A260 – Special paediatric consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special paediatric consultation is a consultation in which the physician provides all the elements of a consultation (A265) and spends a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A260 when a complex paediatric case requires a comprehensive assessment and management plan that necessitates at least 75 minutes of direct physician-patient interaction, beyond any other separately billable procedures.
- Use A260 for a patient aged 18-21 if they have a chronic condition managed by the pediatrician since before age 18 and require continued specialized care.
- A260 is appropriate for a patient up to age 22, provided written prior approval from the Ministry of Health has been obtained for the ongoing specialized paediatric care.
Common Pitfalls
- Billing A260 when the direct patient contact time is less than 75 minutes; this should be billed as A265 (Consultation) or A565 (Limited Consultation).
- Including time spent on chart review, imaging interpretation, or preparing reports in the 75-minute direct patient contact calculation, which will lead to a claim rejection or fee reduction.
- Failing to obtain and retain a written request for consultation from the referring physician, nurse practitioner, or dental surgeon, unless the consultation occurs in a common medical record environment.
Billing Tips
- Ensure the patient's permanent medical record clearly documents the start and stop times of the 75-minute direct patient contact to substantiate the A260 billing.
- If direct patient contact time reaches 90 minutes, consider billing A662 (Extended special paediatric consultation) instead of A260, as it offers a higher fee.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Time-based consultation
Consultation
A written report must be provided to the referring practitioner.
Minimum of 75 minutes of direct patient contact is required.
Start and stop times of the service must be recorded in the patient's permanent medical record.
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.
Standard paediatric patient.; or Adult patient with a chronic condition and continuous care since before age 18, or with prior MOH approval.
Calculation of time excludes non-patient-facing time such as reviewing charts, imaging, or documentation.
Calculation of time excludes time devoted to any other separately billable service or procedure.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.