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Billing code

A661A — Complex Medical Specific Re-assessment

Complex paediatric re-assessment

Bill A661 when a paediatrician re-assesses a patient because the condition is complex, obscure or serious.

Watch for: Send a written report to the primary care physician, or it is paid at a lesser fee; limit four per 12 months.

Code

A661A

Description

Complex Medical Specific Re-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

Paediatrics (26) complex medical specific re-assessment, for a complex, obscure or serious condition, with a written report to the primary care physician.

What it covers

A661 is the complex medical specific re-assessment in the Paediatrics (26) listing (A170). It is a re-assessment because of the complexity, obscurity or seriousness of the patient's condition, and includes everything a medical specific re-assessment requires (GP24).

The paediatrician must send findings, opinions or recommendations in writing to the patient's primary care physician (GP24).

Billing rules

• Without the written report to the primary care physician, it is paid at a lesser assessment fee (GP24).
• Four per patient per physician per 12 months; medical specific assessments (A263) and complex re-assessments combined are also limited to four. Extras are paid at a lesser assessment fee (GP23, GP24).
• E078 chronic disease premium (+50%) in an office or hospital out-patient clinic (not the ED, an in-patient or LTC), for an established chronic disease with a diagnostic code from the GP26 list (A170, GP25, GP26).
• Can be billed by video or telephone as comprehensive virtual care with an existing relationship, with K300A or K301A; telephone pays 85% (A70, AJ1).
• Patients 18 or older: only if the paediatrician saw them in the 12 months before their 18th birthday, ongoing chronic care is needed and they are under 22, or with the Ministry's written approval (A168).

Often billed with

• E078 chronic disease assessment premium, with a GP26 diagnostic code on the claim (GP25, GP26).
• G202 allergy injection: up to 2 when an assessment is payable for the same visit (J3, J4).

Common rejections

• 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: A263, A264, A262, E078, C661

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), pages A168 and A170; General Preamble GP23 to GP26 (complex medical specific re-assessment, chronic disease assessment premium)

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