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Billing code

A250A — Retinopathy of prematurity (ROP) assessment

Premature baby retina check

An ophthalmologist bills A250 to assess retinopathy of prematurity in a patient 9 months or younger, or up to 16 with stage 3 disease.

Watch for: Only for patients meeting the age and stage criteria, and no other assessment by you that day is payable.

Code

A250A

Description

Retinopathy of prematurity (ROP) 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

Initial or follow-up ophthalmologist assessment of a patient with retinopathy of prematurity (ROP).

What it covers

A250 is an initial or follow-up assessment by an ophthalmologist of a patient with retinopathy of prematurity who is either 9 months of age or younger, or aged 10 months to 16 years with at least stage 3 ROP disease (A156).

The in-hospital equivalent is C250, subject to the same conditions (A162).

Billing rules

• Only for patients who meet the age and ROP-stage criteria (A156).
• No other assessment or consultation by the same physician for the same patient the same day is payable (A156).
• Detention (K001) is payable only after 60 minutes (GP30).
• Not on the Appendix J virtual care lists, so not payable as virtual care (AJ1–AJ2).

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).

Related codes: C250, A233, A235, A251, A230

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A156.

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