A395 – Limited Consultation
OHIP General Listings Code — Psychiatry (19) · 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. A full consultation is defined as an assessment rendered following a written request from a referring: 1. physician 2. nurse practitioner or 3. dental surgeon in connection with an insured dental procedure rendered in a hospital, who, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the "consultant physician”) competent to give advice in this field because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. (Source: , )
When to Use
- Bill A395 when a specialist provides a focused opinion on a specific psychiatric question, as opposed to a comprehensive assessment (which would be A007).
- Use A395 for a psychiatric assessment requested by a nurse practitioner for a patient with a clearly defined, limited issue, rather than a broad diagnostic workup.
- A395 is appropriate when a referring physician requests a second opinion on a specific aspect of a patient's psychiatric condition, provided the request meets all consultation requirements.
Common Pitfalls
- Billing A395 when the service provided is a full consultation (A007) or a general assessment (A001), leading to underpayment.
- Failure to obtain and retain a written referral from the requesting physician, NP, or dental surgeon will result in claim rejection.
- Billing A395 for a service that is primarily psychotherapy or counselling on the same day, without a clearly defined separate diagnosis, will be disallowed.
Billing Tips
- Ensure the written referral clearly specifies the limited nature of the psychiatric opinion required, differentiating it from a full consultation.
- Verify that the referring practitioner's name and OHIP billing number are accurately included on the referral documentation.
Effective: June 1, 2025
Consultations and Visits
Psychiatry (19)
Consultation
Consultations
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 request identifies the consultant by name, 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.
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.
Under the heading of “Family Practice & Practice in General", a limited consultation is the service rendered by any physician who is not a specialist, where the service meets all the requirements for a consultation but, because of the nature of the referral, only those services which constitute a specific assessment are rendered.
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