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OHIP Billing Guide🩺 ServicePublished 2026
A395

A395 OHIP Billing Code: Simplified Psychiatric Assessment

A395, or Limited Consultation, allows psychiatrists to provide concise, targeted consultations for straightforward cases. Billed at CAD 120.30.

For Ontario Physicians & Billing StaffOHIP Schedule of Benefits Reference120.30 CAD~3 min read

1What Is the A395 OHIP Code?

What is A395?

A395 represents the Limited Consultation billing code for psychiatric services under OHIP, typically used for brief assessments in outpatient settings. It is specifically designed for cases requiring a focused evaluation, such as determining the viability of tapering medication or offering a second opinion on an already substantial diagnosis.

Usually, this service is requested when a complete psychiatric assessment is not necessary. It is crucial to ensure that the scope and complexity of the case fit the definition of a 'limited' consultation. Otherwise, a full consultation (A195) might be more appropriate.

2Related Codes

CodeNameFrequencyDescription
A190Special psychiatric consultationNot specifiedComprehensive psychiatric evaluation service.
A195ConsultationNot specifiedFull consultation service in psychiatry.
A196Repeat consultationNot specifiedAllows for a repeated assessment with the same scope as limited consultation.
A695Neurodevelopmental consultationNot specifiedDetailed assessment targeting neurodevelopmental disorders.

3Eligibility Requirements

Eligibility Requirements for A395

  • Frequency: Limited to one service per two consecutive 12-month periods for the same patient, physician, and diagnosis. Alternatively, one service every 12 months for an unrelated diagnosis.
  • Virtual Care: Eligible as A395A under video consultation only; telephone is not permissible.
  • Hospital In-Patient Equivalent: C395 is the respective code for hospital in-patient scenarios.

Refer to the OHIP Schedule of Benefits for comprehensive eligibility verification.

4What Your Clinical Note Must Show

1Patient Documentation

Ensure patient medical history and current condition indicate a limited consultation.

  • Document the specific question or issue being addressed.
  • Include a summary of relevant prior assessments and outcomes.
2Consultation Details

Record the focused nature of the assessment.

  • Include time spent directly with the patient, documented symptoms or concerns.
  • Specify the final decision or opinion provided.

5Weak vs. Strong Note Examples

The strong note provides clear documentation of the consultation's purpose and outcome, ensuring clarity for billing purposes. The weak note lacks specificity and thoroughness, which might lead to billing discrepancies.

❌ Weak Note

Patient seen for quick check-up. Advised to continue current medication.

✓ Strong Note

Patient presented for assessment regarding potential tapering of medication.

After review of prior history and current presentation, advised tapering as symptoms appear managed.

  • Documented patient history thoroughly.
  • Detailed current examination and treatment decision outlined.

6Common Reasons This Code Is Missed

1
Inadequate Documentation
Failure to document the focused scope and specific question or issue addressed.
2
Overuse for Complex Cases
Using A395 when a full psychiatric consultation (A195) is warranted.
3
Misuse in Hospital Settings
Inappropriately billing A395 for hospital in-patient scenarios instead of C395.
4
Ineligible Virtual Consultations
Billing for telephone consultations instead of video when claiming virtual care.
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8Frequently Asked Questions

What is the fee for billing A395?
The fee for A395 is CAD 120.30.
In which scenarios should a psychiatrist use A395 over A195?
A395 is appropriate for straightforward cases like confirming medication plans or providing a brief diagnostic opinion.
Can A395 be used for new psychiatric disorders?
Yes, if the disorder requires a limited consultation. For more extensive evaluations, A195 is preferred.
How do you determine the need for a limited psychiatric consultation?
Referral for focused questions such as medication adjustments or concise diagnostic reviews can be grounds for a limited consultation.
What documentation is required for A395?
Provide notes on the specific issue addressed, relevant patient history, and the advised outcome or action.
Is A395 applicable for hospital in-patient services?
No, use C395 for in-patient consults instead of A395.
How should A395 consultations be documented for telemedicine?
Ensure video interaction is noted and detailed consultation findings are recorded, specifying the video as the mode of contact.
Disclaimer: This article is intended as a general educational resource for physicians and billing staff. It does not constitute billing advice or a definitive interpretation of the OHIP Schedule of Benefits. Always verify current billing codes, eligibility criteria, and documentation requirements directly against the official Schedule of Benefits or consult with a qualified medical billing specialist.
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