What are the billing rules for A204A?

Add E432 when a pelvic exam with speculum is done outside a hospital or ICHSC. E432 is limited to one per patient per day, must be done personally, and is not payable with E430, E431 or E542 (A150). Cervical screening collection is included when the pelvic exam is a normal part of the visit, but E430 or E431 can be added when it is done outside a hospital or ICHSC (A150). Can be done by video or phone with an existing patient-physician relationship; add K300A or K301A. Phone pays 85% of the in-person fee (Appendix J AJ1, A70).

What is A204A often billed with?

E432 pelvic exam with speculum outside hospital or ICHSC (A150). E430 or E431 cervical cancer screening collection (A150).

Why is A204A rejected?

AT3: Usually means it was billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person visit with you in the past 24 months (A66).

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Billing code

A204A — Obstetrics and gynaecology partial assessment

Q: What is OHIP billing code A204A?

An OB/GYN's limited visit: history of the presenting complaint, the needed exam, advice and a record.

Brief OB/GYN visit

An obstetrician-gynaecologist bills A204 for a partial assessment: history of the complaint, the needed exam, advice and a record.

Watch for: Billed as virtual care only with an existing patient relationship and K300A or K301A; E432 isn't payable with E430, E431 or E542.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$40.50	$0.00	$0.00	$0.00

Code: A204A
Description: Obstetrics and gynaecology partial 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

An OB/GYN's limited visit: history of the presenting complaint, the needed exam, advice and a record.

What it covers

A partial assessment is the limited service that is a history of the presenting complaint, the necessary physical examination, advice to the patient and an appropriate record (GP25).

A204 is the Obstetrics and Gynaecology (20) office and general listing (A150).

Billing rules

Add E432 when a pelvic exam with speculum is done outside a hospital or ICHSC. E432 is limited to one per patient per day, must be done personally, and is not payable with E430, E431 or E542 (A150).
Cervical screening collection is included when the pelvic exam is a normal part of the visit, but E430 or E431 can be added when it is done outside a hospital or ICHSC (A150).
Can be done by video or phone with an existing patient-physician relationship; add K300A or K301A. Phone pays 85% of the in-person fee (Appendix J AJ1, A70).

Often billed with

E432 pelvic exam with speculum outside hospital or ICHSC (A150).
E430 or E431 cervical cancer screening collection (A150).

Common rejections

AT3: Usually means it was billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person visit with you in the past 24 months (A66).

Related codes: A203, A205, A206, E432, E430

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Obstetrics and Gynaecology (20), page A150. Rules GP25.

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