What are the billing rules for W255A?

Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart; otherwise it pays as a lesser assessment (GP16). A written report with your findings and recommendations goes to the referrer (GP16). Consultations for the same patient and diagnosis are limited to one 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); an unrelated diagnosis allows one per 12 months. Excess claims pay as an assessment (GP17, GP18).

Why is W255A rejected?

ARP: OHIP needs the referring provider's number on a consultation claim; add the referrer's billing number from the written request and resubmit (GP16).

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Billing code

W255A — Endocrinology limited consultation – long-term care

Q: What is OHIP billing code W255A?

Limited consultation by an endocrinologist for a long-term care resident: less demanding and much shorter than a full consultation.

LTC endocrinology limited consultation

Bill for an endocrinologist's shorter, less demanding consultation on a long-term care resident, at a referrer's written request.

Watch for: Put the referrer's billing number from the written request on the claim; a missing number is rejected.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$110.15	$0.00	$0.00	$0.00

Code: W255A
Description: Endocrinology limited 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

Limited consultation by an endocrinologist for a long-term care resident: less demanding and much shorter than a full consultation.

What it covers

A limited consultation is less demanding and normally needs substantially less of your time than a full consultation; otherwise it has the same requirements (GP19).

W-prefix codes are for non-emergency care in chronic care and convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent beds, but not designated palliative care beds (A103, GP49).

Billing rules

Needs a written, signed request naming you or the specialty, the referrer and their billing number, and the patient and health number, kept in your chart; otherwise it pays as a lesser assessment (GP16).
A written report with your findings and recommendations goes to the referrer (GP16).
Consultations for the same patient and diagnosis are limited to one 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); an unrelated diagnosis allows one per 12 months. Excess claims pay as an assessment (GP17, GP18).
Patients under 16 get an age premium of 10% to 30%, depending on age (GP64).
Not on the virtual care list, so not payable by video or phone (Appendix J).
For emergency calls and other special visits to long-term care patients, bill the General Listings (A-prefix) code with the special visit premium instead (A103, GP49).

Common rejections

ARP: OHIP needs the referring provider's number on a consultation claim; add the referrer's billing number from the written request and resubmit (GP16).

Related codes: A255, C255, W155, W156

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Endocrinology & Metabolism (15), page A103; rules GP16–GP19.

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