What are the billing rules for W130A?

Start and stop times must be recorded in the chart, or it is paid at a lesser fee (A129). Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16). Time-based consultations count toward the consultation limits: same diagnosis, one per two consecutive 12-month periods (with the in-patient/ED exception); excess claims are paid as an assessment (GP17–GP18).

Why is W130A rejected?

ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16). AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

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Billing code

W130A — Comprehensive internal medicine consultation – long-term care

Q: What is OHIP billing code W130A?

Internal medicine consultation of at least 75 minutes' direct contact for a long-term care resident, with start and stop times charted.

Long internal medicine consult, LTC

Bill for an internal medicine consultation with at least 75 minutes of direct contact for a long-term care resident.

Watch for: Chart the start and stop times, or it pays a lesser fee; include the referrer's billing number.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$342.25	$0.00	$0.00	$0.00

Code: W130A
Description: Comprehensive internal medicine consultation – long-term care
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

Internal medicine consultation of at least 75 minutes' direct contact for a long-term care resident, with start and stop times charted.

What it covers

A comprehensive internal medicine consultation is a consultation by an internal medicine specialist with all the elements of a consultation and at least 75 minutes of direct patient contact, excluding time for other separately billable services and non-patient-facing time such as chart or imaging review (A129).

W130 is the long-term care (W-prefix) version, subject to the same conditions as the office code A130 (A131).

Billing rules

Start and stop times must be recorded in the chart, or it is paid at a lesser fee (A129).
Needs a written, signed request from a physician or nurse practitioner that names you or your specialty, the referrer and their billing number, and the patient's health number; otherwise it is paid as a lesser assessment (GP16).
Time-based consultations count toward the consultation limits: same diagnosis, one per two consecutive 12-month periods (with the in-patient/ED exception); excess claims are paid as an assessment (GP17–GP18).
Detention (K001) can start only after 120 minutes and is assessed on an IC basis with a written explanation (GP31).
Age premiums apply for patients under 16, from +10% to +30% depending on age (GP64).
By video only, and for in-patients or LTC residents only when you are not the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer saw the patient in person within the prior 30 days (AJ2, A69).

Common rejections

ARF: The claim has no referring provider number. A consultation must follow a written referral that identifies the referring physician or nurse practitioner and their billing number (GP16).
AT2: Billed by telephone (K301A). This code is on Appendix J's video-only list, so it must be done by video and claimed with K300A (AJ2).

Related codes: A130, C130, W235, W435, W236

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Internal Medicine (13), page A131; conditions on A129; rules GP16–GP18.

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