Billing code
C063A — Orthopaedic surgery in-patient specific assessment
Orthopaedic in-patient specific assessment
Bill C063 for an orthopaedic surgeon's full history of the complaint and detailed exam of the affected parts for a hospital in-patient.
Watch for: A surgeon can't bill an admission assessment unless it is also the major pre-operative visit.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $45.55 | $0.00 | $0.00 | $0.00 |
- Code
- C063A
- Description
- Orthopaedic surgery in-patient specific assessment
- 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
Specific assessment of a hospital in-patient by an orthopaedic surgeon: full history of the complaint and detailed exam of the affected parts.
What it covers
C063 is the Orthopaedic Surgery (06) specific assessment for non-emergency hospital in-patients (A164). A specific assessment needs a full history of the presenting complaint and a detailed exam of the affected parts, regions or systems (GP23).
An admission assessment by a physician who hasn't assessed the patient for the same illness in the past 90 days is a consultation or specific assessment (GP40).
Billing rules
- One per patient per physician per 12 months; two when the second is for a clearly different, unrelated diagnosis. Extra ones pay as a lesser assessment (GP23).
- A surgeon can't bill a hospital or day-care admission assessment unless it is also the major pre-operative visit (SP2, GP40).
- Only one consultation or assessment per admission when an in-patient is transferred between physicians in the same hospital (GP40).
- For emergency calls and other special visits to in-patients, use the General Listings (A-prefix) and special visit premiums instead (A164, GP65–GP78).
- Video only, with K300A. For in-patients, virtual care is paid only if you aren't the MRP, the hospital has no physician on staff with the needed expertise (documented by the referrer), and for a consultation the referrer saw the patient in person in the previous 30 days (AJ2, A69, A70).
- Detention (K001) can be added only after 60 minutes (GP29–GP30).
Common rejections
- AT2: OHIP describes this as 'Must include video modality': this code is video-only in Appendix J, so it can't be billed by phone with K301A (AJ2).
Related codes: C064, C065, C062, A063, C066
Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Orthopaedic Surgery (06), page A164. Admission and assessment rules GP23, GP40.
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