What is OHIP billing code C053?

C053 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C053 pay?

The current OHIP fee for C053 is $83.85, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C053 to OHIP?

C053 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C053 claims against the Schedule of Benefits rules before submission.

What codes are related to C053?

Codes related to C053 in the Schedule of Benefits include C054, C051.

All codes

C053

C053 – Medical specific assessment

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

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Levels of this visit

The C05x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C054 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist in an acute care hospital (non-emergency in-patient) requiring a full, relevant history and physical…
$64.30
C051 Complex medical specific re-assessment
A re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition.
$74.45
C053 Medical specific assessment(this code)
A medical specific assessment rendered by a specialist in Community Medicine for a non-emergency hospital in-patient.
$83.85

Consultations

C056 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…
$94.75
C055 Consultation
A consultation rendered to a hospital in-patient by a specialist in Community Medicine (05) following a written request from a referring physician, nurse practitioner, or dental…
$152.80
C050 Special community medicine consultation
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…
$176.10

A medical specific assessment rendered by a specialist in Community Medicine for a non-emergency hospital in-patient. This service requires a full history of the presenting complaint and a 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. In addition to the common elements, all assessments include the following specific elements as per : • A direct physical encounter with the patient including taking a patient history and performing a physical examination. • Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. • Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. 'Procedure' in this context includes obtaining specimens, preparation of the patient, interpretation of results and, unless otherwise specified, all diagnostic (including laboratory) and therapeutic (including surgical) services. • Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. • Making arrangements for follow-up care. • Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative, whether by telephone or otherwise, on matters related to the service and results of related procedures. • When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided. • Providing premises, equipment, supplies, and personnel for the specific elements of the service except for any aspect(s) that is (are) performed in a hospital or nursing home.

All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.

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 clearly different and unrelated diagnosis, or if at least 90 days have passed since the last specific assessment and this service is a hospital admission assessment.

C054 C051

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