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W925
W925 – Limited consultation
OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered in a non-emergency long-term care setting (such as a chronic care hospital or nursing home) that is less demanding and requires substantially less of the physician’s time than a full consultation. It requires a written request from a referring physician, nurse practitioner, or dental surgeon and a subsequent written report to the referring provider.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A written request from a referring physician, nurse practitioner, or dental surgeon must be documented in the medical record.
The consultant must provide a written report (including findings, opinions, and recommendations) to the referring provider.
The request must identify the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identify the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Usage limits
Consultations for the same patient by the same physician for the same diagnosis are limited to one service per two consecutive 12-month periods (except for repeat consultations).
W925 is the Long-Term Care equivalent of the office-based code A925.
Special Visit Premiums (travel, etc.) are generally not eligible for payment when the patient is seen during rounds at a long-term care institution ().
Eligible for age-based fee premiums for patients under 16 years of age (10-30% increase), but not eligible for the 15% premium for patients 65+ ().
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