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A355 – Consultation

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

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Levels of this visit

The A35x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • A354 Partial assessment

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

    $30.60

  • A353 Specific assessment

    A specific assessment rendered by a specialist in Urology, requiring a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or…

    $51.45

Consultations

  • A356 Repeat consultation

    An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval…

    $64.90

  • A355 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…

    $93.15
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.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
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.
Usage limits
Limited to one service per two consecutive 12-month periods for the same patient by the same physician for the same diagnosis (unless it qualifies as a repeat consultation or meets specific hospital/ED exceptions). Limited to one service every 12 months for a clearly defined unrelated diagnosis.
A353Specific assessmentA354Partial assessmentA356Repeat consultation

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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