A135 – Consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring: 1. physician 2. nurse practitioner or 3. dental surgeon in connection with an insured dental procedure rendered in a hospital, who, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the “consultant physician”) competent to give advice in this field because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient’s representative. 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.
When to Use
- Bill A135 when a physician receives a written referral from another physician, nurse practitioner, or dental surgeon requesting their expert opinion on a complex patient case.
- Use A135 for an assessment performed in response to a patient's or their representative's request for a second opinion, provided a formal referral is obtained.
- A135 is appropriate when a consultant physician reviews all relevant patient data, performs a comprehensive assessment, and provides a written report with findings and recommendations to the referring provider.
Common Pitfalls
- Claims for A135 will be rejected if a written referral is not present in the chart, unless the consultation occurs in a hospital or clinic with common medical records.
- Do not bill A135 if the referral request is obtained after the consultation service has already been rendered; bill the appropriate visit code instead.
- A135 is not payable on the same day as a colonoscopy if a major pre-operative visit (e.g., A120) was performed within the preceding 12 months; use A120 in this scenario.
Billing Tips
- Ensure the written referral for A135 clearly identifies the consultant by name/specialty, the referring provider by name/billing number, and the patient by name/health number.
- When a nurse practitioner refers for A135, remember to send the written report to both the nurse practitioner and the patient's primary care provider, if applicable.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
A. 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.
A written report including findings, opinions, and recommendations must be sent to the referring provider.
Consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
If the physician is in the hospital but not on duty in the ED, A135 is used for seeing patients in the Emergency or OPD.
Eligible for the 17% Hospitalist Premium if the physician meets qualifying criteria.
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