A655 – Limited Consultation
OHIP General Listings Code — Haematology (61) · Schedule of Benefits
A limited consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital. This service is defined as less demanding and normally requires substantially less of the physician's time than a full consultation. However, it otherwise has the same requirements as a full consultation, including: - The referral is made because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or their representative. - A copy of the written request must be kept in the consulting physician's medical record. - The consultant must prepare a written report of findings, opinions, and recommendations for the referring practitioner.
When to Use
- Bill A655 when a specialist provides a focused assessment for a complex dental issue requiring hospital management, based on a written request from a dentist.
- Use A655 for a specialist's opinion on a patient's condition related to an insured dental procedure in a hospital, when requested by a physician or nurse practitioner.
- A655 is appropriate when a specialist performs a limited assessment for a patient 17 years or older, following a referral for a second opinion on a complex case tied to a hospital-based dental procedure.
Common Pitfalls
- Claim rejection if the referral is not from a physician, nurse practitioner, or dental surgeon, or if the referral letter is missing from the chart.
- A655 is not payable if the physician requests the referral after providing the service; claim the appropriate assessment fee instead.
- Billing A655 for a patient under 17 years of age will result in rejection, as the code has an age restriction.
Billing Tips
- Ensure the written referral clearly states the reason for the consultation and the specific service required, and keep a copy in the patient's hospital record.
- If the patient has seen the same consultant for the same diagnosis within the last two years, A655 may not be payable unless it meets the specific criteria for a repeat or second consultation within the defined timeframe.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
Consultation
Consultations
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. In a hospital, long-term care institution, or multi-specialty clinic with common medical records, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
For patients 17 years of age and older
The referring physician, nurse practitioner or dental surgeon must determine if multiple requests by a patient or the patient’s representative to different physicians in the same specialty for the same condition are medically necessary. Services that are not medically necessary are uninsured.
If the physician rendering the service requests a referring physician, nurse practitioner or dental surgeon to submit a consultation request for that service after the service has been provided, a consultation is not payable. The visit fee appropriate to the service rendered may be claimed.
Where a physician who has been paid for a consultation for the patient for the same diagnosis makes a request for a referral for ongoing management of the patient, the service rendered following the referral is not payable as a consultation, except as outlined in the Virtual Care Services section under definitions, part 3, commentary 3.
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