A075 – Geriatric consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in Geriatrics (07) following a written request from a referring physician, nurse practitioner, or dental surgeon. It includes the assessment of the patient and a written report back to the referrer.
When to Use
- Bill A075 for an initial geriatric assessment requested by a family physician for a patient experiencing new-onset cognitive decline, where a comprehensive report back to the referrer is required.
- Use A075 when a nurse practitioner refers a patient with complex medication management issues related to aging for a specialist geriatric assessment.
- A075 is appropriate for a consultation requested by a dentist for an elderly patient with mobility issues impacting their ability to attend dental appointments.
Common Pitfalls
- Billing A075 more than once every 24 months for the same patient and diagnosis without a new, distinct, and unrelated geriatric issue.
- Failing to obtain and retain a written referral from the requesting physician, NP, or dental surgeon, unless the consultation occurs in a hospital or LTC setting with common records.
- Submitting A075 when the service is part of a special visit premium (e.g., C, W, K prefixes); A070 should be used in these instances.
Billing Tips
- Ensure the written report to the referrer clearly outlines findings, opinions, and specific recommendations for geriatric care management.
- If the consultation addresses a clearly defined, unrelated new geriatric issue, it can be billed again after 12 months, provided documentation supports the distinct problem.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
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. In such cases, the written request may be contained on the common medical record.
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.
The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
Where a physician who has been paid for a consultation for the patient for the same diagnosis makes a request for a referral for ongoing management of the patient, the service rendered following the referral is not payable as a consultation, except as outlined in the Virtual Care Services section under definitions, part 3, commentary 3.
In the preoperative preparation of a patient undergoing the following low risk elective surgical procedures under local anaesthesia and/or I.V. sedation, a preoperative consultation by any physician is only eligible for payment where the medical record demonstrates the consultation is medically necessary: cataract surgery, colonoscopy, cystoscopy, carpal tunnel surgery, or arthroscopic surgery.
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