< Billing codes

Billing code

A235A — Ophthalmology consultation

Ophthalmology consultation

An ophthalmologist bills A235 for a consultation on a written referral from a physician or nurse practitioner.

Watch for: Put the referrer's billing number on the claim; virtually, it can be done by video only, not telephone.

Code

A235A

Description

Ophthalmology consultation

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

Consultation by an ophthalmologist on a written referral from a physician or nurse practitioner, office or general listings.

What it covers

A consultation is an assessment done after a written request from a referring physician, nurse practitioner or (for hospital dental care) dental surgeon, because of the complexity, seriousness or obscurity of the case, or because another opinion was requested (GP16). The consultant must perform a general or specific assessment, review relevant data and send a written report (GP16).

Ophthalmology consultations and visits may include retinal photography as a specific element of the service where medically necessary (A154).

Billing rules

• The written, signed request must name the consultant or specialty, the referrer with billing number and the patient with health number, and be kept in the chart. Otherwise it pays as a lesser assessment (GP16).
• Same patient, same diagnosis: 1 consultation per 2 consecutive 12-month periods, with a second allowed only for a hospital in-patient or ED patient 12–24 months after the first (GP17).
• Clearly unrelated diagnosis: 1 per 12 months. Consultations over the limits pay as a specific assessment (GP17–GP18).
• A pre-operative consultation before cataract surgery under local or IV sedation is payable only when the chart shows it was medically necessary (GP18).
• Age premiums apply to specialist consultations: +10% to +30% for patients under 16 (GP64).
• Video only, with an existing relationship; add K300A. Telephone is not allowed (AJ2, A70).
• Detention (K001) may start after 60 minutes (GP30).

Often billed with

• Ophthalmology diagnostic tests billed separately, for example G818/G820 OCT, G858/G432 visual fields (J3, J91, J93).
• A230 orthoptic assessment, payable in addition to an ophthalmology consultation (A156).

Common rejections

• ARF: The claim is missing the referring provider's number. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• AT2: Must include video modality: A235 is a video-only virtual service, so it can't be billed with K301A telephone (AJ2).

Related codes: A236, A935, A231, A930, C235, A233, A234, A253

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

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