A286 – Limited consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation, including a written request from a referring physician, nurse practitioner, or dental surgeon, and a written report of findings and recommendations.
When to Use
- Bill A286 when a specialist provides a focused assessment and report based on a specific question from a referring physician, nurse practitioner, or dental surgeon, without requiring a full patient workup.
- Use A286 for a specialist's opinion on a clearly defined, isolated issue, distinct from a broader diagnostic workup (A585) or a comprehensive review (A580).
- A286 is appropriate for a non-specialist performing only a specific assessment, as outlined in the 'Family Practice & Practice in General' notes, differentiating it from a partial assessment (A284).
Common Pitfalls
- Claiming A286 when the service provided is primarily ongoing patient management rather than a distinct consultation, which is not payable.
- Failing to obtain and retain a written request from the referring provider, which can lead to the claim being reduced to a lesser assessment fee.
- Billing A286 for a consultation on the same diagnosis within a 24-month period, unless a clearly defined, unrelated diagnosis is documented.
Billing Tips
- Ensure the written report clearly addresses the specific question(s) posed in the referral request to justify the limited nature of the consultation.
- If the referral is from a nurse practitioner, confirm the report is sent to both the NP and the patient's primary care provider, if applicable, to meet documentation requirements.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Laboratory Medicine
Consultation
A consultation is an assessment rendered following a written request from a referring: 1. physician 2. nurse practitioner or 3. dental surgeon in connection with an insured dental procedure rendered in a hospital, who, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the “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 physician, nurse practitioner or dental surgeon. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable. Except where otherwise specified, 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.
Under 'Family Practice & Practice in General', a limited consultation is the service rendered by a non-specialist where only services constituting a specific assessment are rendered.
Preoperative consultations for low-risk elective procedures (e.g., cataract surgery, colonoscopy) are only eligible if the medical record demonstrates medical necessity.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.