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Billing code

A315A — Physical medicine and rehabilitation consultation

Physiatry consultation

A physiatrist bills A315 for a consultation in the office or other non-in-patient setting at a physician's or nurse practitioner's written request.

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

Code

A315A

Description

Physical medicine and rehabilitation 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 physiatrist (physical medicine and rehabilitation specialist) at the request of a referring physician or nurse practitioner.

What it covers

A consultation is an assessment done at the written request of a physician or nurse practitioner who wants a consultant's opinion because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

A315 is the Physical Medicine & Rehabilitation (31) consultation in the General Listings, used in the office and other non-in-patient settings (A175).

Billing rules

• Needs a written, signed request from the referring physician or nurse practitioner naming the patient, the referrer's billing number and the reason; otherwise it is paid as a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (GP16).
• Same patient, same physician, same diagnosis: one consultation per two consecutive 12-month periods, with a second allowed only for an in-patient or ED consult 12–24 months after the first; a clearly unrelated diagnosis allows one per 12 months. Extra consults are paid as an assessment (GP17, GP18).
• Specialist consultations, limited consultations and repeat consultations get an age premium: +30% under 30 days, +25% to 1 year, +20% to 2 years, +15% to 5 years, +10% to 16 years (GP64).
• Can be done by video only, never by telephone; bill the code with K300A (Appendix J AJ2, A70).

Often billed with

• K001 detention after 60 minutes of consultation time (GP30).

Common rejections

• ARF: The referring provider number is missing. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).
• A4D: Specialists must bill from the Consultations and Visits listing of their own specialty; this code is in the Physical Medicine & Rehabilitation (31) listing (GP9).

Related codes: A425, A515, A316, A313, C315, W515

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A175.

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