C250 – Retinopathy of prematurity assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is an assessment for retinopathy of prematurity for a non-emergency hospital in-patient, rendered by an ophthalmologist (specialty 23). As a 'C' prefix code, it is intended for use in an acute care hospital for in-patient services as described on . The service is subject to the same conditions as A250. As an assessment, it includes all specific elements outlined in , such as a direct physical encounter, history taking, examination, and arranging follow-up care.
When to Use
- Use C250 for scheduled, non-emergency in-patient ROP screenings for infants 9 months or younger in a NICU or hospital setting.
- Use C250 for follow-up ROP assessments in patients aged 10 months to 16 years, provided the clinical documentation confirms the presence of at least stage 3 ROP disease.
Common Pitfalls
- Billing C250 when a special visit premium is applicable; you must use A250 with the appropriate special visit premium code instead of C250 for emergency or after-hours hospital visits.
- Attempting to bill C250 alongside other assessment or consultation codes for the same patient on the same day, which will trigger an automatic rejection.
- Failing to document the specific stage of ROP for patients aged 10 months to 16 years, which is a mandatory requirement to justify the claim under the age-based criteria.
Billing Tips
- Always apply the appropriate age-based premium (e.g., Under 30 Days or Under 1 Year) to the C250 base fee to maximize the claim value, as these are eligible add-ons for specialist assessments.
- If the patient is in an ICU or CCU, ensure you append the C101 premium if the service is not already bundled with other intensive care management fees.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments
As an assessment, the service must be documented in appropriate records, establishing that the service was provided, is the service for which the account is submitted, and was medically necessary, as per .
The service is for initial assessment or follow-up assessment(s) of a patient with ROP who is either: a. 9 months of age or younger; or b. aged 10 months to 16 years with minimum stage 3 ROP disease.
9 months of age or younger OR aged 10 months to 16 years with minimum stage 3 ROP disease
Retinopathy of prematurity assessment - subject to the same conditions as A250.
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