W725 – Consultation - Occupational Medicine - Long-Term Care (LTC)
OHIP Neurology Code · Schedule of Benefits
A consultation rendered by a specialist in occupational medicine to a patient in a non-emergency long-term care in-patient setting, including chronic care hospitals, convalescent hospitals, nursing homes, and homes for the aged.
When to Use
- Use W725 when a patient in a long-term care facility requires a formal specialist opinion on an occupational-related health issue, provided a written referral is received.
- Use this code for a comprehensive assessment of a patient's occupational exposure history or work-related condition that does not meet the 75-minute threshold required for W720.
Common Pitfalls
- Billing W725 when the service is an emergency; emergency visits to LTC patients must be billed using General Listing codes like A725 plus applicable Special Visit Premiums.
- Failing to maintain the written referral request in the patient's record, which leads to automatic downgrades to a lesser assessment fee during audits.
- Attempting to bill W725 on the same day as other assessments or visits by the same physician, which will trigger a rejection.
Billing Tips
- Ensure the written referral explicitly identifies the referring provider's billing number and the specific occupational medicine service requested to satisfy the documentation requirements.
- If the patient requires a follow-up for the same condition within the same 12-month period, use W726 instead of repeating W725.
Effective: April 1, 2026
Medical
Consultation
Requires a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital).
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.
A copy of the written request must be kept in the patient's medical record (or common medical record in LTC).
The request must identify the consultant, the referring provider (name and billing number), and the patient (name and health number).
The written request sets out the information relevant to the referral and specifies the service(s) required.
W725 is the LTC equivalent of the office consultation A725.
If the consultation is requested by a Medical Trainee, the fee is adjusted to a lesser assessment fee.
Special visit premiums (travel and person seen) are generally not eligible for payment with W-prefix codes as they are designated for non-emergency/routine care.
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