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Billing code

A243A — Otolaryngology specific assessment

ENT specific assessment

An otolaryngologist bills A243 for a full history of the complaint and detailed exam of the affected parts, outside the patient's home.

Watch for: One per patient per physician per 12 months, two only for an unrelated diagnosis; extras pay as a lesser assessment.

Code

A243A

Description

Otolaryngology 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

Full ENT assessment by an otolaryngologist: full history of the complaint and detailed exam of the affected parts or systems.

What it covers

A specific assessment is rendered by a specialist, outside the patient's home, and needs a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) needed to make a diagnosis, exclude disease or assess function (GP23).

A243 is the Otolaryngology (24) general listing for this service (A166).

Billing rules

• Specialists bill from the Consultations and Visits listing of their own specialty (GP9).
• Limit: one per patient per physician per 12 months, or two if the second visit is for a clearly different, unrelated diagnosis. Excess pays as a lesser assessment (GP23).
• Not for home visits (GP23).
• If you made the decision to operate in the past 12 months, only a partial assessment is payable before a Z-code (IOP) procedure that day (SP4).
• Detention (K001) may start only after 60 minutes (GP29–GP31).
• Can be done by video or phone with an existing relationship; add K300A or K301A (AJ1, A66, A70).

Often billed with

• Z296 flexible fiberoptic nasal endoscopy, an IOP payable in addition to an assessment (GP4, P1).
• Audiometry (G440/G525, G441/G526) (J99).

Common rejections

• AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).

Related codes: A245, A244, A246, C243, Z296

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Otolaryngology (24), page A166.

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