C905 – Limited consultation
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A limited consultation is a consultation which is less demanding and, in terms of time, normally requires substantially less of the physician's time than a full consultation. A limited consultation has the same requirements as a full consultation. This service is for a non-emergency hospital in-patient (C prefix). Under the heading of 'Family Practice & Practice in General', a limited consultation is the service rendered by any physician who is not a specialist, where the service meets all the requirements for a consultation but, because of the nature of the referral, only those services which constitute a specific assessment are rendered. For a consultation to be payable, it must follow a written request from a referring physician, nurse practitioner, or dental surgeon for an opinion from a consultant physician.
When to Use
- Use C905 when you are requested by a colleague to provide a specific, focused opinion on an inpatient's condition that does not require the comprehensive workup of a full consultation (C003).
- Use C905 when the referral request specifies a limited scope, such as a request for a medication review or a specific diagnostic opinion, rather than a full management plan for the patient's entire hospital stay.
Common Pitfalls
- Billing C905 without a formal written referral request from a physician, nurse practitioner, or dental surgeon, which will lead to a clawback upon audit.
- Submitting C905 for a patient who is not an inpatient in a non-emergency hospital setting; this code is strictly reserved for the 'C' prefix environment.
- Failing to differentiate C905 from a subsequent hospital visit (C002); C905 requires a new referral and a distinct consultative opinion, not just daily rounding.
Billing Tips
- Ensure the referral request explicitly names you as the consultant to satisfy the documentation requirements for a valid consultation.
- If the referral is for a comprehensive evaluation, bill C003 instead of C905 to avoid under-billing, as C905 is specifically for less demanding, limited-scope assessments.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Consultation
Consultations, Hospital and Institutional Consultations and Assessments
Limited consultation has the same requirements as a full consultation.
Under the heading of “Family Practice & Practice in General”, a limited consultation is the service rendered by any physician who is not a specialist, where the service meets all the requirements for a consultation but, because of the nature of the referral, only those services which constitute a specific assessment are rendered.
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