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A085 – Consultation

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

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Levels of this visit

The A08x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • A084 Partial assessment

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

    $34.75

  • A083 Specific assessment

    A specific assessment is a service rendered by a specialist in a place other than a patient's home.

    $54.40

Consultations

  • A086 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…

    $62.80

  • A085 Consultation(this code)

    A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for insured dental procedures in hospital).

    $106.25
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for insured dental procedures in hospital). The consultant physician, due to the complexity, seriousness, or obscurity of the case, provides an opinion and advice. The service includes a general, specific, or medical specific assessment, a review of all relevant data, and the preparation of a written report to the referring provider.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
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.
A written report (including findings, opinions, and recommendations) must be sent 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.
Includes a general, specific or medical specific assessment, including a review of all relevant data.
Usage limits
Limited to one service per patient per physician per two consecutive 12-month periods for the same diagnosis. Limited to one service every 12 months for a clearly defined unrelated diagnosis.
A935Special surgical consultationA086Repeat consultationA083Specific assessmentA084Partial assessment

Age-based premiums apply: 30% (<30 days), 25% (30 days to <1 year), 20% (1 to <2 years), 15% (2 to <5 years), and 10% (5 to <16 years).

Special Visit Premiums (Travel and Person Seen) may be applicable for non-elective visits (see -).

Preoperative consultations for low-risk elective procedures (e.g., cataract, colonoscopy) are only payable if medically necessary and documented.

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