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Billing code

A411A — Complex Medical Specific Re-assessment

Complex gastroenterology re-assessment

Bill A411 when a gastroenterologist re-assesses a patient because the condition is complex, obscure or serious.

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

A411A

Description

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

A gastroenterologist's 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 everything in a medical specific re-assessment (GP24).

You must report your findings, opinions or recommendations in writing to the patient's primary care physician, or OHIP pays a lesser assessment (GP24).

Billing rules

• Written report to the primary care physician is required, or it pays a lesser fee (GP24).
• Limited to 4 per patient per physician per 12 months (GP24).
• Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months (GP23–GP24).
• Add E098 (+28%) for patients with established Crohn's disease, ulcerative colitis, malnutrition, celiac disease or chronic liver cirrhosis, seen in the office or a hospital out-patient clinic (not ED) (A104–A105).
• If a major pre-operative visit was done by any physician in the prior 12 months, A120 is the only assessment payable on the day of a colonoscopy (A104).
• Virtual care by video or phone with an existing patient-physician relationship; add K300A or K301A. Phone pays 85% (Appendix J AJ1, A66, A70).

Often billed with

• E098 gastroenterology chronic disease assessment premium (A104).
• K300A or K301A modality indicator for virtual care (A70).

Common rejections

• AT3: Usually means it was billed as virtual care and OHIP found no existing patient-physician relationship, such as an in-person service with you in the past 24 months or a video consultation in that time (A66).

Related codes: A414, A413, A418, E098, C411

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Gastroenterology (41), page A104.

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