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Billing code

A233A — Ophthalmology specific assessment

Ophthalmology specific assessment

An ophthalmologist bills A233 for a full history of the presenting complaint and detailed exam of the affected parts, outside the patient's home.

Watch for: Bill only under specialty 23; one per patient per physician per 12 months, extras pay as a lesser assessment.

Code

A233A

Description

Ophthalmology 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

Specific assessment by an ophthalmologist: full history of the presenting complaint and detailed exam of the affected parts.

What it covers

A233 is a specific assessment by an ophthalmologist (specialty 23), in a place other than the patient's home (A154; GP23). It needs a full history of the presenting complaint and a detailed examination of the affected part(s), region(s) or system(s) needed to make a diagnosis, exclude disease or assess function (GP23).

Ophthalmology consultations and visits may include retinal photography, where medically necessary, as part of the service (A154, note). The in-hospital equivalent is C233 (A162).

Billing rules

• One per patient per physician per 12 months; two if the patient returns with a clearly different, unrelated diagnosis. Extras pay as a lesser assessment (GP23).
• E423 manual cycloplegic refraction can be added for patients 15 and under being evaluated for strabismus and/or amblyopia needing glasses or contacts; done personally; max 2 per patient per physician per 12 months (A155).
• E424 can be added for a patient 10 or under in active amblyopia treatment (occlusion, penalization, dichoptic, refractive therapy or similar); done personally; submit with diagnostic code 368 (A155).
• Age premium for patients under 16: 30% under 30 days, 25% to 1 year, 20% to 2 years, 15% to 5 years, 10% to 16 years (GP64, item e).
• Detention (K001) is payable only after 60 minutes (GP30).
• Can be done by video or telephone for a patient with an existing relationship (for example an in-person service with you in the past 24 months), adding K300A (video) or K301A (phone) (Appendix J AJ1; A66, A70).

Often billed with

• E423 manual cycloplegic refraction (A155).
• E424 paediatric amblyopia assessment (A155).
• A230 orthoptic assessment, payable in addition to an ophthalmology visit when done and interpreted personally (A156).

Common rejections

• A4D: 'Invalid specialty for this service code': ophthalmology codes are for specialty 23. Specialists must bill from their own specialty's listings (GP9).
• AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service with you in the past 24 months (A66).

Related codes: A234, A235, A236, C233, E423, E424, A230, A253

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A154.

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