What is OHIP billing code C055?

C055 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C055 pay?

The current OHIP fee for C055 is $152.80, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C055 to OHIP?

C055 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C055 claims against the Schedule of Benefits rules before submission.

What codes are related to C055?

Codes related to C055 in the Schedule of Benefits include A055, C050, C400, C405, C056.

All codes

C055

C055 – Consultation

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
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(this code)
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 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 surgeon. The service includes the necessary assessment and a written report back to the referrer.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures) is mandatory.

The consultant must provide a written report (findings, opinions, and recommendations) to the referring practitioner.

The request must be kept in the medical record (common hospital records are acceptable).

The request must identify the consultant, the referrer (including billing number), and the patient (including health number).

The written request sets out the information relevant to the referral and specifies the service(s) required.

Usage limits

Limited to one service per two consecutive 12-month periods for the same diagnosis by the same physician, unless the second service is rendered to a hospital in-patient or ED patient between 12 and 24 months after the first. Limited to one service every 12 months for a clearly defined unrelated diagnosis.

A055Consultation (Community Medicine - Out-patient/General)C050Special community medicine consultation C400Comprehensive community medicine consultation C405Limited consultation C056Repeat consultation

If the consultation is requested by a Medical Trainee, the fee is adjusted to a lesser assessment fee.

Preoperative consultations for low-risk elective procedures (e.g., cataracts, colonoscopy) are only eligible if medically necessary and documented as such.

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