C151 – 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 and includes all the requirements of a medical specific re-assessment. The physician must report his/her findings, opinions, or recommendations in writing to the patient’s primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee.
When to Use
- Use C151 when managing a hospitalized patient with a multi-system or obscure condition that requires a comprehensive re-evaluation beyond the scope of a standard subsequent visit (C152).
- Select C151 instead of C154 when the clinical complexity necessitates a formal written report to the referring primary care physician to coordinate ongoing care.
Common Pitfalls
- Failing to document the written report to the primary care physician will result in an automatic downward adjustment to the C154 fee rate.
- Billing C151 on the same day as a subsequent visit (C152, C157, or C159) by the same physician will trigger a rejection or adjustment.
- Exceeding the limit of 4 services per 12-month period (combined with C153) will lead to automatic fee reduction to the lower assessment rate.
Billing Tips
- Ensure the chart contains a dated copy of the letter or report sent to the primary care physician to satisfy the mandatory documentation requirement for audit purposes.
- If the written report requirement cannot be met, bill C154 initially to avoid the administrative burden of an automatic adjustment.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Hospital In-patient (Non-emergency)
Assessment
Must include all elements of a medical specific re-assessment (full, relevant history and physical examination of one or more systems).
The physician must report findings, opinions, or recommendations in writing to the patient’s primary care physician.
The prefix 'C' denotes non-emergency hospital in-patient services.
The fee for C151 is $83.40 (as of April 1, 2026).
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