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Billing code

A476A — Respiratory disease repeat consultation

Repeat respirology consultation

Bill A476 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; if the repeat consultation rules aren't met, it pays as an assessment.

ProviderSpecialistAssistantAnaesthetistNon-anaesthetist
$0.00$119.35$0.00$0.00$0.00
Code
A476A
Description
Respiratory disease 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

Repeat consultation by a respirologist for the same problem after another physician has cared for the patient in between.

What it covers

A476 is a repeat consultation by a specialist in Respiratory Disease (A197).

A repeat consultation is another consultation by the same consultant for the same presenting problem after another physician has cared for the patient in the interval (GP19).

Billing rules

  • Needs a new written request from the referring physician or nurse practitioner, like any consultation (GP19, GP16).
  • If the repeat consultation rules aren't met, it pays as an assessment (GP18).
  • Repeat consultations don't count toward the consultation limits (GP18).
  • Detention (K001) is payable only after 60 minutes (GP30).
  • Virtual care: video only, not phone, with an existing patient relationship; add K300A (AJ2, A66).

Common rejections

  • ARF: OHIP's message is 'Missing Physician Referring Number': a consultation needs a written request from a physician or nurse practitioner, and the referrer's billing number must be on the claim (GP16).
  • AT2: OHIP's message is 'Must Include Video Modality': this code is on the video-only list, so a phone claim (K301A) is refused (AJ2).

Related codes: A475, A575, A470, C476, A474

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A197. Rules GP16–GP19.

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