W515 – Consultation - Non-Emergency Long-Term Care In-Patient Services
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered in a non-emergency long-term care in-patient setting (e.g., Chronic Care Hospital, Nursing Home, Home for the Aged) by a specialist in Physical Medicine & Rehabilitation (31). This service requires 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 another opinion. It includes all the specific elements of an assessment as defined in , including a direct physical encounter, history, and examination. The consulting physician must prepare and send a written report of their findings, opinions, and recommendations to the referring practitioner. A copy of the referral request must be maintained in the patient's medical record. For emergency calls and other special visits to in-patients, use General Listings (A prefix) and Special Visit Premiums.
When to Use
- Use W515 for a formal, requested specialist assessment of a patient residing in a long-term care facility or chronic care hospital when the primary care provider requires a specialist opinion on a complex, non-emergency clinical issue.
- Use W515 when a patient in a long-term care setting requests a second opinion from a Physical Medicine & Rehabilitation specialist regarding their ongoing management or treatment plan.
Common Pitfalls
- Billing W515 for routine follow-up visits or ongoing management; once the consultation is complete, subsequent visits must be billed as assessments or follow-up visits, not as a new consultation.
- Failing to maintain a copy of the written referral request in the patient's chart, which is a mandatory audit requirement unless the request is documented in a shared common medical record.
- Attempting to bill W515 for emergency situations; emergency visits in these settings must be billed using the 'A' prefix codes and appropriate Special Visit Premiums.
Billing Tips
- Ensure the written referral specifically identifies the consultant by name or specialty and clearly outlines the clinical question to satisfy the documentation requirements of GP16.
- If you have previously billed a consultation for the same diagnosis within the last 12 months, W515 will be rejected unless it meets the specific criteria for a repeat consultation.
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 physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.
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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