W055 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation, as defined in of the Schedule of Benefits, for a patient in a non-emergency long-term care institution. This service requires a written request from a referring physician, nurse practitioner, or dental surgeon for the consultant's opinion on a complex, serious, or obscure case. The service includes all elements of an assessment, a review of all relevant data, and the preparation of a written report (including findings, opinions, and recommendations) to the referring practitioner. This code is specifically for services rendered in settings such as chronic care hospitals, convalescent hospitals, nursing homes, or homes for the aged.
When to Use
- Use W055 when providing a formal consultation for a patient residing in a nursing home or home for the aged, provided the request is non-emergent and meets the GP16 definition of a consultation.
- Use this code for specialist opinions in chronic or convalescent care hospital beds, as it is specifically designated for these institutional settings rather than acute care hospital wards.
- Select W055 when the referring practitioner requests a formal opinion on a complex clinical issue, distinguishing it from a routine follow-up visit (W056) or a subsequent assessment.
Common Pitfalls
- Billing W055 for patients in acute care hospital beds; these patients require W050 instead, as W055 is strictly limited to long-term, chronic, or convalescent settings.
- Failure to document the specific written request from the referring practitioner, which is a mandatory requirement under GP16 and a common trigger for audit recovery.
- Billing W055 when the service is requested by a medical trainee; per the Schedule of Benefits, this must be downgraded to a general or specific assessment fee.
Billing Tips
- Ensure the referring physician's name and billing number are clearly linked to the consultation record to satisfy the documentation requirements of GP16.
- If you see the same patient for a follow-up after the initial W055, switch to the appropriate follow-up code (e.g., W056) to avoid rejection for duplicate consultation billing.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.