< Billing codes

Billing code

A234A — Ophthalmology partial assessment

Brief ophthalmology visit

An ophthalmologist bills A234 for a partial assessment: history of the presenting complaint, needed exam, advice and a record.

Watch for: Bill only under specialty 23; virtual care needs an existing patient relationship and K300A or K301A.

Code

A234A

Description

Ophthalmology 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

Partial assessment by an ophthalmologist: history of the presenting complaint, needed exam, advice and record.

What it covers

A234 is a partial assessment by an ophthalmologist (specialty 23) (A155). A partial assessment is the limited service of a history of the presenting complaint, the necessary physical examination, advice to the patient and an appropriate record (GP25).

Ophthalmology consultations and visits may include retinal photography, where medically necessary, as part of the service (A154, note).

Billing rules

• 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).
• Before a Z-code procedure (IOP) the same day, if the major pre-operative visit was in the past 12 months, a specialist's partial assessment is the only assessment payable (SP4, §13).
• Detention (K001) is payable only after 30 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 (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: A233, A235, E423, E424, A230, C233

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A155.

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