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Billing code

W162A — Nephrology LTC subsequent visit – chronic care hospital, first 4 visits in the month

Chronic care visit, nephrology

Bill for a nephrologist's first 4 routine visits per patient per month in a chronic care or convalescent hospital.

Watch for: Bill later visits that month as W161; a fifth W162 in the month is rejected.

Code

W162A

Description

Nephrology LTC subsequent visit – chronic care hospital, first 4 visits in the month

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

Nephrology routine follow-up visit to a patient in a chronic care or convalescent hospital: the first 4 subsequent visits per patient per month.

What it covers

A subsequent visit is any routine assessment after the patient's admission to a long-term care institution (GP49). In a chronic care or convalescent hospital, the first 4 subsequent visits per patient per month are W162; additional visits are W161 (maximum 6 per patient per month) (A139).

LTC (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 (A138, GP49).

Billing rules

• W162 covers the first 4 subsequent visits per patient per month; bill further visits that month as W161 (A139).
• Visits for an acute intercurrent illness are billed as W121 whenever needed, regardless of the monthly limits; if a special visit is needed, use A-prefix General Listings and premiums (GP49).
• W-prefix codes are for your own LTC patients; assessing another physician's patient on an emergency basis uses the A-prefix General Listings (GP49).
• Palliative care visits in this setting are W982 (A139, GP50).
• For chronic dialysis patients, consultations and visits to manage dialysis, its complications and end-stage renal disease are included in the weekly chronic dialysis team fee (G860–G865) and are paid at nil to other physicians (J39).
• Not listed in Appendix J, so it is not payable by video or telephone (A68, AJ1–AJ2).

Common rejections

• AC1: The first 4 visits that month were already paid as W162; resubmit later visits as W161 (A139).

Related codes: W161, W163, W168, W121, W982, W862

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A139; rules GP49.

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