What is OHIP billing code C163?

C163 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C163 pay?

The current OHIP fee for C163 is $95.95, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C163 to OHIP?

C163 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C163 claims against the Schedule of Benefits rules before submission.

All codes

C163

C163 – Medical specific assessment

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

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Levels of this visit

The C16x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C164 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist to a non-emergency hospital in-patient.
$72.00
C161 Complex medical specific re-assessment
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.
$83.40
C163 Medical specific assessment(this code)
A medical specific assessment rendered by a Nephrology specialist for a non-emergency hospital in-patient.
$95.95

Consultations

C166 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…
$116.75
C165 Consultation
A consultation rendered by a nephrologist for a non-emergency hospital in-patient, aged 17 years or older.
$180.75
C160 Comprehensive nephrology consultation
A comprehensive nephrology consultation is a service rendered by a specialist in nephrology for a hospital in-patient.
$342.25

A medical specific assessment rendered by a Nephrology specialist for a non-emergency hospital in-patient. This service requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function. As defined on page , in addition to the common elements, all services which are described as assessments include the following specific elements: • A direct physical encounter with the patient including taking a patient history and performing a physical examination. • Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition. • Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. • Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. • Making arrangements for follow-up care. • Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative. • When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided.

In addition to common medical record requirements (see ), the record must include a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) needed to make a diagnosis, and/or exclude disease, and/or assess function as per .

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