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A095 – Consultation

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

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Levels of this visit

The A09x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • A094 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…

    $30.35

  • A093 Specific assessment

    A service rendered by a specialist in Cardiac Surgery (09) in a place other than a patient’s home, requiring a full history of the presenting complaint and a detailed examination…

    $55.70

Consultations

  • A096 Repeat consultation

    An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval…

    $75.20

  • A095 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).

    $113.15
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, competent in the field due to the complexity, seriousness, or obscurity of the case, provides an opinion and recommendations. The service includes the necessary assessment (general, specific, or medical specific), a review of all relevant data, and the preparation of a written report back to the referrer.
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.
The written request sets out the information relevant to the referral and specifies the service(s) required.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) 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.
Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
Usage limits
Limited to one service per two consecutive 12-month periods for the same patient by the same physician for the same diagnosis (except for repeat consultations or specific hospital/ED circumstances). Limited to one service every 12 months for a clearly defined unrelated diagnosis.
A935Special surgical consultationA096Repeat consultationA093Specific assessmentA094Partial assessmentC095Consultation (In-patient)

For emergency calls and special visits to in-patients, refer to Special Visit Premiums ( to ).

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

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