What is OHIP billing code C263?

C263 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C263 pay?

The current OHIP fee for C263 is $95.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C263 to OHIP?

C263 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C263 claims against the Schedule of Benefits rules before submission.

What codes are related to C263?

Codes related to C263 in the Schedule of Benefits include A263, C264, C661.

All codes

C263

C263 – Medical specific assessment

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

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Levels of this visit

The C26x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C264 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a Paediatrics specialist (26) for a non-emergency hospital in-patient.
$70.75
C263 Medical specific assessment(this code)
A medical specific assessment is a service rendered by a specialist to a non-emergency hospital in-patient.
$95.75

Consultations

C266 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…
$104.70
C265 Consultation
A consultation is an assessment rendered to a hospital in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon.
$190.35
C260 Special paediatric consultation
A special paediatric consultation is an assessment rendered in a non-emergency acute care hospital in-patient setting.
$342.25

A medical specific assessment is a service rendered by a specialist to a non-emergency hospital in-patient. It requires a full history of the presenting complaint and 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 a 'C' prefix code, this service is for non-emergency in-patient services in an acute care hospital. See the General Preamble for full requirements for assessments (, ).

A direct physical encounter with the patient is required, including taking a patient history and performing a physical examination.

Must include a full history of the presenting complaint.

Must include 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.

A263 C264 C661

The 'C' prefix indicates this service is for non-emergency hospital in-patient services.

For emergency calls and other special visits to in-patients, use General Listings ('A' prefix codes) and Premiums when applicable.

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