What is OHIP billing code W535?

W535 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does W535 pay?

The current OHIP fee for W535 is $85.90, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill W535 to OHIP?

W535 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates W535 claims against the Schedule of Benefits rules before submission.

What codes are related to W535?

Codes related to W535 in the Schedule of Benefits include W536, W231, W930.

All codes

W535

W535 – Consultation

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

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Levels of this visit

The W53x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

W536 Repeat consultation
A repeat consultation rendered by an ophthalmologist (specialty 23) in a non-emergency long-term care setting.
$48.00
W535 Consultation(this code)
Represents an ophthalmology consultation rendered in a non-emergency long-term care facility.
$85.90

Represents an ophthalmology consultation rendered in a non-emergency long-term care facility. As per the general definition in , a consultation is an assessment provided following a written request from a referring practitioner (physician, nurse practitioner, or dental surgeon) due to the complexity, seriousness, or obscurity of the case. The consultant physician must provide a written report back to the referring practitioner. The 'W' prefix specifies the location of service as a long-term care institution.

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, 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.

W536 W231 W930

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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