What are the billing rules for W078A?

Specialists bill from the Consultations and Visits listing for their own Royal College specialty on file with the Ministry, here Geriatrics (07) (GP9). Maximum 3 W078 per patient per month; extra routine visits are not payable (A122). Visits for an acute intercurrent illness are W121 and are payable whenever done, regardless of the monthly limit. If the illness needs a special visit, use the General Listings (A-prefix) and premiums (GP49).

Why is W078A rejected?

AM1: OHIP describes this as 'Service limit exceeded': more subsequent visits in the month than this code allows (A122).

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Billing code

W078A — Geriatric nursing home subsequent visit – additional

Q: What is OHIP billing code W078A?

Additional routine geriatric visits to a nursing home or home for the aged resident after the first 2 in a month. Maximum 3 per month.

Extra nursing home visits, geriatrics

Bill for a geriatrician's routine nursing home or home for the aged visits after the first 2 (W073) in the month.

Watch for: Maximum 3 per patient per month; bill acute intercurrent illness visits as W121 instead.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$40.05	$0.00	$0.00	$0.00

Code: W078A
Description: Geriatric nursing home subsequent visit – additional
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

Additional routine geriatric visits to a nursing home or home for the aged resident after the first 2 in a month. Maximum 3 per month.

What it covers

W078 is the Geriatrics (07) subsequent visit in a nursing home or home for the aged after the first 2 in the month, to a maximum of 3 per patient per month (A122). A subsequent visit is any routine assessment after the patient's admission to the long-term care institution (GP49).

Long-term care (W-prefix) services cover chronic care and convalescent hospitals, nursing homes, homes for the aged, and designated chronic or convalescent beds, but not patients in designated palliative care beds (GP49).

Billing rules

Specialists bill from the Consultations and Visits listing for their own Royal College specialty on file with the Ministry, here Geriatrics (07) (GP9).
Maximum 3 W078 per patient per month; extra routine visits are not payable (A122).
Visits for an acute intercurrent illness are W121 and are payable whenever done, regardless of the monthly limit. If the illness needs a special visit, use the General Listings (A-prefix) and premiums (GP49).
When you are already in the institution and see your own patient, use the W-prefix subsequent visit; seeing another physician's patient on an emergency basis uses the General Listings (GP49).
Special visit premiums are not payable for elective visits in long-term care, or for routine patients seen on rounds (GP65–GP66).
Subsequent visits are part of W010 monthly management of a nursing home or home for the aged patient. If you are the MRP billing W010 for the month, don't also bill them (GP51–GP52).
Not on the Appendix J virtual care list, so it is not payable by video or phone (AJ1–AJ3).

Common rejections

AM1: OHIP describes this as 'Service limit exceeded': more subsequent visits in the month than this code allows (A122).

Related codes: W073, W121, W972, W010, W124

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Geriatrics (07), page A122. LTC subsequent visits GP49.

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