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Nephrology OHIP billing codes
Nephrology consultations, the post-transplant premium, dialysis and haemofiltration, transplant management and vascular access.
45 codes in 7 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 16 is in the full Nephrology listing.
Consultations & assessments — office
- A165Nephrology Consultation—
- A160Comprehensive nephrology consultation—
- A865Limited consultation—
- A166Nephrology repeat consultation—
- A163Medical specific assessmentMedical specific assessment - Nephrology—
- A164Medical specific re-assessmentA medical specific re-assessment rendered by a nephrologist, which requires a full, relevant history and physical examination of one or more systems.—
- A161Complex medical specific re-assessment—
- A168Partial assessmentPartial assessment (Nephrology)—
Hospital in-patient
- C165Nephrology consultationA consultation provided by a nephrologist to a non-emergency hospital in-patient, aged 17 years or older. This service requires a written request from a referring practitioner.—
- C160Comprehensive nephrology consultationComprehensive nephrology consultation (hospital in-patient)—
- C865Limited consultation - NephrologyA limited consultation provided by a Nephrologist for a non-emergency hospital in-patient. This service is less demanding and requires less time than a full consultation but has the same referral and documentation requirements.—
- C166Nephrology repeat consultationA repeat consultation for a non-emergency hospital in-patient, rendered by a nephrologist. This service requires a new written request for the same presenting problem after the patient has received care from another physician following the initial consultation.—
- C163Nephrology medical specific assessmentA medical specific assessment, for a non-emergency hospital in-patient, rendered by a specialist in Nephrology (16). See page <SectionPages>A136</SectionPages> for specialty listing and <SectionPages>GP23</SectionPages> for general rules and limits.—
- C164Medical specific re-assessmentA medical specific re-assessment for a non-emergency hospital in-patient, rendered by a nephrologist. This service involves a full, relevant history and physical examination of one or more systems.—
- C161Complex medical specific re-assessment—
- C162Nephrology subsequent visit - first five weeksSubsequent visit for a Nephrology patient during the first five weeks of an acute care hospital stay.—
- C167Nephrology subsequent visit - sixth to thirteenth week inclusiveSubsequent visit by a Nephrologist for an acute care hospital in-patient from the sixth to the thirteenth week of admission, inclusive, with a maximum of three visits per patient per week.—
- C169Nephrology subsequent visit - after thirteenth weekA subsequent visit by a Nephrologist to a hospital in-patient after the thirteenth week of admission, limited to a maximum of six per patient per month.—
- C168Subsequent visitsA routine assessment rendered in hospital by a consultant providing continued directive care at the request of the patient's most responsible physician. This service is limited to 4 per week for the first week, and 2 per week thereafter.—
Dialysis & haemofiltration
- G860Hospital haemodialysis or haemodiafiltrationA weekly team fee for the management of a patient receiving chronic haemodialysis in a hospital setting. This fee covers the collective services provided by the medical team over a seven-day period.$135.80
- G861Hospital peritoneal dialysisA weekly team fee for chronic peritoneal dialysis provided in a hospital setting. This fee covers all dialysis-related management for a 7-day period.$135.80
- G862Hospital self-care haemodialysis or satellite haemodialysisA weekly team fee for managing a patient receiving self-care haemodialysis or satellite haemodialysis in a hospital setting.$135.80
- G085Continuous venovenous haemofiltration - initial and acuteProvides for the initial and acute management of continuous venovenous haemofiltration (CVVH), a type of continuous renal replacement therapy. This code is limited to the first three services per episode of care.$385.75
Dialysis access
- G324Subclavian or jugular catheter for haemodialysis - insertionInsertion of a subclavian or external jugular catheter for the purpose of haemodialysis.$102.95
- G336Subclavian or jugular catheter for haemodialysis - revisionRevision of a subclavian or external jugular catheter for haemodialysis.$17.65
- G099Percutaneous insertion of permanent jugular/femoral dialysis catheterPercutaneous insertion of permanent jugular/femoral dialysis catheter (including subcutaneous positioning)$168.40
- R854Removal of Tenckhoff type peritoneal catheterSurgical removal of a Tenckhoff type chronic peritoneal catheter, often used for peritoneal dialysis.$63.10
Transplant
- G411Nephrological management of donor procurementNephrological management of a neurologically dead donor to maintain kidney viability for transplantation, including monitoring, assessment, and immunotherapy.$213.00
- G4121st day following transplantationA per diem fee for the complete nephrological care and management of a patient on the first day following a renal transplantation.$354.30
- G4082nd to 10th day, inclusive (per diem)Provides per diem payment for the comprehensive nephrological management of a patient from the 2nd to the 10th day inclusive, following a kidney transplant. This fee includes all aspects of patient care for this period.$177.10
- G40911th to 21st day, inclusive (per diem)Provides per diem payment for the nephrological management of a patient from the 11th to the 21st day, inclusive, following a renal transplant. This fee includes all aspects of complete patient care and is only payable for kidney transplant recipients.$88.55
- G347Renal perfusion with hypothermia for organ transplantationA procedure for renal perfusion with hypothermia, performed as part of the organ transplantation process. This service is classified as a major invasive procedure.$96.35
- G348Renal preservation with continuous machine perfusionA specialized nephrology procedure for preserving a kidney using continuous machine perfusion, typically performed in the context of organ transplantation.$96.35
- Z631Fine needle aspiration of renal transplantA surgical procedure for the fine needle aspiration of a transplanted kidney, typically performed for diagnostic purposes to assess the health of the graft.$45.15
Long-term care
- W165ConsultationA consultation service rendered by a Nephrology specialist for a patient in a non-emergency, long-term care in-patient setting.—
- W166Repeat ConsultationA repeat consultation by a nephrologist for a patient in a non-emergency long-term care institution setting. Requires a new written referral for the same problem.—
- W865Limited consultationA limited consultation for a patient in a non-emergency, long-term care institution, rendered by a nephrologist. This service is less demanding and requires substantially less time than a full consultation.—
- W160Comprehensive Nephrology ConsultationA comprehensive consultation by a nephrologist for a patient in a long-term care institution, subject to the same conditions as <billingCode>A160</billingCode>.—
- W862Admission Assessment - Type 1A general assessment for a patient upon a planned, non-emergency admission to a long-term care institution, such as a nursing home or chronic care hospital, performed by a nephrologist.—
- W867Admission Assessment - Type 3A general re-assessment for a patient being re-admitted by a nephrologist to a long-term care facility after a minimum three-day stay in another institution.—
- W869Periodic health visitA periodic health visit provided by a Nephrologist to a patient in a long-term care institution. This service is for routine health maintenance for patients over two years of age and is limited to one per 12-month period.—
How to use this nephrology code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to nephrology (specialty 16) — 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 nephrology 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 nephrology bill?
The consultations & assessments — office section of this set starts with A165 (Nephrology Consultation). 8 codes are listed in that section.
What is in the Nephrology code set?
45 OHIP billing codes across 7 sections: Consultations & assessments — office; Hospital in-patient; Premiums; Dialysis & haemofiltration; Dialysis access; Transplant; Long-term care. Nephrology consultations, the post-transplant premium, dialysis and haemofiltration, transplant management and vascular access.
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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