What is OHIP billing code C085?

C085 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C085 pay?

The current OHIP fee for C085 is $106.25, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C085 to OHIP?

C085 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C085 claims against the Schedule of Benefits rules before submission.

What codes are related to C085?

Codes related to C085 in the Schedule of Benefits include W085, C086.

All codes

C085

C085 – Consultation

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

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Levels of this visit

The C08x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C084 Specific re-assessment
A specific re-assessment is a service rendered by a specialist (Plastic Surgery, specialty 08) for a hospital in-patient.
$34.90
C083 Specific assessment
A specific assessment is a service rendered by a specialist (Plastic Surgery) for a hospital in-patient, requiring a full history of the presenting complaint and a detailed…
$54.40

Consultations

C086 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…
$62.80
C085 Consultation(this code)
A consultation rendered by a Plastic Surgeon following a written request from a referring physician, nurse practitioner, or dental surgeon, including a review of relevant data…
$106.25

A consultation rendered by a Plastic Surgeon following a written request from a referring physician, nurse practitioner, or dental surgeon, including a review of relevant data, assessment, and a written report.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

Written request from a referring physician, NP, or dental surgeon

Written report sent to the referring provider

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.

The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.

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

Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable.

Usage limits

One per patient per two consecutive 12-month periods for the same diagnosis by the same physician.

W085Consultation (LTC setting)C086Repeat Consultation

If consultation requirements (e.g., written report) are not met, the fee is reduced to a lesser assessment fee.

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