C054 – Medical specific re-assessment
OHIP Surgical Procedures Code — COMMUNITY MEDICINE (05) · Schedule of Benefits
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 examination of one or more systems.
When to Use
- Use C054 when performing a comprehensive re-assessment on an existing hospital in-patient for a new or evolving medical issue that requires a full history and physical examination.
- Use C054 for an admission assessment when you have previously assessed the patient for the same illness within 90 days of the current hospital admission.
- Use C054 when a surgical specialist admits a patient for a procedure where they have already performed a pre-admission assessment for the same condition.
Common Pitfalls
- Billing C054 more than twice in a 12-month period for the same patient will trigger an automatic adjustment to a lower subsequent visit fee unless it qualifies as a new admission assessment.
- Attempting to bill E078 alongside C054 will result in a rejection, as chronic disease premiums are strictly prohibited for hospital in-patient services.
- Billing C054 when a subsequent visit (C052) is more appropriate; C054 requires a full, relevant history and physical examination, not just a routine follow-up.
Billing Tips
- Always append the appropriate Special Visit Premium (C960-C964 or C990-C997) if the C054 was performed outside of your regular hospital rounds or during an emergency call-back.
- Ensure your documentation explicitly records the 'full, relevant history and physical examination' to justify the C054 fee over a standard subsequent visit code.
Effective: June 1, 2025
A. Consultations and Visits
COMMUNITY MEDICINE (05)
Acute Care Hospital - Non-Emergency In-Patient Services
Assessment
Requires a full, relevant history and physical examination of one or more systems.
Must be rendered in an acute care hospital for a non-emergency in-patient.
C-prefix codes are designated for Acute Care Hospital - Non-Emergency In-Patient Services.
If the limit of 2 per 12 months is exceeded (and it is not an admission assessment), the fee is adjusted to a lesser assessment fee.
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