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A015 – Consultation

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The A01x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • A014 Partial assessment

    A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate…

    $31.45

  • A013 Specific assessment

    A specialist assessment rendered by an anaesthesiologist (specialty 01) in a place other than the patient's home.

    $64.65

Consultations

  • A016 Repeat consultation

    A repeat consultation is an additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another…

    $52.15

  • A015 Consultation(this code)

    A consultation rendered by an anaesthesia (01) specialist following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital dental…

    $109.70
A consultation rendered by an anaesthesia (01) specialist following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital dental procedures) due to the complexity, seriousness, or obscurity of the case. The service includes a general, specific, or medical specific assessment and a written report to the referrer.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
Written request from a referring physician, nurse practitioner, or dental surgeon (dental surgeon requests must be in connection with an insured dental procedure in a hospital).
The request must identify the consultant, the referrer (name and billing number), and the patient (name and health number).
The request must specify the information relevant to the referral and the services required.
A written report (including findings, opinions, and recommendations) must be provided to the referring provider.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
Usage limits
Limited to one service per two consecutive 12-month periods for the same diagnosis by the same physician, except when the second consultation is rendered for a hospital in-patient or in an Emergency Department more than 12 months but less than 24 months after the first. Consultations for clearly defined unrelated diagnoses are limited to one service every 12 months.
C015In-patient ConsultationA016Repeat consultationA210Special anaesthetic consultation (minimum 50 minutes)A215Limited consultation for acute pain managementA013Specific assessmentA014Partial assessment

The routine pre-anaesthetic evaluation of the patient does not constitute a consultation, regardless of where or when it is performed.

If the requirements for a consultation (e.g., written request, report) are not met, the fee will be reduced to a lesser assessment fee.

A015 is used for out-patients or patients in the Emergency/OPD when the physician is not on duty in that department.

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