What are the billing rules for W105A?

The written, signed request must name the consultant or specialty, the referring provider and billing number, and the patient and health number; in an LTC institution it can be on the common medical record. Otherwise it is paid as a lesser assessment (GP16). Limit one consultation per patient per physician for the same diagnosis per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later); one per 12 months for an unrelated diagnosis. Extras are paid as an assessment (GP17, GP18). A consultation requested after the service is done is not payable as a consultation (GP16).

Why is W105A rejected?

ARF: 'Missing physician referring number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).

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Billing code

W105A — LTC consultation (family practice)

Q: What is OHIP billing code W105A?

Consultation by a family physician for a patient in a long-term care institution, on a written request from a physician or nurse practitioner.

Long-term care consultation

Bill for a family physician's consultation on a long-term care patient, at a physician's or nurse practitioner's written request.

Watch for: Put the referrer's billing number on the claim; without a written request it pays as a lesser assessment.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$95.60	$0.00	$0.00	$0.00	$0.00

Code: W105A
Description: LTC consultation (family practice)
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 a family physician for a patient in a long-term care institution, on a written request from a physician or nurse practitioner.

What it covers

A consultation is an assessment after a written request from a physician or nurse practitioner who wants your opinion because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16). W105 is the consultation listed for long-term care in-patients (A19).

It includes preparing a written report with findings, opinions and recommendations for the referring provider (GP16).

Billing rules

The written, signed request must name the consultant or specialty, the referring provider and billing number, and the patient and health number; in an LTC institution it can be on the common medical record. Otherwise it is paid as a lesser assessment (GP16).
Limit one consultation per patient per physician for the same diagnosis per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later); one per 12 months for an unrelated diagnosis. Extras are paid as an assessment (GP17, GP18).
A consultation requested after the service is done is not payable as a consultation (GP16).
If you did the consultation before admission, your LTC admission assessment is Type 2 (W104), not Type 1 (GP49).
Detention (K001) can start only after 60 minutes (GP30).
FHO: a Schedule 2A code for enrolled LTC patients (Agreement p.86).

Common rejections

ARF: 'Missing physician referring number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).

Related codes: W106, W911, W912, A005, C005, W104

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A19; rules GP16–GP18.

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