Billing code
W004A — General Re-assessment Of Patient In Nursing Home (per The Nursing Homes Act)
Nursing home general re-assessment
Bill for the general re-assessment of a nursing home patient required by the Nursing Homes Act, 6 months after the periodic health visit.
Watch for: Claim it no sooner than 6 months after W109, and not separately when W010 is billed that month.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $38.35 | $0.00 | $0.00 | $0.00 | $0.00 |
- Code
- W004A
- Description
- General Re-assessment Of Patient In Nursing Home (per The Nursing Homes Act)
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Jun 1, 2025
- Termination date
- No end date
Explanation
Updated October 26, 2026
General re-assessment of a nursing home patient under the Nursing Homes Act, claimable 6 months after the periodic health visit.
What it covers
W004 is the general re-assessment of a patient in a nursing home, as required by the Nursing Homes Act (A19). A general re-assessment includes all parts of a general assessment, except that the history can leave out details already obtained (GP22).
W-prefix codes apply to patients in chronic care or convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent beds, but not designated palliative care beds (GP49).
Billing rules
- May be claimed 6 months after the periodic health visit (W109) (A19).
- General re-assessments are limited to two per patient per physician per 12 months, except for hospital admissions; extras are paid at a lesser fee (GP22).
- Patients 65 and over: the fee is increased by 15% automatically (GP64).
- Included in W010 when the MRP bills the monthly management fee for that month; don't bill it separately then (GP51, GP52).
- FHO: a Schedule 2A code for enrolled LTC patients (Agreement p.86) and counts toward the long-term care special payment (Agreement p.67 §8.10).
Often billed with
- E079 smoking cessation initial discussion (A56).
Related codes: W109, W102, W107, W010, W003
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A19.
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