What is OHIP billing code C005?

C005 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C005 pay?

The current OHIP fee for C005 is $95.60, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C005 to OHIP?

C005 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C005 claims against the Schedule of Benefits rules before submission.

All codes

C005

C005 – Consultation

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

Ask a question

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
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(this code)
A consultation rendered by a family or general practitioner for a non-emergency hospital in-patient.
$95.60

A consultation rendered by a family or general practitioner for a non-emergency hospital in-patient. A consultation is defined as an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon who requests the opinion of a consultant because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or their representative. This service includes all the specific elements of an assessment as defined in , such as a direct physical encounter, history taking, and physical examination. The consulting physician must prepare a written report of findings, opinions, and recommendations for the referring practitioner. The service must meet all the requirements outlined in of the Schedule of Benefits. This code is specifically for services rendered to non-emergency in-patients in an acute care hospital, as defined in to .

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician's medical record (unless in a common hospital record).

The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.

The written request must set out the information relevant to the referral and specify the service(s) required.

A written report including findings, opinions, and recommendations must be prepared for the referring practitioner.

A direct physical encounter with the patient is required, including taking a patient history and performing a physical examination.

Usage limits

OR([1, "24_months", "per_patient_per_physician", "Consultations rendered to the same patient by the same physician for the same diagnosis are limited to one service per two consecutive 12 month periods. An exception allows for a second consultation for a hospital inpatient or a patient in an Emergency Department if rendered more than 12 but less than 24 months following the first consultation."], [1, "12_months", "per_patient_per_physician", "Consultations for a clearly defined unrelated diagnosis are limited to one service every 12 months."])

See to for rules on Non-Emergency Hospital In-Patient Services.

For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable. See to .

Ready to bill this code?

SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.

Get Started Free Already have an account? Sign in