A315 – Consultation - Physical Medicine & Rehabilitation
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 Physical Medicine & Rehabilitation, provides an opinion or advice due to the complexity, seriousness, or obscurity of the case, or at the request of the patient/representative. The service includes the necessary assessment and the preparation of a written report back to the referrer.
When to Use
- Bill A315 when a patient is referred by a primary care provider for a complex spinal cord injury assessment requiring specialized PM&R input and a written report.
- Use A315 for a patient referred by a specialist for evaluation of severe, chronic, and widespread musculoskeletal pain that has not responded to initial treatments, necessitating a comprehensive PM&R opinion.
- A315 is appropriate for a patient referred for assessment of a new diagnosis of multiple sclerosis affecting motor function, requiring a PM&R consultation and management plan.
Common Pitfalls
- Billing A315 without a valid written referral from a physician, NP, or dental surgeon will result in claim rejection or adjustment to a lesser assessment fee.
- Submitting A315 for a patient already seen for the same diagnosis within the last 12 months (unless they are a hospital inpatient or ED patient eligible for a second consultation between 12-24 months) will lead to claim denial.
- Failing to document the written referral, including the referrer's name, billing number, patient details, and the service requested, is a common audit risk for A315.
Billing Tips
- Ensure the written report back to the referring provider is comprehensive and includes findings, opinions, and recommendations to fully support the A315 claim.
- If the consultation is provided virtually, append 'A' to the A315 code (A315A) and confirm the encounter was via video, as telephone consultations are not permitted for this virtual service.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultations and Visits
Consultation
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.
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.
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