What is OHIP billing code C264?

C264 is "Medical specific re-assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C264 pay?

The current OHIP fee for C264 is $70.75, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C264 to OHIP?

C264 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C264 claims against the Schedule of Benefits rules before submission.

What codes are related to C264?

Codes related to C264 in the Schedule of Benefits include C263, C661, C262, A264.

All codes

C264

C264 – Medical specific re-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(this code)
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
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 re-assessment is a service rendered by a Paediatrics specialist (26) for a non-emergency hospital in-patient. It requires a full, relevant history and physical examination of one or more systems. The patient's history need not include all the details already obtained in the original assessment. See for the general definition. This service is used for follow-up care in a hospital setting and is subject to the rules for non-emergency hospital in-patient services outlined in to .

Requires documentation of a full, relevant history and physical examination of one or more systems in the patient's medical record. (Source: ).

All insured services require documentation in the medical record to establish that the service was provided, medically necessary, and is the service for which the account is submitted. (Source: ).

All insured services include keeping and maintaining appropriate medical records as a common element. (Source: ).

C263 C661 C262 A264

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