C601 – Complex medical specific re-assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
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 requirements of a medical specific re-assessment as defined on . The service is rendered by a specialist to a non-emergency hospital in-patient, as indicated by the 'C' prefix (). The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician; otherwise, the amount payable for the service will be adjusted to a lesser assessment fee (). It includes all common elements (, ) and specific elements of assessments (), such as history taking, physical examination, arranging follow-up, and providing advice to the patient.
When to Use
- Use C601 when performing a complex re-assessment of an existing hospital inpatient that exceeds the scope of a standard subsequent visit (C002) due to diagnostic obscurity or clinical instability.
- Select C601 instead of C603 or C604 when the clinical complexity requires a comprehensive re-evaluation but does not meet the criteria for a full consultation (C003) or a specific chronic disease management assessment.
Common Pitfalls
- Failing to send a written report to the referring or primary care physician will trigger an automatic adjustment to a lower assessment fee, as this is a mandatory requirement for the C601 premium.
- Attempting to bill a special visit premium (e.g., K962) with C601 will result in a rejection; use an 'A' prefix code instead if a special visit premium is required for an inpatient.
- Over-billing C601 for routine daily rounds; the Ministry monitors frequency and will adjust claims to a standard subsequent visit fee if the complexity is not supported by the clinical documentation.
Billing Tips
- Always append the C101 premium if the patient is located in an ICU or CCU, provided you are not already claiming a team-based fee like critical care or supportive care.
- Ensure your clinical notes explicitly document the 'complexity, obscurity, or seriousness' of the condition to justify the C601 fee over a standard subsequent visit code during a potential audit.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The physician must report his/her findings, opinions, or recommendations in writing to the patient's primary care physician or the amount payable for the service will be adjusted to a lesser assessment fee.
Claims submission instructions: Submit claims with diagnostic code 428.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.