A065 – Consultation
OHIP General Listings Code — Orthopaedic Surgery (06) · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures). The consultant physician must be competent to give advice due to the complexity, seriousness, or obscurity of the case. The service includes necessary elements to prepare a written report back to the referring provider.
When to Use
- Bill A065 when you receive a written request from a primary care physician for an opinion on a complex orthopedic case, and you provide a detailed written report back.
- Use A065 for an initial consultation requested by a Nurse Practitioner for a patient with a rare condition requiring specialized orthopedic expertise.
- A065 is appropriate when a dental surgeon requests an orthopedic consultation for a patient with a complex facial trauma requiring surgical intervention.
Common Pitfalls
- Billing A065 for a routine follow-up visit or a simple assessment that does not meet the complexity criteria for a consultation.
- Failing to obtain and retain a written request from the referring provider, which is a common reason for claim rejection or audit.
- Using A065 for consultations within the hospital or long-term care setting; C065 or W065 should be used instead, respectively.
Billing Tips
- Ensure the written report back to the referring provider is comprehensive, detailing findings, opinions, and recommendations, as this is a key component of the A065 service.
- If a consultation exceeds 50 minutes of direct patient contact and involves complex management, consider if A935 (Special surgical consultation) might be more appropriate than A065.
Effective: June 1, 2025
Consultations and Visits
Orthopaedic Surgery (06)
Consultations and Visits
Consultation
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.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Eligible for age-based fee premiums (): <30 days (30%), 30 days to <1 year (25%), 1 to <2 years (20%), 2 to <5 years (15%), 5 to <16 years (10%).
Eligible for Special Visit Premiums (-) if criteria for non-elective or travel are met.
If rendered in the Emergency Department by a physician not on duty, use General Listings (A065).
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