A225 – Genetic consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a specialist in Genetics (22) or a specialist with FCCMG designation, following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary elements to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring provider. The consultant is required to perform a general, specific, or medical specific assessment, including a review of all relevant data.
When to Use
- Bill A225 when a Genetics specialist provides a comprehensive assessment and written report for a patient with a suspected inherited condition, following a referral from a primary care physician.
- Use A225 for a Genetics specialist's initial assessment of a patient with a complex family history of cancer, requiring review of pedigrees and genetic testing interpretation.
- A225 is appropriate for a Genetics specialist's consultation regarding a patient with developmental delay and dysmorphic features, after referral from a pediatrician.
Common Pitfalls
- Billing A225 for a service that does not include a written report to the referring provider, which is a mandatory component of this code.
- Submitting A225 when the patient has already received a consultation for the same diagnosis within the last 24 months, unless it's a hospital inpatient or ED patient eligible for a second consultation.
- Failing to retain the written referral, especially when the consultation is not performed in a hospital, long-term care, or multi-specialty clinic with common records.
Billing Tips
- Ensure the written report clearly outlines findings, opinions, and recommendations to justify the A225 consultation.
- If the referral originates from a Nurse Practitioner, confirm the report is also sent to the patient's primary care provider, if one exists, to avoid claim rejection.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Professional
Consultation
A written request signed by the referring provider must be kept in the consultant'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 must identify 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 consultant must provide a written report of findings, opinions, and recommendations to the referring provider.
If the referral is from a nurse practitioner, the report must also be sent to the patient's primary care provider, if applicable.
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