< Billing codes

Billing code

A161A — Nephrology complex medical specific re-assessment

Complex nephrology re-assessment

A nephrologist bills A161 in the office 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

A161A

Description

Nephrology 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

Nephrology re-assessment of a patient whose condition is complex, obscure or serious, with a written report to the primary care physician.

What it covers

A complex medical specific re-assessment is a re-assessment because of the complexity, obscurity or seriousness of the patient's condition. It includes everything in a medical specific re-assessment (a full relevant history and exam of one or more systems) (GP23–GP24).

A161 is the nephrology office version; the in-patient version is C161 (A136–A137).

Billing rules

• You must report your findings, opinions or recommendations in writing to the patient's primary care physician, or it is paid as a lesser assessment (GP24).
• Limited to 4 per patient per physician per 12 months; excess is paid as a lesser assessment (GP24).
• Any combination of medical specific assessments and complex medical specific re-assessments is also limited to 4 per patient per physician per 12 months (GP23–GP24).
• Add E060 (+50%) when the visit is post-transplant care within 3 years of the patient's renal transplant, outside the ED and not for an in-patient (A136).
• Can be done by video or telephone with an existing patient-physician relationship; add K300A (video) or K301A (phone) (AJ1, A66).
• For chronic dialysis patients, consultations and visits to manage dialysis, its complications and end-stage renal disease are included in the weekly chronic dialysis team fee (G860–G865) and are paid at nil to other physicians (J39).

Often billed with

• E060 post renal transplant assessment premium, +50% in person or +25% for a virtual visit (A136, A74).

Common rejections

• AT3: Billed as virtual care and OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).

Related codes: A163, A164, A168, E060, C161, A165

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A136; rules GP23–GP24.

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