C801 – Comprehensive midwife or aboriginal midwife-requested genetic assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A comprehensive midwife or aboriginal midwife-requested genetic assessment rendered to a non-emergency hospital in-patient. 'C' prefix codes are used for services rendered in an acute care hospital for non-emergency in-patients, as described on . Per the Schedule, this service is subject to the same conditions as A801.
When to Use
- Use C801 when a midwife requests a formal genetic assessment for an inpatient who is not in an emergency status.
- Select C801 instead of C800 when the clinical complexity requires a comprehensive assessment rather than a limited consultation.
Common Pitfalls
- Failure to send written findings to both the referring midwife and the patient's primary care provider will result in a mandatory fee reduction.
- Recording only total duration without explicit start and stop times in the chart will lead to claim rejection or audit recovery.
- Billing C801 for time spent reviewing imaging or charts, which is explicitly excluded from the time calculation per the Schedule.
Billing Tips
- Ensure the written referral from the midwife is physically or digitally attached to the patient record before submitting the claim to avoid payment clawbacks.
- When calculating time, strictly exclude any non-patient-facing activities or concurrent procedures to ensure compliance with the A801 time-based constraints.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The geneticist must submit his/her findings, opinions and recommendations in writing to both the midwife or aboriginal midwife and the patient’s primary care physician or nurse practitioner, if applicable, or the amount payable for the service will be reduced to a lesser fee.
The service is eligible for payment only if start and stop times of the service are recorded in the patient's permanent medical record.
The written request from the midwife or aboriginal midwife must be retained on the patient’s permanent medical record, or the amount payable for the service will be reduced to a lesser fee.
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