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Billing code

C005A — Hospital in-patient consultation (family practice)

Hospital family practice consultation

Bill C005 for a family physician's consultation on a hospital in-patient, on a written request from a physician or nurse practitioner.

Watch for: The signed request must name the referrer and their billing number, or OHIP pays a lesser assessment.

Code

C005A

Description

Hospital in-patient consultation (family practice)

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Consultation by a family physician for a hospital in-patient, on a written request from another physician or nurse practitioner.

What it covers

A consultation is an assessment done after a written request from a physician, nurse practitioner, or dental surgeon (for an insured dental procedure in hospital) who wants your opinion because of the complexity, seriousness or obscurity of the case, or because the patient asked for another opinion (GP16).

It includes what you need to prepare a written report with findings, opinions and recommendations to the referring provider (GP16). C005 is the in-patient version of A005 (A12).

Billing rules

• The written, signed request must name the consultant or specialty, the referring provider and billing number, and the patient and health number. In hospital it can be on the common medical record. Otherwise it is paid as a lesser assessment (GP16).
• Limit one consultation per patient per physician for the same diagnosis per two consecutive 12-month periods; a second is allowed only for an in-patient or ED patient 12 to 24 months after the first. An unrelated diagnosis allows one per 12 months (GP17).
• Extra consultations, or ones requested by a medical trainee, are paid as an assessment (GP17, GP18).
• A consultation requested after the service has been provided is not payable as a consultation (GP16).
• If you then admit the patient, the consultation is the admission assessment (GP40).
• Detention (K001) can start only after 60 minutes (GP30).
• FHO: counts toward the hospital services special payment (Agreement Schedule 3, p.90; §8.5, p.66). In-patient services to enrolled patients are paid full fee-for-service (Agreement p.64 §7.2).

Often billed with

• E082 admission assessment by the MRP premium when the consultation is your admission assessment (GP40, GP42).

Common rejections

• ARF: 'Missing physician referring number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).

Related codes: A005, C905, C006, C911, C912, C945, C003

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Family Practice & Practice in General (00), page A12; rules GP16–GP19.

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