< Billing codes

Billing code

A063A — Orthopaedic surgery specific assessment

Orthopaedic specific assessment

An orthopaedic surgeon bills A063 for a full history of the complaint and detailed exam of the affected parts, outside the patient's home.

Watch for: One per patient per physician yearly; if you decided to operate within 12 months, only a partial assessment is payable before a same-day Z-code procedure.

Code

A063A

Description

Orthopaedic surgery 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

Specific assessment by an orthopaedic surgeon: full history of the complaint and detailed exam of the affected parts, outside the patient's home.

What it covers

A063 is the Orthopaedic Surgery (06) specific assessment (A164). A specific assessment is done by a specialist somewhere other than the patient's home. It needs a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, rule out disease or assess function (GP23).

Billing rules

• Specialists bill from the Consultations and Visits listing of their own specialty, here Orthopaedic Surgery (06) (GP9).
• One per patient per physician per 12 months. Two are allowed when the second visit is for a clearly different, unrelated diagnosis. Extra ones pay as a lesser assessment (GP23).
• The major pre-operative visit is billed separately from the surgical fee (SP2).
• Before a Z-code procedure (IOP): if your major pre-operative visit was in the past 12 months, only a partial assessment is payable before the IOP that day (SP4).
• Can be done by video or phone with an existing patient relationship; add K300A (video) or K301A (phone) (AJ1, A70).
• Detention (K001) can be added only after 60 minutes (GP29–GP30).

Often billed with

• Special visit premiums when the visit is a non-elective special visit (GP65–GP78).
• K001 detention, after the first 60 minutes (GP29–GP30).

Common rejections

• AT3: OHIP describes this as 'No patient-physician relationship': billed as virtual care (K300A/K301A) without an existing relationship, such as an in-person service by you in the past 24 months (A66).

Related codes: A064, A065, A066, C063, C064, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Orthopaedic Surgery (06), page A164. Assessment rules GP23.

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