What are the billing rules for A483A?

Specific and medical specific assessments are limited to one per patient per physician per 12 months; two if a clearly different, unrelated diagnosis is made, or if 90+ days later the second is a hospital admission assessment (GP23). Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months; extras are paid at a lesser fee (GP23). 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).

What is A483A often billed with?

E078 chronic disease assessment premium (A200, GP25).

Why is A483A rejected?

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).

< Billing codes

Billing code

A483A — Rheumatology medical specific assessment

Q: What is OHIP billing code A483A?

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

Rheumatology specialist assessment

Bill A483 for a rheumatologist's full history of the presenting complaint and detailed exam of the affected parts or systems.

Watch for: One per patient per physician per 12 months, unless a clearly different, unrelated diagnosis is made.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$95.95	$0.00	$0.00	$0.00

Code: A483A
Description: Rheumatology 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 rheumatologist: full history of the complaint and detailed exam of the affected parts or systems.

What it covers

A medical specific assessment is rendered by a specialist outside the patient's home and requires a full history of the presenting complaint and a detailed exam of the affected part(s), region(s) or system(s) needed to make a diagnosis, exclude disease or assess function (GP23).

For rheumatology services not listed in the Rheumatology section, use the Internal Medicine listings (A200).

Billing rules

Specific and medical specific assessments are limited to one per patient per physician per 12 months; two if a clearly different, unrelated diagnosis is made, or if 90+ days later the second is a hospital admission assessment (GP23).
Medical specific assessments and complex medical specific re-assessments combined are limited to 4 per patient per physician per 12 months; extras are paid at a lesser fee (GP23).
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).
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).

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, A481, A480, A488, E078, C483

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

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing