< Billing codes

Billing code

A265A — Consultation

Paediatric consultation

A paediatrician bills A265 for an assessment at a physician's or nurse practitioner's written request, with a written report back.

Watch for: Enter the referrer's six-digit billing number from the signed request, and check your paediatrics specialty registration is active.

Code

A265A

Description

Consultation

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) consultation: a paediatrician's assessment at the written request of a referring physician or nurse practitioner, with a report.

What it covers

A265 is the Paediatrics (26) consultation (A168): an assessment after a written request from a referring physician, nurse practitioner or dental surgeon, because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

It includes the written report to the referrer and, unless stated otherwise, a general, specific or medical specific assessment with review of all relevant data (GP16).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for in-hospital dental care) naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart. The consultant sends a written report back. Otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16).
• Same patient, physician and diagnosis: one consultation per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later). Unrelated diagnosis: one per 12 months. Extras are paid as an assessment (GP17, GP18).
• Longer consultations have their own codes, with start and stop times charted: A260 (75 minutes or more), A662 and A667 neurodevelopmental (90 minutes or more) (A168).
• Patients under 16: specialist consultation age premium of 10% to 30% (GP64).
• Video only (with K300A), never telephone (AJ2).
• Patients 18 or older: only if the paediatrician saw them in the year before their 18th birthday for a chronic condition needing ongoing care and they are under 22, or with Ministry approval (A168).

Common rejections

• AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the request.
• 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.
• 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.
• VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.

Related codes: A260, A662, A667, A565, A266, A263

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A168; General Preamble GP16 to GP19 (consultations)

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