< Billing codes

Billing code

C065A — Orthopaedic surgery in-patient consultation

Orthopaedic in-patient consultation

Bill C065 for an orthopaedic surgeon's consultation on a hospital in-patient, at the written request of 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

C065A

Description

Orthopaedic surgery 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

Consultation by an orthopaedic surgeon for a hospital in-patient, at the written request of a physician or nurse practitioner.

What it covers

C065 is the Orthopaedic Surgery (06) consultation for non-emergency hospital in-patients (A164). A consultation is an assessment done at the written request of a physician or nurse practitioner who wants your opinion, and includes a written report to the referrer (GP16).

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

Billing rules

• Needs a written, signed request from a physician or nurse practitioner (or a dental surgeon for hospital dental work) naming you or your specialty, the referrer and their billing number, and the patient and health number. Without it, 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. A clearly unrelated diagnosis allows one every 12 months. Extra consultations pay as an assessment (GP17–GP18).
• A surgeon can't bill a hospital or day-care admission assessment unless it is also the major pre-operative visit (SP2, GP40).
• If you spend at least 50 minutes in direct contact (not counting other billable services), bill the special surgical consultation (A935 or C935) instead (GP19).
• Age premiums of 10% to 30% apply to specialist consultations for patients under 16 (GP64).
• 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).

Often billed with

• K001 detention, after the first 60 minutes (GP29–GP30).

Common rejections

• ARF: OHIP describes this as 'Missing Physician Referring Number': a consultation claim needs the referring physician's or nurse practitioner's billing number (GP16).
• EQ6: OHIP describes this as 'Referring provider number not registered with the Ministry': check the referrer's billing number against the written request and resubmit (GP16).
• 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: C935, C066, C063, C064, C062, A065

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Orthopaedic Surgery (06), page A164. In-patient rules GP40–GP48; consultation rules GP16–GP19.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing