< Billing codes

Billing code

A245A — Otolaryngology consultation

ENT consultation

An otolaryngologist bills A245 for a consultation in the office or general setting at a physician's or nurse practitioner's written request.

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

Code

A245A

Description

Otolaryngology 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

Office or general consultation by an otolaryngologist (ENT) at the written request of a physician or nurse practitioner.

What it covers

A consultation is an assessment requested in writing by a physician, nurse practitioner or dental surgeon who wants the opinion of a specialist because of the complexity, seriousness or obscurity of the case, or because another opinion is requested (GP16).

The consultant does the appropriate specific assessment, reviews relevant data and writes a report to the referrer (GP16). A245 is the general listing for Otolaryngology (24) (A166).

Billing rules

• Specialists bill from the Consultations and Visits listing of their own specialty (GP9).
• Needs a written, signed request from a physician, nurse practitioner or (hospital dental) dental surgeon naming you or the specialty, the referrer and billing number, and the patient and health number, kept in your chart. Otherwise it pays as a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (GP16).
• A referral requested after you have already seen the patient is not a consultation; bill the visit you provided (GP16).
• Limit: one consultation per patient for the same diagnosis per two consecutive 12-month periods (a second is allowed only for an in-patient or ED consult 12–24 months after the first), and one per 12 months for a clearly unrelated diagnosis. Excess pays as a specific assessment (GP17, GP18).
• Patients under 16 get the specialist consultation age premium (10–30% by age) (GP64).
• A special surgical consultation (A935) needs at least 50 minutes of direct contact (GP19); detention (K001) starts only after 60 minutes of a consultation (GP29–GP31).
• Can be done by video only (not phone) with an existing relationship; add K300A (AJ2, A66, A70).

Often billed with

• Z296 flexible fiberoptic nasal endoscopy, an IOP payable in addition to an assessment (GP4, P1).
• G526/G441 or G525/G440 audiometry when done the same visit (J99).

Common rejections

• ARF: OHIP describes this as 'Missing physician referring number': a consultation needs the referring physician's or NP's billing number from the written request (GP16).
• AT3: Billed as virtual care (K300A/K301A) and OHIP found no existing patient-physician relationship, such as an in-person service by you in the past 24 months (A66).
• AT2: OHIP describes this as 'Must include video modality': this code is video only for virtual care, so it can't be billed by telephone (K301A) (AJ2).

Related codes: A246, A935, A243, A244, C245, Z296

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Otolaryngology (24), page A166.

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