A355 – Consultation
OHIP General Listings Code — Urology (35) · 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 in the field due to the complexity, seriousness, or obscurity of the case, provides an opinion and submits a written report to the referrer.
When to Use
- Bill A355 when a urologist provides a comprehensive assessment and written report for a complex case of recurrent UTIs, following a referral from a family physician.
- Use A355 for a nephrologist's opinion on a patient with newly diagnosed, severe glomerulonephritis, requested by the patient's primary care physician.
- A355 is appropriate when a pediatric urologist evaluates a child with suspected congenital bladder abnormalities, based on a referral from a pediatrician.
Common Pitfalls
- Billing A355 without a valid written referral from a physician, nurse practitioner, or dental surgeon is a common rejection reason.
- Failure to submit a written report to the referring provider, or submitting an incomplete report, can lead to payment reduction or denial.
- Claiming A355 for a condition already managed by the same consultant within the last 12 months, without meeting repeat consultation criteria (A356), will be rejected.
Billing Tips
- Ensure the written referral clearly states the specific urological question or problem requiring consultation to justify the A355 service.
- When a nurse practitioner refers, remember to send the A355 report to both the NP and the patient's primary care provider, if applicable, to avoid issues.
Effective: June 1, 2025
Consultations and Visits
Urology (35)
Professional Stream
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
The request must identify the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify the patient by name and health number.
A written report including findings, opinions, and recommendations must be sent 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.
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 written request sets out the information relevant to the referral and specifies the service(s) required.
Does not include endoscopic examination.
If consultation requirements (like the written request or report) are not met, the fee will be reduced to a lesser assessment fee.
Special visit premiums (-) are not eligible for routine rounds in long-term care facilities.
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