W275 – Limited Consultation
OHIP Neurology Code — Infectious Disease (46) · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation. A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon in connection with an insured dental procedure rendered in a hospital. The request is made because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. The service includes the work necessary to prepare a written report with findings, opinions, and recommendations to the referring practitioner. A copy of the written request must be kept in the medical record. For payment rules and conditions, refer to to .
When to Use
- Use W275 for a focused specialist assessment of a specific clinical problem that requires less time and complexity than a full consultation (e.g., W460).
- Select W275 when the referring practitioner requests an opinion on a single, well-defined issue rather than a comprehensive multi-system review.
Common Pitfalls
- Billing W275 without a formal written request from the referring practitioner, which is a mandatory requirement under GP16.
- Failing to send a written report back to the referring practitioner, which will cause the claim to be downgraded to a standard assessment during an audit.
- Attempting to bill W275 for a routine follow-up; consultations are for new episodes of care or new clinical questions, not for ongoing management.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly documented in your chart to satisfy the audit requirements for a valid referral.
- If the case complexity increases during the encounter, consider billing a full consultation (e.g., W460) instead, provided the documentation supports the higher level of service.
Effective: June 1, 2025
Consultations and Visits
Infectious Disease (46)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record. In cases where common medical records are maintained (e.g., hospital, long-term care institution), the written request may be contained on the common medical record.
The request identifies the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner.
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 .
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