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By practice setting
Long-term care OHIP billing codes
Nursing home and long-term care visits, the monthly management fee, and LTC special-visit premiums.
12 codes in 3 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 00 is in the full Family Practice listing.
Visits & management
- W010Monthly management feeA monthly management fee for the provision of routine medical care, management, and supervision of a patient in a nursing home or home for the aged by the most responsible physician (MRP). The service requires a minimum of two assessments per month and includes numerous other specified services.$135.30
- W002Subsequent visits - Chronic care or convalescent hospitalA routine assessment of a patient in a long-term care institution (e.g., nursing home, home for the aged) following their admission.$40.05
- W003Subsequent visits - Nursing home or home for the agedA routine assessment for a patient in a long-term care institution following admission. This service is limited to the first 2 subsequent visits per patient per month and is a component of the monthly management fee (<billingCode>W010</billingCode>), subject to specific billing rules when billed individually.$40.05
- W004General re-assessment of patient in nursing homeA general re-assessment for a patient in a long-term care institution. This service includes all the components of a general assessment but does not require a full patient history if one has been previously obtained.$38.35
- W008Additional subsequent visitsAn intermediate assessment for a patient in a long-term care institution. This service is a routine subsequent visit and is a component of the monthly management fee W010.$40.05
Forms & certificates
How to use this long-term care code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to family practice and practice in general (specialty 00) — its own consultation and assessment codes, in-patient visits, premiums and the diagnostics or procedures that make up most of a day — sectioned the way a shift sheet reads. Codes open to every specialty that a long-term care physician also bills (general assessments, forms, special visit premiums) live in the Family Practice and Special visit premiums sets.
Each code links to its full Schedule entry: fee history, restrictions, required diagnoses and the codes it can or cannot be billed with. Fees shown are the current provider or specialist fee; percentage premiums show the percentage they add to the base service.
Common questions
Which consultation or assessment code does long-term care bill?
The visits & management section of this set starts with W010 (Monthly management fee), which pays $135.30 under the current Ontario Schedule of Benefits. 5 codes are listed in that section.
What is in the Long-term care code set?
12 OHIP billing codes across 3 sections: Visits & management; Special visit premiums — long-term care (first person seen); Forms & certificates. Nursing home and long-term care visits, the monthly management fee, and LTC special-visit premiums.
Are these the current OHIP fees?
Fees are read from the current Ontario Schedule of Benefits for Physician Services and refreshed hourly. Claims are paid at the fee in force on the service date, so always confirm the effective date on the code page.
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