C057 – Subsequent visit - sixth to thirteenth week
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Subsequent visit - sixth to thirteenth week (maximum 3 per patient per week) (per visit)
When to Use
- Use C057 for routine daily hospital rounds for an inpatient whose length of stay has reached the 6th week but has not yet exceeded the 13th week.
- Use C057 when the patient is stable and does not meet the criteria for C121 (intercurrent illness) or C058 (concurrent care) during the 6-13 week window.
Common Pitfalls
- Billing C057 beyond the 13th week of hospitalization, which should instead be billed as C059.
- Attempting to claim C057 on the same day as a discharge visit (C124 or C126) by the same physician, which will result in an automatic rejection.
- Exceeding the maximum of 3 visits per week, as any visits beyond this limit are considered non-payable routine care.
Billing Tips
- Always append the E083 premium to C057 if you are the Most Responsible Physician (MRP) to increase the base fee by 30%, provided you do not receive hospital-based remuneration for these services.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital Subsequent Visit
Assessment
The service must be a routine assessment of a hospital in-patient.
The patient must be in their sixth to thirteenth week of hospitalization.
C057 is part of a tiered subsequent visit structure for Community Medicine: C052 (first 5 weeks), C057 (6-13 weeks), and C059 (after 13 weeks).
The fee for C057 is $34.10 (Specialist fee). Note: Some versions of the Numeric Index may list $40.05, but the specialist-specific fee for specialty 05 is $34.10.
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