What are the billing rules for A164A?

Two per patient per physician per consecutive 12 months, except re-assessments for hospital admissions. Extras are paid at a lesser assessment fee (GP23). E060 post renal transplant premium (+50%) can be added by a nephrologist when the purpose is post-transplant care in the first three years after the transplant; not for ED, hospital in-patient or long-term care patients (A136, A137). E078 chronic disease premium isn't available: Nephrology (16) isn't one of the specialties on the GP25 list (GP25).

What is A164A often billed with?

K301A or K300A when the re-assessment is done by telephone or video (A70). E060 post renal transplant assessment premium, within three years of the transplant (A136).

Why is A164A rejected?

AT3: Billed by video or phone (K300A/K301A), but OHIP found no existing relationship: no in-person service in 24 months and no enrolment to you or your group (A66). Otherwise bill A101/A102. EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. Correct it, or update the registration, then resubmit.

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Billing code

A164A — Medical Specific Re-assessment

Q: What is OHIP billing code A164A?

Nephrology (16) medical specific re-assessment: a nephrologist's follow-up history and exam. Two per patient per physician per 12 months.

Nephrology follow-up

A nephrologist bills A164 for a follow-up re-assessment with a full relevant history and exam of one or more systems.

Watch for: Limited to 2 per patient per physician per 12 months, except for hospital admissions; the E078 chronic disease premium isn't available.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$72.00	$0.00	$0.00	$0.00

Code: A164A
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

Nephrology (16) medical specific re-assessment: a nephrologist's follow-up history and exam. Two per patient per physician per 12 months.

What it covers

A164 is the medical specific re-assessment in the Nephrology (16) listing (A136). It is a specialist service that requires a full, relevant history and physical examination of one or more systems (GP23).

Billing rules

Two per patient per physician per consecutive 12 months, except re-assessments for hospital admissions. Extras are paid at a lesser assessment fee (GP23).
E060 post renal transplant premium (+50%) can be added by a nephrologist when the purpose is post-transplant care in the first three years after the transplant; not for ED, hospital in-patient or long-term care patients (A136, A137).
E078 chronic disease premium isn't available: Nephrology (16) isn't one of the specialties on the GP25 list (GP25).
Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; telephone pays 85%, and E060 is 25% of the virtual fee (A70, A74, AJ1).

Often billed with

K301A or K300A when the re-assessment is done by telephone or video (A70).
E060 post renal transplant assessment premium, within three years of the transplant (A136).

Common rejections

AT3: Billed by video or phone (K300A/K301A), but OHIP found no existing relationship: no in-person service in 24 months and no enrolment to you or your group (A66). Otherwise bill A101/A102.
EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. Correct it, or update the registration, then resubmit.

Related codes: A163, A161, A168, A165, E060, C164

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), pages A136 to A137; General Preamble GP23 (medical specific re-assessment)

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