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Billing code

C064A — Orthopaedic surgery in-patient specific re-assessment

Orthopaedic in-patient re-assessment

Bill C064 for an orthopaedic surgeon's in-patient re-assessment with a full relevant history and exam of one or more systems.

Watch for: Two per patient per physician per 12 months, except admissions; extras pay as a lesser assessment.

Code

C064A

Description

Orthopaedic surgery in-patient specific re-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 re-assessment of a hospital in-patient by an orthopaedic surgeon: full relevant history and exam of one or more systems.

What it covers

C064 is the Orthopaedic Surgery (06) specific re-assessment for non-emergency hospital in-patients (A164). It needs a full, relevant history and physical exam of one or more systems (GP23).

An admission assessment is a specific re-assessment when you assessed the patient for the same illness in the 90 days before admission, or when a surgeon admits for a Z-code (IOP) procedure after assessing the patient before admission (GP23, GP40).

Billing rules

• Two per patient per physician per 12 months, except re-assessments for hospital admissions. 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 40 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: C063, C065, C062, C066, A063

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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