W279 – Periodic health visit
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A periodic health visit rendered by a Geriatrics specialist in a non-emergency long-term care setting (such as a chronic care hospital, nursing home, or home for the aged) for a patient over two years old who presents without an acute illness. According to the definition on , 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.
When to Use
- Use W279 for a scheduled, non-acute wellness examination of a patient residing in a long-term care facility who is over two years of age.
- Select this code when performing a comprehensive age-appropriate health screening and physical exam that does not meet the criteria for a full consultation.
Common Pitfalls
- Billing W279 in the same month as the monthly management fee (W010) will result in a rejection or recovery, as these are mutually exclusive.
- Claiming W074 within six months of a W279 service is a common audit trigger and will lead to payment adjustments.
- Exceeding the limit of one W279 per patient per 12-month period per physician will result in the claim being rejected as non-insured.
Billing Tips
- Ensure your clinical notes explicitly document the age-appropriate screening and counseling components to satisfy the requirements of GP21.
Effective: June 1, 2025
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.
For a patient after their second birthday.
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