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Billing code

A414A — Medical Specific Re-assessment

Gastroenterology follow-up assessment

Bill A414 for a gastroenterologist's follow-up with a full relevant history and exam of one or more systems.

Watch for: Limited to 2 per patient per physician per 12 months, except hospital admission re-assessments; extras pay a lesser fee.

Code

A414A

Description

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 follow-up assessment with a full relevant history and exam of one or more systems. Limited to 2 per patient per 12 months.

What it covers

A medical specific re-assessment is rendered by a specialist and requires a full, relevant history and physical exam of one or more systems (GP23).

An admission assessment counts as a re-assessment when the same physician assessed the patient for the same illness before admitting them (GP23, GP40).

Billing rules

• Limited to 2 per patient per physician per 12 months, except re-assessments for hospital admissions; extras pay a lesser fee (GP23).
• 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).
• Before a Z-code procedure the same day, only a partial assessment (A418) is payable if your major pre-operative visit was in the prior 12 months (SP4).
• Detention (K001) may follow only after 40 minutes for a specific re-assessment (GP30).
• 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: A413, A411, A418, E098, A415, C414

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

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