A375 – Limited Consultation
OHIP General Listings Code — Geriatrics (07) · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician’s time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation, including a written request and a written report.
When to Use
- Use A375 for a focused geriatric assessment where the patient's condition is stable and the referral specifically requests a limited opinion on a single issue, such as reviewing a new medication's appropriateness.
- Bill A375 when a referring provider requests a brief opinion on a specific geriatric syndrome, like a fall risk assessment, and the time commitment is clearly less than a full consultation (A075).
- A375 is appropriate for a follow-up opinion on a previously diagnosed geriatric condition where the patient's status hasn't significantly changed and a full reassessment isn't warranted.
Common Pitfalls
- Billing A375 when the service provided is more complex and warrants a full consultation (A075), leading to potential audits for under-servicing.
- Failing to obtain and document a written request from the referring provider, or not sending a written report back, will result in the claim being reduced to a lesser assessment fee.
- Submitting A375 for a patient already seen for the same diagnosis within the last two years, unless the visit is in a hospital/ED setting or for a distinct, unrelated issue.
Billing Tips
- Ensure the written request clearly specifies the limited nature of the consultation and the specific question(s) to be addressed, differentiating it from a full consultation (A075).
- Retain a copy of the written request in your patient's chart to substantiate the A375 billing, especially if the referring provider's request is brief.
Effective: June 1, 2025
Consultations and Visits
Geriatrics (07)
Consultations and Visits
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon.
Written report including findings, opinions, and recommendations sent to the referring provider.
A copy of the written request must be kept in the consultant's 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.
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