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Billing code

W265A — Paediatric consultation – long-term care

LTC paediatric consultation

Bill for a paediatrician's consultation on a non-emergency patient in a chronic care or convalescent hospital, nursing home or home for the aged.

Watch for: Put the referrer's billing number on the claim; patients 18 or older are payable only in limited situations.

Code

W265A

Description

Paediatric 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

Consultation by a paediatrician for a patient in a chronic care or convalescent hospital, nursing home or home for the aged.

What it covers

A consultation is an assessment done at the written request of a physician or nurse practitioner who wants a consultant's opinion because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

W265 is the Paediatrics (26) consultation for a non-emergency long-term care in-patient (A174).

Billing rules

• Needs a written, signed request from the referring physician or nurse practitioner naming the patient, the referrer's billing number and the reason; otherwise it is paid as a lesser assessment (GP16).
• Send a written report with findings, opinions and recommendations to the referrer (GP16).
• Same patient, same physician, same diagnosis: one consultation per two consecutive 12-month periods, with a second allowed only for an in-patient or ED consult 12–24 months after the first; a clearly unrelated diagnosis allows one per 12 months. Extra consults are paid as an assessment (GP17, GP18).
• Non-emergency long-term care in-patient service: chronic care and convalescent hospitals, nursing homes, homes for the aged and designated chronic or convalescent beds, but not designated palliative care beds. Emergency calls and special visits use the General Listings (A prefix) with premiums (A174, GP49).
• Specialist consultations, limited consultations and repeat consultations get an age premium: +30% under 30 days, +25% to 1 year, +20% to 2 years, +15% to 5 years, +10% to 16 years (GP64).
• For a patient 18 or older, a paediatrician is paid only if they saw the patient from the Paediatrics general listings in the 12 months before the 18th birthday, ongoing management of a chronic condition is needed and the patient is under 22, or the MOH gave written prior approval (A168).

Often billed with

• K001 detention after 60 minutes of consultation time (GP30).

Common rejections

• ARF: The referring provider number is missing. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• A4D: Specialists must bill from the Consultations and Visits listing of their own specialty; this code is in the Paediatrics (26) listing (GP9).

Related codes: A265, C265, W260, W662, W565, W266

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A174.

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