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Billing code

A481A — Rheumatology complex medical specific re-assessment

Complex rheumatology re-assessment

Bill A481 when a rheumatologist re-assesses a patient because the condition is complex, obscure or serious.

Watch for: Send a written report to the primary care physician, or it is paid at a lesser fee; limit 4 per 12 months.

Code

A481A

Description

Rheumatology complex 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

Complex medical specific re-assessment by a rheumatologist for a complex, obscure or serious condition, with a written report to the family doctor.

What it covers

A complex medical specific re-assessment is a re-assessment because of the complexity, obscurity or seriousness of the patient's condition, and includes all requirements of a medical specific re-assessment (GP24).

You must send your findings, opinions or recommendations in writing to the patient's primary care physician (GP24).

Billing rules

• Send a written report to the primary care physician, or it is paid at a lesser fee (GP24).
• Limited to 4 per patient per physician per 12 months (GP24).
• Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months (GP24).
• Add E078 (+50%) 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 listed diagnostic codes, documented in the chart (A200, GP25–GP26).
• Can be done by video or telephone with an existing relationship; add K300A or K301A (Appendix J, A66).

Often billed with

• E078 chronic disease assessment premium (A200, GP25).

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).

Related codes: A484, A483, A480, A488, E078, C481

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Rheumatology (48), page A200.

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