What is OHIP billing code C265?

C265 is "Consultation", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C265 pay?

The current OHIP fee for C265 is $190.35, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C265 to OHIP?

C265 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C265 claims against the Schedule of Benefits rules before submission.

What codes are related to C265?

Codes related to C265 in the Schedule of Benefits include C260, C662, C667, C665, C565, C266, C263, C264.

All codes

C265

C265 – Consultation

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
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(this code)
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 consultation is an assessment rendered to a hospital in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon. The paediatric consultant provides an opinion because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or patient's representative. A written report of findings, opinions, and recommendations must be provided to the referring practitioner. This service is for patients under the care of the Paediatrics specialty (26).

Referral requiredFrom: Physician, NursePractitioner, DentalSurgeon

A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.

The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.

The written request sets out the information relevant to the referral and specifies the service(s) required.

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. Where the referral is made by a nurse practitioner, the consultant shall provide the report to the nurse practitioner and the patient’s primary care provider, if applicable. Except where otherwise specified, the consultant is required to perform a general, specific or medical specific assessment, including a review of all relevant data.

C260 C662 C667 C665 C565 C266 C263 C264 C661 A265

The 'C' prefix indicates a non-emergency hospital in-patient service.

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

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