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A465 – Consultation

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

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Levels of this visit

The A46x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • A468 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…

    $62.15

  • A464 Medical specific re-assessment

    A medical specific re-assessment is a service rendered by a specialist that requires a full, relevant history and physical examination of one or more systems.

    $82.10

  • A461 Complex medical specific re-assessment

    A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition.

    $95.05

  • A463 Medical specific assessment

    A service rendered by an infectious disease specialist in a place other than a patient’s home, requiring a full history of the presenting complaint and a detailed examination of…

    $107.00

Consultations

  • A466 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…

    $124.00

  • A465 Consultation(this code)

    A consultation rendered by an infectious disease specialist following a written request from a referring physician, nurse practitioner, or dental surgeon.

    $205.90

  • A460 Comprehensive infectious disease consultation

    A comprehensive infectious disease consultation requiring a minimum of 75 minutes in direct contact with the patient, satisfying all elements of a consultation as defined in the…

    $342.25
A consultation rendered by an infectious disease specialist following a written request from a referring physician, nurse practitioner, or dental surgeon. The service includes a comprehensive assessment, review of relevant data, and a written report to the referrer.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A written request from the referring provider must be kept in the consultant's medical record.
A written report (including findings, opinions, and recommendations) must be sent to the referring provider.
The start and stop times must be recorded in the patient’s permanent medical record or the amount payable will be adjusted to a lesser paying fee.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
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.
Usage limits
Consultations for the same diagnosis are limited to one service per two consecutive 12-month periods by the same physician. Consultations for a clearly defined unrelated diagnosis are limited to one service every 12 months.
A460Comprehensive infectious disease consultationA275Limited consultationA466Repeat consultationA270Complex infectious disease assessmentC465Hospital Consultation

Start and stop times are mandatory for the full fee to be payable.

For hospital in-patients seen in the Emergency or OPD when the physician is not on duty, use General Listings (A465).

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