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Billing code

A266A — Repeat Consultation

Paediatric repeat consultation

A paediatrician bills A266 for a second consultation on the same problem after another physician cared for the patient, on a new referral.

Watch for: Needs a new written request; enter that referrer's six-digit billing number, and bill only under the Paediatrics specialty.

Code

A266A

Description

Repeat 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) repeat consultation: a paediatrician's second consultation for the same problem after another physician's care, on a new referral.

What it covers

A266 is the repeat consultation in the Paediatrics (26) listing (A170). A repeat consultation is an additional consultation by the same consultant for the same presenting problem, after another physician has cared for the patient since the first consultation (GP19).

It has the same requirements as a consultation, including a new written request from the referring physician or nurse practitioner and a written report back (GP16, GP19).

Billing rules

• Needs a new written, signed request naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart (GP16, GP19).
• If the repeat consultation requirements aren't met, it is paid as a general or specific assessment, depending on the specialty (GP17, GP18).
• Not counted in the consultation limits of one per two consecutive 12-month periods (GP18).
• Detention (K001) can only start after 60 minutes (GP30).
• Patients under 16: specialist consultation age premium of 10% to 30% (GP64).
• Video only (with K300A), never telephone (AJ2). For hospital in-patients bill C266 (A173).
• 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).

Common rejections

• AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer. A repeat consultation needs a new written request, so enter that referrer's six-digit number (GP19).
• 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: A265, A260, A565, A263, C266

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), pages A168 and A170; General Preamble GP16 to GP19 (consultations, repeat consultation)

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