What is OHIP billing code C043?

C043 is "Specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C043 pay?

The current OHIP fee for C043 is $64.90, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C043 to OHIP?

C043 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C043 claims against the Schedule of Benefits rules before submission.

What codes are related to C043?

Codes related to C043 in the Schedule of Benefits include A043, C044, C045, C042.

All codes

C043

C043 – Specific assessment

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

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Levels of this visit

The C04x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C044 Specific re-assessment
A specific re-assessment is an admission assessment rendered for the purpose of admitting a patient to a hospital or long-term care facility when the admitting physician has…
$33.40
C043 Specific assessment(this code)
Specific assessment is a service rendered by specialists, in a place other than a patient’s home, and requires a full history of the presenting complaint and detailed examination…
$64.90

Consultations

C046 Repeat consultation
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…
$64.85
C045 Consultation
A consultation provided to a non-emergency hospital in-patient by a neurosurgeon (Specialty 04) following a written request from a referring physician, nurse practitioner, or…
$145.60

Specific assessment is a service rendered by specialists, in a place other than a patient’s home, and requires a full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.

Full history of the presenting complaint and detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function.

Usage limits

Limited to one per patient per physician per 12-month period. The limit is increased to two per 12-month period if the patient presents a second time with a complaint for which the diagnosis is clearly different and unrelated to the diagnosis made at the time of the first specific assessment. Assessments in excess of these limits are adjusted to a lesser assessment fee.

A043Specific assessment (Office/Outpatient)C044Specific re-assessment (Hospital)C045Consultation (Hospital)C042Subsequent visit - first five weeks

C043 is specifically for Neurosurgery (04). Other specialties use different codes for specific assessments (e.g., C033 for General Surgery).

If the patient is transferred from one physician to another within the same hospital, an additional admission assessment is not eligible for payment.

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