A050 – Special Community Medicine Consultation
OHIP General Listings Code — Community Medicine (05) · Schedule of Benefits
A consultation rendered by a specialist in community medicine who provides all the appropriate elements of a consultation and spends a minimum of 50 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use A050 when a patient requires an in-depth assessment for complex social determinants of health impacting their well-being, necessitating a full 50 minutes of direct physician-patient interaction.
- Bill A050 for a comprehensive review of a patient's multiple chronic conditions and their impact on community reintegration, provided the direct contact meets the 50-minute minimum.
- Consider A050 for a patient presenting with significant psychosocial challenges requiring extensive discussion and planning, exceeding the scope of a standard consultation (A055).
Common Pitfalls
- Claims for A050 are frequently rejected if the required 50 minutes of direct patient contact is not clearly documented, including start and stop times.
- Billing A050 when the patient encounter is less than 50 minutes, or if significant time was spent on separately billable procedures, will lead to payment adjustments or rejections.
- Failure to include a written report to the referring physician, nurse practitioner, or dental surgeon with findings and recommendations will result in claim denial for A050.
Billing Tips
- Ensure the referral is from a physician, nurse practitioner, or dental surgeon and is clearly documented in the patient's chart to support the A050 claim.
- When billing A050, confirm that no other separately billable services were performed during the 50-minute direct patient contact period to avoid time exclusion issues.
Effective: June 1, 2025
Consultations and Visits
Community Medicine (05)
Time-based consultation
Consultation
Must satisfy all the elements of a consultation as defined in General Preamble .
Requires a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital.
A written report including findings, opinions, and recommendations must be sent to the referring physician, nurse practitioner or dental surgeon.
Minimum of 50 minutes of direct contact with the patient is required, exclusive of time spent rendering any other separately billable intervention to the patient.
The start and stop times must be recorded in the patient’s permanent medical record.
Calculation of the 50-minute minimum excludes non-patient-facing time (e.g., reviewing charts, imaging, or documentation).
If the consultation is requested by a Medical Trainee, the fee is adjusted to a lesser assessment fee.
Special visit premiums (-) may apply if the service is rendered in a qualifying location (e.g., home, hospital, or LTC) and meets the criteria for an emergency or special visit.
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