Billing code
W565A — Paediatric limited consultation – long-term care
LTC paediatric limited consultation
Bill for a paediatrician's shorter, less demanding consultation on a non-emergency long-term care patient, at a written request.
Watch for: Put the referrer's billing number on the claim; without a written request it pays as a lesser assessment.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $104.70 | $0.00 | $0.00 | $0.00 |
- Code
- W565A
- Description
- Paediatric 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
A shorter, less demanding paediatric consultation for a long-term care patient. Same written-request rules as a full consultation.
What it covers
A limited consultation is less demanding and normally takes substantially less of the physician's time than a full consultation; otherwise it has the same requirements (GP19).
W565 is the Paediatrics (26) limited 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).
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).
Related codes: A565, C565, W265, W266
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Paediatrics (26), page A174.
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