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Billing code

W168A — Nephrology LTC subsequent visit – nursing home, additional visits

Extra nursing home visits, nephrology

Bill for a nephrologist's routine nursing home or home for the aged visits after the first 2 (W163) in the month.

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

Code

W168A

Description

Nephrology LTC subsequent visit – nursing home, additional visits

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 in a nursing home or home for the aged after the first 2 visits in the month, up to 3 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 visits per month are W163; further 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

• Bill W168 after W163 has covered the first 2 subsequent visits that month; maximum 3 per patient per month (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).
• 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

• AM1: More W168 visits than the maximum of 3 per patient per month were claimed (A139). Use W121 for acute intercurrent illness visits (GP49).

Related codes: W163, W121, W972, W161, W162

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

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