C695 – Neurodevelopmental Consultation
OHIP Surgical Procedures Code — Psychiatry (19) · Schedule of Benefits
A neurodevelopmental consultation for a non-emergency acute care hospital in-patient. This service is subject to the same conditions as the general listing A695. It requires a written request from a referring physician, nurse practitioner, or dental surgeon as per the definition of a consultation on . A written report must be sent to the referring practitioner. This service is intended for non-emergency in-patient services as per .
When to Use
- Use C695 for a formal, requested neurodevelopmental consultation for a non-emergency hospital inpatient where the minimum 120-minute time requirement is met.
- Use C695 when providing a comprehensive assessment for complex neurodevelopmental disorders that require significant time for history, examination, and synthesis of findings.
Common Pitfalls
- Billing C695 for less complex conditions like ADHD or for visits that do not meet the 120-minute minimum time requirement will result in a reduction to a lesser assessment fee.
- Failing to document the formal written request from the referring physician, nurse practitioner, or dental surgeon in the patient's chart is a primary cause for audit recovery.
- Submitting C695 for an emergency patient or an outpatient visit; use 'A' prefix codes for emergency or outpatient settings.
Billing Tips
- Ensure your documentation explicitly reflects the 120-minute time commitment and the complexity of the neurodevelopmental case to justify the specialist fee over standard assessment codes.
- If the patient is in an ICU or CCU, remember to append the C101 premium to the C695 claim to capture the additional institutional setting fee.
Effective: June 1, 2025
Consultations and Visits
Psychiatry (19)
Consultation
Hospital and Institutional Consultations and Assessments, Consultations
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 physician, nurse practitioner or dental surgeon.
Subject to same conditions as A695.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.