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Billing code

A151A — Complex Medical Specific Re-assessment

Complex endocrinology re-assessment

An endocrinologist bills A151 to re-assess a complex, obscure or serious condition, with a written report to the primary care physician.

Watch for: Send your findings in writing to the primary care physician, or OHIP pays a lesser fee; limit 4 per patient per 12 months.

Code

A151A

Description

Complex Medical Specific Re-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

Endocrinology complex medical specific re-assessment for a complex, obscure or serious condition. Needs a written report to the primary care physician.

What it covers

A151 is the endocrinologist's complex medical specific re-assessment (A98). It is a re-assessment because of the complexity, obscurity or seriousness of the patient's condition, and must include everything required for a medical specific re-assessment: a full, relevant history and physical examination of one or more systems (GP23, GP24).

The physician must send findings, opinions or recommendations in writing to the patient's primary care physician, or the service is paid at a lesser assessment fee (GP24).

Billing rules

• Limited to 4 per patient per physician per 12 months; extras are paid at a lesser assessment fee (GP24).
• A151 and A153 medical specific assessments together are limited to 4 per patient per physician per 12 months (GP23, GP24).
• Billed from the Endocrinology & Metabolism (15) listing by an endocrinologist (A98, GP9).
• E078 chronic disease assessment premium (+50%) applies only in an office or hospital out-patient clinic (not ED, in-patient or LTC), for an established chronic disease, with one of the GP26 diagnostic codes such as 250 diabetes on the claim (GP25, GP26).
• Can be billed by video or telephone as comprehensive virtual care with an existing patient-physician relationship; add K300A or K301A, and telephone pays 85% (AJ1, A70). E078 is payable on the virtual service (A74).
• In hospital the in-patient code is C151 (A102).

Often billed with

• E078 chronic disease assessment premium for an established chronic disease on the GP26 list, office or out-patient clinic only (A98, GP25, GP26).
• K045 diabetes management by a specialist: A151 visits count toward the 4 consultations or assessments K045 needs in the 12 months (A99).
• K301A or K300A modality indicator when the re-assessment is done by phone or video (A70).

Common rejections

• A4D: The code is in the Endocrinology & Metabolism (15) listing, and specialists bill from their own specialty's listing (GP9). The specialty on the claim must be 15; another specialty bills the equivalent code from its own listing.

Related codes: A153, A154, A158, A155, A760, C151, E078, K045

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), page A98; General Preamble GP23 to GP26 (medical specific and complex medical specific re-assessment, chronic disease assessment premium)

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