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Billing code

K481A — Rheumatoid Arthritis Management By A Specialist

Annual rheumatoid arthritis management

Bill K481 once a year when the rheumatologist most responsible for a patient's rheumatoid arthritis care has documented the required measures.

Watch for: Rheumatology only; needs at least 3 visits in the 12 months and more than 100 rheumatoid arthritis patients.

Code

K481A

Description

Rheumatoid Arthritis Management By A Specialist

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

Annual rheumatoid arthritis management fee for the rheumatologist most responsible for a patient's ongoing RA care.

What it covers

K481 is paid to the rheumatology specialist most responsible for ongoing management of a patient with rheumatoid arthritis. It covers coordinating, providing and documenting that care using a planned care approach (A202).

The chart for the previous 12 months must record tender and swollen joint counts, physician and patient global assessments, patient pain score, patient function (e.g. HAQ or SF36), ESR or CRP, and a pooled disease activity score (DAS-28, SDAI or CDAI) (A202).

Billing rules

• Only payable to Rheumatology (48) (A202).
• Maximum one per patient per 12 months (A202).
• You must have provided at least three consultations or assessments to the patient in the 12 months claimed (A202).
• You must have treated more than 100 patients with rheumatoid arthritis in that 12-month period (A202).
• Submit only once all required elements are done for the 12 months claimed (A202).
• Comprehensive virtual visits count toward the required visits (A75).

Common rejections

• A4D: OHIP describes this as 'Invalid specialty for this service code': K481 is only payable to Rheumatology (48) (A202).
• AM1: OHIP describes this as 'Service Limit Exceeded': K481 is limited to one per patient per 12 months (A202).

Related codes: A484, A481, A483, A480, K480

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Rheumatology (48), page A202.

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