Referral and Transferral

A referral takes place when one physician requests for their patient the services of another physician. The services of the latter may consist of:

(a) an opinion (i.e. a consultation), 

(b) diagnostic tests or procedures (e.g. skin test, biopsy, etc.), and 

(c) treatment (surgical or medical) 

A referral also takes place when a primary care physician is not available and a Nurse Practitioner requests for his or her patient the services of a specialist physician and it is appropriate to the patient needs and practice setting to do so as described in the Nurse Practitioner Primary Health Care Regulations. 

A transferral, as distinguished from a referral, takes place where the responsibility for the care of the patient is completely transferred permanently or temporarily, from one physician to another (e.g. where the first physician is leaving temporarily on holidays and is unable to continue to care for the patient). Transferral to a physician in the same specialty or discipline should be considered as continuing care and the physician to whom the patient is transferred is not entitled to claim for a consultation.

 For hospital in-patients, transferral to a physician in the same specialty or discipline should be considered as continuing care and SHV rates are payable as for one period of hospitalization. The visit fee on the date of transfer is payable only to the second physician. In such cases, the physician to whom the patient is transferred is not entitled to claim for a major exam. When a patient is transferred to a physician in another specialty, the patient is deemed to have been referred and the rates payable are as for a new admission. Where the family physician transfers the day-to-day responsibility for the care of the patient to the consultant for a period of time, the consultant should claim on a per diem basis and the family physician should not claim for that period.

Physicians who are substituting for other physicians should consider that patients of the other physician have been temporarily transferred (not referred) to their care. The physician to whom the patient is transferred should be regarded as substituting for the other physician. 

 When a specialist assesses a non-referred patient, the service should be claimed using the specialist fee code billed at the corresponding General Practice rate. If there is no equivalent General Practice code, then the service should be billed at the rate for General Practice fee code 121. In either case, the claim must be identified as non-referred.