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Billing code

A425A — Comprehensive Physical Medicine And Rehabilitation Consultation

Long physiatry consultation

Bill A425 for a physiatry consultation with at least 75 minutes of direct patient contact, once every 2 years per physician.

Watch for: Record start and stop times in the chart, or payment drops to a lesser fee; chart and imaging review don't count.

Code

A425A

Description

Comprehensive 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

Physiatry consultation with at least 75 minutes of direct patient contact. One every 2 years by the same physician.

What it covers

A comprehensive physical medicine and rehabilitation consultation includes all the elements of a consultation plus at least 75 minutes in direct contact with the patient, not counting time on other separately billable services (A175).

A425 is the General Listings version; C425 and W425 are the in-patient and long-term care versions (A175, A178, A179).

Billing rules

• Minimum 75 minutes of direct contact with the patient; time excludes other separately billable services and non-patient-facing work such as chart or imaging review (A175).
• Limited to one every 2 years by the same physician (A175).
• Record start and stop times in the permanent record, or payment is reduced to a lesser fee (A175).
• 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).
• 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). Time-based consultations count toward these limits.
• 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, only after 120 minutes of comprehensive physical medicine and rehabilitation consultation time (GP31).

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: A315, C425, W425, A515, A316, K001

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

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