W726 – Repeat consultation, Occupational Medicine, Long-Term Care setting.
OHIP Neurology Code · Schedule of Benefits
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval following the initial consultation but preceding the repeat consultation, provided to a patient in a non-emergency long-term care in-patient setting.
When to Use
- Use W726 when a patient in a long-term care facility requires a new occupational medicine assessment for the same condition after an intervening period of care provided by a different physician (e.g., the attending GP or a hospitalist).
- Use this code when the clinical status of the patient has changed significantly enough to warrant a formal re-evaluation, distinguishing it from routine follow-up visits which would be billed under assessment codes.
Common Pitfalls
- Billing W726 without a new, formal written referral request from the attending physician or nurse practitioner, which is a mandatory requirement for every repeat consultation.
- Submitting W726 for ongoing management or routine follow-up; if no intervening care by another physician occurred, the claim will be rejected or downgraded to a lower-value assessment code upon audit.
- Confusing W726 with C726; W726 is strictly for designated long-term care settings, whereas C726 is reserved for acute care hospital in-patients.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the consultation report to satisfy the mandatory referral requirements for repeat consultations.
- When billing W726, always append the suffix 'A' to the code to ensure proper processing for both in-person and video-based services.
Effective: April 1, 2026
Long-Term Care In-Patient Services
Consultation
New written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
A written report must be provided to the referring provider.
Must include a general, specific, or medical specific assessment.
Intervening care by another physician must have occurred between the initial consultation and the repeat consultation.
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.
If the requirements for a repeat consultation are not met, the fee may be adjusted to a lesser assessment fee.
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