C101 – Intensive or Coronary Care Unit premium
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
A premium payable for each patient seen on a visit to an Intensive Care Unit (ICU) or Coronary Care Unit (CCU), subject to specific exclusions regarding team-based care and supportive care.
When to Use
- Use C101 when performing a standard hospital visit (e.g., C122 or C123) for a patient admitted to a designated ICU or CCU bed.
- Use C101 as a standalone claim when you assess a patient in the ICU or CCU but no other billable procedure or visit code is applicable for that encounter.
Common Pitfalls
- Billing C101 alongside G521 or other critical care team-based codes will trigger an automatic rejection as the premium is already bundled into those higher-value fees.
- Claiming C101 for patients in step-down units or general telemetry wards that are not formally designated as an ICU or CCU will result in audit recovery.
Billing Tips
- Always append C101 to your primary visit code on the same claim to ensure the premium is processed correctly as an add-on to the hospital visit.
Effective: April 1, 2025
GP. General Preamble
GENERAL PREAMBLE
Hospital Visit Premium
Premium
The patient must be seen in a designated Intensive Care Unit (ICU) or Coronary Care Unit (CCU).
Patient must be an in-patient in an ICU or CCU setting.
C101 is one of the few premiums that is explicitly 'payable alone' when no other separate fee is payable for the service provided in the ICU or CCU.
This premium is intended to recognize the additional complexity or intensity of care provided in these specialized units.
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