A905 – 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. In the context of Family Practice & Practice in General, it is the service rendered by any physician who is not a specialist, where the service meets all the requirements for a consultation but, because of the nature of the referral, only those services which constitute a specific assessment are rendered.
When to Use
- When a patient is referred by a physician or NP for a specific, limited assessment (e.g., evaluation of a single new symptom or condition) that does not require the full scope of a comprehensive consultation (A005).
- When a specialist referral is for a focused opinion on a particular issue, and the consultant's assessment is confined to that specific problem, rather than a broad review of the patient's health.
- For pre-operative assessments of low-risk elective procedures where medical necessity for the consultation is clearly documented, beyond routine pre-op clearance.
Common Pitfalls
- Billing A905 when a full consultation (A005) is warranted; A905 is for less demanding, time-limited assessments.
- Failing to obtain and retain a written referral request from the referring provider, which is a mandatory requirement for payment.
- Not sending a written report of findings and recommendations back to the referring provider, which can lead to claim adjustments or audits.
Billing Tips
- Ensure the referral request clearly specifies the information required and the service needed to avoid ambiguity and potential claim rejection.
- A905 is not payable for ongoing management of a condition; subsequent services for the same diagnosis should be billed using appropriate assessment or visit codes.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
A written request for the consultation, signed by the referring provider, must be kept in the medical record.
The request must identify the consultant, the referring provider (including billing number), and the patient.
The request must specify the information relevant to the referral and the service(s) required.
A written report (including findings, opinions, and recommendations) must be sent back to the referring provider.
The request must be made before the service is provided; if requested after the service, a consultation is not payable.
Must include a specific assessment and a review of all relevant data.
Pre-operative consultations for low-risk elective surgical procedures (cataract surgery, colonoscopy, cystoscopy, carpal tunnel surgery, or arthroscopic surgery) are only eligible for payment where the medical record demonstrates the consultation is medically necessary.
A905 is not eligible for virtual care (video or telephone) under its own code; virtual equivalents are found in Appendix J or under specific focused practice codes (e.g., A906).
Not eligible for age-based fee premiums () as it is not rendered by a specialist.
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