C111 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition. It includes all the requirements of a medical specific re-assessment, which requires a full, relevant history and physical examination of one or more systems.
When to Use
- Use C111 when managing a hospitalized patient with a complex, multi-system deterioration that requires a comprehensive re-evaluation beyond the scope of a standard C114 or C112 visit.
- Use C111 for the initial assessment of a patient transferred to your service from another physician, provided the clinical complexity meets the 'obscure or serious' threshold.
Common Pitfalls
- Failure to generate and send a formal written report to the primary care physician will result in an automatic downgrade to the lower-paying C118 partial assessment.
- Exceeding the 4-service annual limit per patient, as this cap is shared with C713, leading to automatic rejections for subsequent claims.
- Billing C111 on the same day as a C112, C117, or C119 visit, which triggers a mandatory rejection due to same-day assessment restrictions.
Billing Tips
- Ensure your documentation explicitly justifies the 'complexity, obscurity, or seriousness' of the condition to withstand potential post-payment audits.
- Attach the E082 admission premium if you are the MRP and this is the initial assessment of the admission, as C111 is an eligible base code for this premium.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient
Assessment
The fee for C111 is $83.40 (as per the Numeric Index effective April 1, 2026).
If the written report requirement is not met, the claim may be adjusted to a Partial Assessment fee (C118).
Special Visit Premiums (SVPs) may apply if the physician is called to the hospital specifically to see the patient (see -).
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