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Billing code

A073A — Geriatric medical specific assessment

Geriatric specific assessment

A geriatrician bills A073 for a full specialist assessment of a problem in a patient 65 or older, or for dementia at any age.

Watch for: Only for patients 65 or older or a dementia assessment; one per patient per physician per 12 months, extras pay less.

Code

A073A

Description

Geriatric medical 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

Full specialist assessment by a geriatrician of a problem, for patients 65+ or any patient being assessed for dementia.

What it covers

A073 is the Geriatrics (07) medical specific assessment (A120). A medical specific assessment needs 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. It is done by a specialist, somewhere other than the patient's home (GP23).

It is limited to patients at least 65 years old, or to assessments for dementia at any age (A120).

Billing rules

• Specialists bill from the Consultations and Visits listing for their own Royal College specialty on file with the Ministry, here Geriatrics (07) (GP9).
• Only payable for a patient at least 65 years old, or at any age when the visit is to assess dementia (A120).
• One per patient per physician per 12 months, or two if the patient returns with a clearly different, unrelated diagnosis or (at least 90 days after the last) the second is a hospital admission assessment. Extra ones pay a lesser fee (GP23).
• Medical specific assessments and complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months; extras pay a lesser fee (GP23–GP24).
• Add E078 (chronic disease assessment premium, +50%) in the office or a hospital out-patient clinic when the patient has an established chronic disease from the GP26 list on the claim, such as 290 dementia, 332 Parkinson's disease or 250 diabetes. Not payable for in-patients, LTC residents or ED patients (GP25–GP26).
• Can be done by video or phone when you have an existing relationship with the patient (for example, an in-person visit with you in the past 24 months). Add K300A (video) or K301A (phone); phone pays 85% of the fee (AJ1, A66, A70).

Often billed with

• E078 chronic disease assessment premium for an established chronic disease on the GP26 list (GP25–GP26).

Common rejections

• AT3: Billed as virtual care (K300A/K301A) but OHIP found no existing patient-physician relationship, such as an in-person service with you in the past 24 months (A66).

Related codes: A074, A071, A078, A075, C073, E078

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Geriatrics (07), page A120. Assessment rules GP23–GP26.

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