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Billing code

A262A — Level 2 - Paediatric Assessment

Regular paediatric visit

A paediatrician bills A262 for a history and exam of the affected systems, and for well-baby care in the first two years.

Watch for: Check the paediatrics specialty is registered and active on the service date; patients 18 or older qualify only in listed cases.

Code

A262A

Description

Level 2 - 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 2 assessment: history and exam of the affected systems by a paediatrician. Also covers well-baby care.

What it covers

A level 2 paediatric assessment needs a more extensive examination than a level 1 (A261): a history of the presenting complaint, and inquiry into and examination of the affected parts, regions, systems, or mental or emotional disorder as needed to make a diagnosis, exclude disease or assess function (GP27, A170).

It also includes well-baby care: a periodic assessment of a well newborn or infant in the first two years of life, with a complete examination, weight and measurements, and instructions to the parents (GP27).

Billing rules

• Specialists bill consultations and visits from their own specialty's listing (GP9).
• Detention (K001) can only start after 30 minutes (GP30).
• A262 can be billed by video or telephone as comprehensive virtual care when an existing relationship exists, with K300A or K301A (A70, AJ1).
• For patients 18 or older, paediatricians may bill only if they saw the patient in the 12 months before the 18th birthday, ongoing chronic care is needed and the patient is under 22, or with the Ministry's written approval (A168).
• For the enhanced 18-month well-baby visit, paediatricians bill A268 (A170, GP34).

Often billed with

• E078 chronic disease assessment premium (+50%) in an office or hospital out-patient clinic (not the ED), for an established chronic disease on the GP26 diagnostic code list (A170, GP25, GP26).
• E080 first visit after an acute care discharge, when the paediatrician is the patient's primary care physician (GP28).
• Periodic health visit codes K267 (2 to 11) or K269 (12 to 17), which are built on a level 2 paediatric assessment (GP21, A170).

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.
• EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
• AT3: Billed by video or phone (K300A/K301A), but OHIP found no existing relationship: no in-person service in 24 months and no enrolment to you or your group (A66). Otherwise bill A101/A102.
• V22: The diagnostic code isn't a valid OHIP code. Replace it with the three-digit code for the main reason for the visit.
• V21: OHIP's description is 'diagnostic code required': the claim had no diagnostic code. Add the code for the main reason for the visit.

Related codes: A261, A263, A264, A268, K267, K269

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A170; General Preamble GP27 (level 2 paediatric assessment)

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