C206 – Repeat consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A repeat consultation is an additional consultation rendered by the same consultant for the same presenting problem, following care rendered to the patient by another physician in the interval following the initial consultation. This service is for non-emergency hospital in-patients and is identified with a 'C' prefix. It requires a new written request from the referring practitioner and must meet all the requirements of a standard consultation, including a written report back to the referring practitioner. The C-prefix indicates this service is for acute care hospital non-emergency in-patient services as outlined in :26.
When to Use
- Use C206 when you have already provided an initial consultation (C205) for the same problem, but the patient's clinical status has significantly changed or worsened following active management by another physician (e.g., the primary team or a different specialist).
- Use C206 for a non-emergency hospital inpatient when a new, distinct clinical question arises regarding the same diagnosis that requires a formal re-evaluation and a new written report to the referring practitioner.
Common Pitfalls
- Billing C206 without a new, formal written request from the referring practitioner; a verbal request or a simple progress note does not satisfy the requirement for a repeat consultation.
- Using C206 for routine follow-up visits or daily inpatient rounds; these should be billed as subsequent hospital visits (C002/C007) rather than a consultation code.
- Failing to document a new written report back to the referring practitioner, which is a mandatory requirement for all consultation codes, including C206.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly linked to the new request in your records to avoid rejection during an audit.
- If the patient is under 16, remember to append the appropriate age premium to the C206 claim to maximize the fee, as these are eligible for the same age-based increases as standard consultations.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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. :33
A copy of the written request for the consultation, signed by the referring practitioner, must be kept in the consulting physician's medical record. As this is a hospital service, the written request may be contained on the common medical record. :30
The written request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number. :30
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner. :30
The asterisk (*) indicates that there are notes or special payment rules applicable to this service. Refer to the General Preamble and specific notes for details.
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