A915 – 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. Otherwise, a limited consultation has the same requirements as a full consultation, including a written request from a referring physician, nurse practitioner, or dental surgeon, and a written report to the referring provider.
When to Use
- When a specialist provides an opinion on a specific, well-defined issue (e.g., interpretation of a single diagnostic test result) requested by another physician, and a full consultation (A715) is not warranted.
- For a follow-up opinion on a different, unrelated diagnosis that occurred more than 12 months after the initial consultation for the first diagnosis.
- When a patient requires a second opinion on a distinct, new problem more than 24 months after the initial limited consultation for a previous, resolved issue.
Common Pitfalls
- Billing A915 when the service provided is a simple follow-up visit or management of an ongoing condition, which should be billed using an intermediate (A007) or complex (A009) visit code.
- Failing to obtain a written request from the referring provider or neglecting to send a written report back, both of which are mandatory requirements for A915.
- Billing A915 for the same diagnosis within a 24-month period, or for an unrelated diagnosis within a 12-month period, violating the usage limits.
Billing Tips
- Ensure the written report clearly outlines the specific question asked by the referring physician and the consultant's findings, opinions, and recommendations related to that question.
- If providing virtual care via video, append the 'A' suffix to A915 (A915A) to indicate the service was rendered remotely.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Medical
Consultation
Eligible for age-based fee premiums for patients under 16 years of age ().
If the physician is not on duty in the Emergency Department, A915 may be used for consultations rendered in the ED ().
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