W305 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon, for their opinion on a complex, serious, or obscure case. This service is provided by a specialist in Obstetrics and Gynaecology to a non-emergency in-patient in a long-term care institution, such as a chronic care hospital, convalescent hospital, nursing home, or home for the aged. The service includes all the required elements of a consultation as defined in the Schedule of Benefits (), including a review of relevant data and a written report to the referring practitioner. This fee also includes payment for a biopsy of the cervix, collection of cervical cancer screening specimens, and examination of trichomonas suspension, when performed.
When to Use
- Use W305 when a specialist in Obstetrics and Gynaecology is formally requested by a physician or nurse practitioner to provide an opinion on a complex, non-emergency gynecological issue for a patient residing in a long-term care institution.
- Use W305 when performing a consultation that includes a cervical biopsy or collection of cervical cancer screening specimens, as these procedures are bundled into the consultation fee.
Common Pitfalls
- Billing W305 without a formal, written request from the referring practitioner; a verbal request or a simple chart note without a documented referral source is insufficient for audit purposes.
- Attempting to bill for a cervical biopsy or cervical cancer screening separately; these procedures are considered included in the W305 fee and cannot be claimed as additional service codes.
- Failing to provide a formal written report to the referring practitioner, which is a mandatory requirement for all consultation codes under GP16.
Billing Tips
- Ensure you append the appropriate Special Visit Premium (e.g., W992, W994, or W998) when traveling to a long-term care institution, as W305 only covers the professional fee for the assessment itself.
- If the consultation requirements are not met, the claim may be downgraded to a general assessment fee; ensure the documentation explicitly reflects the complexity of the case to justify the consultation status.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record or in the common medical record.
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out information relevant to the referral and specify the service(s) required.
The consultant is required to prepare a written report (including findings, opinions, and recommendations) to the referring practitioner.
Includes (where indicated) biopsy of cervix, collection of cervical cancer screening specimen(s), examination of trichomonas suspension.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.