A285 – 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, competent in the field due to the complexity, seriousness, or obscurity of the case, provides an opinion and recommendations. The service includes a general, specific, or medical specific assessment and requires a written report to the referring provider.
When to Use
- When a specialist provides a comprehensive assessment and written report for a complex patient case referred by a primary care physician, exceeding the scope of a simple assessment (e.g., A283, A284).
- When a specialist receives a written request from a Nurse Practitioner for an opinion on a patient's condition that requires a detailed assessment and management plan.
- When a dental surgeon requests a specialist's opinion on a medically complex issue related to an insured dental procedure in a hospital setting.
Common Pitfalls
- Billing A285 without a corresponding written referral from the requesting provider, which is a common reason for claim rejection or adjustment to a lesser fee code.
- Failing to provide a written report to the referring provider; this omission can lead to audits and clawbacks of paid consultation fees.
- Submitting A285 for a patient already seen for the same diagnosis within the last 12 months, unless the patient is a hospital in-patient and the second consultation occurs between 12-24 months after the first.
Billing Tips
- Ensure the written referral clearly outlines the patient's condition and the specific questions the consultant is expected to address to support the complexity of the A285 service.
- If a consultation is for a clearly unrelated diagnosis to a previous A285 service, document the unrelated nature of the new diagnosis in the report to justify billing again within 12 months.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon must be kept in the medical record (except in hospital, LTC, or multi-specialty clinic with common records).
The request must identify the consultant by name and/or specialty, the referring provider by name and billing number, and the patient by name and health number.
The written request must set out information relevant to the referral and specify services required.
The consultant must provide a written report (findings, opinions, and recommendations) to the referring provider (and primary care provider if referral by NP).
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
Consultations for the same patient by the same consultant with a clearly defined unrelated diagnosis are limited to one service every 12 months.
For emergency calls and other special visits to in-patients, use General Listings and Premiums ( to ).
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.