What are the billing rules for A595A?

Needs a written, signed request from a physician or nurse practitioner naming you or your specialty, the referrer and billing number, and the patient and health number, kept on the chart; otherwise it's paid as a lesser assessment (GP16). Limited to one consultation per patient per physician for the same diagnosis in two consecutive 12-month periods (a second is allowed only for an in-patient or ED consult 12–24 months after the first); an unrelated diagnosis allows one per 12 months (GP17). Consultations over the limit, or requested by a medical trainee, are paid as an assessment (GP17–GP18).

Why is A595A rejected?

ARP: OHIP describes this as 'Referring Physician Number Required': a consultation needs the referring physician's or nurse practitioner's billing number (GP16). AT2: OHIP describes this as 'Must Include Video Modality': this code is on the video-only virtual care list, so it can't be billed by telephone (K301A) (Appendix J).

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Billing code

A595A — Rheumatology limited consultation

Q: What is OHIP billing code A595A?

Limited rheumatology consultation: a referred consultation that needs substantially less time than a full consultation.

Rheumatology limited consultation

Bill A595 for a referred rheumatology consultation that takes substantially less time than a full consultation.

Watch for: Keep the signed written request with the referrer's billing number on the chart, or it's paid as a lesser assessment.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$124.50	$0.00	$0.00	$0.00

Code: A595A
Description: Rheumatology 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

Limited rheumatology consultation: a referred consultation that needs substantially less time than a full consultation.

What it covers

A595 is the rheumatology limited consultation (A200). 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).

The listing appears under the comprehensive consultation heading on A200 but is a separate, shorter consultation service.

Billing rules

Needs a written, signed request from a physician or nurse practitioner naming you or your specialty, the referrer and billing number, and the patient and health number, kept on the chart; otherwise it's paid as a lesser assessment (GP16).
Limited to one consultation per patient per physician for the same diagnosis in two consecutive 12-month periods (a second is allowed only for an in-patient or ED consult 12–24 months after the first); an unrelated diagnosis allows one per 12 months (GP17).
Consultations over the limit, or requested by a medical trainee, are paid as an assessment (GP17–GP18).
Age premium of 10–30% for patients under 16 (GP64).
Can be done by video only (not telephone) with K300A, when the virtual care conditions are met (Appendix J, A66).

Common rejections

ARP: OHIP describes this as 'Referring Physician Number Required': a consultation needs the referring physician's or nurse practitioner's billing number (GP16).
AT2: OHIP describes this as 'Must Include Video Modality': this code is on the video-only virtual care list, so it can't be billed by telephone (K301A) (Appendix J).

Related codes: A485, A590, A486, C595, A483

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Rheumatology (48), page A200.

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