< Billing codes

Billing code

A085A — Consultation

Plastic surgery consultation

A plastic surgeon bills A085 for an assessment at the written request of a referring physician or nurse practitioner, with a report back.

Watch for: Bill it only under the Plastic Surgery specialty, with the signed request kept in the chart; otherwise it pays as an assessment.

Code

A085A

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

Plastic surgery consultation: a plastic surgeon's assessment at the written request of a referring physician or nurse practitioner, with a report back.

What it covers

A085 is the Plastic Surgery (08) consultation (A181): 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 naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart, and 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, A181).
• A same-day Z-prefix procedure (IOP) is payable in addition to the consultation (GP4). A pre-operative consultation before carpal tunnel surgery under local anaesthesia or IV sedation needs documented medical necessity (GP18).
• Patients under 16: specialist consultation age premium of 10% to 30% (GP64).
• Video only (with K300A), never telephone (AJ2).

Often billed with

• A990 and A960 office special visit premiums on a non-elective call with travel, weekdays 07:00 to 17:00; not for walk-ins or patients seen around regular office hours (GP65, GP69, GP76).
• Z159 removal of a lesion by electrocoagulation or curetting, an IOP payable in addition to the consultation (GP4, M3).

Common rejections

• A4D: The code is in the Plastic Surgery (08) listing, and specialists bill consultations from their own specialty's listing (GP9). The specialty on the claim can't bill it; a general surgeon, for example, bills A035.

Related codes: A935, A086, A083, A084, C085

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Plastic Surgery (08), page A181; General Preamble GP16 to GP19 (consultations); Surgical Preamble SP4

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