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Billing code

U235A — Ophthalmology initial e-assessment

Ophthalmology initial e-assessment

Bill for your first written opinion on a patient and diagnosis, requested electronically by their primary care physician or nurse practitioner.

Watch for: Put the requester's provider number on the claim, and send your opinion within 30 days of the request.

Code

U235A

Description

Ophthalmology initial e-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

An ophthalmologist's first written opinion on a patient, given through a secure electronic request from a primary care physician or NP.

What it covers

An e-assessment is a specialist's opinion and/or recommendations for managing a specific patient, given in response to a primary care physician's or nurse practitioner's request sent through a secure electronic system. The specialist must review all relevant data provided, including information sent later (GP35).

An initial e-assessment is the first e-assessment by a specialist for a specific patient and diagnosis. It needs a written opinion with a diagnosis and/or management advice; time and intensity are the same as a regular consultation (GP37).

Billing rules

• Limited to 1 per patient per specialist per 12 months, or 2 if the second request is for a clearly different, unrelated diagnosis (GP37). A related later e-assessment is a repeat, follow-up or minor e-assessment (GP37).
• The request must come electronically through a secure system (e.g. secure messaging, EMR) from the patient's primary care physician or nurse practitioner (GP35).
• Send your opinion and/or recommendations within 30 days of the request (GP35).
• Not payable if the purpose is to transfer care or to arrange a consultation, visit, procedure, test or K-prefix time-based service, or if you bill a K-prefix time-based service for the patient within 30 days (GP35).
• A consultation, assessment or visit by you for the same diagnosis within 60 days of the request pays only as a specific or partial assessment (GP35).
• Chart the patient's name and health number, the requester's name, the date and reason for the request, and your opinion (GP36).
• Include the primary care physician's or nurse practitioner's provider number on the claim (GP36).

Often billed with

• K738 to the primary care physician only when they had to collect new data, such as eye images not already in their records (GP35).

Common rejections

• ARF: Missing referring physician number: an e-assessment claim must include the requesting primary care physician's or NP's provider number (GP36).

Related codes: U233, U236, U231, K738, A235

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A155. Rules on GP35–GP37.

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