What is OHIP billing code C166?

C166 is "Repeat consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C166 pay?

The current OHIP fee for C166 is $116.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C166 to OHIP?

C166 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C166 claims against the Schedule of Benefits rules before submission.

What codes are related to C166?

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

All codes

C166

C166 – Repeat 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(this code)
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 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 physician in the interval following the initial consultation but preceding the repeat consultation. A repeat consultation has the same requirements as a consultation including the requirement for a new written request by the referring physician, nurse practitioner or dental surgeon. This service is rendered for a non-emergency hospital in-patient under the care of a nephrologist. A consultation includes the services necessary to enable the consultant to prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data. As an assessment, this service includes the following specific elements in addition to common elements (as described on ): • A direct physical encounter with the patient including taking a patient history and performing a physical examination. • Other inquiry to arrive at an opinion as to the nature of the patient's condition. • Performing any procedure(s) during the same encounter unless separately payable. • 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 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.

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A new written request by the referring physician, nurse practitioner or dental surgeon is required for the repeat consultation.

A copy of the written request, 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 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.

C165 C765 C160 C865 C163 C164 C161

The limits applicable to all consultations (e.g., one service per two consecutive 12 month periods) do not apply to repeat consultations.

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