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Billing code

A065A — Orthopaedic surgery consultation

Orthopaedic consultation

An orthopaedic surgeon bills A065 for a consultation at the written request of a physician or nurse practitioner, with a written report back.

Watch for: Put the referrer's registered billing number on the claim and keep the signed request, or OHIP pays a lesser assessment.

Code

A065A

Description

Orthopaedic surgery consultation

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

Consultation by an orthopaedic surgeon at the written request of a physician or nurse practitioner, in the office or another non-in-patient setting.

What it covers

A065 is the Orthopaedic Surgery (06) consultation under the General Listings (A164). A consultation is an assessment done at the written request of a physician, nurse practitioner (or a dental surgeon for hospital dental work) who wants your opinion because the case is complex, serious or obscure, or because the patient asked for another opinion. It includes a general or specific assessment, a review of relevant data and a written report to the referrer (GP16).

A physician in hospital but not on duty in the emergency department who sees patients in the ED or out-patient department uses these General Listings (A164).

Billing rules

• Specialists bill from the Consultations and Visits listing of their own specialty, here Orthopaedic Surgery (06) (GP9).
• Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for hospital dental work) naming you or your specialty, the referrer and their billing number, and the patient and health number. Without it, OHIP pays a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods. A second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first. A clearly unrelated diagnosis allows one every 12 months. Extra consultations pay as an assessment (GP17–GP18).
• Send a written report with your findings, opinion and recommendations to the referrer, and also to the primary care provider when a nurse practitioner referred (GP16).
• A pre-operative consultation before carpal tunnel or arthroscopic surgery under local anaesthesia and/or IV sedation is paid only when the chart shows it was medically necessary (GP18).
• If you spend at least 50 minutes in direct contact (not counting other billable services), bill the special surgical consultation (A935 or C935) instead (GP19).
• Age premiums of 10% to 30% apply to specialist consultations for patients under 16 (GP64).
• Can be done by video only, not phone, with modality indicator K300A (AJ2, A70).

Often billed with

• K001 detention, after the first 60 minutes (GP29–GP30).
• Special visit premiums when the consultation is a non-elective special visit (GP65–GP78).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).
• EQ6: OHIP describes this as 'Referring provider number not registered with the Ministry': check the referrer's billing number against the written request and resubmit (GP16).
• AT2: OHIP describes this as 'Must include video modality': this code is video-only in Appendix J, so it can't be billed by phone with K301A (AJ2).

Related codes: A935, A066, A063, A064, C065, W065, K001

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Orthopaedic Surgery (06), page A164. Consultation rules GP16–GP19.

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