A625 – Consultation
OHIP General Listings Code — Clinical Immunology (62) · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based insured dental procedures). The consultant physician, due to the complexity, seriousness, or obscurity of the case, provides an opinion and recommendations. The service includes a general, specific, or medical specific assessment, a review of all relevant data, and the preparation of a written report to the referrer.
When to Use
- When a patient aged 17 or older is referred by a physician, NP, or dental surgeon for a complex diagnostic workup of a suspected autoimmune condition not previously investigated by you.
- When a referring provider requests your expert opinion on management of a patient with a rare or poorly understood immunological disorder, requiring a comprehensive review of their history and investigations.
- When a patient requires a detailed assessment and written recommendations for management of a newly diagnosed or complex immunological condition, following a formal referral.
Common Pitfalls
- Billing A625 when the patient is under 17 years old; use A765 instead.
- Failing to obtain and retain a written request from the referring provider, unless the consultation occurs in a hospital, long-term care, or multi-specialty clinic with common records.
- Submitting A625 without a corresponding written report to the referring provider, which is a mandatory component of the consultation.
Billing Tips
- Ensure the written request clearly identifies the patient, referring provider (with OHIP billing number), and the consultant by name/specialty.
- Remember that A625 is limited to one service per diagnosis by the same physician every 24 months, unless the patient is a hospital inpatient or seen in the ED between 12-24 months after the first consultation.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
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 written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.
Patient must be 17 years of age or older. For patients 16 years of age and under, use A765.
For services not listed under Clinical Immunology, refer to the Internal Medicine section.
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