< Billing codes

Billing code

A625A — Consultation

Clinical immunology consultation

Bill A625 for a clinical immunologist's consultation on a written request from a physician, nurse practitioner or dental surgeon.

Watch for: Keep the signed request naming the referrer and their billing number in your record, or it pays as a lesser assessment.

Code

A625A

Description

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

Clinical immunology consultation on a written referral. One per patient per diagnosis in two consecutive 12-month periods.

What it covers

A625 is the consultation in the Clinical Immunology (62) listing (A83). A consultation is an assessment requested in writing by a physician, a nurse practitioner, or a dental surgeon for an insured hospital dental procedure, because of the complexity, seriousness or obscurity of the case, or because the patient asks for another opinion (GP16).

The consultant performs a general, specific or medical specific assessment, reviews all relevant data, and sends a written report of findings, opinions and recommendations to the referrer, and to the primary care provider when a nurse practitioner referred (GP16).

Billing rules

• The signed written request must be kept in your record and name the consultant or specialty, the referrer with billing number, and the patient with health number, plus the information relevant to the referral and the services required; otherwise it pays as a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods; a second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first. A clearly unrelated diagnosis allows one per 12 months. Excess consultations pay as an assessment (GP17-GP18).
• Not a consultation if you ask for the referral after the service, or if, after being paid for a consultation for the same diagnosis, you request a referral for ongoing management of the patient (GP16).
• In hospital in-patients, bill C625 (A84).
• Detention (K001) can only start after 60 minutes (GP30).
• Specialist consultations for children pay an age premium: 30% under 30 days, 25% to age 1, 20% to age 2, 15% to age 5 and 10% from 5 to 15 years (GP64).
• Payable by video only, never telephone, as comprehensive virtual care with K300A (AJ2, A70). A video consultation listed in Appendix J is itself an existing relationship for virtual follow-up (A66).

Often billed with

• G209 (technical) and G197 (professional) skin tests, billed per test, each to a maximum of 50 per year (J5).
• G208 provocation testing for foods, food additives and medications, per hour or major part, to a maximum of 5 sessions per 12 months (J4).
• G202 hyposensitisation injection, maximum 2 when an assessment is payable for the same visit (J4).

Common rejections

• A4D: A625 is in the Clinical Immunology (62) listing, and specialists bill consultations and visits from their own specialty's listing (GP9). A claim under another registered specialty rejects; bill that specialty's code instead.
• AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the written request (GP16).
• AC1: OHIP's description is 'maximum reached - resubmit with a different fee code'. The consultation limits for this patient and diagnosis were reached (GP17); resubmit as A623, or as A626 if the repeat consultation rules are met (GP19).
• EQ2: The specialty code on the claim wasn't registered and active for the physician on the service date. Correct it, or update the registration, then resubmit.
• EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.

Related codes: A525, A626, A623, C625, G197, G209

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Clinical Immunology (62), pages A83-A84; General Preamble GP16-GP18 (consultation), GP30 and GP64

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