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Billing code

C025A — Dermatology in-patient consultation

Dermatology in-patient consultation

Bill C025 for a dermatologist's non-emergency consultation on a hospital in-patient, at the written request of a physician or nurse practitioner.

Watch for: Keep the signed request naming the referrer and their billing number in the chart, or OHIP pays a lesser assessment.

Code

C025A

Description

Dermatology in-patient consultation

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

A dermatologist's non-emergency consultation for a hospital in-patient, at the written request of another physician or NP.

What it covers

C025 is a dermatology consultation for a hospital in-patient in a non-emergency setting (A95). A consultation needs a written request and a written report back to the referrer (GP16).

In hospital, the written request may be on the common medical record (GP16).

Billing rules

• Keep the referrer's written, signed request in the chart. It must name you or the specialty, the referrer and their billing number, and the patient and health number; otherwise OHIP pays a lesser assessment (GP16).
• Same patient, same diagnosis: one consultation per two consecutive 12-month periods. A second is allowed only for a hospital in-patient or ED patient 12 to 24 months after the first (GP17).
• A clearly unrelated diagnosis allows one consultation per 12 months. Consultations over the limits, or requested by a medical trainee, are paid as an assessment (GP17, GP18).
• If you admit the patient, your consultation is the admission assessment; only one consultation or assessment is payable per admission when care transfers between physicians (GP40).
• For emergency calls and other special visits to in-patients, use the General Listings (A prefix) with premiums instead (A95).
• Age premiums apply to specialist consultations and repeat consultations: +30% under 30 days down to +10% for ages 5 to 15 (GP64).
• Virtual care: video only (Appendix J AJ2), with an existing patient relationship and the K300A video indicator; not payable by phone (A66, A70). Virtual in-patient services need all of: you are not the MRP, no physician on staff with the expertise (documented by the referrer), and an in-person assessment by the referrer within 30 days (A69).

Often billed with

• Diagnostic and therapeutic procedures, such as G375/G377 intralesional infiltration, are payable in addition to a consultation or assessment (J3).

Common rejections

• ARF: The claim is missing the referring provider's number. A consultation follows a written request that names the referrer and their billing number (GP16).
• AT2: This code is video only in Appendix J; billing it with the phone indicator K301A is not allowed (AJ2, A70).

Related codes: C026, C023, C020, A025, A027, C022, C028

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Dermatology (02), page A95; rules GP16–GP18, GP40.

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