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Billing code

A153A — Medical Specific Assessment

Endocrinology full assessment

An endocrinologist bills A153 for a full history of the complaint and detailed exam of the affected systems, outside the patient's home.

Watch for: Needs an active Endocrinology (15) registration on the service date; one per patient per physician per 12 months, extras pay less.

Code

A153A

Description

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

Endocrinology medical specific assessment: full history of the complaint and detailed exam of affected systems. Usually one per patient per 12 months.

What it covers

A153 is the endocrinologist's medical specific assessment (A98). It is a specialist service, rendered somewhere other than the patient's home, that requires 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 (GP23).

Billing rules

• One per patient per physician per 12 months. A second is allowed when the patient returns with a clearly different, unrelated diagnosis, or when at least 90 days have passed and the second is a hospital admission assessment. Extras are paid at a lesser assessment fee (GP23).
• A153 and A151 complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months (GP23).
• Not payable in the patient's home (GP23).
• 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).
• In hospital the in-patient code is C153 (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: A153 counts toward the 4 consultations or assessments K045 needs in the 12 months (A99).

Common rejections

• EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. A153 needs an active Endocrinology (15) registration; correct the claim or the registration, then resubmit.
• EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.
• 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: A154, A151, A155, A158, A760, C153, E078, K045

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), page A98; General Preamble GP23 (specific and medical specific assessment) and GP25 to GP26 (chronic disease assessment premium)

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