C105 – Additional person(s) seen
OHIP Surgical Procedures Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit premium payable to specialists for additional patients seen during a non-elective special visit to a hospital for diagnostic services between 17:00 and 24:00, Monday through Friday.
When to Use
- Use C105 for the second patient seen when you are called into the hospital to perform urgent diagnostic procedures or interpretations for multiple patients between 17:00 and 24:00.
- Apply this code when you have already billed C109 for the first patient seen during the same non-elective hospital visit.
Common Pitfalls
- Billing C105 for the first patient seen instead of using C109 will result in a rejection or audit recovery.
- Attempting to bill C105 for services rendered remotely via PACS or teleradiology is ineligible, as physical presence in the hospital is a mandatory requirement.
- Exceeding the maximum limit of two C105 premiums per time period (17:00-24:00) will lead to automatic claim rejection.
Billing Tips
- Always pair C105 with the appropriate diagnostic fee code and ensure C102 is added if you traveled to the hospital specifically for these services.
Effective: April 1, 2025
GP. General Preamble
GENERAL PREAMBLE
Special Visit Premium
Premium
The service must be non-elective.
The physician must be physically present in the hospital (services rendered via PACS or outside the hospital are not eligible).
The request for interpretation or procedure must relate to a patient's condition requiring urgent interpretation that affects the patient's management.
The visit must be for the purpose of interpreting results, performing a procedure, rendering a consultation, or concluding a procedure is not medically indicated.
Applicable to services in Nuclear Medicine, Radiation Oncology, Diagnostic Radiology, Clinical Procedures Associated with Diagnostic Radiology Examinations, MRI, and Diagnostic Ultrasound.
Subject to general Special Visit Premium rules defined on page .
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