C816 – Midwife or Aboriginal Midwife-Requested Anaesthesiologist Assessment (MAMRAA)
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Midwife or Aboriginal Midwife-Requested Anaesthesiologist Assessment (MAMRAA) is an assessment of a mother or newborn provided by an anaesthesiologist in a non-emergency hospital in-patient setting. It is requested via a written request from a midwife or aboriginal midwife due to the complex, obscure, or serious nature of the patient's problem. The service must include the common and specific elements of a general or specific assessment. The anaesthesiologist must submit their findings, opinions, and recommendations verbally to the midwife or aboriginal midwife and in writing to both the midwife or aboriginal midwife and the patient's primary care physician, if applicable. Urgent or emergency requests may be initiated verbally but must be followed by a written request, which must be retained in the patient's permanent medical record. This service is subject to the same conditions as A816.
When to Use
- Use C816 when a midwife requests an anaesthesiologist to assess a mother or newborn with a complex, non-emergency condition in an inpatient hospital setting.
- Use this code for a formal consultation requested by a midwife that requires a detailed written report to both the midwife and the primary care physician.
Common Pitfalls
- Do not bill C816 in conjunction with a special visit premium; if a premium applies, you must use A215 instead.
- Failure to provide a written report to both the midwife and the primary care physician will result in a clawback during an audit.
- Billing C816 for emergency services is incorrect; emergency requests should be handled under different codes as this is specifically for non-emergency assessments.
Billing Tips
- Ensure the midwife's written request is physically or digitally attached to the patient's permanent hospital record to satisfy documentation requirements.
- Always verify if the patient has a primary care physician on file, as the written report must be sent to them in addition to the midwife to satisfy the billing criteria.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
The written request from the midwife or aboriginal midwife must be retained on the patient's permanent medical record.
The physician must submit his/her findings, opinions and recommendations verbally to the midwife or aboriginal midwife and in writing to both the midwife or aboriginal midwife and the patient's primary care physician, if applicable.
Subject to the same conditions as A816.
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