Billing code
W035A — Consultation
Long-term care surgical consultation
Bill for a general surgeon's consultation, at a referrer's written request, for a non-emergency patient in a long-term care setting.
Watch for: Put the referring physician's or nurse practitioner's number on the claim; without a written request it pays as a lesser assessment.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $114.75 | $0.00 | $0.00 | $0.00 |
- Code
- W035A
- Description
- 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
General surgeon's consultation for a patient in a long-term care setting (chronic care, convalescent hospital, nursing home or home for the aged).
What it covers
W035 is a consultation for a non-emergency long-term care in-patient in the General Surgery (03) listings (A108).
A consultation is an assessment done at the written request of a referring physician, nurse practitioner or dental surgeon (GP16).
Billing rules
- Needs a written, signed request from a physician, nurse practitioner or dental surgeon (in-hospital dental) naming you or your specialty, the referrer and their billing number, and the patient and health number; in hospital it may be in the common record. 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 diagnosis: one consultation per two consecutive 12-month periods (a second is allowed only for an in-patient or ED consult 12–24 months after the first); a clearly unrelated diagnosis allows one every 12 months. Extra ones are paid as an assessment (GP17, GP18).
- Specialist consultations take the age premium for patients under 16 (GP64).
- W-prefix services apply to chronic care and convalescent hospitals, nursing homes, homes for the aged, and chronic or convalescent beds, but not designated palliative care beds (GP49, A108).
- For emergency calls and other special visits, use the General Listings (A-prefix) with the Table IV special visit premiums (A108, GP73).
Common rejections
- ARF: OHIP describes this as 'Missing physician referring number': a consultation needs a written request from the referring physician or nurse practitioner, and their number belongs on the claim (GP16).
Related codes: W036, W032, W033, C035, A035
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, General Surgery (03), page A108.
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