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Billing code

A163A — Nephrology medical specific assessment

Nephrology full assessment

A nephrologist bills A163 in the office for a full history of the complaint and detailed exam of the affected systems.

Watch for: One per patient per physician per 12 months, two only for a different diagnosis or later admission; extras pay as a lesser assessment.

Code

A163A

Description

Nephrology 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

Nephrology office assessment with a full history of the presenting complaint and a detailed exam of the affected systems.

What it covers

A medical specific assessment is a specialist assessment, not in the patient's home, with a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, exclude disease or assess function (GP23).

A163 is the nephrology office version; the in-patient version is C163 (A136–A137).

Billing rules

• Limited to 1 per patient per physician per 12 months, or 2 if the second is for a clearly different diagnosis or is a hospital admission assessment at least 90 days after the last one; excess is paid as a lesser assessment (GP23).
• Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months (GP23).
• 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: A164, A161, A168, A165, E060, C163

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

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