< Billing codes

Billing code

A865A — Nephrology limited consultation

Nephrology limited consultation

Bill A865 for a nephrologist's less demanding referral that takes substantially less time than a full consultation.

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

Code

A865A

Description

Nephrology 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 nephrology consultation: a less demanding referral that takes substantially less time than a full consultation.

What it covers

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

A865 is the nephrology office version; the full consultation is A165 (A136).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second only for a hospital in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Excess claims are paid as an assessment (GP17–GP18).
• Age premiums apply for patients under 16, from +10% to +30% depending on age (GP64).
• Can be done by video only (not telephone); add K300A to the claim (Appendix J AJ2, A66).
• For chronic dialysis patients, consultations and visits to manage dialysis, its complications and end-stage renal disease are included in the weekly chronic dialysis team fee (G860–G865) and are paid at nil to other physicians (J39).

Common rejections

• ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16).
• AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

Related codes: A165, A166, A160, A163, C865

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A136; rules GP16–GP19.

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