A275 – Limited consultation - Infectious Disease
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. It requires a written request from a referring physician/NP and a written report back to the referrer.
When to Use
- Use A275 for a focused opinion on a specific, uncomplicated infectious disease query, such as confirming the appropriateness of a single antibiotic choice for a common infection.
- A275 is appropriate when the referring physician needs a specialist's input on a straightforward management question, like interpreting a single positive culture result for a non-complex case.
- Bill A275 when the infectious disease specialist's assessment involves reviewing a limited set of patient data for a clear-cut diagnostic or therapeutic question, not requiring a deep dive into multiple comorbidities.
Common Pitfalls
- Claiming A275 when a formal written referral is missing or incomplete, leading to rejection as the referral requirement is not met.
- Billing A275 for a patient encounter that involves a comprehensive review of multiple complex issues, which would be better suited for A460 or A465.
- Failing to provide a written report back to the referring provider, which is a mandatory component for A275 and can result in claim adjustments or audits.
Billing Tips
- Ensure the written report back to the referring provider clearly outlines the specific findings, opinion, and recommendations related to the infectious disease query.
- Verify that the patient's record contains a copy of the written request, including the referring provider's name, billing number, and patient's health number, unless the consultation occurred in a shared record environment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon.
Written report back to the referring provider including findings, opinions, and recommendations.
The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
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.
If the physician requests a referral after the service has already been provided, a consultation is not payable; a visit fee should be claimed instead.
Services in excess of frequency limits are adjusted to a lesser assessment fee.
The referring physician, nurse practitioner or dental surgeon must determine if multiple requests by a patient or the patient’s representative to different physicians in the same specialty for the same condition are medically necessary. Services that are not medically necessary are uninsured.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.