A345 – Consultation
OHIP General Listings Code — Radiation Oncology (34) · Schedule of Benefits
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.
When to Use
- Bill A345 when a specialist provides a comprehensive assessment and written report following a formal referral for a complex or obscure condition, distinct from a simple referral for management.
- Use A345 for a second opinion requested by the patient or their representative, provided a formal referral and written report are completed.
- Bill A345 when a dental surgeon requests a consultation related to an insured dental procedure performed in a hospital setting.
Common Pitfalls
- Billing A345 without a valid written referral from a physician, NP, or dental surgeon is a common rejection reason.
- Failure to send a written report to the referring provider will result in payment reduction to a lesser assessment fee.
- Submitting A345 for a service that is less demanding and requires substantially less time than a full consultation; consider A745 instead.
Billing Tips
- Ensure the written referral clearly identifies the consultant, referring provider (name and OHIP billing number), and patient (name and health number) to avoid documentation issues.
- If the consultation occurs in a hospital or multi-specialty clinic with common records, the written request can be part of the shared medical record, but a report to the referring provider is still mandatory.
Effective: June 1, 2025
Consultations and Visits
Radiation Oncology (34)
Consultations and Visits
Consultation
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.
For patients aged 17 years and older.; or For patients 16 years of age and under, see A765.
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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