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Billing code

A475A — Respiratory disease consultation

Respirology consultation

Bill A475 for a respirologist's consultation after a written request from a physician or nurse practitioner, with a written report back.

Watch for: Keep the signed written request with the referrer's billing number in your chart, or OHIP pays a lesser assessment.

Code

A475A

Description

Respiratory disease 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 respirologist after a written request from a physician or nurse practitioner, with a written report back.

What it covers

A475 is a consultation by a specialist in Respiratory Disease (A197).

A consultation is an assessment requested in writing by a physician, nurse practitioner or dental surgeon because of the complexity, seriousness or obscurity of the case, or because another opinion is requested. It includes a general, specific or medical specific assessment, review of relevant data, and a written report to the referrer (GP16).

Billing rules

• Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart (a common hospital record is fine). 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 an in-patient or ED patient 12 to 24 months after the first. Excess claims pay as an assessment (GP17, GP18).
• A retroactive request obtained after the service makes it a visit, not a consultation (GP16).
• Detention (K001) is payable only after 60 minutes (GP30).
• Virtual care: video only, not phone, with an existing patient relationship; add K300A (AJ2, A66).
• Services not listed under Respiratory Disease are billed from the Internal Medicine section (A197).

Often billed with

• Pulmonary function studies such as J301/J304 spirometry, J310 diffusing capacity or J307 lung volumes, which are payable in addition to a consultation (J3, H4–H5).

Common rejections

• ARF: OHIP's message is 'Missing Physician Referring Number': a consultation needs a written request from a physician or nurse practitioner, and the referrer's billing number must be on the claim (GP16).
• AT2: OHIP's message is 'Must Include Video Modality': this code is on the video-only list, so a phone claim (K301A) is refused (AJ2).

Related codes: A470, A575, A476, A473, C475, J304

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Respiratory Disease (47), page A197. Rules GP16–GP19.

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