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Billing code

K738A — Referring Physician (E Consultation)

E-consultation, referring physician

Bill K738 when you send a secure electronic request for another physician's opinion on a patient you'll keep caring for.

Watch for: Paid only if the consultant replies with an opinion within 30 days; maximum one per patient per day and 6 per year.

Code

K738A

Description

Referring Physician (E 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

E-consultation, referring physician: you send a secure electronic request for a specialist's opinion and keep caring for the patient.

What it covers

K738 pays the referring physician or nurse practitioner who, knowing the patient, asks another physician for an opinion on a complex, serious or obscure case, with both request and reply sent through a secure server (A48).

It includes sending the relevant data (history, test results where indicated) and everything else you do to obtain the advice. You must intend to continue the patient's care (A48).

Billing rules

• Payable only if the consultant gives an opinion or recommendations within 30 days of the request (A48).
• Maximum 1 per patient per day, 6 per patient per 12 months (any physician), and 400 per physician per 12 months (A48).
• Payable in addition to a visit or other service you provide to the same patient the same day (A48).
• Not payable if the purpose is to transfer care, to arrange a consultation, visit, K-prefix time-based service, procedure or test, or mainly to discuss test results (A48–A49).
• Not payable to either physician if the consultant sees the patient for a consultation, assessment, visit or K-prefix time-based service the same day or the next day (A49).
• The chart must hold the patient's name and health number, both physicians' names, the reason, and the consultant's opinion and recommendations (A49).
• Also payable to the primary care physician who must collect new data, such as dermatology or ophthalmology images, for a specialist's e-assessment; not when the data is already in your records (A49, GP37).
• Not payable if you're paid other than fee-for-service for the e-consultation (A49).

Often billed with

• A same-day visit such as A007, which is payable in addition (A48).
• The consultant bills K739, which needs your provider number on the claim (A48, A50).

Common rejections

• EH2: The health card version code doesn't match OHIP's record; get the current version code and resubmit (EH2 guide).
• V21: A diagnostic code is required on the claim and was missing; add the code for the condition the e-consultation was about.
• VJ7: The claim reached OHIP more than three months after the service date; resubmit as stale-dated only if it was first sent on time (VJ7 guide; GP9).
• A3H: More services than allowed were billed; K738 is limited to one per patient per day (A48; A3H guide).
• EH4: The patient's OHIP coverage had ended before the service date; check the health number and the patient's eligibility (EH4 guide).

Related codes: K739, K730, K731, K734, K732

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), Physician/Nurse Practitioner to Physician E-consultation, pages A48–A50.

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