< Billing codes

Billing code

A261A — Level 1 - Paediatric Assessment

Brief paediatric visit

A paediatrician bills A261 for a brief history and exam of the affected part, or brief advice about a health issue.

Watch for: If the visit needs a more extensive exam, bill the level 2 assessment A262; the E078 premium doesn't apply to A261.

Code

A261A

Description

Level 1 - Paediatric 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

Paediatrics (26) level 1 assessment: a brief history and exam of the affected part, or brief advice, by a paediatrician.

What it covers

A261 is the level 1 paediatric assessment in the Paediatrics (26) listing (A170). It includes a brief history and examination of the affected part or region or of a mental or emotional disorder, and/or brief advice or information on health maintenance, diagnosis, treatment or prognosis (GP27).

When the visit needs a more extensive examination, bill the level 2 assessment, A262 (GP27, A170).

Billing rules

• Specialists bill consultations and visits from their own specialty's listing (GP9).
• Detention (K001) can only start after 30 minutes (GP30).
• E078 chronic disease premium doesn't apply: among paediatric assessments it is payable with the level 2 assessment and the medical specific codes, not level 1 (GP25).
• Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; telephone pays 85% (A70, AJ1).
• Patients 18 or older: only if the paediatrician saw them in the 12 months before their 18th birthday, ongoing chronic care is needed and they are under 22, or with the Ministry's written approval (A168).

Often billed with

• G202 allergy injection: up to 2 are payable when an assessment is payable for the same visit. If the child needs only a brief assessment of the allergic condition with the injection, the Schedule says to claim the injection and the basic fee rather than an assessment; claim an assessment as well only for an unrelated problem, such as an acute infection, that would otherwise need its own visit (J4).
• E080 first visit after an acute care discharge, when the paediatrician is the patient's primary care physician (GP28).

Common rejections

• EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. Correct it, or update the registration, then resubmit.

Related codes: A262, A263, A264, G202, G212

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), pages A168 and A170; General Preamble GP27 (level 1 paediatric assessment); Diagnostic and Therapeutic Procedures, Allergy, page J4

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