What are the billing rules for C069A?

Maximum 6 per patient per month after week 13; visits over the limit are not payable (A164, GP43). For the operating surgeon, weeks are counted from the admission date if you admitted the patient, or from the referral date if the patient was referred to you in hospital (SP2, GP43). After 5 weeks, a visit for an acute intercurrent illness beyond the weekly or monthly limits is billed as C121 (GP43).

What is C069A often billed with?

E083 MRP premium (GP47). C121 for acute intercurrent illness beyond the limit (GP43).

Why is C069A rejected?

AM1: OHIP describes this as 'Service limit exceeded': more than 6 subsequent visits in a month after week 13 (A164, GP43).

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Billing code

C069A — Orthopaedic in-patient subsequent visit – after week 13

Q: What is OHIP billing code C069A?

Routine hospital visit by an orthopaedic surgeon after the 13th week of admission, up to 6 per patient per month.

Orthopaedic hospital visit, week 14+

Bill C069 for an orthopaedic surgeon's routine in-patient visit after the 13th week of admission.

Watch for: Maximum 6 per patient per month; bill extra visits for an acute intercurrent illness as C121.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$31.00	$0.00	$0.00	$0.00

Code: C069A
Description: Orthopaedic in-patient subsequent visit – after week 13
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Jun 1, 2025
Termination date: No end date

Explanation

Updated October 26, 2026

Routine hospital visit by an orthopaedic surgeon after the 13th week of admission, up to 6 per patient per month.

What it covers

C069 is the Orthopaedic Surgery (06) subsequent visit after the thirteenth week of a hospital stay, with a maximum of 6 per patient per month (A164). A subsequent visit is any routine assessment in hospital after the admission assessment (GP43).

Billing rules

Maximum 6 per patient per month after week 13; visits over the limit are not payable (A164, GP43).
For the operating surgeon, weeks are counted from the admission date if you admitted the patient, or from the referral date if the patient was referred to you in hospital (SP2, GP43).
After 5 weeks, a visit for an acute intercurrent illness beyond the weekly or monthly limits is billed as C121 (GP43).
Seeing another physician's patient on an emergency basis uses the General Listings (A-prefix) (GP43).
As the MRP, add E083 (+30%). E084 (weekend/holiday MRP premium) is not available to Orthopaedic Surgery (06) (GP47).
Not a virtual care code: C069 isn't in Appendix J (AJ1–AJ3).

Often billed with

E083 MRP premium (GP47).
C121 for acute intercurrent illness beyond the limit (GP43).

Common rejections

AM1: OHIP describes this as 'Service limit exceeded': more than 6 subsequent visits in a month after week 13 (A164, GP43).

Related codes: C062, C067, C068, C121, E083

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Orthopaedic Surgery (06), page A164. Subsequent visit rules GP43–GP47.

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