W109 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit rendered to a patient in a long-term care institution (e.g., nursing home, home for the aged, chronic care hospital). The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling, as defined in . This service may be rendered as a periodic health visit/general re-assessment (). The service is eligible for an age-based premium for patients 65 and over ().
When to Use
- Use W109 for the annual comprehensive physical examination of a patient residing in a long-term care facility, nursing home, or chronic care hospital.
- Use this code when performing a scheduled, age-appropriate health screening and physical assessment that is distinct from routine monthly management visits.
Common Pitfalls
- Billing W109 in the same calendar month as W010 will result in an automatic rejection, as W109 is considered a component of the monthly management fee.
- Attempting to bill W109 more than once in a 12-month period per patient per physician will trigger a rejection due to the annual frequency limit.
- Failing to document the specific components of an intermediate or partial assessment (history, physical, and screening) will lead to clawbacks during an audit.
Billing Tips
- Always append the 15% age premium for patients aged 65 and older to maximize the value of the W109 claim.
- Ensure your billing software correctly flags the service date to avoid conflicts with W010, as the Ministry strictly enforces the monthly exclusivity rule.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling.
W109 is specified as a general assessment eligible for a 15% fee premium when provided to an insured person who is at least 65 years of age.
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