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OHIP Billing Guide🩺 ServicePublished 2026
A570

A570 OHIP Billing Code: Maximizing Reimbursement for Complex Respiratory Assessments

The A570 code covers complex respiratory assessments by respirology specialists, critical for managing intricate respiratory conditions in Ontario.

For Ontario Physicians & Billing StaffOHIP Schedule of Benefits Reference108.95 CAD~3 min read

1What Is the A570 OHIP Code?

What is A570?

The A570 OHIP billing code is designated for complex respiratory assessments performed by respirology specialists in Ontario. These assessments are required for the ongoing management of chronic and intricate respiratory conditions, including chronic respiratory failure, bronchiectasis, and cystic fibrosis. The assessment involves a thorough review of the patient's respiratory physiology, imaging, and management plans, especially in advanced cases like severe COPD or interstitial lung disease.

Missing this code is common when physicians overlook the need for thorough documentation of time and complexity, or when eligibility criteria are not fully met. It is essential to document the assessment's start and end times, as stipulated in the OHIP General Preamble, to ensure proper reimbursement.

2Related Codes

CodeNameFrequencyDescription
A470Comprehensive respiratory disease consultationCheck code-specific rules for frequencyA comprehensive consultation for diagnosing and managing severe respiratory diseases.
A475ConsultationCheck code-specific rules for frequencyA standard consultation for patient evaluation in the respiratory domain.
A476Repeat consultationCheck code-specific rules for frequencyA follow-up consultation for ongoing patient management.
A575Limited consultationCheck code-specific rules for frequencyA brief consultation dealing with straightforward respiratory issues.

3Eligibility Requirements

Eligibility Requirements

To bill the A570 code, the service must meet specific conditions:

  • Patient Condition: The patient must have a complex respiratory condition that necessitates a specialist's continuous management. Eligible conditions include:

    • Chronic respiratory failure with PaO2 <60mmHg or PaCO2 >50mmHg.
    • Bronchiectasis with frequent infections.
    • Cystic fibrosis.
    • Active mycobacterial tuberculosis complex (excludes latent tuberculosis infection).
    • Active non-tuberculous mycobacterial disease (excludes colonization without disease).

  • Service Delivery: The assessment can be rendered in an office, outpatient clinic, or virtually (A570A).

  • Documentation: Record the duration of service in the patient's permanent medical records, noting the start and end times.

4What Your Clinical Note Must Show

1Time Documentation

Accurate time recording is mandatory.

  • Record the start and end time of the service.
  • Include time details in the patient's permanent medical record.
2Assessment Elements

Include comprehensive assessment details.

  • Symptoms, imaging, and management review are required.
  • Ensure the assessment meets the criteria for a medical-specific re-assessment.

5Weak vs. Strong Note Examples

The strong note succeeds because it includes specific details regarding the assessment, times, and management plan, ensuring clarity and compliance with documentation requirements. The weak note lacks detail and fails to document time.

❌ Weak Note

Complex respiratory assessment conducted.

✓ Strong Note

Patient presented with chronic respiratory failure. Assessment involved reviewing patient's PaO2 levels, imaging, and customizing a management plan.

  • Assessment start time: 10:00 AM
  • Assessment end time: 11:15 AM
  • Reviewed imaging and adjusted management plan for advanced COPD.

6Common Reasons This Code Is Missed

1
Insufficient Documentation
Failure to note specific times or assessment details.
2
Ineligible Condition
Billing for conditions not covered under the complex assessment criteria.
3
Virtual Service Not Properly Billed
Not using the A570A code for virtual assessments.
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8Frequently Asked Questions

How often can A570 be billed?
The A570 can be billed as needed for complex assessments, following the general respirology guidelines.
What diagnoses qualify for A570?
Diagnoses include chronic respiratory failure, bronchiectasis with frequent infections, cystic fibrosis, and certain mycobacterial diseases.
Is A570 applicable for virtual consultations?
Yes, A570A can be used for virtual consultations, ensuring eligibility requirements are met.
What makes a respiratory condition 'complex' under A570?
Complex conditions require ongoing specialist management and include criteria such as symptomatic low PaO2 or elevated PaCO2.
Can A570 be billed for hospital inpatient services?
No, for hospital inpatients, use the C570 code for the equivalent service.
Why is it critical to document assessment times?
Documenting start and end times ensures compliance with billing rules and avoids payment rejections.
What patient scenarios typically require a complex assessment?
Patients with severe COPD or advanced interstitial lung disease often necessitate such assessments.
What should be included in a comprehensive management plan?
A thorough review of physiology, imaging, and a tailored management strategy are essential.
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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