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Billing code

W235A — Internal medicine long-term care consultation

LTC internal medicine consultation

Bill for an internist's consultation on a non-emergency long-term care resident, at a physician's or nurse practitioner's written request.

Watch for: Put the referrer's billing number on the claim; if virtual, it must be by video, not phone.

Code

W235A

Description

Internal medicine long-term care consultation

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 an internist for a long-term care resident, at the written request of a physician or nurse practitioner.

What it covers

W235 is the Internal Medicine (13) consultation for non-emergency long-term care residents (A131). A consultation is an assessment done at the written request of a physician, nurse practitioner (or a dental surgeon for hospital dental work) who wants your opinion because the case is complex, serious or obscure, or because the patient asked for another opinion. It includes a general, specific or medical specific assessment, a review of relevant data and a written report to the referrer (GP16).

Long-term care (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 (GP49). For emergency calls and other special visits to LTC residents, use the General Listings and special visit premiums instead (A131).

Billing rules

• Specialists bill from the Consultations and Visits listing for their own Royal College specialty on file with the Ministry, here Internal Medicine (13) (GP9).
• 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 and health number. Without it, OHIP pays a lesser assessment (GP16).
• Same patient, same consultant, same diagnosis: one consultation per two consecutive 12-month periods. A second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first; a clearly unrelated diagnosis allows one every 12 months. Extra consultations pay as an assessment (GP17–GP18).
• A referral you ask for after seeing the patient does not make the visit a consultation; bill the visit you actually provided (GP16).
• Detention (K001) can be added only after 60 minutes of consultation time (GP30–GP31).
• Video only (not phone), and for a hospital in-patient or LTC resident only if you are not the MRP, the facility has no physician with the needed expertise (documented by the referrer), and the referrer saw the patient in person within the past 30 days (AJ2, A69).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).
• AT2: OHIP describes this as 'Must include video modality': this code is video-only in Appendix J, so it can't be billed by phone with K301A (AJ2).

Related codes: W130, W435, W236, A135, C135

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Internal Medicine (13), page A131. Consultation rules GP16–GP19; LTC rules GP49.

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