C623 – Medical Specific Assessment
OHIP Surgical Procedures Code — Clinical Immunology (62) · Schedule of Benefits
A medical specific assessment rendered by a Clinical Immunology specialist (specialty 62) for a non-emergency hospital in-patient. As per the Schedule, a medical specific assessment requires a detailed 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 includes all the specific elements of assessments described in and common elements detailed in -.
When to Use
- Use C623 for a non-emergency hospital in-patient assessment when the clinical focus is limited to a specific immunological system or condition, rather than a comprehensive general assessment.
- Use this code for a follow-up assessment of a specific immunological issue when the patient has exceeded the frequency limits for C624 or when the clinical complexity does not meet the threshold for a full consultation.
Common Pitfalls
- Billing C623 for an admission assessment when you have already assessed the patient for the same condition within the previous 90 days, which triggers a mandatory downgrade to C624.
- Exceeding the annual frequency limit of four combined assessments (C623/C624) per patient, which results in automatic payment adjustments to a lower-valued assessment fee.
- Failing to document the specific immunological system examined, which is required to justify the 'specific' nature of the assessment compared to a general hospital visit.
Billing Tips
- If the patient is in the ICU or CCU, ensure you append the C101 premium to C623 to capture the additional institutional intensity, provided no other team-based critical care fees are claimed.
- Always verify the 90-day window for previous assessments of the same illness; if the window is met, bill C624 instead to avoid rejection or audit-driven clawbacks.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
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 patient's medical record. (from )
All insured services must be documented in the patient's medical record to establish that the service was provided, medically necessary, and matches the service claimed. (from )
See General Preamble to for terms and conditions.
For emergency calls and other special visits to in-patients, use General Listings and Premiums when applicable - see General Preamble to .
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