W425 – Comprehensive physical medicine and rehabilitation consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive physical medicine and rehabilitation consultation rendered for a patient in a non-emergency long-term care setting (e.g., chronic care hospital, nursing home). This service must be initiated by a written request from a referring physician, nurse practitioner, or dental surgeon due to the complexity, seriousness, or obscurity of the case, or at the patient's request for a second opinion. The service includes all constituent elements of a consultation as defined in the Schedule of Benefits (, ), including: - A direct physical encounter with the patient. - A full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s). - Review of all relevant data. - Preparation of a written report with findings, opinions, and recommendations sent to the referring practitioner. This service is subject to the same conditions as A425. A comprehensive physical medicine and rehabilitation consultation requires the physician to spend a minimum of 75 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention. The start and stop time must be recorded in the patient’s permanent medical record or the payment for the service will be reduced to a lesser fee.
When to Use
- Use W425 for complex rehabilitation assessments in chronic care or long-term care facilities when the 75-minute direct patient contact threshold is met.
- Select W425 over W515 or W510 when the clinical complexity requires a comprehensive consultation report and the patient is located in an eligible non-emergency institutional setting.
Common Pitfalls
- Failing to document exact start and stop times in the medical record, which triggers an automatic reduction to a lower assessment fee.
- Billing W425 without a formal, written referral request from a physician, nurse practitioner, or dental surgeon, which invalidates the consultation status.
- Including time spent on chart review or report writing toward the 75-minute requirement, as only direct patient contact time is eligible.
Billing Tips
- Ensure the written referral is physically or electronically present in the chart before billing to satisfy audit requirements for consultation status.
- Use a standardized time-tracking template in your clinical notes to clearly delineate the 75 minutes of direct patient contact from other administrative tasks.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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 facilities with a common medical record, the written request may be contained on that 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 consulting physician must prepare a written report including findings, opinions, and recommendations to the referring practitioner.
The start and stop time must be recorded in the patient’s permanent medical record or the payment for the service will be reduced to a lesser fee.
subject to the same conditions as A425
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