< Billing codes

Billing code

A155A — Consultation

Endocrinology consultation

An endocrinologist bills A155 for an assessment at a physician's or nurse practitioner's written request, with a written report back.

Watch for: Bill under specialty 15 with the referrer's six-digit billing number from the signed request, or it pays as a lesser assessment.

Code

A155A

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

Endocrinology consultation at the written request of a physician or nurse practitioner, with a written report. Usually one per diagnosis per 24 months.

What it covers

A155 is the consultation in the Endocrinology & Metabolism listing (A98). A consultation is an assessment after a written request from a referring physician, nurse practitioner or (for in-hospital dental care) dental surgeon, because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

It includes a general, specific or medical specific assessment with review of all relevant data, and the written report of findings, opinions and recommendations to the referrer (and to the primary care provider when a nurse practitioner referred) (GP16).

Billing rules

• Needs a written, signed request in the chart naming the consultant or specialty, the referrer and billing number, and the patient and health number. 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, with a second allowed only for an in-patient or ED patient 12 to 24 months after the first. Clearly unrelated diagnosis: one per 12 months. Extras are paid as an assessment (GP17, GP18).
• Use A156 for a repeat consultation and A255 for a limited consultation. A150 is the comprehensive consultation, which needs at least 75 minutes of direct contact with start and stop times charted (A98).
• Patients under 16: a 10% to 30% age premium applies to specialist consultations (GP64).
• Video only, not telephone, as comprehensive virtual care (AJ2).
• Detention (K001) can only start after 60 minutes of a consultation (GP30, GP31).
• In-patient and long-term care equivalents are C155 and W155 (A102, A103).

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.
• AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the request.
• 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.
• EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. It often comes with AC4 on the same claim; fix the specialty or registration and the referring number together, then resubmit.
• AC1: A limit was reached. Consultations over the GP17 limits are payable only as an assessment, so resubmit with the assessment code that fits, such as A153.

Related codes: A150, A156, A255, A153, C155, W155, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), page A98; General Preamble GP16 to GP19 (consultations) and GP64 (age premiums)

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing