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Billing code

W065A — Orthopaedic surgery long-term care consultation

Long-term care orthopaedic consultation

Bill for an orthopaedic surgeon's consultation, at a referrer's written request, for a non-emergency long-term care patient.

Watch for: Put the referrer's billing number on the claim, checked against the written request; a missing number is rejected.

Code

W065A

Description

Orthopaedic surgery long-term care 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

Consultation by an orthopaedic surgeon for a patient in a long-term care institution, chronic care or convalescent hospital.

What it covers

W065 is the Orthopaedic Surgery (06) consultation for non-emergency long-term care in-patients (A165). These W-prefix listings are for patients in chronic care or convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent beds, but not designated palliative care beds (A165, GP49).

A consultation is an assessment done at the written request of a physician or nurse practitioner who wants your opinion, with a written report to the referrer (GP16).

Billing rules

• Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for hospital dental work) naming you or your specialty, the referrer and their billing number, and the patient and health number. Without it, OHIP pays a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods. A second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first. A clearly unrelated diagnosis allows one every 12 months. Extra consultations pay as an assessment (GP17–GP18).
• Send a written report with your findings, opinion and recommendations to the referrer, and also to the primary care provider when a nurse practitioner referred (GP16).
• Age premiums of 10% to 30% apply to specialist consultations for patients under 16 (GP64).
• For emergency calls and other special visits to long-term care patients, use the General Listings (A-prefix) and special visit premiums instead (A165, GP49).
• Not a virtual care code: W065 isn't in Appendix J (AJ1–AJ3).

Often billed with

• K001 detention, after the first 60 minutes (GP29–GP30).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).
• EQ6: OHIP describes this as 'Referring provider number not registered with the Ministry': check the referrer's billing number against the written request and resubmit (GP16).

Related codes: W066, A065, C065, W062, W063

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Orthopaedic Surgery (06), page A165. Long-term care rules GP49; consultation rules GP16–GP19.

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