< Billing codes

Billing code

A165A — Nephrology consultation

Nephrology consultation

A nephrologist bills A165 for a consultation at a physician's or nurse practitioner's written request, with a written report back.

Watch for: Put the referrer's billing number on the claim; virtually, it can be done by video only, not telephone.

Code

A165A

Description

Nephrology 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 a nephrologist at the written request of a physician or nurse practitioner, with a written report back to the referrer.

What it covers

A consultation is an assessment requested in writing by a physician or nurse practitioner because of the complexity, seriousness or obscurity of the case, or because the patient asks for another opinion (GP16).

It includes the assessment, review of relevant data, and a written report to the referrer (GP16). A consultation with at least 75 minutes of direct contact is the comprehensive nephrology consultation A160 (A136).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second only for a hospital in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Excess claims are paid as an assessment (GP17–GP18).
• Detention (K001) can start only after 60 minutes and is assessed on an IC basis with a written explanation (GP30–GP31).
• Age premiums apply for patients under 16, from +10% to +30% depending on age (GP64).
• Can be done by video only (not telephone); add K300A to the claim (Appendix J AJ2, A66).
• For chronic dialysis patients, consultations and visits to manage dialysis, its complications and end-stage renal disease are included in the weekly chronic dialysis team fee (G860–G865) and are paid at nil to other physicians (J39).

Common rejections

• ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16).
• AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

Related codes: A160, A865, A166, A163, C165, W165

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A136; rules GP16–GP18.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing