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Medical specialties
Community Medicine OHIP billing codes
Community medicine consultations and assessments across office, hospital and long-term care.
31 codes in 3 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 05 is in the full Community Medicine listing.
Consultations & assessments — office
- A055Consultation—
- A050Special Community Medicine ConsultationSpecial community medicine consultation—
- A400Comprehensive Community Medicine ConsultationComprehensive community medicine consultation—
- A405Limited ConsultationA limited consultation by a Community Medicine specialist, which is less demanding and requires less time than a full consultation. It must meet all other requirements for a full consultation, including a written request from a referring practitioner.—
- A056Repeat ConsultationRepeat Consultation (Community Medicine)—
- A053Medical Specific AssessmentMedical Specific Assessment - Community Medicine—
- A054Medical Specific Re-AssessmentMedical specific re-assessment (Community Medicine)—
- A051Complex Medical Specific Re-AssessmentComplex medical specific re-assessment—
- A058Partial Assessment - Community Medicine—
Hospital in-patient
- C055ConsultationConsultation - Community Medicine (Hospital In-Patient)—
- C050Special community medicine consultation - hospital in-patient—
- C400Comprehensive community medicine consultation (hospital in-patient)A comprehensive community medicine consultation for a hospital in-patient, rendered by a specialist in Community Medicine, requiring a minimum of 75 minutes of direct patient contact. This service must meet all standard consultation requirements.—
- C405Limited consultationA limited consultation for a non-emergency hospital in-patient by a Community Medicine specialist. It requires less time than a full consultation but must meet all other requirements for a consultation, including a written referral.—
- C056Repeat consultationRepeat consultation - Community Medicine (Hospital Inpatient)—
- C054Medical specific re-assessmentMedical specific re-assessment (In-patient)—
- C051Complex medical specific re-assessment—
- C057Subsequent visit - sixth to thirteenth weekSubsequent visit - 6th to 13th week—
- C059Subsequent visit after thirteenth week—
- C053Subsequent visits - Nursing home or home for the agedA medical specific assessment for a non-emergency hospital in-patient, rendered by a specialist in Community Medicine, requiring a full history of the presenting complaint and a detailed examination of the affected regions or systems.—
- C058Additional subsequent visits - nursing home or home for the agedConcurrent care (per visit)—
Long-term care
- W055Consultation - Non-Emergency Long-Term Care In-Patient ServicesA consultation service rendered by a Community Medicine specialist for a patient in a non-emergency long-term care in-patient setting, following a written request from a referring practitioner.—
- W050Special community medicine consultationA special community medicine consultation for a patient in a non-emergency long-term care institution. This service is subject to the same conditions as <billingCode>A050</billingCode> and requires a written request from a referring practitioner.—
- W400Comprehensive community medicine consultationA comprehensive community medicine consultation for a non-emergency in-patient in a long-term care facility, subject to the same conditions as a comprehensive consultation under general listings (<billingCode>A400</billingCode>).—
- W056Repeat consultation - Non-Emergency Long-Term Care In-Patient ServicesA repeat consultation by a specialist for the same presenting problem, requested for a patient in a long-term care facility after care has been rendered by another physician in the interim.—
- W054General re-assessment of patient in nursing homeA general re-assessment for a patient in a long-term care facility, such as a nursing home. This service is performed as per the requirements of the Nursing Homes Act and is subject to specific frequency limits.—
- W402Admission assessment - Type 1A Type 1 admission assessment, which is a general assessment rendered for a patient on admission to a non-emergency long-term care institution. Payment may be adjusted if the physician has rendered another assessment prior to admission.—
- W404Admission assessment - Type 2A Type 2 admission assessment for a patient in a long-term care institution, rendered by the admitting physician who has previously performed a consultation or another form of assessment for the patient prior to admission.—
- W053First 2 subsequent visits per patient per month - Nursing home or home for the agedRepresents one of the first two routine subsequent visits for a patient in a nursing home or home for the aged within a calendar month. This service is for ongoing assessment and management following admission.—
- W052Subsequent visits - chronic care or convalescent hospital - first 4 per patient per monthA subsequent visit by a Community Medicine specialist for a patient in a chronic care or convalescent hospital. Limited to the first four visits per patient per month.—
- W051Additional subsequent visits (chronic care or convalescent hospital)An additional subsequent visit for a patient in a chronic care or convalescent hospital, payable for the 5th and 6th visits after the initial four visits in a calendar month have been rendered.—
- W058Nursing home or home for the aged - additional subsequent visitsRepresents an additional routine subsequent visit to a patient in a nursing home or home for the aged, payable after the first two visits per month. This service is limited to a maximum of 3 visits per patient per month.—
How to use this community med code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to community medicine (specialty 05) — its own consultation and assessment codes, in-patient visits, premiums and the diagnostics or procedures that make up most of a day — sectioned the way a shift sheet reads. Codes open to every specialty that a community med physician also bills (general assessments, forms, special visit premiums) live in the Family Practice and Special visit premiums sets.
Each code links to its full Schedule entry: fee history, restrictions, required diagnoses and the codes it can or cannot be billed with. Fees shown are the current provider or specialist fee; percentage premiums show the percentage they add to the base service.
Common questions
Which consultation or assessment code does community medicine bill?
The consultations & assessments — office section of this set starts with A055 (Consultation). 9 codes are listed in that section.
What is in the Community Medicine code set?
31 OHIP billing codes across 3 sections: Consultations & assessments — office; Hospital in-patient; Long-term care. Community medicine consultations and assessments across office, hospital and long-term care.
Are these the current OHIP fees?
Fees are read from the current Ontario Schedule of Benefits for Physician Services and refreshed hourly. Claims are paid at the fee in force on the service date, so always confirm the effective date on the code page.
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