premiums on a non-elective call to a hospital out-patient department (GP69, GP71, SP2).
• A same-day colonoscopy (Z491 to Z499 or Z555) with E740, E741 or E705 for the extent reached, payable in addition to the consultation (GP4, S17, S18). A preoperative consultation before a colonoscopy under local anaesthesia and/or IV sedation is payable only when the chart shows it was medically necessary (GP18).
• Z546 Barron ligation, an IOP payable in addition to the consultation (GP4, S28).

Common rejections

• VJ7: OHIP received the claim more than three months after the service date, so it was rejected as stale-dated (GP9).

Related codes: A035, A935, A033, A034, C036

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, General Surgery (03), page A107; General Preamble GP16 to GP19 (consultations, repeat consultation); Surgical Preamble SP2 and SP4; Digestive System Surgical Procedures S17 to S18 (colonoscopy)

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