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C016 – Repeat consultation

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

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Levels of this visit

The C01x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • C014 Specific re-assessment

    A specific re-assessment is a service rendered by a specialist (specifically Anaesthesia for code C014) to a hospital in-patient.

    $28.00

  • C013 Specific assessment

    A service rendered by a specialist in anaesthesia for a hospital in-patient, requiring a full history of the presenting complaint and detailed examination of the affected part(s)…

    $64.65

Consultations

  • C016 Repeat consultation(this code)

    A repeat consultation is an additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another…

    $52.15

  • C015 Consultation

    A consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for insured dental procedures in hospital).

    $109.70
A repeat consultation is 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 following the initial consultation but preceding the repeat consultation.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based insured dental procedures) is mandatory.
The consultant must provide a written report (findings, opinions, and recommendations) to the referring provider.
The service must be for the same presenting problem as the initial consultation.
Another physician must have rendered care to the patient in the interval between the initial consultation and the repeat consultation.
A new written request is required for each repeat consultation.
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, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
The written request sets out the information relevant to the referral and specifies the service(s) required.
Usage limits
Repeat consultations (C016) are not subject to the limit of one consultation per two consecutive 12-month periods that applies to other consultation types.
A016Repeat consultation (Office/Out-patient)C015Consultation (Hospital In-patient)A210Special anaesthetic consultation

If the requirements for a consultation are not met (e.g., no written request), the fee will be adjusted to a lesser assessment fee.

The pre-anaesthetic evaluation is considered part of the general anaesthesia service and is not separately billable as a consultation.

The routine pre-anaesthetic evaluation required by the Public Hospitals Act does not constitute a consultation.

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