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C096 – Repeat consultation

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

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Levels of this visit

The C09x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

  • C094 Specific re-assessment

    A service rendered by a specialist (Cardiac Surgery) in a hospital in-patient setting, requiring a full, relevant history and physical examination of one or more systems.

    $32.70

  • C093 Specific assessment

    A specific assessment is a service rendered by a specialist in Cardiac Surgery for a hospital in-patient, requiring a full history of the presenting complaint and a detailed…

    $55.70

Consultations

  • C096 Repeat consultation(this code)

    An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval…

    $75.20

  • C095 Consultation

    A consultation rendered to a non-emergency hospital in-patient by a Cardiac Surgeon following a written request from a referring physician, nurse practitioner, or dental surgeon.

    $113.15
An additional consultation rendered by the same consultant, in respect of the same presenting problem, following care rendered to the patient by another physician in the interval following the initial consultation but preceding the repeat consultation.
Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon
A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory.
The consultant must be competent to give advice in the field due to the complexity, seriousness, or obscurity of the case.
The service must include a review of all relevant data and the performance of a general, specific, or medical specific assessment.
A written report (findings, opinions, and recommendations) must be prepared and sent to the referring provider.
Care must have been rendered to the patient by another physician in the interval between the initial consultation and the repeat consultation.
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.
Usage limits
Repeat consultations are an exception to the general limit of one consultation per two consecutive 12-month periods for the same diagnosis.
C095Consultation (In-patient)A096Repeat consultation (Out-patient)W096Repeat consultation (Long-term care)C935Special surgical consultation

Non-Emergency Long-Term Care In-Patient Services includes Chronic Care Hospitals, Convalescent Hospitals, Nursing Homes, Homes for the Aged, designated chronic or convalescent care beds in hospitals and nursing homes or homes for the aged, other than patients in designated palliative care beds.

If the requirements for a consultation (e.g., written request, report) are not met, the amount payable for a consultation will be reduced to a lesser assessment fee.

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