C665 – Prenatal Consultation
OHIP Surgical Procedures Code — Paediatrics (26) · Schedule of Benefits
A prenatal consultation is an assessment provided by a paediatrician (specialty 26) to a hospital in-patient following a written request from a referring physician, nurse practitioner, or dental surgeon. As per , this service requires the consultant to provide their opinion and recommendations in a written report to the referring practitioner. This code is specifically for non-emergency in-patient services as indicated by the 'C' prefix (). The payment for C665 is subject to the same conditions as A665.
When to Use
- Use C665 when a paediatrician is requested to provide a formal opinion on a high-risk pregnancy or fetal anomaly for an in-patient mother.
- Use C665 for a planned in-patient consultation regarding neonatal management strategies requested by an obstetrician prior to delivery.
Common Pitfalls
- Billing C665 when the referral request was generated or backdated after the service was already performed, which mandates a downgrade to a standard assessment code.
- Failing to document the specific written request in the hospital chart, which triggers an automatic reduction to a lower assessment fee during audit.
- Attempting to bill C665 for a patient seen by the same physician for the same diagnosis within the previous 12 months, as this exceeds the frequency limit.
Billing Tips
- Ensure the referring practitioner's name and billing number are clearly captured in the consultation report to satisfy the documentation requirements of GP16.
- Always append the appropriate age-based premium if the patient is between 30 days and one year of age, as this is not automatically calculated by the system.
Effective: June 1, 2025
Consultations and Visits
Paediatrics (26)
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 written report including findings, opinions, and recommendations must be prepared and sent to the referring practitioner.
Subject to the same conditions as A665.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.