A195 – Psychiatric Consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · 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 insured dental procedures). The consultant physician, a specialist in psychiatry, provides an opinion on a complex, serious, or obscure case and must provide a written report (including findings, opinions, and recommendations) to the referring provider.
When to Use
- Bill A195 for a standard psychiatric consultation requested by a GP for a patient with a new, complex diagnostic dilemma not fitting A190, A795, or A695 criteria.
- Use A195 when a psychiatrist provides a written opinion and recommendations to a referring NP on a patient's complex mood disorder management.
- Bill A195 for a consultation requested by a dental surgeon for a patient requiring psychiatric assessment prior to a hospital-based insured dental procedure.
Common Pitfalls
- Billing A195 without a written referral from a physician, NP, or dental surgeon is a common rejection reason.
- Failure to provide a written report to the referring provider, or documenting it incorrectly, can lead to payment reduction to a lesser assessment fee.
- Billing A195 for a patient under 16 without applying the age-based fee premium (GP64) will result in underpayment.
Billing Tips
- Ensure the written referral clearly states the patient's health number, referring provider's name and OHIP billing number, and the specific service required.
- If the consultation requirements (request/report) are not met, bill an appropriate assessment code instead of A195 to avoid potential penalties.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Psychiatry
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) 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.
<16
If the requirements for a consultation (request/report) are not met, the fee is reduced to a lesser assessment fee.
For psychiatric consultation extensions with parents or caregivers, see K630.
A195 is the general listing code; for specific complex scenarios, see A190 (Special), A795 (Geriatric), or A695 (Neurodevelopmental).
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