What are the billing rules for A515A?

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).

Why is A515A rejected?

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).

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Billing code

A515A — Physical medicine and rehabilitation limited consultation

Q: What is OHIP billing code A515A?

A shorter, less demanding physiatry consultation. Same written-request rules as a full consultation.

Physiatry limited consultation

Bill A515 for a shorter, less demanding physiatry consultation that still meets the same written-request rules as a full one.

Watch for: Needs a signed written request naming the referrer's billing number, or it is paid as a lesser assessment.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$106.60	$0.00	$0.00	$0.00

Code: A515A
Description: Physical medicine and rehabilitation limited 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

A shorter, less demanding physiatry consultation. Same written-request rules as a full consultation.

What it covers

A limited consultation is less demanding and normally takes substantially less of the physician's time than a full consultation; otherwise it has the same requirements (GP19).

A515 is the Physical Medicine & Rehabilitation (31) limited consultation in the General Listings (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).

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).

Related codes: A315, A425, A316, C515, W310

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

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