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Billing code

A485A — Rheumatology consultation

Rheumatology consultation

Bill A485 for a rheumatologist's consultation following a written referral from a physician or nurse practitioner.

Watch for: Keep the signed written request with the referrer's billing number on the chart, or it's paid as a lesser assessment.

Code

A485A

Description

Rheumatology 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

Consultation by a rheumatologist in the office or other general setting, following a written referral.

What it covers

A485 is the standard rheumatology consultation (A200). A consultation is an assessment requested in writing by a referring physician, nurse practitioner or (in hospital) dental surgeon, because of the complexity, seriousness or obscurity of the case or at the patient's request for another opinion (GP16).

It includes a general, specific or medical specific assessment, a review of relevant data and a written report to the referrer (GP16). A consultation of at least 75 minutes of direct contact is the comprehensive consultation, A590 (A200).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner naming you or your specialty, the referrer and billing number, and the patient and health number, kept on the chart; otherwise it's paid as a lesser assessment (GP16).
• Limited to one consultation per patient per physician for the same diagnosis in two consecutive 12-month periods (a second is allowed only for an in-patient or ED consult 12–24 months after the first); an unrelated diagnosis allows one per 12 months (GP17).
• Consultations over the limit, or requested by a medical trainee, are paid as an assessment (GP17–GP18).
• Age premium of 10–30% for patients under 16 (GP64).
• Can be done by video only (not telephone) with K300A, when the virtual care conditions are met (Appendix J, A66).
• Detention (K001) may start after 60 minutes of consultation time (GP30).

Often billed with

• K001 detention after the 60-minute minimum (GP30).

Common rejections

• ARP: OHIP describes this as 'Referring Physician Number Required': a consultation needs the referring physician's or nurse practitioner's billing number (GP16).
• AT2: OHIP describes this as 'Must Include Video Modality': this code is on the video-only virtual care list, so it can't be billed by telephone (K301A) (Appendix J).

Related codes: A590, A595, A486, A483, C485, K001

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

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