What is OHIP billing code C613?

C613 is "Medical specific assessment", an OHIP Consultations and Visits code from the Ontario Schedule of Benefits (Physician Services).

How much does C613 pay?

The current OHIP fee for C613 is $95.95, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill C613 to OHIP?

C613 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates C613 claims against the Schedule of Benefits rules before submission.

What codes are related to C613?

Codes related to C613 in the Schedule of Benefits include A613, C615, C616, C614, C611, C655.

All codes

C613

C613 – Medical specific assessment

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

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Levels of this visit

The C61x codes in this part of the Schedule of Benefits, lowest fee first. Bill the level the history and examination support.

Assessments

C614 Medical specific re-assessment
A medical specific re-assessment rendered by a specialist in Haematology (61) to a patient in an acute care hospital as a non-emergency in-patient service.
$72.00
C611 Complex medical specific re-assessment
A complex medical specific re-assessment is a re-assessment of a patient by a specialist because of the complexity, obscurity, or seriousness of the patient's condition.
$83.40
C613 Medical specific assessment(this code)
A medical specific assessment rendered by a specialist for a non-emergency hospital in-patient.
$95.95

Consultations

C616 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…
$118.05
C615 Consultation
This service is a consultation for a non-emergency acute care hospital in-patient (GP12, A117).
$192.90

A medical specific assessment rendered by a specialist for a non-emergency hospital in-patient. The 'C' prefix indicates the service is for an acute care hospital non-emergency in-patient, as defined in . As per , this service requires a full history of the presenting complaint and 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. In addition to the common elements of all insured services (, ), all assessments include the following specific elements as per : • A direct physical encounter with the patient including history taking and physical examination. • Other inquiries to arrive at a medical opinion. • Performing any procedures not separately billable. • Making arrangements for related assessments, procedures, or therapy, and interpreting results. • Making arrangements for follow-up care. • Discussion and provision of advice to the patient or their representative. • Monitoring the patient's condition until the next insured service.

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 must be documented in the medical record.

A613 C615 C616 C614 C611 C655

For Services not listed, refer to Internal Medicine Section.

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