A445 – Consultation
OHIP General Listings Code — Medical Oncology (44) · Schedule of Benefits
A consultation rendered by a specialist in Medical Oncology (44) following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes the necessary assessment and review of data to provide a written report with findings, opinions, and recommendations to the referring provider.
When to Use
- Bill A445 when a Medical Oncologist provides a comprehensive assessment and written report to a referring physician for a patient aged 17 or older with a complex cancer diagnosis requiring specialist input.
- Use A445 for an initial consultation by a Medical Oncologist following a formal written request, where the patient's condition is obscure or serious, necessitating expert opinion and recommendations.
- A445 is appropriate when a Medical Oncologist reviews extensive prior investigations and provides a detailed written report outlining findings and management strategies to the referring primary care physician or another specialist.
Common Pitfalls
- Billing A445 without a documented written request from the referring provider is a common reason for rejection.
- Failure to provide a comprehensive written report to the referring physician can lead to claim adjustments or audits, potentially reducing the fee to a lesser assessment code.
- Submitting A445 for a patient under 17 years of age without meeting the criteria for A765 will result in rejection; ensure age requirements are met or use the appropriate pediatric code.
Billing Tips
- Ensure the written request for A445 clearly identifies the patient, referring provider (including OHIP billing number), and the consultant specialist.
- Retain a copy of the signed written request in your records for A445, unless the patient's chart is shared within a hospital or LTC setting, to support the consultation service.
Effective: June 1, 2025
Consultations and Visits
Medical Oncology (44)
Consultations and Visits
Consultation
Patient must be 17 years of age or older. For patients 16 years of age and under, see A765.
If the requirements for a consultation (e.g., written request or report) are not met, the fee will be adjusted to a lesser assessment fee.
Preoperative consultations for low-risk elective procedures (e.g., cataract surgery, colonoscopy) are only payable if medically necessary and documented as such.
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