What is OHIP billing code C065?

C065 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C065 pay?

The current OHIP fee for C065 is $89.80, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C065 to OHIP?

C065 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C065 claims against the Schedule of Benefits rules before submission.

What codes are related to C065?

Codes related to C065 in the Schedule of Benefits include A065, C063, C064, C062, C122, C124.

All codes

C065

C065 – Consultation

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

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Levels of this visit

The C06x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C064 Specific re-assessment
A specific re-assessment is a service rendered by a specialist in a non-emergency hospital in-patient setting.
$27.30
C063 Specific assessment
A specific assessment rendered by a specialist in Orthopaedic Surgery for a non-emergency hospital in-patient.
$45.55

Consultations

C066 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…
$55.35
C065 Consultation(this code)
A consultation rendered to a hospital in-patient by an Orthopaedic Surgeon (specialty 06) following a written request from a referring physician, nurse practitioner, or dental…
$89.80

A consultation rendered to a hospital in-patient by an Orthopaedic Surgeon (specialty 06) following a written request from a referring physician, nurse practitioner, or dental surgeon. It includes the necessary assessment and a written report back to the referrer.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

Written request from a referring physician, nurse practitioner, or dental surgeon (for hospital-based dental procedures).

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

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

The service includes a general, specific, or medical specific assessment and a review of all relevant data.

Usage limits

Limited to one service per two consecutive 12-month periods for the same diagnosis by the same physician, with exceptions for hospital in-patients where a second consultation may be eligible between 12 and 24 months after the first. Unrelated diagnoses are limited to one per 12 months.

A065Orthopaedic Surgery - Out-patient Consultation C063Specific assessment (Hospital In-Patient)C064Specific re-assessment (Hospital In-Patient)C062Subsequent visit (first 5 weeks)C122Subsequent visit by the MRP – day following admission C124Subsequent visit by the MRP – day of discharge

If consultation requirements (request/report) are not met, the fee is adjusted to a lesser assessment fee.

Preoperative consultations for low-risk elective procedures (e.g., cataract, colonoscopy, arthroscopic surgery) are only eligible if the medical record demonstrates medical necessity.

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