A515 – Limited consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · 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.
When to Use
- Use A515 for a focused assessment of a specific problem, such as reviewing a single abnormal lab result or a brief follow-up on a previously diagnosed condition, where a full consultation (A315) is not warranted.
- Bill A515 when a patient is referred for a specific, time-limited question that can be answered with a brief review of records and a short patient interaction, distinct from a comprehensive assessment.
Common Pitfalls
- Claims for A515 will be rejected if the physician bills it on the same day as another assessment code (e.g., A007, A001) for the same patient and diagnosis, unless it's in a hospital/ED setting.
- Failure to obtain and retain a written request from a physician, NP, or dental surgeon, specifying the patient, referring provider, and service required, will lead to claim adjustment to a lesser assessment fee.
Billing Tips
- Ensure the written referral clearly states the specific question or problem being addressed, differentiating it from the broader scope required for a full consultation (A315).
- Remember that A515 has a usage limit of one service per patient per diagnosis every two years by the same physician, unless the service occurs in a hospital or ED setting.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
A. Consultations and Visits
Consultation
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 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.
A limited consultation is defined as being less demanding and requiring substantially less time than a full consultation.
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