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Billing code

A313A — Physical medicine and rehabilitation medical specific assessment

Physiatry full assessment

A physiatrist bills A313 for a full history of the complaint and detailed exam of the affected parts or systems, outside the patient's home.

Watch for: One per patient per physician per 12 months, two only for a different diagnosis or later admission; extras pay a lesser fee.

Code

A313A

Description

Physical medicine and rehabilitation medical specific 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 assessment with a full history of the complaint and a detailed exam of the affected parts or systems. Not in the patient's home.

What it covers

A medical specific assessment is a specialist service, not in the patient's home, with a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) needed to make a diagnosis, exclude disease or assess function (GP23).

A313 is the Physical Medicine & Rehabilitation (31) code in the General Listings (A175).

Billing rules

• Medical specific assessments are limited to one per patient per physician per 12 months, or two if a clearly different diagnosis is made or (after 90 days) the second is a hospital admission assessment; extras are paid at a lesser fee (GP23).
• 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).
• K001 detention after 60 minutes (GP30).

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, A311, A318, A315, C313, E078

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

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