What is OHIP billing code W516?

W516 is "Repeat consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does W516 pay?

The current OHIP fee for W516 is $106.60, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill W516 to OHIP?

W516 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates W516 claims against the Schedule of Benefits rules before submission.

What codes are related to W516?

Codes related to W516 in the Schedule of Benefits include A425, A510, A511.

All codes

W516

W516 – Repeat consultation

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The W51x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

W510 Complex neuromuscular assessment
A complex neuromuscular assessment rendered to a non-emergency in-patient in a Long-Term Care Institution.
$104.85
W511 Complex physiatry assessment
A complex physiatry assessment for a non-emergency in-patient in a Long-Term Care Institution, which includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, and…
$114.80

Consultations

W516 Repeat consultation(this code)
A repeat consultation rendered by a Physical Medicine & Rehabilitation (31) specialist for a patient in a non-emergency long-term care institution.
$106.60
W515 Consultation
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 &…
$233.65

A repeat consultation rendered by a Physical Medicine & Rehabilitation (<specialtyCodes>31</specialtyCodes>) specialist for a patient in a non-emergency long-term care institution. As defined on page of the Schedule, a repeat consultation is an additional consultation for the same presenting problem, rendered by the same consultant, but only after care has been provided by another physician since the initial consultation. It requires a new written request from a referring practitioner. All standard consultation requirements, including the need for a written referral and specific documentation as outlined on page , apply. Eligible locations are detailed on page and include chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

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 a hospital, long-term care institution or multi-specialty clinic with common medical records, the written request may be on the common record.

The request must identify the consultant by name, 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.

A425 A510 A511

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