C050 – Special community medicine consultation - hospital in-patient
OHIP Surgical Procedures Code — NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES · Schedule of Benefits
This service is a consultation rendered by a specialist in community medicine who provides all the appropriate elements of a consultation and spends a minimum of 50 minutes in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
When to Use
- Use C050 when conducting a comprehensive, time-intensive consultation for a complex community medicine case where the direct patient contact exceeds 50 minutes, distinguishing it from the standard C055 consultation.
- Select C050 over C400 when the clinical focus is on a specific community medicine issue rather than a comprehensive multi-system assessment requiring the higher-intensity C400 fee.
Common Pitfalls
- Failing to document exact start and stop times in the medical record is the most frequent cause of payment adjustment to a lower-value assessment code.
- Including chart review or report writing time in the 50-minute calculation will lead to audit rejection, as the requirement is strictly for direct patient contact time.
- Billing C050 alongside another consultation or assessment code on the same day by the same physician will result in an automatic rejection.
Billing Tips
- If the consultation exceeds 90 minutes of total service delivery, you may bill K001 (Detention) in addition to C050 to capture the extended time spent beyond the initial 50-minute requirement.
- Ensure the referral request is explicitly documented in the chart to satisfy the GP16 consultation requirements, as the Ministry strictly enforces the referral source and content criteria for this code.
Effective: June 1, 2025
A. Consultations and Visits
NON-EMERGENCY HOSPITAL IN-PATIENT SERVICES
Hospital In-patient
Consultation
Written request from a referring physician, nurse practitioner, or dental surgeon must be kept in the consulting physician’s medical record (unless common medical records are maintained in hospital/LTC/multi-specialty clinic).
The request identifies the consultant by name and/or specialty, referring provider by name and billing number, and patient by name and health number.
The written request sets out relevant referral information and specifies service(s) required.
A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner or dental surgeon (and patient's primary care provider if NP referral).
Start and stop times must be recorded in the patient's permanent medical record.
Must satisfy all elements of a consultation as defined in .
Calculation of the 50-minute minimum excludes time for other billable services and non-patient-facing time (e.g., chart review).
Subject to the same conditions as A050.
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