C815 – Midwife or Aboriginal Midwife-Requested Special Assessment
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A Midwife or Aboriginal Midwife-Requested Special Assessment rendered to a non-emergency hospital in-patient. This service is for the assessment of a mother or newborn where the complex, obscure, or serious nature of the problem requires the physician to spend at least 50 minutes in direct patient contact, exclusive of time for tests. This service is subject to the same conditions as A815. If the time requirement is not documented, the service is payable as C813.
When to Use
- Use C815 when a midwife requests an urgent, complex assessment of a newborn or mother in a non-emergency hospital setting that requires at least 50 minutes of direct physician time.
- Select C815 instead of C813 when the clinical complexity necessitates a prolonged, intensive evaluation that exceeds the standard assessment time frame.
Common Pitfalls
- Failure to explicitly record the start and stop times in the patient's chart will result in an automatic payment adjustment to the lower-valued C813.
- Billing C815 for routine newborn or postpartum checks that do not meet the 'complex, obscure, or serious' threshold will trigger audit flags for inappropriate code selection.
Billing Tips
- Ensure the referral from the midwife is clearly documented in the chart, as this is a mandatory requirement for C815 eligibility under the Schedule of Benefits.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments, Hospital and Institutional Consultations and Assessments
The start and stop times of the assessment must be recorded on the patient's permanent medical record.
Subject to the same conditions as A815.
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