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Billing code

A251A — Special ophthalmologic assessment

Eye exam, patient with disability

An ophthalmologist bills A251 for a complete eye assessment with at least 20 minutes of direct contact when a disability limits the patient's participation.

Watch for: Chart start and stop times, the condition and how it limits participation, and keep the team letter, or it pays less.

Code

A251A

Description

Special ophthalmologic 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

Complete eye assessment for a patient whose disability limits participation, with at least 20 minutes of direct contact and a written care plan.

What it covers

A251 is a complete ophthalmologic assessment of a person with a psychological problem, developmental delay, learning disability or significant physical disability that so limits participation that the ophthalmologist spends at least 20 minutes in direct contact with the patient, family and/or legal representative (A160).

It also requires a continuing comprehensive vision care plan, appropriate information to the patient's health care team for general and academic planning, and a written report to other team members (A160–A161). Examples include certain chromosomal abnormalities, autism, cerebral palsy, or children with low vision linked to developmental delay (A161 commentary).

Billing rules

• No other assessment or consultation by the same physician for the same patient the same day is payable (A161).
• Maximum 2 per patient per physician per 12 months (A161).
• Chart the start and stop times, a statement of the medical condition and how it limits participation, and keep a copy of the letter to the team; otherwise it pays as a lesser fee (A161).
• The 20 minutes excludes other separately payable services and non-patient-facing time such as chart, imaging or documentation review (A160; A161 commentary).
• 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).
• AM1: 'Service limit exceeded': more than 2 A251 for this patient by you in 12 months (A161).

Related codes: A233, A235, A250, A252, A230

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A161.

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