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Billing code

A474A — Respiratory medical specific re-assessment

Respirology follow-up assessment

Bill A474 for a respirologist's follow-up with a full relevant history and exam of one or more systems.

Watch for: Limited to two per patient per physician per 12 months, except for hospital admissions; extras pay a lesser assessment.

Code

A474A

Description

Respiratory 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

Medical specific re-assessment by a respirologist: a full relevant history and exam of one or more systems.

What it covers

A474 is a medical specific re-assessment by a specialist in Respiratory Disease (A197).

It needs a full, relevant history and physical examination of one or more systems (GP23).

Billing rules

• Limited to two per patient per physician per 12 months, except when rendered for a hospital admission. Excess claims pay as a lesser assessment (GP23).
• 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 40 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).

Related codes: A473, A471, A478, A570, C474, E078

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

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