A595 – 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
- When a patient is referred for a specific, non-complex issue that requires a specialist's opinion but not an in-depth, comprehensive assessment, such as a referral for a specific dermatological rash evaluation.
- When a patient requires a specialist's opinion on a clearly defined, unrelated diagnosis that has not been assessed by the same specialist in the past 12 months.
- When a patient is referred for a follow-up on a specific aspect of a previous consultation, provided it meets the criteria for a limited consultation and the time interval requirements.
Common Pitfalls
- Billing A595 when the service provided is more akin to a general assessment (e.g., A007) or a more complex consultation (e.g., A485), leading to claim rejection or downward adjustment.
- Failing to obtain and retain a written request from the referring provider, which is a mandatory requirement for A595 and can lead to audits and clawbacks.
- Not sending a written report back to the referring provider, which is a required component of the consultation and failure to do so can result in the claim being adjusted to a lesser assessment fee.
Billing Tips
- Ensure the referral specifies a clear reason for the limited consultation to justify the service and differentiate it from a general assessment.
- When billing for a virtual limited consultation, always append the 'A' suffix and confirm the service was conducted via video, not phone, as per submission instructions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Limited Consultation
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital) must be kept in the consulting physician’s medical record.
The consultant must be competent to give advice in the field due to the complexity, seriousness, or obscurity of the case.
A written report (including findings, opinions, and recommendations) must be sent to the referring provider.
The consultant is required to perform a general, specific, or medical specific assessment, including a review of all relevant data.
A limited consultation is intended for cases that are less demanding than a full consultation.
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.
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