A405 OHIP Billing Code: Streamlined Consultations in Preventive Medicine

A405 describes a limited consultation service under OHIP for services provided by preventive medicine specialists. It involves a focused assessment on specific issues, typically requiring less time than a full consultation. This could include advising on post-exposure prophylaxis or determining vaccine contraindications.

These consultations are especially relevant in public health and preventive medicine settings where time-efficient assessments are crucial for timely healthcare decisions. Despite their utility, A405 consultations are often missed for complex assessments that result in applying for a different consultation code instead.

To ensure accurate billing, physicians should ensure their reasons for using a limited consultation align with the needs for focused, time-efficient assessments commonly handled in preventive medicine contexts.

To bill under A405, a written request is required from a referring physician, nurse practitioner, or dental surgeon for circumstances requiring preventive medical expertise. Virtual consultations can be billed as A405A, but only if conducted via video, not telephone. Billing frequency is restricted to one service every two consecutive 12-month periods for the same patient and diagnosis, with allowances for unrelated diagnoses once every 12 months. Guidelines require that the consultation prompt the opinion of a physician due to case complexity or patient request.