What is OHIP billing code C130?

C130 is "Comprehensive internal medicine consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C130 pay?

The current OHIP fee for C130 is $342.25, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C130 to OHIP?

C130 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C130 claims against the Schedule of Benefits rules before submission.

What codes are related to C130?

Codes related to C130 in the Schedule of Benefits include A130, W130, C135, C435, C136.

All codes

C130

C130 – Comprehensive internal medicine consultation

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

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Levels of this visit

The C13x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C134 Medical specific re-assessment
A medical specific re-assessment is an admission assessment rendered by an Internal Medicine specialist for the purpose of admitting a patient to an acute care hospital, when the…
$72.00
C131 Complex medical specific re-assessment
A re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient’s condition.
$83.40
C133 Medical specific assessment
A medical specific assessment is a service rendered by a specialist in Internal Medicine in a hospital in-patient setting (non-emergency).
$95.95

Consultations

C136 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…
$123.10
C135 Consultation
A consultation rendered by a specialist in Internal Medicine (13) to a hospital in-patient in a non-emergency setting.
$192.85
C130 Comprehensive internal medicine consultation(this code)
A consultation rendered by a specialist in internal medicine who provides all the appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of…
$342.25

A consultation rendered by a specialist in internal medicine who provides all the appropriate elements of a consultation and spends a minimum of seventy-five (75) minutes of direct contact with the patient exclusive of time spent rendering any other separately billable intervention to the patient.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A written request from a referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record (or common medical record in hospital, long-term care institution or multi-specialty clinic).

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

The written request must set out the information relevant to the referral and specify the service(s) required.

A written report (including findings, opinions, and recommendations) must be provided to the referring physician, nurse practitioner or dental surgeon (and the patient’s primary care provider, if applicable, for nurse practitioner referrals).

Minimum of seventy-five (75) minutes of direct contact with the patient exclusive of time spent rendering any other separately billable intervention to the patient.

The start and stop times must be recorded in the patient’s permanent medical record.

Must satisfy all elements of a consultation as defined in (general, specific or medical specific assessment, including a review of all relevant data).

Usage limits

Limited to one service per two consecutive 12-month periods for the same diagnosis (unless it is a repeat consultation or rendered in a hospital/ED setting between 12 and 24 months after the first). Limited to one service every 12 months for a clearly defined unrelated diagnosis.

A130Comprehensive internal medicine consultation (Out-patient)W130Comprehensive internal medicine consultation (Long-Term Care)C135Internal Medicine Consultation C435Internal Medicine Limited Consultation C136Internal Medicine Repeat Consultation

Calculation of time excludes non-patient-facing time (e.g., chart review, documentation) and time for other billable services.

If the patient was assessed in the ED/OPD by the same specialist and then admitted, the initial assessment constitutes the admission assessment (C130).

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