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A905
A905 – Limited consultation
OHIP Consultations and Visits 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.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
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.
Usage limits
Limited to one service per two consecutive 12-month periods for the same patient by the same physician for the same diagnosis. For a clearly defined unrelated diagnosis, the limit is one service every 12 months.
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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