Billing code
A005A — Consultation family practice & practice in general
Family practice consultation
Bill A005 for an assessment done at another physician's or nurse practitioner's written request, with a written report back.
Watch for: Keep the signed written request in the chart and put the referrer's billing number on the claim, or it pays as a lesser assessment.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $95.60 | $0.00 | $0.00 | $0.00 | $0.00 |
- Code
- A005A
- Description
- Consultation family practice & practice in general
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Apr 1, 2026
- Termination date
- No end date
Explanation
Updated October 26, 2026
Family practice consultation: an assessment done at the written request of another physician or a nurse practitioner, with a written report back.
What it covers
A consultation is an assessment after a written request from a referring physician, nurse practitioner or dental surgeon, because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).
A005 is the family and general practice consultation. It includes the written report and, unless stated otherwise, a general or specific assessment with review of all relevant data (GP16).
Billing rules
- Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for in-hospital dental care) naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart. The consultant sends a written report back. Otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16).
- Same patient, physician and diagnosis: one consultation per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later). Unrelated diagnosis: one per 12 months. Extras are paid as an assessment (GP17, GP18).
- Use A006 for a repeat consultation (new written request, another physician cared for the patient in between) and A905 when only a specific-assessment level was needed (GP19).
- A911 (at least 50 minutes) and A912 (at least 75 minutes of direct contact) are the longer consultations; start and stop times must be charted (A1).
- Not on the Appendix J list, so it can't be billed by video or telephone (A68, AJ1, AJ2).
Often billed with
- E079 smoking cessation initial discussion, once per patient per 12 months (A56).
Common rejections
- AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the request.
- AC1: A limit was reached. Consultations over the GP17 limits are payable only as an assessment, so resubmit with the assessment code that fits.
- EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
- VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.
- AD3: OHIP's description is 'not allowed with visit': another visit billed that day conflicts with this one. Check the other services billed.
Related codes: A905, A006, A911, A912, A003, A010
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A1; General Preamble GP16 to GP19 (consultations)
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