What are the billing rules for A264A?

Two per patient per physician per consecutive 12 months, except re-assessments for hospital admissions. Extras are paid at a lesser assessment fee (GP23). E078 chronic disease premium (+50%) in an office or hospital out-patient clinic (not the ED, an in-patient or LTC), for an established chronic disease with a diagnostic code from the GP26 list (A170, GP25, GP26). Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; E078 is still 50% of the virtual fee (A70, A74, AJ1).

What is A264A often billed with?

E078 chronic disease assessment premium, for example for asthma (493) or another GP26 diagnosis (GP25, GP26). G208 provocation testing, per hour or major part, maximum 5 sessions per 12 months; diagnostic and therapeutic procedures are payable in addition to an assessment (J3, J4). G197 and G209 skin testing, professional and technical components, each to a maximum of 50 per year (J3, J5).

Why is A264A rejected?

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 on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit. A4D: The code is in the Paediatrics (26) listing, and specialists bill from their own specialty's listing (GP9). The specialty on the claim can't bill it.

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Billing code

A264A — Medical Specific Re-assessment

Q: What is OHIP billing code A264A?

Paediatrics (26) medical specific re-assessment: a paediatrician's follow-up history and exam. Two per patient per 12 months.

Paediatric follow-up

A paediatrician bills A264 for a follow-up re-assessment with a full relevant history and exam of one or more systems.

Watch for: Limited to 2 per patient per physician per 12 months, except for hospital admissions; extras pay a lesser fee.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$70.75	$0.00	$0.00	$0.00

Code: A264A
Description: Medical Specific Re-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) medical specific re-assessment: a paediatrician's follow-up history and exam. Two per patient per 12 months.

What it covers

A264 is the medical specific re-assessment in the Paediatrics (26) listing (A170). It is a specialist service requiring a full, relevant history and physical examination of one or more systems (GP23).

Billing rules

Two per patient per physician per consecutive 12 months, except re-assessments for hospital admissions. Extras are paid at a lesser assessment fee (GP23).
E078 chronic disease premium (+50%) in an office or hospital out-patient clinic (not the ED, an in-patient or LTC), for an established chronic disease with a diagnostic code from the GP26 list (A170, GP25, GP26).
Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; E078 is still 50% of the virtual fee (A70, A74, 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

E078 chronic disease assessment premium, for example for asthma (493) or another GP26 diagnosis (GP25, GP26).
G208 provocation testing, per hour or major part, maximum 5 sessions per 12 months; diagnostic and therapeutic procedures are payable in addition to an assessment (J3, J4).
G197 and G209 skin testing, professional and technical components, each to a maximum of 50 per year (J3, J5).
G202 allergy injection: up to 2 when an assessment is payable for the same 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.
EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.
A4D: The code is in the Paediatrics (26) listing, and specialists bill from their own specialty's listing (GP9). The specialty on the claim can't bill it.

Related codes: A263, A661, A262, A261, E078, C264

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), pages A168 and A170; General Preamble GP23 (medical specific re-assessment) and GP25 to GP26 (chronic disease assessment premium); Diagnostic and Therapeutic Procedures, Allergy, pages J3 to J5

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