W058 – Nursing home or home for the aged - additional subsequent visits
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An additional subsequent visit for a patient in a nursing home or home for the aged, claimed after the initial two monthly visits (e.g., W053). As per , a subsequent visit is any routine assessment following the patient's admission to a long-term care institution. Visits for acute intercurrent illness should be claimed using W121.
When to Use
- Use for a third, fourth, or fifth routine follow-up visit in a calendar month after the two monthly W053 visits have already been exhausted.
- Use when a patient requires non-acute, routine monitoring or medication reviews that exceed the standard two-visit monthly allowance.
Common Pitfalls
- Claiming W058 for acute intercurrent illnesses, which must be billed as W121 to avoid rejection or audit recovery.
- Attempting to bill W058 when the monthly management fee W010 has already been claimed for the same patient, as W058 is considered included in the W010 fee.
- Exceeding the maximum of 3 claims per patient per month, which will result in automatic rejection by the Ministry.
Billing Tips
- Ensure you have already billed two W053 visits for the patient in the current month before submitting W058 to prevent unnecessary claim rejections.
- If the patient presents with a new acute issue, prioritize W121 over W058, as W121 is not subject to the same monthly volume restrictions.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
All insured services must be documented in appropriate records to establish that the service was provided, medically necessary, and matches the service claimed. See for details.
See General Preamble for rules regarding subsequent visits in long-term care institutions.
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