Billing code
W163A — Nephrology LTC subsequent visit – nursing home, first 2 visits in the month
Nursing home visit, nephrology
Bill for a nephrologist's first 2 routine visits per patient per month in a nursing home or home for the aged.
Watch for: Bill later visits that month as W168; a third W163 in the month is rejected.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $40.05 | $0.00 | $0.00 | $0.00 |
- Code
- W163A
- Description
- Nephrology LTC subsequent visit – nursing home, first 2 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 nursing home or home for the aged: the first 2 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 nursing home or home for the aged, the first 2 subsequent visits per patient per month are W163; later visits are W168, to a maximum of 3 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
- W163 covers the first 2 subsequent visits per patient per month; bill further visits that month as W168 (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 a nursing home or home for the aged are W972 (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 2 visits that month were already paid as W163; resubmit later visits as W168 (A139).
Related codes: W168, W162, W161, W121, W972, W164
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Nephrology (16), page A139; rules GP49.
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