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Billing code

A115A — Major Eye Examination

Major eye exam, ages 20–64

Bill A115 for a complete eye exam in a patient aged 20 to 64 with a listed condition or a valid eye exam requisition.

Watch for: Only for ages 20 to 64; one per patient per 12 months across all physicians and optometrists.

Code

A115A

Description

Major Eye Examination

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

Complete eye and vision exam for a patient aged 20–64 who has a listed eye or medical condition, or a valid requisition for an eye exam.

What it covers

A major eye examination is a complete evaluation of the eye and vision system for patients aged 20 to 64. It must include relevant history, a comprehensive exam (acuity, confrontation fields, ocular mobility, slit lamp, ophthalmoscopy and, where indicated, dilated ophthalmoscopy and tonometry), visual fields where indicated, refraction, advice, and written findings to the primary care physician or nurse practitioner (A10).

It is insured only if the patient has diabetes, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis or optic pathway disease, or has a valid 'request for eye examination requisition' from another physician or a nurse practitioner (A11). Ophthalmologists bill it from their own listing, which refers to page A10 (A156).

Billing rules

• Patients aged 20 to 64 inclusive (A10).
• 1 per patient per 12 consecutive months across all physicians and optometrists. Extra exams stay insured but pay as a lesser assessment (A11).
• No other service by the same physician to the same patient on the same day is payable (A11).
• If not all elements are done, it pays as a lesser assessment (A11).
• A requisition is valid until March 31 of the fifth year after the year it was completed (A11).
• A visit only for refraction for patients aged 20 to 64 is not insured (A11).
• Not listed in Appendix J, so not payable as a virtual service (AJ1–AJ2).

Common rejections

• A2A: Outside of age limit: A115 is for patients aged 20 to 64; use A237 (19 and under) or A239 (65 and over) for periodic eye exams (A10, A156).

Related codes: E077, A237, A239, A110, A112, A233

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A10; also listed under Ophthalmology (23), page A156.

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