W010 – Monthly management fee
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Monthly Management of a Nursing Home or Home for the Aged Patient is the provision by the most responsible physician (MRP) of routine medical care, management and supervision of a patient in a nursing home or home for the aged for one calendar month. The service requires a minimum of two assessments of the patient each month, where these assessments constitute services described as "W" prefix assessments. In addition to the common elements, this service includes the provision of the following services by any physician to the same patient during the month: A. Services described by subsequent visits (e.g. W003, W008). B. Services described by additional visits due to “intercurrent illness” (W121) except if the conditions described in Payment rule #7 are satisfied. C. Services described by palliative care subsequent visits (e.g. W872). D. Services described by admission assessments (e.g. W102, W104, W107). E. Services described by periodic health visit or general re-assessments (e.g. W109, W004). F. Services described by visit for pronouncement of death (W777) or certification of death (W771) except if the services are performed in conjunction with a special visit. G. Service described by anticoagulation supervision (G271). H. Completion of home care referral form and home care supervision (K070, K071, K072). I. Services described by the following diagnostic and therapeutic procedures – venipuncture (G489), injection (G372, G373), immunization (G538, G590), collection of cervical cancer screening specimen(s) (G365, G394, E430, E431), intravenous (G379), and laboratory test codes (G001, G002, G481, G004, G005, G009, G010, G011, G012, G014). J. All medication reviews. K. All discussions with the staff of the institution related to the patient’s care. L. All telephone calls from the staff of the institution, patient, patient’s relative(s) or patient’s representative in respect of the patient between the hours of 0700 hours and 1700 hours Monday to Friday (excluding holidays). M. Ontario Drug Benefit Limited Use prescriptions/forms or Section 8 Ontario Drug Benefits Act requests.
When to Use
- Use W010 when you are the Most Responsible Physician (MRP) and have completed at least two 'W' prefix assessments for a patient in a long-term care facility within a single calendar month.
- Use W010 to capture routine medical supervision, medication reviews, and staff discussions that occur throughout the month, which are otherwise bundled into this fee.
Common Pitfalls
- Failing to include the patient's admission date on the claim, which results in an automatic rejection.
- Submitting claims for routine subsequent visits (W003, W008) or intercurrent illness visits (W121) in the same month as W010, as these are considered components of the management fee and will be rejected.
- Assuming W010 covers all services; it does not include special visit premiums, psychotherapy/counselling (20+ minutes), or physician-to-physician consultations.
Billing Tips
- Ensure you have documented at least two 'W' prefix assessments in the chart to satisfy the minimum requirement for the monthly fee.
- If you perform more than four 'W' prefix assessments in a month, you may bill W121 for any intercurrent illness visits exceeding that threshold in addition to the W010.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
ManagementFee
Hospital and Institutional Consultations and Assessments
The admission date of the patient must be provided on the claim for W010 or the service is not eligible for payment.
Payment for W010 is for management of the patient for the entire month for all the services listed as components of the W010 service, regardless of when the claim for W010 is submitted.
When claiming W010, do not also submit claims for "W" prefix services listed as components of the W010 for the same month.
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