A525 – 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 (written request, assessment, and written report).
When to Use
- When a patient requires a focused assessment for a specific immunological concern, such as evaluating a suspected drug reaction or a single autoimmune marker, and a full consultation (A625) is not warranted.
- To assess a patient with a known immunological condition who presents with a new, distinct, and less complex issue that requires specialist input but not a comprehensive review of their entire history.
- When a referring physician requests a specific opinion on a limited aspect of a patient's immunological status, with a clear expectation of a brief, targeted report.
Common Pitfalls
- Billing A525 when the service provided is a simple follow-up or management of a stable condition, which might be better billed as an intermediate (A626) or minor assessment.
- Failing to obtain and retain a written request from a physician, NP, or dental surgeon, which is a mandatory requirement for all consultations, including A525.
- Submitting A525 for a service that is essentially a medical-specific assessment (e.g., A623, A624, A621, A628), as these are mutually exclusive with A525.
Billing Tips
- Ensure the written report clearly delineates the limited scope of the consultation and the specific recommendations made, differentiating it from a full consultation (A625).
- Verify that the patient's primary care provider receives a copy of the report if the referral was made by an NP, as per documentation requirements.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Clinical Immunology
Consultation
Written request identifying the consultant by name and/or specialty, referring physician, nurse practitioner or dental surgeon by name and billing number, and patient by name and health number.
Written request must be kept in the consulting physician’s medical record (unless common medical records are maintained in hospital/LTC/multi-specialty clinic).
Written request sets out information relevant to the referral and specifies service(s) required.
Written report including findings, opinions, and recommendations sent to the referring physician, nurse practitioner or dental surgeon (and patient's primary care provider if referral by NP).
Performance of a general, specific, or medical specific assessment, including a review of all relevant data.
A525 is the Clinical Immunology specific code for a limited consultation.
For services not listed in the Clinical Immunology section, refer to the Internal Medicine section.
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