A205 – Obstetrics and Gynaecology 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. The referring practitioner requests the opinion of a 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 practitioner. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. For this specific consultation (A205) in Obstetrics and Gynaecology, the collection of cervical cancer screening specimen(s) is included in the service when a pelvic examination is a normal part of the consultation. However, the add-on codes E430 or E431 can be billed in addition when this collection is performed outside of a hospital or IHCSC.
When to Use
- Bill A205 when a GP refers a patient for a second opinion on a complex obstetric complication, and you provide a written report with recommendations.
- Use A205 when a patient requires a specialist opinion on a gynaecological issue, and the referral explicitly requests your expertise for a written assessment.
- A205 is appropriate when a dental surgeon refers a patient for an opinion on a condition impacting oral health that requires gynaecological expertise, accompanied by a written request and report.
Common Pitfalls
- Billing A205 without a valid written referral from a physician, NP, or dental surgeon will result in claim rejection.
- Failure to provide a written report to the referring practitioner for A205 is a common reason for audits and potential clawbacks.
- Submitting A205 for routine follow-up care that does not meet the complexity or obscurity criteria for a consultation can lead to claim adjustments.
Billing Tips
- When performing a pelvic exam as part of A205, remember that cervical cancer screening specimen collection is included; bill E430 or E431 only if performed outside a hospital or IHCSC.
- Ensure the written report for A205 clearly outlines findings, opinions, and specific recommendations to the referring practitioner to support the consultation service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations
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 must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
The collection of cervical cancer screening specimen(s) is included in the consultation, repeat consultation, general or specific assessment (or re-assessment), or routine post-natal visit when pelvic examination is normal part of the foregoing services. However, the add-on codes E430 or E431 can be billed in addition to these services when collection of cervical cancer screening specimen(s) is performed outside of a hospital or IHCSC.
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