A925 – Limited consultation - Occupational Medicine
OHIP General Listings Code · 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. It is rendered by a specialist in occupational medicine following a written request from a referring physician, nurse practitioner, or dental surgeon to provide an opinion on a patient's condition.
When to Use
- When a referring provider requests a specialist opinion on a specific occupational health issue that does not require extensive assessment, such as evaluating a patient's fitness for modified work duties after a minor injury.
- To obtain a specialist's opinion on a patient's work-related condition that is straightforward and does not necessitate the time commitment of a full consultation (A725).
- When a nurse practitioner requires a specialist's input regarding a patient's occupational exposure and its immediate health impact, where a brief assessment suffices.
Common Pitfalls
- Billing A925 when the service rendered was more complex and time-consuming, which should have been billed as a full consultation (A725).
- Failing to obtain and retain a written request from the referring provider, which is mandatory for this code.
- Submitting A925 for a patient seen for the same diagnosis within the last 12 months, unless the patient is a hospital inpatient or in an Emergency Department.
Billing Tips
- Ensure the written report provided to the referring physician clearly outlines the findings, opinion, and recommendations specific to the occupational medicine issue.
- Verify that the service is distinct from a general assessment or a more comprehensive occupational medicine consultation (A720) by focusing on a specific work-related health question.
Effective: April 1, 2026
Professional Fee
Consultation
A written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures) is mandatory.
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.
The consultant must perform a general, specific, or medical specific assessment, including a review of all relevant data.
A copy of the signed written request must be maintained in the physician's medical record (except in hospitals/LTCs with common records).
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
The request must specify the information relevant to the referral and the services required.
If the requirements for a consultation (e.g., written request, report) are not met, the fee will be adjusted to a lesser assessment fee (e.g., A723).
Eligible for age-based fee premiums for patients under 16 years of age (30% for <30 days, 25% for 30 days to <1 year, 20% for 1 to <2 years, 15% for 2 to <5 years, 10% for 5 to <16 years).
Special visit premiums (Travel and First Person Seen) may be applicable if the service is non-elective and meets travel/time requirements.
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