OHIP billing code for consultation

OHIP consultation codes for family practice: A005A for a consultation with a written report, A905A for a limited consultation.

Code	What it is	Fee
A005A	Consultation family practice & practice in general	$95.60
A905A	Limited consultation	$80.15

A005A: Consultation family practice & practice in general

Family practice consultation: an assessment done at the written request of another physician or a nurse practitioner, with a written report back.

Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for in-hospital dental care) naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart. The consultant sends a written report back. Otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16).
Same patient, physician and diagnosis: one consultation per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later). Unrelated diagnosis: one per 12 months. Extras are paid as an assessment (GP17, GP18).
Use A006 for a repeat consultation (new written request, another physician cared for the patient in between) and A905 when only a specific-assessment level was needed (GP19).
A911 (at least 50 minutes) and A912 (at least 75 minutes of direct contact) are the longer consultations; start and stop times must be charted (A1).
Not on the Appendix J list, so it can't be billed by video or telephone (A68, AJ1, AJ2).

AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the request.
AC1: A limit was reached. Consultations over the GP17 limits are payable only as an assessment, so resubmit with the assessment code that fits.
EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
VJ7: OHIP received the claim more than three months after the service date (GP9). If it was first sent on time, use the stale-dated process.
AD3: OHIP's description is 'not allowed with visit': another visit billed that day conflicts with this one. Check the other services billed.

Family practice limited consultation: a referred consultation where the referral only needed a specific-assessment level of service.

Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for in-hospital dental care) naming the consultant or specialty, the referrer and billing number, and the patient and health number, kept in the chart. The consultant sends a written report back. Otherwise it is paid as a lesser assessment, and a request obtained after the service doesn't count (GP16).
Same patient, physician and diagnosis: one consultation per two consecutive 12-month periods (a second only for an in-patient or ED patient 12 to 24 months later). Unrelated diagnosis: one per 12 months. Extras are paid as an assessment (GP17, GP18).
The consultation limits apply to all consultations, including limited ones (GP18).
A905 is not on the Appendix J list, so it can't be billed by video or telephone. GP focused practice physicians have a video code, A906 (A72, AJ1, AJ2).

AC4: The referring provider number was missing, mistyped, your own number, or from a provider type that can't refer for this code. Enter the referrer's six-digit number from the request.
EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.
VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
AC1: A limit was reached and OHIP asks for a different fee code. Consultations over the GP17 limits are payable only as an assessment, so resubmit with the assessment code that fits the service.

OHIP consultation codes for family practice: A005A for a consultation with a written report, A905A for a limited consultation.

Updated October 26, 2026.