K731 – Physician to physician telephone consultation - Consultant physician
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Physician to physician telephone consultation is a service where the referring physician or nurse practitioner, in light of his/her professional knowledge of the patient, requests the opinion of a physician (the “consultant physician") by telephone who is competent to give advice in the particular field because of the complexity, seriousness, or obscurity of the case. This service is only eligible for payment if the consultant physician has provided an opinion and/or recommendations for patient treatment and/or management. For the purpose of this service, “relevant data” include family/patient history, history of the presenting complaint, laboratory and diagnostic tests, where indicated and feasible in the circumstances. Definition/Required elements of service – Consultant physician This service includes all services rendered by the consultant physician to provide opinion/advice/recommendations on patient care, treatment and management to the referring physician. The consultant physician is required to review all relevant data provided by the referring physician or nurse practitioner.
When to Use
- Use K731 when a referring physician calls you to discuss a complex management plan for a patient they are currently treating, provided you offer specific clinical recommendations.
- Use K731 when providing an urgent specialist opinion on a patient's diagnostic results or medication adjustments to avoid an unnecessary emergency department referral.
Common Pitfalls
- Do not bill K731 if you subsequently see the patient for an in-person consultation (A-code) on the same day, as the telephone advice is considered part of the consultation service.
- Avoid billing K731 for routine administrative tasks, such as discussing appointment scheduling or clarifying a referral letter, as these do not constitute a clinical opinion.
- Claims will be rejected if the referring physician's billing number is missing or if the service is billed for a patient who is not currently under the care of the referring physician.
Billing Tips
- Ensure your clinical note explicitly records the name of the referring physician and the specific clinical advice provided, as this is the primary evidence required for audit compliance.
- If the consultation exceeds 10 minutes, consider if K734 or K735 is more appropriate based on the time spent, as K731 is a flat-fee code regardless of duration.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations
All insured services must be documented in appropriate records, establishing that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary, as per .
Keeping and maintaining appropriate medical records is a common element of all insured services, as per .
The Definition/Required elements of service and payment rules for consultations in the General Preamble are not applicable to physician to physician telephone consultations.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.