C895 – Consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A consultation rendered by a psychiatrist for a non-emergency hospital in-patient, following a written request from a referring physician, nurse practitioner, or dental surgeon. It requires an assessment of the patient due to the complexity, seriousness, or obscurity of the case, or because a second opinion is requested. The service includes all elements necessary to prepare a written report with findings, opinions, and recommendations to the referring practitioner.
When to Use
- Use C895 when a psychiatrist is formally requested to provide a specialized opinion on a complex, obscure, or serious psychiatric case for a non-emergency hospital inpatient.
- Use this code when a second opinion is explicitly requested by the attending physician, nurse practitioner, or dental surgeon for a patient already admitted to the hospital.
Common Pitfalls
- Billing C895 without a documented, written referral request from the referring practitioner in the patient's chart will lead to a clawback to a lower assessment fee during audit.
- Attempting to bill C895 on the same day as psychotherapy or other psychiatric care for the same patient is prohibited unless you document two distinct, unrelated diagnoses for each service.
- Failing to include the referring practitioner's name and billing number in the consultation report or medical record is a common cause for claim rejection.
Billing Tips
- Ensure the written consultation report is sent to the referring practitioner; if the referral originated from a nurse practitioner, you must also copy the patient's primary care provider.
- If you perform a consultation after the patient has already been seen for the same condition by you or a partner in the same specialty, you must bill a subsequent visit code (e.g., C190) rather than C895.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
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. In a hospital where common medical records are maintained, the written request may be on the common record.
The request must identify the consultant by name, the referring practitioner by name and billing number, and the patient by name and health number.
The written request must set out the information relevant to the referral and specify the service(s) required.
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring practitioner. Where the referral is from a nurse practitioner, the report must be provided to the nurse practitioner and the patient's primary care provider, if applicable.
C-prefix codes apply to non-emergency hospital in-patient services.
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