What are the billing rules for A603A?

Limit one per patient per physician per 12 months; two if the second is for a clearly different, unrelated diagnosis, or at least 90 days later as a hospital admission assessment. Extras are paid at a lesser fee (GP23). Medical specific assessments and complex medical specific re-assessments combined: maximum 4 per patient per physician per 12 months (GP23, GP24). Add E088 when the patient has an established, documented diagnosis of congestive heart failure and you see them in the office or a hospital out-patient clinic (not ED, in-patient or LTC) (A79).

What is A603A often billed with?

E088 congestive heart failure premium (A79).

Why is A603A rejected?

AT3: Billed as virtual care (K300A/K301A) without an existing patient-physician relationship (A66).

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Billing code

A603A — Cardiology medical specific assessment

Q: What is OHIP billing code A603A?

Medical specific assessment by a cardiologist: full history of the presenting complaint and detailed exam of the affected systems.

Cardiology specialist assessment

Bill A603 for a cardiologist's full history of the presenting complaint and detailed exam of the affected systems.

Watch for: One per patient per physician per 12 months, unless the second is for a clearly unrelated diagnosis; extras pay less.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$96.70	$0.00	$0.00	$0.00

Code: A603A
Description: Cardiology 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 cardiologist: full history of the presenting complaint and detailed exam of the affected systems.

What it covers

A medical specific assessment is a specialist service, not in the patient's home, with a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems needed to make a diagnosis, exclude disease or assess function (GP23).

A603 is the cardiology (60) medical specific assessment (A79).

Billing rules

Limit one per patient per physician per 12 months; two if the second is for a clearly different, unrelated diagnosis, or at least 90 days later as a hospital admission assessment. Extras are paid at a lesser fee (GP23).
Medical specific assessments and complex medical specific re-assessments combined: maximum 4 per patient per physician per 12 months (GP23, GP24).
Add E088 when the patient has an established, documented diagnosis of congestive heart failure and you see them in the office or a hospital out-patient clinic (not ED, in-patient or LTC) (A79).
Detention (K001) can start only after 60 minutes (GP30).
Can be done by video or phone as comprehensive virtual care when you have an existing relationship with the patient (Appendix J AJ1).

Often billed with

E088 congestive heart failure premium (A79).

Common rejections

AT3: Billed as virtual care (K300A/K301A) without an existing patient-physician relationship (A66).

Related codes: A604, A601, A608, A605, E088, C603

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Cardiology (60), page A79; rules GP23.

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