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Billing code

A416A — Gastroenterology repeat consultation

Repeat gastroenterology consultation

Bill A416 when you consult again on the same problem after another physician has cared for the patient in between.

Watch for: Needs a new written request, and another physician must have given care in between, or OHIP pays an assessment instead.

Code

A416A

Description

Gastroenterology repeat 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 repeat consultation by the same gastroenterologist for the same problem, after another physician has cared for the patient in between.

What it covers

A repeat consultation is an additional consultation by the same consultant for the same presenting problem, after another physician has given care in the interval since the first consultation (GP19).

It has the same requirements as a consultation, including a new written request from the referring physician, nurse practitioner or dental surgeon (GP19).

Billing rules

• Needs a new written, signed request; the chart must hold it (GP16, GP19).
• Another physician must have cared for the patient between your first consultation and this one, or OHIP pays an assessment instead (GP18, GP19).
• Repeat consultations don't count toward the consultation limits (GP18).
• Send a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (GP16).
• Detention (K001) may follow only after 60 minutes (GP30).
• 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 repeat consultation (A70).
• K001 detention after the first 60 minutes (GP30).

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: A415, A545, A413, A414, C416

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

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