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Billing code

U236A — Ophthalmology follow-up e-assessment

Ophthalmology follow-up e-assessment

Bill for a limited e-assessment when you have already provided an insured service to the patient for the same diagnosis.

Watch for: Put the requester's provider number on the claim; limit is 4 per patient per 12 months.

Code

U236A

Description

Ophthalmology follow-up 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

A limited e-assessment by an ophthalmologist who has already provided an insured service to the patient for the same diagnosis.

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).

A follow-up e-assessment is a limited e-assessment by a specialist who has already rendered any insured service to the patient for the same diagnosis. Time and intensity are the same as a partial assessment (GP38).

Billing rules

• Limited to 1 per patient per day, 4 per patient per 12 months (same physician), and 1,000 per physician per 12 months (GP38).
• 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).

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).
• AM1: Service limit exceeded: follow-up e-assessments are limited to 4 per patient per 12 months (GP38).

Related codes: U235, U233, U231, A234

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A155. Rules on GP35–GP38.

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