C625 – Consultation
OHIP Surgical Procedures Code — Clinical Immunology (62) · Schedule of Benefits
A consultation rendered by a Clinical Immunology (62) specialist for a non-emergency hospital in-patient. A consultation is defined in () as an assessment rendered following a written request from a referring physician, nurse practitioner, or dental surgeon (in connection with an insured dental procedure in a hospital). The consultant's opinion is sought because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient or their representative. The service requires the consultant to perform a general, specific or medical specific assessment, including a review of all relevant data, and to prepare a written report with findings, opinions, and recommendations for the referring practitioner. This service is for non-emergency acute care hospital in-patient services, as indicated by the 'C' prefix (, ).
When to Use
- Use C625 when a hospital inpatient requires a complex immunological evaluation for a new, distinct diagnosis requested by the attending physician.
- Use C625 for a formal second opinion on a complex, obscure immunological case where the referring physician explicitly requests your expert input in writing.
Common Pitfalls
- Billing C625 for a patient aged 16 or under will result in a rejection; use C765 for these patients instead.
- Submitting C625 when the patient has already had a consultation for the same diagnosis within the last 12 months will trigger a downgrade to a lower assessment fee.
- Failure to document the written referral request in the chart is a primary audit risk, even if the request is noted in the common hospital record.
Billing Tips
- Ensure the written referral specifically identifies the consultant by name or specialty and the referring practitioner by name and billing number to avoid payment adjustments.
- If the consultation occurs within 24 hours of a qualifying trauma, append the E420 trauma premium to the C625 claim to increase the fee by 50%.
Effective: June 1, 2025
Consultations and Visits
Clinical Immunology (62)
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
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.
Patient is 17 years of age or older. For patients 16 years of age and under, use C765.
For Services not listed, refer to Internal Medicine Section.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.