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Billing code

A545A — Gastroenterology limited consultation

Gastroenterology limited consultation

Bill A545 for a shorter, less demanding gastroenterology consultation that still meets all consultation requirements.

Watch for: Keep the signed written request with the referrer's billing number in the chart, or OHIP pays a lesser assessment.

Code

A545A

Description

Gastroenterology limited 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

A shorter, less demanding consultation by a gastroenterologist that still meets all consultation requirements.

What it covers

A limited consultation is less demanding than a full consultation and normally takes substantially less of the physician's time. Otherwise it has the same requirements as a full consultation (GP19).

That means a written request from the referrer, an assessment, and a written report back (GP16, GP19).

Billing rules

• Needs a written, signed request from a physician, nurse practitioner or (hospital dental) dental surgeon naming you or the specialty, the referrer and billing number, the patient and health number, and the reason; keep it in the chart or OHIP pays a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (and to the primary care provider when an NP referred) (GP16).
• Consultation limits apply to all consultations except repeat consultations: one per two consecutive 12-month periods for the same diagnosis, one per 12 months for an unrelated diagnosis (GP17–GP18).
• A request obtained after the service makes it not a consultation; bill the visit fee for what you did (GP16).
• A pre-operative consultation before colonoscopy under local anaesthesia or IV sedation is only payable when the chart shows it was medically necessary (GP18).
• Under-16 age premiums (10–30%) apply to specialist consultations, limited consultations and repeat consultations (GP64).
• Virtual care by video only (not telephone) with an existing patient-physician relationship; add K300A (Appendix J AJ2, A66, A70).

Often billed with

• K300A video modality indicator for a video consultation (A70).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': 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 video-only for virtual care, so a telephone (K301A) claim is refused (Appendix J AJ2).
• AT3: Usually means it was billed as virtual care and OHIP found no existing patient-physician relationship, such as an in-person service with you in the past 24 months or a video consultation in that time (A66).

Related codes: A415, A416, A413, A414, C545

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Gastroenterology (41), page A104.

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