Billing code
W511A — Complex physiatry assessment – long-term care
LTC complex physiatry assessment
Bill for a physiatrist's long-term care assessment managing complex traumatic brain injury, stroke or spinal cord injury.
Watch for: Must include a medical specific re-assessment's elements; limit is 6 per patient per 12 months, and E078 isn't payable with it.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $114.80 | $0.00 | $0.00 | $0.00 |
- Code
- W511A
- Description
- Complex physiatry assessment – 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
Long-term care physiatrist assessment for complex traumatic brain injury, stroke or spinal cord injury. Same conditions as A511.
What it covers
A complex physiatry assessment is for traumatic brain injury, stroke (haemorrhagic or ischaemic) or spinal cord injury where the complexity needs ongoing management by a physiatrist (A176). It is not meant for uncomplicated disorders such as TIA, uncomplicated concussion or ASIA level E spinal cord injury (A177).
W511 is the long-term care version and is subject to the same conditions as A511 (A179).
Billing rules
- Must include the elements of a medical specific re-assessment, or it is paid at a lesser fee (A176).
- Limited to 6 per patient per physician per 12 months; extras are paid at a lesser fee (A176).
- E078 is not payable with it (A176).
- 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 (A179, GP49).
- Video only (never telephone) as virtual care (Appendix J, AJ2). For in-patients or long-term care residents, the virtual physician must not be the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer must have assessed the patient in person within 30 days (A69).
Often billed with
- K001 detention after 60 minutes of complex physiatry assessment time (GP30).
Common rejections
- AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).
Related codes: A511, C511, W510, W312, W313
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A179.
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