W318 – Subsequent visits per month (maximum of 3 per patient per month) - Nursing home or home for the aged
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a routine subsequent assessment for a patient in a non-emergency, long-term care setting such as a nursing home or home for the aged, rendered by a specialist in Physical Medicine & Rehabilitation. According to , subsequent visits are routine assessments following the patient's admission to a long-term care institution. The service includes the specific elements of an assessment as outlined in , such as a direct physical encounter, history taking, examination, and providing advice to the patient. This service is distinct from visits for acute intercurrent illness (which should be billed as W121). It is not payable if the monthly management fee (W010) is claimed for the same patient in the same month. For emergency calls or special visits, an appropriate 'A' prefix code and Special Visit Premium must be used instead of W318.
When to Use
- Use W318 for routine, non-urgent follow-up assessments of a patient in a long-term care facility when you are not billing the monthly management fee W010.
- Use this code for planned periodic reviews of chronic conditions that do not meet the criteria for an acute intercurrent illness visit under W121.
Common Pitfalls
- Billing W318 in the same month as the monthly management fee W010 will trigger an automatic rejection as the visit is considered included in the management fee.
- Attempting to bill W318 for an acute, unexpected illness will result in a claim rejection; use W121 for acute intercurrent illness instead.
- Exceeding the maximum limit of 3 visits per patient per month will result in the rejection of the fourth and subsequent claims.
Billing Tips
- Ensure your billing software tracks the monthly count of W318 claims per patient to avoid exceeding the 3-visit cap and subsequent audit scrutiny.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
For general rules regarding non-emergency long-term care in-patient services, see General Preamble .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.