A945 – Special palliative care consultation
OHIP General Listings Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A special palliative care consultation is a consultation requested because of the need for specialized management for palliative care where the physician spends a minimum of 50 minutes in direct contact with the patient and/or patient's representative/family in consultation (majority of time must be spent in consultation with the patient) exclusive of time spent rendering any other separately billable intervention to the patient. In addition to the general requirements for a consultation, the service includes a psychosocial assessment, comprehensive review of pharmacotherapy, appropriate counselling and consideration of appropriate community services, where indicated.
When to Use
- When a patient is terminally ill, has made the decision to forgo aggressive treatment, and requires a comprehensive assessment of their palliative care needs, including psychosocial and pharmacotherapy review, by a physician other than their primary care provider.
- When a patient requires specialized palliative care management, and the physician will spend at least 50 minutes in direct consultation, focusing on comfort and symptom management, with the patient and/or their family.
- When a patient's family requests a specialized consultation to discuss end-of-life care options, pharmacotherapy, and potential community support services, and the physician anticipates a minimum of 50 minutes of direct patient/family contact.
Common Pitfalls
- Billing A945 when the physician has already provided another consultation (A005) or assessment (e.g., A007) to the same patient on the same day, as these are mutually exclusive.
- Failing to document the start and stop times of the 50-minute minimum direct patient/family contact, which can lead to reduced payment.
- Including time spent on separately billable procedures or non-consultation activities within the 50-minute minimum, as only direct consultation time is eligible.
Billing Tips
- Ensure the referral request clearly specifies the need for specialized palliative care management and is kept on file, unless the consultation occurs in a setting with common medical records.
- Document the comprehensive psychosocial assessment, pharmacotherapy review, and any counselling or community service considerations as part of the patient's record to support the A945 service.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Palliative Care
Consultation
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.
Start and stop times must be recorded in the patient’s permanent medical record or the amount payable for the service will be adjusted to a lesser paying fee.
Minimum of 50 minutes in direct contact with the patient and/or patient's representative/family.
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