What is OHIP billing code C004?

C004 is "General re-assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C004 pay?

The current OHIP fee for C004 is $38.35, effective 2025-06-01, per the Ontario Schedule of Benefits.

How do I bill C004 to OHIP?

C004 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C004 claims against the Schedule of Benefits rules before submission.

What codes are related to C004?

Codes related to C004 in the Schedule of Benefits include C003, C005, C122.

All codes

C004

C004 – General re-assessment

OHIP Consultations and Visits Code — CONSULTATIONS AND VISITS · Schedule of Benefits

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Levels of this visit

The C00x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C004 General re-assessment(this code)
A general re-assessment includes all the services listed for a general assessment, with the exception of the patient’s history, which need not include all the details already…
$38.35
C003 General assessment
A general assessment is a service rendered for a hospital in-patient that requires a full history (including history of the presenting complaint, family medical history, past…
$89.65

Consultations

C006 Repeat consultation
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval…
$47.10
C005 Consultation
A consultation rendered by a family or general practitioner for a non-emergency hospital in-patient.
$95.60

A general re-assessment includes all the services listed for a general assessment, with the exception of the patient’s history, which need not include all the details already obtained in the original assessment. It is typically used as a hospital admission assessment when the physician has seen the patient for the same illness within the previous 90 days.

Full history (excluding details already known) and physical examination of all body parts and systems.

Direct physical encounter with the patient.

Arranging follow-up care and interpreting results.

Usage limits

Limited to one consultation, general assessment, or re-assessment per patient per hospital admission. General re-assessments for hospital admissions are exempt from the standard 'two per 12 months' limit applicable to office re-assessments, but are restricted by the 'one per admission' rule.

C003General assessment C005Consultation C122Subsequent visit by the MRP – day following admission

If a patient is transferred within the same hospital, an additional admission assessment is not eligible for payment.

Excess assessments beyond the 'one per admission' limit will be adjusted to a lesser fee.

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