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OHIP Billing Guide🩺 ServicePublished 2026
A590

A590 OHIP Billing Code: Maximizing Your Rheumatology Consultations

The A590 code allows rheumatologists to bill for comprehensive consultations involving detailed assessments and treatment plans.

For Ontario Physicians & Billing StaffOHIP Schedule of Benefits Reference342.25 CAD~3 min read

1What Is the A590 OHIP Code?

What is the A590 Code?

The A590 billing code is designated for comprehensive rheumatology consultations under OHIP, requiring a minimum of 75 minutes of direct patient contact. This extensive consultation is typically indicated for complex cases such as undifferentiated inflammatory arthritis or suspected systemic connective tissue diseases.

Given the complexity and time commitment, these consultations are essential for developing a thorough understanding and robust treatment plan for patients with intricate rheumatological conditions. Occasionally, it can be overlooked due to its specific eligibility criteria and the need for detailed documentation, including the start and stop times of the consultation.

2Related Codes

CodeNameFrequencyDescription
A485ConsultationN/AStandard consultation for rheumatology.
A486Repeat consultationN/AFor follow-up evaluations in rheumatology cases.
A595Limited consultationN/AShorter, specific consultation in rheumatology.
C485ConsultationN/AHospital in-patient consultation equivalent.

3Eligibility Requirements

Eligibility Requirements for A590

  • Consultation Criteria: Must be a formal consultation initiated by a written request from a referring physician, nurse practitioner, or dental surgeon.
  • Duration: At least 75 minutes of uninterrupted, direct contact with the patient, excluding other billable services.
  • Frequency: One service per patient per rheumatologist within two consecutive 12-month periods, with certain exceptions for inpatient or emergency department scenarios.
  • Documentation: Ensure detailed medical records with start and stop times for the consultation.
  • Virtual Consultations: May be conducted via video (A590A), but telephone consultations are not eligible.

4What Your Clinical Note Must Show

1Medical Record Documentation

Ensure the following are kept in the patient's permanent medical record:

  • Record start and end times of the consultation.
  • Maintain a copy of the written consultation request.
  • Include a comprehensive consultation report with findings and recommendations.

5Weak vs. Strong Note Examples

The strong note provides detailed timing and specific actions taken during the consultation, aligning with billing requirements, whereas the weak note lacks details necessary for compliance.

❌ Weak Note

Reviewed patient's history. Met for consultation, advised treatment plan.

✓ Strong Note

Comprehensive rheumatology consultation performed for systemic connective tissue disease.

  • Consultation start time: 10:00 AM, end time: 11:30 AM.
  • Detailed joint-by-joint examination conducted.
  • Developed and discussed a comprehensive treatment plan with the patient.

6Common Reasons This Code Is Missed

1
Insufficient Duration Documented
Failing to record the full 75 minutes of patient contact can lead to billing rejections.
2
Incomplete Referral Documentation
Lacking a written referral request from the consulting physician, nurse practitioner, or dental surgeon.
3
Misunderstanding Frequency Limits
Exceeding the allowed frequency of consultations per patient, especially under similar diagnosis.
4
Virtual Consultation Missteps
Conducting a consultation by telephone instead of the required video format.
5
Omission of Written Report
Not completing a thorough consultation report, including findings and recommendations, for the referring professional.
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8Frequently Asked Questions

What is the fee for billing the A590 code?
The A590 comprehensive rheumatology consultation fee is CAD 342.25.
How often can A590 be billed for the same patient and diagnosis?
It can be billed once per two consecutive 12-month periods, with some exceptions for hospital inpatient or emergency department scenarios.
For what conditions should a comprehensive rheumatology consultation be billed?
It should be billed for complex cases such as undifferentiated inflammatory arthritis or systemic connective tissue diseases.
Can an A590 consultation be conducted for a patient in the emergency department?
Yes, it can be billed if provided to an emergency department patient, under certain conditions.
How should I document a comprehensive consultation for billing compliance?
Document the start and stop times, maintain a copy of the referral request, and write a comprehensive report including findings and treatment plan.
If a patient presents with joint pain and suspected arthritis, can I use A590?
Yes, if the case requires 75 minutes of direct consultation and a detailed examination and treatment plan development.
Is a virtual consultation allowed under the A590 code?
Yes, but only if conducted via video. Telephone consultations are not eligible.
What should be included in the report back to the referring physician for A590?
The report should include your findings, professional opinion, and a recommended treatment plan.
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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