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Billing code

A256A — Special Optometrist-requested Assessment

Long optometrist-requested assessment

An ophthalmologist bills A256 for an optometrist-requested assessment with at least 50 minutes of direct patient contact.

Watch for: Record start and stop times or it isn't payable; limited to 1 per patient per physician per 24 months.

Code

A256A

Description

Special Optometrist-requested 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

Optometrist-requested assessment with at least 50 minutes of direct patient contact. Once per patient per 24 months; start and stop times required.

What it covers

A special optometrist-requested assessment includes all elements of an ORA (A253) and at least 50 minutes in direct contact with the patient, not counting time spent on other separately billable services (A159).

Time excludes any other separately payable service and non-patient-facing time such as chart, imaging or documentation review (A161).

Billing rules

• Limited to 1 per patient per physician per 24 months (A159).
• Record start and stop times in the chart, or the service is not payable (A159).
• All A253 requirements apply, including the optometrist's written request (A159).
• Video only (no telephone) with an existing relationship; add K300A (AJ2, A70).
• Detention (K001) may start after 90 minutes (GP30).

Common rejections

• AM1: Service limit exceeded: A256 is limited to 1 per patient per physician per 24 months (A159).
• AT2: Must include video modality: A256 by virtual care is video-only (AJ2).

Related codes: A253, A931, A241, A935, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A159.

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