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Billing code

A415A — Gastroenterology consultation

Gastroenterology consultation

Bill A415 for a full gastroenterology consultation done at the written request of a referring physician or nurse practitioner.

Watch for: Keep the signed written request with the referrer's billing number in the chart, or OHIP pays a lesser assessment.

Code

A415A

Description

Gastroenterology 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

A full consultation by a gastroenterologist, done at the written request of a referring physician or nurse practitioner.

What it covers

A consultation is an assessment by a specialist after a written request from a physician, nurse practitioner, or a dental surgeon for a hospital dental procedure, because the case is complex, serious or obscure, or another opinion is wanted (GP16).

It includes a general, specific or medical specific assessment, a review of all relevant data, and a written report to the referrer (GP16). A415 is the general listing for Gastroenterology (41) (A104).

Billing rules

• Needs a written, signed request from a physician, nurse practitioner or (hospital dental) dental surgeon naming you or the specialty, the referrer and billing number, the patient and health number, and the reason; keep it in the chart or OHIP pays a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods; a second is allowed only for an in-patient or ED patient 12–24 months after the first. Clearly unrelated diagnosis: one per 12 months. Extra consultations pay as an assessment (GP17–GP18).
• A request obtained after the service makes it not a consultation; bill the visit fee for what you did (GP16).
• A pre-operative consultation before colonoscopy under local anaesthesia or IV sedation is only payable when the chart shows it was medically necessary (GP18).
• 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).
• Under-16 age premiums (10–30%) apply to specialist consultations, limited consultations and repeat consultations (GP64).
• Virtual care by video only (not telephone) with an existing patient-physician relationship; add K300A (Appendix J AJ2, A66, A70).

Often billed with

• K300A video modality indicator for a video consultation (A70).
• K001 detention after the first 60 minutes of the consultation; claims are reviewed with a written explanation (GP30–GP31).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': a consultation needs the referring physician's or nurse practitioner's billing number (GP16).
• AT2: OHIP describes this as 'Must Include Video Modality': this code is video-only for virtual care, so a telephone (K301A) claim is refused (Appendix J AJ2).
• 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: A416, A545, A413, A414, A411, C415, A120

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

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