W795 – Geriatric psychiatric consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Geriatric Psychiatric Consultation is an assessment of a patient in a long-term care institution, such as a Chronic Care Hospital, Convalescent Hospital, Nursing Home, or Home for the Aged, following a written request from a referring practitioner. The service is subject to the same conditions as A795. As a consultation, it requires a written request, a review of all relevant data, a general, specific or medical specific assessment, and a written report back to the referring practitioner. This service is for non-emergency situations and is not payable for patients in designated palliative care beds. For emergency calls, use General Listings 'A' prefix codes with Special Visit Premiums.
When to Use
- Use W795 for the initial psychiatric evaluation of a patient residing in a long-term care facility, such as a nursing home or home for the aged, following a formal written request.
- Select W795 when performing a comprehensive geriatric psychiatric assessment in a chronic care or convalescent hospital setting that meets all consultation criteria, including a written report to the referring practitioner.
Common Pitfalls
- Billing W795 for patients in designated palliative care beds is strictly prohibited and will result in claim rejection.
- Attempting to bill W795 for emergency psychiatric assessments; these must be billed using General Listing 'A' codes combined with applicable Special Visit Premiums.
- Failing to document the formal written request from the referring practitioner, which is a mandatory requirement for all consultation codes unless common medical records are maintained.
Billing Tips
- Ensure the written report is sent to the referring practitioner; the consultation is only considered complete and billable once this documentation is finalized.
- If the patient has been seen by the same consultant for the same condition within the preceding 12 months, W795 will be downgraded to a repeat assessment fee unless specific repeat consultation criteria are met.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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.
A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. 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.
The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Subject to same conditions as A795.
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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