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Billing code

A154A — Medical Specific Re-assessment

Endocrinology follow-up

An endocrinologist bills A154 for a follow-up re-assessment with a full relevant history and exam.

Watch for: Limited to 2 per patient per physician per 12 months, except for hospital admissions; extras pay a lesser fee.

Code

A154A

Description

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 medical specific re-assessment: a follow-up with a full relevant history and exam. Limited to 2 per patient per 12 months.

What it covers

A154 is the endocrinologist's medical specific re-assessment (A98). It requires a full, relevant history and a physical examination of one or more systems (GP23).

Billing rules

• Limited to 2 per patient per physician per consecutive 12 months, except specific re-assessments rendered for hospital admissions; extras are paid at a lesser assessment fee (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).
• For a complex, obscure or serious problem with a written report to the primary care physician, A151 applies instead (GP24).
• In hospital the in-patient code is C154 (A102).

Often billed with

• K301A or K300A modality indicator when the re-assessment is done by phone or video (A70).
• E078 chronic disease assessment premium for an established chronic disease on the GP26 list, office or out-patient clinic only (A98, GP25, GP26).

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, A151, A158, A155, C154, E078, K045

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

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