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A345 – Consultation

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The A34x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • A348 Partial assessment

    A partial assessment is a limited service that constitutes a history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate…

    $44.75

  • A340 Medical specific re-assessment

    A medical specific re-assessment is a service rendered by a specialist in Radiation Oncology that requires a full, relevant history and physical examination of one or more systems.

    $72.00

  • A341 Complex medical specific re-assessment

    A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition.

    $83.40

  • A343 Medical specific assessment

    Medical Specific Assessment Radiation Oncology

    $95.95

Consultations

  • A346 Repeat consultation

    A repeat consultation is an additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another…

    $114.90

  • A345 Consultation(this code)

    A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental…

    $178.75
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital). The consultant physician, competent to give advice in the field, provides an opinion because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or representative.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A written request from a referring physician, nurse practitioner, or dental surgeon is required.
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
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.
The consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
A written report (including findings, opinions, and recommendations) must be sent to the referring physician, nurse practitioner or dental surgeon.
Usage limits
Consultations for the same patient by the same physician for the same diagnosis are limited to one service per 24-month period (two consecutive 12-month periods). A second consultation is only eligible if rendered to a hospital inpatient or in an Emergency Department more than 12 months but less than 24 months after the first. Consultations for a clearly defined unrelated diagnosis are limited to one every 12 months.
A745Limited consultationA346Repeat consultationA343Medical specific assessmentC345Consultation (In-patient)

If the formal requirements (written request, report, etc.) are not met, the amount payable will be reduced to a lesser assessment fee.

Consultations requested by a Medical Trainee are adjusted to a lesser assessment fee.

Preoperative consultations for low-risk elective procedures (e.g., cataract surgery, colonoscopy) are only payable if the medical record demonstrates medical necessity.

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