< Billing codes

Billing code

W010A — Monthly Management Fee

Monthly nursing home management fee

Bill once a month as the most responsible physician for a nursing home or home for the aged resident, usually after two in-person assessments.

Watch for: Put the patient's admission date on the claim, and don't also bill the component W codes that month.

Code

W010A

Description

Monthly Management Fee

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

Monthly fee for the most responsible physician's routine care, management and supervision of a nursing home or home for the aged resident.

What it covers

W010 pays the MRP for routine medical care, management and supervision of a nursing home or home for the aged patient for one calendar month. It needs at least two W-prefix assessments with a direct physical encounter that month, with the exceptions in payment rule 8 (GP51).

It includes, by any physician that month: subsequent visits, W121 (unless rule 7 applies), palliative visits (W872), admission assessments, W109/W004, W777/W771 (unless with a special visit), G271, K070–K072, listed injections, immunizations, cervical screening, IV and office lab codes, all medication reviews, staff discussions, weekday daytime phone calls, and ODB Limited Use or Section 8 requests (GP51).

Billing rules

• Once per patient per calendar month, payable only to the MRP; still payable to the MRP when another physician covers during a temporary absence (GP52).
• When W010 is paid, none of its component services by any physician that month are payable; don't also bill the component W codes (GP52).
• If you did W010 for the patient in the previous 11 months: 1 W assessment in a month pays only that assessment; 2 to 4 pay only W010; over 4, extra intercurrent illness visits pay as W121 in addition (submit with the manual review indicator) (GP52).
• Fewer than two assessments still qualify when the patient was newly admitted with an admission assessment, or died in the institution or within 48 hours of transfer to hospital (GP52).
• Put the patient's admission date on the claim, or it is not payable (GP52).
• No age premiums on W010 or its component services (GP52).
• Not included: special visits, interviews, psychotherapy or counselling of 20 minutes or more, physician-to-physician phone consultations, and services by a specialist who is not the MRP (GP53).
• FHO: a Schedule 2A code (Agreement p.86) and counts toward the long-term care special payment (Agreement p.67 §8.10).

Often billed with

• W121 for intercurrent illness visits beyond four W assessments in the month (GP52).
• E079 smoking cessation initial discussion (A56).

Common rejections

• AH8: 'Invalid admission date and/or hospital number': the W010 claim must carry the patient's admission date (GP52).

Related codes: W003, W008, W121, W872, W102, W109, W004, K070

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A20; rules GP51–GP53.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing