A911 – Special family and general practice consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a GP/FP physician who provides all the elements of a consultation and spends a minimum of 50 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Bill A911 when a patient requires a comprehensive assessment for a complex chronic condition, such as advanced heart failure management, necessitating a full 50 minutes of direct physician-patient interaction.
- Use A911 for a patient presenting with multiple, distinct, and severe new medical issues that require extensive history taking, examination, and discussion, exceeding the scope of a standard A005 consultation.
- A911 is appropriate for a patient requiring a detailed pre-operative assessment for a major surgical procedure, where the physician spends 50 minutes discussing risks, benefits, and alternatives, and reviewing all relevant investigations.
Common Pitfalls
- Billing A911 when the direct patient contact time is less than 50 minutes; this will result in a fee adjustment to A005.
- Failing to obtain and retain a written request from the referring physician, nurse practitioner, or dental surgeon, which is mandatory for A911 claims.
- Not documenting the start and stop times of the patient encounter in the medical record, leading to potential audits and fee adjustments.
Billing Tips
- Ensure the written report to the referring provider includes detailed findings, opinions, and specific recommendations to support the complexity of the consultation.
- If the consultation extends beyond 50 minutes and reaches 75 minutes of direct contact, consider billing A912 instead of A911.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultation
Must satisfy all the elements of a consultation as defined in the General Preamble ().
A written request from a referring physician, nurse practitioner, or dental surgeon (for insured hospital dental procedures) is mandatory.
The consultant must prepare a written report (findings, opinions, and recommendations) and provide it to the referring provider.
A minimum of 50 minutes of direct contact with the patient is required.
Start and stop times must be recorded in the patient’s permanent medical record.
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.
Time calculation excludes time devoted to any other service for which an amount is payable in addition to the consultation.
Time calculation excludes non-patient-facing time such as reviewing charts, imaging, or documentation.
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