Billing code
A480A — Complex Rheumatology Assessment
Complex rheumatology management visit
Bill A480 for ongoing rheumatologist management of vasculitis, inflammatory myopathy or polymyalgia rheumatica, not uncomplicated problems like osteoarthritis.
Watch for: Not payable for your first evaluation of the patient; limit 6 per patient per 12 months, and E078 isn't payable with it.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $113.85 | $0.00 | $0.00 | $0.00 |
- Code
- A480A
- Description
- Complex Rheumatology 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
Complex rheumatology assessment for ongoing management of vasculitis, inflammatory myopathy, polymyalgia rheumatica or paediatric vasculitis.
What it covers
A480 is an assessment for the ongoing management of systemic vasculitides, inflammatory myopathies, polymyalgia rheumatica or paediatric vasculitides, where the condition's complexity requires continuing management by a rheumatologist (A200).
It is not for uncomplicated problems such as osteoarthritis, bursitis/tendonitis, or neck and back pain. Examples of systemic vasculitides include polyarteritis nodosa, Takayasu's, microscopic polyangiitis and temporal arteritis (A201).
Billing rules
- Must include the elements of a medical specific re-assessment, or it is paid at a lesser fee (A200).
- Not payable for your initial evaluation of the patient; bill a consultation or assessment for that (A200, A201).
- Limited to 6 per patient per physician per 12 months; extras are paid at a lesser fee (A200).
- E078 is not payable with A480 (A200).
- Detention (K001) may start after 60 minutes (GP30).
- Can be done by video or telephone with an existing relationship; add K300A or K301A (Appendix J, A66).
Common rejections
- AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service with you in the past 24 months (A66).
- AM1: OHIP describes this as 'Service Limit Exceeded': more than 6 complex rheumatology assessments per patient per physician in 12 months (A200).
Related codes: A484, A481, A483, C480, A485
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Rheumatology (48), page A200.
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