What are the billing rules for A511A?

Must include the elements of a medical specific re-assessment, or it is paid at a lesser fee (A176). Limited to 6 per patient per physician per 12 months; extras are paid at a lesser fee (A176). E078 is not payable with it (A176).

What is A511A often billed with?

K001 detention after 60 minutes of complex physiatry assessment time (GP30).

Why is A511A rejected?

AT3: Billed as virtual care but OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).

< Billing codes

Billing code

A511A — Complex Physiatry Assessment

Q: What is OHIP billing code A511A?

Physiatrist assessment for ongoing management of complex traumatic brain injury, stroke or spinal cord injury. Up to 6 per patient per year.

Complex brain, stroke, spine care

Bill A511 for a physiatrist's ongoing management of complex traumatic brain injury, stroke or spinal cord injury.

Watch for: Must include the elements of a medical specific re-assessment; limit 6 per patient per 12 months, and no E078.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$114.80	$0.00	$0.00	$0.00

Code: A511A
Description: Complex Physiatry 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

Physiatrist assessment for ongoing management of complex traumatic brain injury, stroke or spinal cord injury. Up to 6 per patient per year.

What it covers

A complex physiatry assessment is for traumatic brain injury, stroke (haemorrhagic or ischaemic) or spinal cord injury where the complexity needs ongoing management by a physiatrist (A176). It is not meant for uncomplicated disorders such as TIA, uncomplicated concussion or ASIA level E spinal cord injury (A177).

A511 is the General Listings version; C511 and W511 are the in-patient and long-term care versions (A176, A178, A179).

Billing rules

Must include the elements of a medical specific re-assessment, or it is paid at a lesser fee (A176).
Limited to 6 per patient per physician per 12 months; extras are paid at a lesser fee (A176).
E078 is not payable with it (A176).
Can be done by video or telephone with an existing patient-physician relationship; add K300A (video) or K301A (telephone). Telephone pays 85% of the fee (Appendix J AJ1, A66, A70).

Often billed with

K001 detention after 60 minutes of complex physiatry assessment time (GP30).

Common rejections

AT3: Billed as virtual care but OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).

Related codes: A510, A310, A311, C511, W511, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A176.

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