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Billing code

H104A — Reassess (Day)

ED re-assessment, weekday day

Bill H104 for an ED re-assessment at least 2 hours after the last one, when more care is needed, weekdays 08:00 to 17:00.

Watch for: Not payable for a discharge assessment, an admission or a consult referral; maximum 2 per physician per patient per day.

Code

H104A

Description

Reassess (Day)

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

Emergency department re-assessment at least 2 hours after the last assessment, when more care is needed. Weekday daytime band.

What it covers

A re-assessment is an ED or Hospital Urgent Care Clinic assessment done at least two hours after the original assessment or re-assessment (including investigation and treatment), which shows that further care and/or investigation is required and is performed (A15).

This code is for re-assessments in the Monday to Friday daytime (08:00 to 17:00) time band (A16).

Billing rules

• Use H-prefix ED codes when you are working a scheduled ED or Hospital Urgent Care Clinic shift, or when you are on call and the visit doesn't qualify for a special visit premium. Any physician on duty, whatever the specialty, must use these codes (GP50).
• Must be at least 2 hours after the original assessment or the previous re-assessment (A15).
• Not payable for a discharge assessment, when the ED physician admits the patient, or when the re-assessment leads directly to a referral for consultation (A15).
• Maximum 3 per patient per day, and 2 per physician per patient per day; extra services are not paid (A15).
• Add E420 (+50%) for a trauma patient whose Injury Severity Score is above 15 (age 16+) or above 12 (under 16), recorded in the chart, on the day of the trauma or within 24 hours. Submit it on the same claim (GP109).
• Special visit premiums are not payable with H-prefix ED codes (GP65).
• Not payable fee-for-service in an ED covered by an alternative funding agreement, except under the AFA's second on-call or GP Expert group numbers (GP110).

Often billed with

• H102 comprehensive assessment and care; re-assessments are payable in addition when the criteria are met (A15).

Common rejections

• ESD: The hospital ED is part of an alternative funding agreement, so H-prefix services there aren't paid fee-for-service unless billed under the AFA's second on-call or GP Expert group number (GP110).
• AM1: Service limit exceeded: ED re-assessments are capped at 3 per patient per day and 2 per physician per patient per day (A15).

Related codes: H102, H103, H101, H134, H154, H124

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00) – Emergency Department Physician, page A16; definitions A15, GP50.

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