W925 – Limited consultation - Long-Term Care
OHIP Neurology Code · 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.
When to Use
- Use W925 when providing a focused opinion on a specific clinical question for a patient in a nursing home or chronic care facility that does not require the depth of a full W725 consultation.
- Use W925 when the referring provider requests a specific, limited assessment of a long-term care resident, such as a medication review or a focused geriatric assessment, rather than a comprehensive evaluation.
Common Pitfalls
- Billing W925 for patients in palliative care beds is a common audit trigger, as these patients are explicitly excluded from this code's eligibility.
- Attempting to claim Special Visit Premiums alongside W925 during routine rounds is prohibited and will result in automatic rejection per GP65.
- Failing to document the formal written request from the referring provider or the subsequent report to them will lead to a clawback if the claim is audited.
Billing Tips
- Ensure you do not apply the 15% age premium for patients 65+ to W925, as this code is specifically excluded from the GP64 premium eligibility.
- If the clinical complexity exceeds the scope of a 'limited' consultation, bill the full consultation code W725 instead to avoid under-billing for the time and effort invested.
Effective: April 1, 2026
Long-Term Care
Consultation
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.
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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