What are the billing rules for A473A?

One per patient per physician per 12 months; two if the second has a clearly different, unrelated diagnosis, or is a hospital admission assessment at least 90 days after the last. Excess claims pay as a lesser assessment (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%) chronic disease assessment premium in the office or a hospital out-patient clinic (not ED, in-patient or LTC) when the patient has an established chronic disease from the GP26 diagnostic code list, such as 491–493 (A197, GP25–GP26).

What is A473A often billed with?

E078 chronic disease assessment premium (+50%), office or hospital out-patient clinic only (A197, GP25). Pulmonary function studies, payable in addition to the assessment (J3, H4–H6).

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Billing code

A473A — Respiratory medical specific assessment

Q: What is OHIP billing code A473A?

Medical specific assessment by a respirologist: full history of the complaint and detailed exam of the affected systems.

Respirology specialist assessment

Bill A473 for a respirologist's full history of the presenting complaint and detailed exam of the affected systems, outside the patient's home.

Watch for: One per patient per physician per 12 months, unless the diagnosis is clearly unrelated; extras pay a lesser assessment.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$102.60	$0.00	$0.00	$0.00

Code: A473A
Description: Respiratory 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

Medical specific assessment by a respirologist: full history of the complaint and detailed exam of the affected systems.

What it covers

A473 is a medical specific assessment by a specialist in Respiratory Disease (A197).

It is rendered somewhere other than the patient's home and needs a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, exclude disease or assess function (GP23).

Billing rules

One per patient per physician per 12 months; two if the second has a clearly different, unrelated diagnosis, or is a hospital admission assessment at least 90 days after the last. Excess claims pay as a lesser assessment (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%) chronic disease assessment premium in the office or a hospital out-patient clinic (not ED, in-patient or LTC) when the patient has an established chronic disease from the GP26 diagnostic code list, such as 491–493 (A197, GP25–GP26).
Detention (K001) is payable only after 60 minutes (GP30).
Can be done by video or phone with an existing patient relationship; add K300A (video) or K301A (phone) (AJ1, A66).

Often billed with

E078 chronic disease assessment premium (+50%), office or hospital out-patient clinic only (A197, GP25).
Pulmonary function studies, payable in addition to the assessment (J3, H4–H6).

Related codes: A474, A471, A478, A570, C473, E078

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A197. Rules GP23, GP25.

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