What is OHIP billing code C313?

C313 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C313 pay?

The current OHIP fee for C313 is $86.40, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C313 to OHIP?

C313 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C313 claims against the Schedule of Benefits rules before submission.

What codes are related to C313?

Codes related to C313 in the Schedule of Benefits include A313, C315, C425, C515, C316, C314, C311, C510.

All codes

C313

C313 – Medical specific assessment

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

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Levels of this visit

The C31x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C314 Medical specific re-assessment
A medical specific re-assessment is a service rendered by a specialist for a non-emergency hospital in-patient.
$75.90
C311 Complex medical specific re-assessment
A complex medical specific re-assessment is a re-assessment of a patient because of the complexity, obscurity, or seriousness of the patient's condition and includes all the…
$82.75
C313 Medical specific assessment(this code)
A medical specific assessment for a non-emergency hospital in-patient, as indicated by the 'C' prefix.
$86.40

Consultations

C316 Repeat consultation
A repeat consultation is an additional consultation rendered by the same consultant for the same presenting problem, following care provided to the patient by another physician in…
$106.60
C315 Consultation
A consultation is an assessment rendered by a specialist in Physical Medicine & Rehabilitation for a non-emergency hospital in-patient, following a written request from a…
$233.65

A medical specific assessment for a non-emergency hospital in-patient, as indicated by the 'C' prefix. According to , this service is rendered by a specialist and requires a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s) to make a diagnosis, exclude disease, or assess function. This service is listed under the Physical Medicine & Rehabilitation specialty.

In addition to the common elements of an insured service, a medical specific assessment requires documentation of a direct physical encounter with the patient, including a full history of the presenting complaint and a detailed examination of the affected part(s), region(s), or system(s).

The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.

Usage limits

OR([1, "12_months", "per_patient_per_physician", "Limited to one medical specific assessment per 12-month period. The limit increases to two per 12-month period if the second service is for a clearly different and unrelated diagnosis, or if the second assessment is a hospital admission assessment rendered at least 90 days after the last specific assessment."], [4, "12_months", "per_patient_per_physician", "Any combination of medical specific assessments and complex medical specific re-assessments is limited to a total of 4 per patient per physician per 12-month period."])

A313 C315 C425 C515 C316 C314 C311 C510 C511 C312 C317 C319

The 'C' prefix indicates a non-emergency hospital in-patient service. See to for rules on non-emergency hospital in-patient services.

For emergency calls and other special visits to in-patients that require a premium, use the corresponding General Listings ('A' prefix) code. See .

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