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A895
A895 – Consultation in association with special visit
OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
Written request from referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures) must be kept in medical record (or common medical record in hospital/LTC/multi-specialty clinic). The request must identify the consultant, referring provider, and patient, and specify service(s) required.
Must include all elements of a consultation (A195), including a written report (findings, opinions, recommendations) to the referring provider.
Start and stop times of the service must be recorded in the patient's permanent medical record.
The physician must spend a minimum of 60 minutes in direct contact with the patient (exclusive of other separately billable interventions) to qualify for the base fee before extensions (K630) apply.
Usage limits
Consultations rendered to the same patient by the same physician for the same diagnosis are limited to one service per two consecutive 12-month periods (with specific exceptions for hospital/ED settings as per ). Consultations for a clearly defined unrelated diagnosis are limited to one service every 12 months.
Calculation of time excludes time devoted to other separately billable services and non-patient-facing time (e.g., chart review, documentation).
Special visit premiums are only eligible for non-elective services (except for home visits) and are subject to specific travel and 'person seen' rules in the General Preamble.
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