What is OHIP billing code C165?

C165 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C165 pay?

The current OHIP fee for C165 is $180.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C165 to OHIP?

C165 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C165 claims against the Schedule of Benefits rules before submission.

What codes are related to C165?

Codes related to C165 in the Schedule of Benefits include C765, C160, C865, C166, C163, C164, C161.

All codes

C165

C165 – Consultation

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
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(this code)
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 consultation rendered by a nephrologist for a non-emergency hospital in-patient, aged 17 years or older. This service is claimed with a 'C' prefix, indicating it is for non-emergency in-patient services in an acute care hospital. Definition As per , a consultation is an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (for in-hospital dental procedures). It is requested due to the complexity, seriousness, or obscurity of the case, or at the request of the patient or their representative. Required Elements • A written request from the referring practitioner must be kept in the consultant's medical record. • The request must identify the consultant, the referring practitioner (with billing number), and the patient (with health number). • The request must detail relevant information and specify the service(s) required. • The consultant must prepare a written report with findings, opinions, and recommendations for the referring practitioner. Failure to meet these requirements may result in the service being paid as a lesser assessment fee. For patients 16 years of age and under, see billing code C765.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. In a hospital where common medical records are maintained, the written request may be on the common medical record.

The request must identify the consultant by name, the referring practitioner 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.

The consultant must prepare a written report including findings, opinions, and recommendations to the referring practitioner.

C765 C160 C865 C166 C163 C164 C161

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