C655 – Limited Consultation
OHIP Surgical Procedures Code — Haematology (61) · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than the full consultation. Otherwise, a limited consultation has the same requirements as a full consultation (). This service is for a non-emergency hospital in-patient, as indicated by the 'C' prefix (). As a consultation, this service requires a written request from a referring physician, nurse practitioner, or dental surgeon who requests the opinion of a consultant physician because of the complexity, seriousness, or obscurity of the case, or because another opinion is requested by the patient. The consultant must prepare a written report of their findings, opinions, and recommendations to the referring practitioner. The request and report must be documented in the medical record ().
When to Use
- Use C655 for a hospital inpatient when the clinical complexity is lower than a full consultation (C615) but still requires a formal written request and report.
- Use C655 when providing a second opinion for a patient already under the care of another physician, provided the request and report requirements are strictly met.
Common Pitfalls
- Billing C655 without a documented written request from the referring physician, which will lead to a clawback to a lower assessment fee during an audit.
- Attempting to bill special visit premiums with C655; these must be billed using the A-prefix equivalent (A655) if a special visit is required.
- Failing to document a formal report sent back to the referring practitioner, as the consultation fee is contingent upon this communication.
Billing Tips
- Ensure the referring physician's billing number is clearly recorded in your chart to satisfy the documentation requirements for a valid consultation claim.
- If you are called to the hospital by a medical trainee (resident or fellow), the claim will be adjusted to a general assessment fee; ensure you have a request from a staff physician to maintain eligibility for the consultation fee.
Effective: June 1, 2025
Consultations and Visits
Haematology (61)
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. For services in a hospital where common medical records are maintained, the written request may be on the common record. ()
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number. ()
The written request must set out the information relevant to the referral and specify 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 practitioner. ()
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.