W911 – Special family and general practice consultation
OHIP Neurology Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon who requests the opinion of a consultant due to the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The consultant must perform an appropriate assessment, review relevant data, and provide a written report with findings and recommendations. This service (W911) is specifically for providing palliative care consultations to patients in long-term care settings, such as chronic care hospitals, convalescent hospitals, nursing homes, or homes for the aged. As per the definition on , palliative care is for a terminally ill patient in the final year of life where the decision is made to not aggressively treat the underlying disease and focus on comfort.
When to Use
- Use W911 when providing a formal palliative care assessment for a patient in a long-term care facility who has transitioned to a comfort-focused care plan.
- Use this code when a primary care physician or nurse practitioner requests your specific expertise to manage complex symptom control for a terminally ill patient in a nursing home.
Common Pitfalls
- Billing W911 for a patient in an acute care hospital bed will result in rejection; ensure the patient is in a chronic care, convalescent, or long-term care facility.
- Failing to document a formal written request from the referring provider will lead to a clawback during audit, as W911 strictly requires a documented referral.
- Claiming W911 for routine follow-up visits after the initial consultation is prohibited; subsequent visits must be billed as subsequent visit codes (e.g., W912).
Billing Tips
- Ensure the written referral specifically mentions the complexity or obscurity of the palliative case to satisfy the consultation definition requirements.
- If the patient is in a designated palliative care bed, W911 is not applicable; verify the facility's bed designation status before submission.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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.
W-prefix services apply to non-emergency in-patient services for patients in chronic care hospitals, convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent care beds in hospitals (other than designated palliative care beds).
If the requirements for a consultation are not met, the amount payable will be reduced to a lesser assessment fee.
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