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Billing code

A311A — Physical medicine and rehabilitation complex medical specific re-assessment

Complex physiatry re-assessment

A physiatrist bills A311 to re-assess a complex, obscure or serious condition, with a written report to the primary care physician.

Watch for: Send your findings in writing to the primary care physician, or OHIP pays a lesser fee; limit 4 per patient per 12 months.

Code

A311A

Description

Physical medicine and rehabilitation complex 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

Physiatrist re-assessment for a complex, obscure or serious condition, with a written report to the primary care physician.

What it covers

A complex medical specific re-assessment is a re-assessment because of the complexity, obscurity or seriousness of the patient's condition. It includes all the requirements of a medical specific re-assessment (GP24).

A311 is the Physical Medicine & Rehabilitation (31) code in the General Listings (A175).

Billing rules

• Report findings, opinions or recommendations in writing to the patient's primary care physician, or it is paid at a lesser fee (GP24).
• Limited to 4 per patient per physician per 12 months; extras are paid at a lesser fee (GP24).
• Medical specific assessments and complex medical specific re-assessments together are limited to 4 per patient per physician per 12 months (GP23, GP24).
• Add E078 (+50%) in the office or a hospital out-patient clinic (not ED, in-patient or LTC) when the patient has an established chronic disease and the claim uses one of the listed diagnostic codes, for example 340 MS, 343 cerebral palsy or 714 rheumatoid arthritis (A175, GP25, GP26).
• Can be done by video or telephone with an existing patient-physician relationship; add K300A (video) or K301A (telephone). Telephone pays 85% of the fee (Appendix J AJ1, A66, A70).

Often billed with

• E078 chronic disease assessment premium (A175, GP25).

Common rejections

• AT3: Billed as virtual care but OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).

Related codes: A310, A313, A510, A511, C311

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A175.

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