< Billing codes

Billing code

W515A — Physical medicine and rehabilitation consultation – long-term care

LTC physiatry consultation

Bill for a physiatrist'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; if virtual, it must be by video, not phone.

Code

W515A

Description

Physical medicine and rehabilitation 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 physiatrist 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).

W515 is the Physical Medicine & Rehabilitation (31) consultation for a non-emergency long-term care in-patient (A179).

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 (A179, 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).
• 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 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).
• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).
• A4D: Specialists must bill from the Consultations and Visits listing of their own specialty; this code is in the Physical Medicine & Rehabilitation (31) listing (GP9).

Related codes: A315, C315, W425, W310, W516

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A179.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing